FUKUSHIMA Lives on the Line

150University Hospital since March. The above criteria for the suitably qualified facility for the secondary examination will be important in determining the facilities outside Fukushima Prefecture to serve the residents who have evacuated or moved to other prefectures. A more detailed confirmatory ultrasound examination is performed as the secondary examination. Following the secondary examination, it is then determined whether or not to perform fine-needle aspiration cytology on the basis of the diagnostic procedures in the revised edition of the Guidebook for Thyroid Ultrasound Screening1) as well as the ultrasound diagnostic criteria of thyroid nodules (tumors) by the Japan Society of Ultrasound in Medicine2). Furthermore, the blood levels of FT4, FT3, TSH, TgAb, TPOAb, and Tg, as well as the urine iodine levels of all subjects will be measured. On the basis of the results of these tests, participants are offered one of the following: a routine follow-up, re-examination or follow-up at a secondary examination facility, or treatment such as surgery, as appropriate. Future ProspectsThe thyroid ultrasound examination is to be provided to all the residents in Fukushima aged 18 years or younger at the time of the earthquake, from the areas outside the evacuation zones, including Fukushima City and Koriyama City, from May 2012 to the end of March 2014. A second round of examinations will commence from April 2014. Participants will then undergo thyroid examinations every 2 years until age 20, and every 5 years after that, for the rest of their lives. We are in the process of designating and contracting other suitably qualified facilities to serve the evacuees living in other prefectures, so they will also be able to participate in the examinations. This study was supported by the following seven academic societies: the Japan Thyroid Association, the Japan Association of Endocrine Surgeons, the Japanese Society of Thyroid Surgery, the Japan Society of Ultrasound in Medicine, the Japanese Society of Sonographers, the Japanese Society for Pediatric Endocrinology, and the Japan Association of Breast and Thyroid Sonology. The external committee formed by specialists from these seven societies is responsible for complying with the diagnostic criteria, qualifying the examiners, selecting the external facilities, and so forth. Examiners for the primary screening examination are indicated to be a medical specialist of either the Japan Thyroid Association, the Japan Association of Endocrine Surgeons, the Japanese Society of Thyroid Surgery, or the Japan Society of Ultrasound in Medicine (a body surface/general medical specialist), a medical sonographer (specializing in the body surface), or a pediatric specialist of the Japan Endocrine Society. It was also recommended that the confirmatory secondary examination be performed at institutions that employ suitably qualified examiners of the Japan Association of Endocrine Surgeons, the Japanese Society of Thyroid Surgery, or the Japan Society of Ultrasound in Medicine (a body surface/general medical specialist). For this long-term study, which will be conducted in the Fukushima cities from May 2012 onward, participation by local medical professionals within the prefecture is essential. Therefore, we are planning to develop a certification system whereby those professionals not meeting the criteria listed above will attend numerous relevant seminars such as the thyroid ultrasound screening training, undertake the appropriate examinations, and once qualified, will be able to contribute to this study. For further sharing of information and examination results as well as developing a long-term follow-up system, the joint efforts and collaboration of relevant specialists and institutions will be critical. Your further support will be greatly appreciated.ConclusionAn increase in thyroid cancer incidence is not expected in Fukushima, judging from the amount of radiation released during this incident, which is not equivalent in scale to the external and internal radiation exposures observed after the disasters in Hiroshima, Nagasaki, and Chernobyl. It is expected, however, that continuing a series of these large-scale, detailed examinations will result in the detection of a certain number of thyroid cancers far earlier than before, even though these may not be unrelated to this nuclear power plant accident. After 4–5 years in Chernobyl and 10–15 years in Hiroshima and Nagasaki, there was a rise in the thyroid cancer incidence observed among those who were <20 years at the time of the incidents. The situation in Fukushima differs significantly from these incidences. Therefore, in order to help monitor the long-term thyroid status, it is critically important to share with the community information about their thyroid status for the next few years, which is apparently unrelated to this nuclear reactor accident. The concern will not be eradicated by these rapid assessments, nor will the incidence of thyroid cancer be prevented by the examination itself. We believe, however, that developing the long-term health evaluation system, in which the The Results of Thyroid Examinations, Our Goals, and Future Prospects