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2011年核灾难后福岛甲状腺癌患病率上升的量化——存在过度诊断的可能性?

Quantification of the increase in thyroid cancer prevalence in Fukushima after the nuclear disaster in 2011--a potential overdiagnosis?

作者信息

Katanoda Kota, Kamo Ken-Ichi, Tsugane Shoichiro

机构信息

Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo

Center for Medical Education, Sapporo Medical University, Sapporo.

出版信息

Jpn J Clin Oncol. 2016 Mar;46(3):284-6. doi: 10.1093/jjco/hyv191. Epub 2016 Jan 10.

Abstract

A thyroid ultrasound examination programme has been conducted in Fukushima Prefecture, Japan, after the nuclear disaster in 2011. Although remarkably high prevalence of thyroid cancer was observed, no relevant quantitative evaluation was conducted. We calculated the observed/expected (O/E) ratio of thyroid cancer prevalence for the residents aged ≤20 years. Observed prevalence was the number of thyroid cancer cases detected by the programme through the end of April 2015. Expected prevalence was calculated as cumulative incidence by a life-table method using the national estimates of thyroid cancer incidence rate in 2001-10 (prior to the disaster) and the population of Fukushima Prefecture. The underlying assumption was that there was neither nuclear accident nor screening intervention. The observed and estimated prevalence of thyroid cancer among residents aged ≤20 years was 160.1 and 5.2, respectively, giving an O/E ratio of 30.8 [95% confidence interval (CI): 26.2, 35.9]. When the recent increasing trend in thyroid cancer was considered, the overall O/E ratio was 22.2 (95% CI: 18.9, 25.9). The cumulative number of thyroid cancer deaths in Fukushima Prefecture, estimated with the same method (annual average in 2009-13), was 0.6 under age 40. Combined with the existing knowledge about radiation effect on thyroid cancer, our descriptive analysis suggests the possibility of overdiagnosis. Evaluation including individual-level analysis is required to further clarify the contribution of underlying factors.

摘要

2011年核灾难后,日本福岛县实施了一项甲状腺超声检查项目。尽管观察到甲状腺癌的患病率显著偏高,但未进行相关的定量评估。我们计算了年龄≤20岁居民甲状腺癌患病率的观察值/预期值(O/E)比。观察到的患病率是该项目截至2015年4月底检测到的甲状腺癌病例数。预期患病率是通过寿命表法,使用2001 - 2010年(灾难发生前)全国甲状腺癌发病率估计值和福岛县人口计算的累积发病率。基本假设是既没有核事故也没有筛查干预。年龄≤20岁居民中观察到的和估计的甲状腺癌患病率分别为160.1和5.2,O/E比为30.8 [95%置信区间(CI):26.2, 35.9]。考虑到甲状腺癌近期的上升趋势,总体O/E比为22.2(95% CI:18.9, 25.9)。用相同方法(2009 - 2013年年度平均值)估计,福岛县40岁以下甲状腺癌死亡累积人数为0.6。结合关于辐射对甲状腺癌影响的现有知识,我们的描述性分析表明存在过度诊断的可能性。需要进行包括个体水平分析在内的评估,以进一步明确潜在因素的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a2b2/4777612/9f83e0b30c20/hyv19101.jpg

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