Department of Radiation Health Management, Fukushima Medical University, Fukushima, Japan.
Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan.
JAMA Otolaryngol Head Neck Surg. 2019 Jan 1;145(1):4-11. doi: 10.1001/jamaoto.2018.3121.
IMPORTANCE: Ultrasonographic (US) screening for thyroid cancer was performed in the Fukushima Health Management Survey after the 2011 Fukushima Daiichi nuclear power station accident. Clinical characteristics of thyroid cancers screened by US among children and young adults during the first 5 years after the accident were analyzed. OBJECTIVES: To evaluate the number of detected thyroid cancers by age group within 5 years of the Fukushima Daiichi nuclear power station accident and to compare the basic clinical characteristics and demographic patterns in first- and second-round examinations. DESIGN, SETTING, AND PARTICIPANTS: In this observational study, 324 301 individuals 18 years or younger at the time of accident were included. Patients received a cytologic diagnosis of malignant or suspected malignant thyroid cancer during the first (fiscal years 2011-2013) or second round (fiscal years 2014-2015) of screening. Number of detected cases of cancer was evaluated, correcting for the number of examinees by age group at the time of the accident and for the incidence of detected cancers according to age group at the time of the screening (age groups were divided into 3-year intervals). Results were compared using the age-specific incidence of unscreened cancers from a national cancer registry. MAIN OUTCOMES AND MEASURES: Clinical baseline characteristics of the patients and the age-specific number and incidence of thyroid cancers detected during the second round. RESULTS: Among 299 905 individuals screened in the first round (50.5% male; mean [SD] age at screening, 14.9 [2.6] years), malignant or suspected thyroid cancer was diagnosed in 116. Among 271 083 individuals screened in the second round (50.4% male; age at screening, 12.6 [3.2] years), malignant or suspected thyroid cancer was diagnosed in 71. The most common pathologic diagnosis in surgical cases was papillary thyroid cancer (149 of 152 [98.0%]). The distribution pattern by age group at the time of the accident, where the number of detected thyroid cancer cases was corrected by the number of examinees, increased with older age in both screening rounds. This demographic pattern was similar between the first and second examinations. The distribution pattern of the incidence rate by age group at the time of screening in the second round also increased with older age. The incidence rate detected by screening was 29 cases per 100 000 person-years for those aged 15 to 17 years, 48 cases per 100 000 person-years for those aged 18 to 20 years, and 64 cases per 100 000 person-years for those aged 21 to 22 years. CONCLUSIONS AND RELEVANCE: Large-scale mass US screening of young people resulted in the diagnosis of a number of thyroid cancers, with no major changes in overall characteristics within 5 years of the 2011 Fukushima nuclear power station accident. These results suggest that US screening can identify many detectable cancers from a large pool of nonclinical and subclinical thyroid cancers among individuals of a relatively young age, in an age-dependent manner.
重要性:2011 年福岛第一核电站事故后,在福岛健康管理调查中进行了甲状腺癌的超声(US)筛查。分析了事故后 5 年内 US 筛查的儿童和青少年甲状腺癌的临床特征。
目的:评估事故后 5 年内按年龄组检出的甲状腺癌数量,并比较第一轮和第二轮检查的基本临床特征和人口统计学模式。
设计、地点和参与者:在这项观察性研究中,纳入了 324301 名在事故时年龄在 18 岁以下的个体。在第一轮(2011-2013 财年)或第二轮(2014-2015 财年)筛查中,患者接受了恶性或疑似恶性甲状腺癌的细胞学诊断。根据筛查时的年龄组(年龄组分为 3 年间隔)校正了癌症检出病例数,并校正了按年龄组(年龄组分为 3 年间隔)计算的检出癌症的发生率。使用国家癌症登记处未筛查癌症的年龄特异性发病率来比较结果。
主要结果和措施:第二轮筛查中患者的临床基线特征以及第二轮筛查中检出的甲状腺癌的年龄特异性数量和发病率。
结果:在第一轮筛查的 299905 名(50.5%为男性;筛查时的平均[标准差]年龄为 14.9[2.6]岁)个体中,诊断出恶性或疑似甲状腺癌 116 例。在第二轮筛查的 271083 名(50.4%为男性;筛查时的平均[标准差]年龄为 12.6[3.2]岁)个体中,诊断出恶性或疑似甲状腺癌 71 例。手术病例中最常见的病理诊断为甲状腺乳头状癌(152 例中的 149 例[98.0%])。根据事故时的年龄组校正检出甲状腺癌病例数的分布模式,在两轮筛查中均随着年龄的增长而增加。这种人口统计学模式在第一轮和第二轮检查之间相似。第二轮筛查时按筛查时年龄组计算的发病率分布模式也随着年龄的增长而增加。筛查检出的发病率为 15 至 17 岁者为每 100000 人年 29 例,18 至 20 岁者为每 100000 人年 48 例,21 至 22 岁者为每 100000 人年 64 例。
结论和相关性:对年轻人进行大规模的甲状腺 US 筛查导致了许多甲状腺癌的诊断,在 2011 年福岛核事故后的 5 年内,整体特征没有重大变化。这些结果表明,US 筛查可以从相对年轻的个体中大量非临床和亚临床甲状腺癌中以年龄依赖的方式识别出许多可检测到的癌症。
Radiat Environ Biophys. 2014-5
EClinicalMedicine. 2025-1-18
Front Endocrinol (Lausanne). 2023
Endocr Rev. 2024-1-4
Asia Pac J Public Health. 2017-3