Department of Human Ecology, Graduate School of Environmental and Life Science, Okayama University, 3-1-1 Tsushima-naka, Kita-ku, Okayama, 700-8530, Japan.
Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
Environ Health. 2022 Aug 24;21(1):77. doi: 10.1186/s12940-022-00884-6.
It is well known that science can be misused to hinder the resolution (i.e., the elimination and/or control) of a health problem. To recognize distorted and misapplied epidemiological science, a 33-item "Toolkit for detecting misused epidemiological methods" (hereinafter, the Toolkit) was published in 2021. Applying the Toolkit, we critically evaluated a review paper entitled, "Lessons learned from Chernobyl and Fukushima on thyroid cancer screening and recommendations in the case of a future nuclear accident" in Environment International in 2021, published by the SHAMISEN (Nuclear Emergency Situations - Improvement of Medical and Health Surveillance) international expert consortium. The article highlighted the claim that overdiagnosis of childhood thyroid cancers greatly increased the number of cases detected in ultrasound thyroid screening following the 2011 Fukushima nuclear accident. However, the reasons cited in the SHAMISEN review paper for overdiagnosis in mass screening lacked important information about the high incidence of thyroid cancers after the accident. The SHAMISEN review paper ignored published studies of screening results in unexposed areas, and included an invalid comparison of screenings among children with screenings among adults. The review omitted the actual state of screening in Fukushima after the nuclear accident, in which only nodules > 5 mm in diameter were examined. The growth rate of thyroid cancers was not slow, as emphasized in the SHAMISEN review paper; evidence shows that cancers detected in second-round screening grew to more than 5 mm in diameter over a 2-year period. The SHAMISEN consortium used an unfounded overdiagnosis hypothesis and misguided evidence to refute that the excess incidence of thyroid cancer was attributable to the nuclear accident, despite the findings of ongoing ultrasound screening for thyroid cancer in Fukushima and around Chernobyl. By our evaluation, the SHAMISEN review paper includes 20 of the 33 items in the Toolkit that demonstrate the misuse of epidemiology. The International Agency for Research on Cancer meeting in 2017 and its publication cited in the SHAMISEN review paper includes 12 of the 33 items in the Toolkit. Finally, we recommend a few enhancements to the Toolkit to increase its utility.
众所周知，科学可能被滥用，从而阻碍对健康问题的解决（即消除和/或控制）。为了识别扭曲和不当应用的流行病学科学，2021 年发布了一个 33 项的“检测误用流行病学方法工具包”（以下简称工具包）。我们应用该工具包，对 2021 年发表在《环境国际》（Environment International）上的一篇题为“切尔诺贝利和福岛核事故后甲状腺癌筛查的经验教训及未来核事故相关建议”的综述论文进行了批判性评估，该论文由 SHAMISEN（核紧急情况-改善医疗和健康监测）国际专家联盟出版。这篇文章强调了这样一种说法，即在 2011 年福岛核事故后进行的超声甲状腺筛查中，儿童甲状腺癌的过度诊断大大增加了检出病例的数量。然而，在 SHAMISEN 综述论文中，关于大规模筛查中过度诊断的原因缺乏与事故后甲状腺癌高发相关的重要信息。SHAMISEN 综述论文忽略了对未受影响地区筛查结果的已发表研究，并对儿童筛查与成人筛查进行了无效比较。该综述省略了福岛核事故后的实际筛查情况，其中只检查了直径大于 5 毫米的结节。正如 SHAMISEN 综述论文所强调的那样，甲状腺癌的生长速度并不慢；有证据表明，在第二轮筛查中发现的癌症在两年内长到了 5 毫米以上。尽管福岛和切尔诺贝利周边地区正在进行甲状腺癌超声筛查，但 SHAMISEN 联盟使用毫无根据的过度诊断假说和误导性证据来反驳甲状腺癌发病率的增加归因于核事故。通过我们的评估，SHAMISEN 综述论文包含了工具包中的 33 项中的 20 项，表明了对流行病学的不当使用。2017 年国际癌症研究机构会议及其在 SHAMISEN 综述论文中的引用包含了工具包中的 33 项中的 12 项。最后，我们建议对工具包进行一些改进，以提高其效用。
