OPEN DISCUSSION ON ISEE’S LETTER TO THE AUTHORITIES IN JAPAN CONCERNING THE PAPER BY TSUDA ET AL. 2015

2/15/2016

The paper by Tsuda et al. 2015 published in Epidemiology reporting an increase in thyroid cancer in Fukushima has been responded by several critical letters (see the end of this post).
Tsuda et al. 2015. Thyroid Cancer Detection by Ultrasound Among Residents Ages 18 Years and Younger in Fukushima, Japan: 2011 to 2014. Epidemiology, 2015 Oct 5.

Following the paper by Tsuda et al, the President of ISEE sent in January 2016 an official letter to the authorities in Japan requesting more research on this topic. The letter also created reactions.
Laden et al. 2016. Correspondence.

We are therefore opening an open space here where these comments can be published and responded, if necessary, by the ISEE. We thank ISEE-Europe for hosting the blog.

Manolis Kogevinas
President ISEE

Disclaimer: Unless clearly stated, the views published in this blog do not represent ISEE’s views.

Letters in Epidemiology, 2016 Feb 3,
Shibata 2016. Re: Thyroid Cancer Among Young People in Fukushima.
Jorgensen 2016. Re: Thyroid Cancer Among Young People in Fukushima .
Wakeford et al. 2016. Re: Thyroid Cancer Among Young People in Fukushima.
Körblein 2016. Re: Thyroid Cancer Among Young People in Fukushima.
Takahashi 2016. Re: Thyroid Cancer Among Young People in Fukushima.
Takamura 2016. Re: Thyroid Cancer Among Young People in Fukushima.
Tsuda et al. 2016. Response to the Commentary by Professor Davis and the Seven Letters. -A well-known fact should be disseminated to remedy the problems.
Suzuki 2016. Re: Thyroid Cancer Among Young People in Fukushima.

7 Comments

Michal Krzyzanowski

2/18/2016 12:35:57 pm

See the following website information:
http://fmu-global.jp/survey/proceedings-of-the-22nd-prefectural-oversight-committee-meeting-for-fukushima-health-management-survey/

Yuri HIranuma link

2/18/2016 04:00:25 pm

During the February 15, 2016 press conference held immediately after the 22nd Oversight Committee meeting for Fukushima Health Management Survey, two of three individuals the ISEE letter was addressed to made comments regarding the letter.

Ms Tomoko Kitajima, Director General, Environmental Health Department, Ministry of the Environment, Government of Japan, states she will take "various opinions received from various places into consideration" without mentioning if Ministry of the Environment will respond to the ISEE letter.
https://www.youtube.com/watch?v=SQTK1QvT6s8

Mr. Hiroyuki Kobayashi, Chief, Department of Health and Welfare, Section for Fukushima Health Management Survey, states Fukushima Prefecture has no plan to respond to the ISEE letter.
https://youtu.be/_CKTnxVbekI?t=1h8m24s

Manolis Kogevinas link

3/2/2016 12:40:50 am

Note: This letter responds to a message sent by Prof Richard Wakeford that criticized ISEE’s initiative to contact the Japanese government concerning a paper published in the journal Epidemiology reporting an increase of thyroid cancer among residents in Fukushima (http://www.iseepi.org/documents/Fukushimaletter.pdf). We welcome this criticism and as President of the ISEE, I asked Prof Wakeford to make public his message to the ISEE by publishing it in our web. Since this has not happened, we publish here below ISEE’s response to him and would be happy to also publish Prof Wakeford’s comment if he agrees. I would like to thank the Policy Committee of ISEE for their work in developing this response.
Manolis Kogevinas
President ISEE
Barcelona, 1 March 2016
--------------------------------------

To: Professor Richard Wakeford
Centre for Occupational and Environmental Health
The University of Manchester, Ellen Wilkinson Building
Oxford Road, Manchester M13 9PL, United Kingdom
E-mail: Richard.Wakeford@manchester.ac.uk
Re: Your correspondence concerning ISEE’s letter to the Government of Japan concerning the Fukushima accident

Dear Professor Wakeford,
Thank you for your message of 5 February 2016 concerning the ISEE letter to the government of Japan advocating continuation of the health studies concerning potential health effects of the Fukushima accident. Our letter was not intended to endorse the research presented by Tsuda et al., in a paper published in Epidemiology in 2015, but simply to note that results suggesting an increase in the risk of thyroid cancer among residents of Fukushima had been reported. We fully support the ongoing discussion of the scientific issues through the process of letters or commentaries published in the open literature – as for example a series of letters, including yours, published in Epidemiology in January.
We do, however, believe that the knowledge on long-term health consequences of low-level ionizing radiation exposure would profit from continuing well-designed epidemiological study (or studies) including the Fukushima population. We appreciate, and support, the ongoing surveys conducted in the Fukushima Prefecture and promote the best use of the gathered data for enrichment of global knowledge. Carefully performed and analysed studies would have practical and biological significance, and would be important for future decision making in case of radiation accidents.
We have found that transparency and balance as well as the involvement of concerned stakeholders in study design and conduct, and in promulgation of its results, are ultimately the most successful ways of gaining trust and promoting calm and rational discussion in contentious environmental crises such as the one in Fukushima. If ISEE can be helpful we would be happy to draw on the expertise of our membership. This is what the ISEE letter to Japanese authorities conveys.
Sincerely
Professor Manolis Kogevinas, MD, PhD
ISEE President
Barcelona, 1 March 2016

Ian Goddard

3/7/2016 06:52:45 pm

The study by Tsuda et al was posted as "Published Ahead-of-Print" on October 5, 2015, and now, five months later, it remains so defined and thus lacks proper citation data like volume, issue and pages. Will it be formally published in the near future?

Several people were confused by the ISEE letter to the Japanese government as it wasn't perfectly clear if the authors were aware of the large-scale screening program currently underway. The responses the letter called for seem to overlap goals of the ongoing screening program. What the letter was missing were specifics on exactly how the current program falls short and what can be done to improve the efforts. Making that clear would bolster the appeal.

The more concern expressed by the international scientific community, the more likely there will be an optimal response on both the social-welfare and scientific-research levels. I commend the authors of the letter for acting on their good intentions! ~Ian

Richard Wakeford link

3/18/2016 10:52:21 pm

Let me first show the email I wrote to ISEE when I was first alerted to the ISEE letter to the Japanese authorities, which I sent on 5th February 2016:

"My attention has been drawn to the letter sent by ISEE to the Japanese authorities concerning thyroid cancer monitoring in Fukushima (http://www.iseepi.org/documents/Fukushimaletter.pdf), which seems to be based on the alarming paper by Tsuda et al. published in Epidemiology. I find this letter very puzzling, since it seems to be assuming that the thyroid cancers being detected by the Fukushima monitoring programme are caused by radiation exposure resulting from the Fukushima Dai-ichi nuclear power station accident in March 2011. Such an assumption is far from being secure, and may serve to reinforce the alarm generated by the Tsuda et al. paper.

"Let me draw your attention to a letter to Epidemiology written by me and my colleagues, and now published by Epidemiology (http://journals.lww.com/epidem/toc/publishahead), which strongly questions the conclusion of Tsuda et al. that the detected thyroid cancers are due to radiation exposure from the Fukushima Dai-ichi accident. I would also draw your attention to an earlier paper by Sir Dillwyn Williams (http://www.karger.com/Article/FullText/437263) where he states his belief that the thyroid cancers being detected at Fukushima are nothing to do with radiation exposure from the Fukushima Dai-ichi accident. The nub of his argument is shown in his Figure 2: the age-at-exposure distribution of the thyroid cancers in Fukushima is quite different from that around Chernobyl, where several thousand excess thyroid cancers are clearly attributable to exposure to radioiodine from the Chernobyl accident because of the high thyroid doses that were received there (mainly from milk consumption). For these (and other) reasons, there are strong grounds for believing that the thyroid cancers being detected by the Fukushima monitoring programme have little, if anything, to do with radiation exposure from the Fukushima Dai-ichi accident.

"Unless you have good grounds for believing otherwise, and I would certainly like to hear these, I would hope that ISEE will take the earliest opportunity of retracting the opinion stated in its letter to the Japanese authorities, or it is likely to increase the unnecessary concern and alarm experienced by the Japanese people.

Richard Wakeford"

Since then, I have also addressed the Tsuda et al. paper in an editorial I have recently had published: http://iopscience.iop.org/article/10.1088/0952-4746/36/2/E1

The ISEE letter did not appear to take a sufficiently critical view of the Tsuda et al. paper. For example, I invite readers to examine the method whereby Tsuda et al. compared the prevalence of thyroid cancer found in the ultrasound screening programme of ~300,000 young people in Fukushima Prefecture with the incidence rate of thyroid cancer in Japan derived from cases that, in general, are not the product of a screening programme. The ISEE letter blithely repeats the claim of a "12-fold higher risk" and an "exceptionally high risk" obtained from this comparison without questioning the methodology, which has now come under criticism in a number of letters to Epidemiology.

The ISEE letter "appeals to the [Japanese] government" to establish scientific studies, but seems to be unaware of the massive health surveillance programme now being undertaken in Japan in the wake of the Fukushima Dai-ichi accident - the large-scale thyroid screening programme is just part of the Fukushima Health Management Survey. Many other scientific studies are now underway in Japan, conducted by government, academic and independent scientists. If some shortfall in these studies had been identified by the ISEE letter then fair enough, but it seemed to be written in ignorance of what is already being undertaken in Japan.

The Tsuda et al. conclusions are highly suspect, and the unquestioning support given to them by the ISEE letter is irresponsible in that it is likely to enhance the anxiety and concern already affecting the people of Fukushima Prefecture. If the ISEE is to write an official letter to the Japanese authorities those composing it have a duty to carefully review the Tsuda et al. study and familiarise themselves with the current situation in Japan with respect to the scientific programme of research underway there. I cannot believe that this was done in any serious fashion.

I suggest that those readers wishing to pursue this issue read the Tsuda et al. study carefully, read the subsequent correspondence in Epidemiology, consider a few relevant papers in the scientific literature, and then read again the ISEE letter. They will then be in a position to make an informed judgement about this matter.

Yuri Hiranuma link

3/31/2016 04:10:09 am

Professor Wakeford points out that Figure 2 of the paper by Sir Dillwyn Williams shows the age-at-exposure distribution is different in Chernobyl and Fukushima. He also refers to Figure 2 in his recently published editorial. However, is it reasonable to compare the age-at-exposure distribution from the two accidents at different post-accident periods: unspecified but speculated to be after the first 4 years for Chernobyl when the number of cases in infants drastically increased; and the first 3 years in Fukushima?

Toshihide Tsuda link

3/31/2016 07:47:39 am

Dear Professor Wakeford,

Thank you very much for your attention to our paper published in Epidemiology.

In case you have not read it, please allow me to refer you to our response to the seven letters, including the one written by you and your colleagues. It can be viewed here: http://journals.lww.com/epidem/Citation/publishahead/Response_to_the_Commentary_by_Professor_Davis_and.99060.aspx. It is possible that your concerns might not have been fully addressed in our response due to the 800-word limit to respond to all seven letters. I would be honored to provide further explanation if necessary. I eagerly await any comments you might have.

“An 12-fold higher risk" ("exceptionally high risk") mentioned in the ISEE letter actually refers to an excess risk in the second round screening, not the first round. This excess cannot be explained by "screening effect" because pre-clinical tumors which may induce such effect were likely “harvested” during the first round screening.

Sincerely yours,

Toshihide Tsuda

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OPEN DISCUSSION ON ISEE’S LETTER TO THE AUTHORITIES IN JAPAN CONCERNING THE PAPER BY TSUDA ET AL. 2015

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