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Cancer and Fukushima: Who to trust?

by

Special To The Japan Times

South Korean director Kim Ki-duk is a noted provocateur. His latest movie, “Stop,” is about a Japanese couple who were living near the Fukushima No. 1 nuclear power plant when it suffered a meltdown in March 2011.

They evacuate to Tokyo, where the wife is pestered by an underground cult that insists she abort her presumably irradiated fetus, and she becomes convinced she should. Her husband is equally convinced there is nothing wrong with the baby and ties his wife up to prevent her from doing anything. Kim’s point seems to be that whichever position you take on the nuclear accident, it will invariably drive you insane.

But these positions do divide families. In an interview that appeared Oct. 20 on Norikoe Net TV, writer Minori Kitahara remarks to filmmaker Hitomi Kamanaka that there are no men in her latest documentary, “Little Voices from Fukushima,” which centers on a group of mothers trying to gain more information about the effects of radiation on their children’s health, because the authorities give them none. Kamanaka says these women’s husbands refused to appear on camera “even though they support what their wives are doing.”

There are even more mothers involved in the movement whose spouses forbade them to participate in the filming. Because of their jobs, these men gravitate toward the establishment stance, which in this case holds that there is no solid evidence showing that the radioactivity released by the Fukushima accident has had a harmful effect on area residents, including children. Public health in Fukushima is, according to Kamanaka, a gender-identified issue. “The nuclear industry is very much a man’s world,” she says.

The male-dominated media augments the confusion by throwing out stories related to radiation in Fukushima filled with unexplained statistics: three Fukushima hospitals ran tests on 2,700 children and discovered no radioactive cesium in their bodies; the International Atomic Energy Agency says an increase in the incidence of thyroid cancer in Fukushima is “unlikely.” Then Toshihide Tsuda, a professor at Okayama University, contradicts the purport of these stories by publishing a study in the journal of the International Society of Environmental Epidemiology that found thyroid cancer incidence rates of Fukushima residents “under the age of 19″ was 20 to 50 times the national level. News items that mention the study also point out that Tsuda’s conclusions are questioned by experts who call them “premature” or indicative of a “screening surge,” meaning that since so many people were tested more cancers than normal were bound to be found and these cancers may not have been caused by radiation.

Tsuda addressed these doubts last month during a press conference at the Foreign Correspondents’ Club of Japan, explaining that even if a screening surge is factored in, the incidence rate for thyroid cancer is well above the norm. Moreover, the rate of cancer incidence four years after the accident is comparable to the rate of thyroid cancer incidence in Belarus four years after the Chernobyl nuclear disaster, and that led to 6,000 children undergoing surgery. He called on the authorities to undertake “better and broader” screenings and implement measures to address this probable increase in cancer cases.

The operative word here is “cancer,” which dominates the conversation because of its terrifying overtones. However, it is treated by both sides as a quantitative matter: How many children will get cancer and how much of it was caused by radioactivity?

What’s missing is the qualitative dimension. Katsuya Kodama, a medical researcher whose specialty is the effects of radiation on cells, pointed out during a recent discussion on the Internet news channel DemocraTV that DNA strands are always being damaged and repair themselves as a matter of course. Radiation above a certain level, however, can cause more permanent damage, which may lead to cancerous cell growth.

But all cancers aren’t the same, and according to his research, the type of cell mutations found in the children in Fukushima don’t usually lead to “shortened life spans.” The small nodules found on the subjects’ thyroid glands are cancerous but that doesn’t mean they’re fatal. Thyroid cancer develops very slowly, but once a parent hears from a doctor that his or her child “has cancer,” the reaction is to have it removed immediately, even though it may not be necessary. Fifteen Chernobyl children diagnosed with thyroid cancer eventually died, but Kodama believes death was due to the effects of surgery and not the cancer itself. Though the number of thyroid cancer diagnoses has risen in the United States in recent decades, the number of annual deaths from the disease has remained unchanged. In Kodama’s view, the argument has less to do with the effects of radiation than with how the medical community addresses cancer.

He isn’t saying that radioactivity isn’t dangerous or that people living in the area shouldn’t be screened; he’s saying the matter should be explained medically and not just statistically. Strangely enough, his research, like Tsuda’s, has been rejected by the establishment. When he presented his findings to the Nuclear Regulation Authority, they told him they were afraid people would “misunderstand.” In accordance with the official line regarding the possible health crisis in Fukushima, it’s better not to talk about it at all.

This attitude only exacerbates the situation. Two years ago the government set up an advisory system for the regions affected by the nuclear accident. Residents could talk to experts about safety and relief measures. Last week, Tokyo Shimbun reported that the program has been a bust, since residents don’t trust anyone representing the authorities to give them straight answers. As one person involved in the program told the paper, “Everyone has different opinions about the effects of radiation, and it always leads to conflicts.”

  • Michele Marcolin

    And they are right, ’cause governative sources never say the truth about it. It is the nature of the nuclear business: being strategic (i.e. military); secret; lucrative (for some); its hazards are hardly immediate or visible; people forget on the long term; generations die and change and loose track of what happened.

  • Enkidu

    I’ve found the coverage of the Tsuda paper over the past few weeks quite fascinating.

    For those that don’t live in Japan and have not been following the Fukushima thyroid study closely, we’ve known that the incidence rate for thyroid cancer in the sample population has been many multiples of the typical background rate since the first results were released nearly four years ago. The pertinent question since that time has been to what degree this incidence rate has been influenced by the screening effect.

    Then comes along Tsuda, et. al., and they compare the Fukushima thyroid incidence rate to the typical background rate. In other words, information that we’ve known for several years now. As for the screening effect, the paper simply said that the increase was too high to be fully attributable to the screening effect, without explaining why or how much.

    Tsuda also ran an internal comparison in an effort to negate any screening effect, where he compared highly contaminated areas to one of his “least contaminated
    areas”. This showed a consistent increase in the incidence rate of nearly two times. However, had he chosen one of his other “least contaminated areas”, the highest contaminated areas would have shown a decrease in incidence rate. In other words, not what we would call a significant result.

    So, understandably, the scientific community kind of shrugged at this paper. It was good for pulling all this data together in once place, but it really didn’t give us anything actionable.

    However, Tsuda decided to run with it, and primarily with the foreign press. Now, for the benefit of those outside of Japan, we don’t generally get the best and brightest journalists on the Tokyo beat, and what we certainly don’t get are any journalists with a hard-science background. So, for example, when Tsuda asserted at the FCCJ press conference that “even if a screening surge is factored in, the incidence rate for thyroid cancer is well above the norm” the normal
    question for anyone who had actually read his paper would have been, “But you didn’t factor in a screening surge in your paper, so why are you making this statement here?”. In other words, Tsuda, without having any scientists around to answer hard questions greatly expanded on what his paper said and the foreign press ate it up.

    Beware the scientist that publishes a paper and then runs straight to the FCCJ to trumpet it.

    • Steve Jackman

      “for the benefit of those outside of Japan, we don’t generally get the best and brightest journalists on the Tokyo beat”.

      This is such a true statement. All the best foreign journalists in Japan are always run out of the country, since they are the ones who have the courage and journalistic integrity to write truthfully and honestly about serious issues in Japan. That is why they draw the ire of the Japanese government and many right wing conservatives here, since these foreign journalists cannot be controlled and herded like sheep (i.e., Japanese media) to always report the party line.

      The Japanese would rather feed those outside of Japan myths and sugar-coated fantasies about Japan, rather than the reality, since in reality things are often much darker and less palatable. This is why all of the brighest foreign journalists assigned to the Japan desk by the world’s top media outlets are always stonewalled and denied access. Not just that but, they are often harassed, bullied, intimidated, threatened and subjected to false rumors, until they are forced to pack up their bags and leave Japan.

    • Sam Gilman

      The calibre of journalists is an interesting issue. I am continually astonished at how many Tokyo-based foreign journalists even four years after the event have a remarkably poor grip of the basics of Fukushima and the health risks. I don’t know if it’s an issue of people not being the brightest or best, or even lacking science training. I don’t have a hard science training, but I think I’ve got a fairly good lay understanding of what the science says.

      I think what’s happened is that they’ve put their journalistic self-interest before the welfare of their readers. When faced with a choice between the truth and the story, they will go for the story. You see it time and again – they ask around proper experts who tell them that whatever scare story has been cooked up by someone is just that, so they go off and dig up a fringe figure or an anti-nuclear acitivist who’ll validate the scare just so they can say “Scientists are divided”. The Japan Times even felt it was OK to publish claims that people in Kyoto – entirely unaffected by Fukushima – had radiation sickness. Absolutely unbelievable.

      The Tsuda case is a great example of this. It’s pretty clear that every appropriate expert has cast severe doubt on the study and his methods, to the point of open contempt on the part of a couple of them. The faults with the paper are not difficult to grasp. It plainly contradicts dramatically what all other respectable studies say. Tsuda can be found giving presentations at anti-nuclear conferences, and collaborating with people like Timothy Mousseau, shepherd of the notoriously awful Yablokov volume on Chernobyl.

      Should the story be “scientist challenges official story”, as it has been presented in many places? Or should a journalist start sniffing around the serial issues of suspect science in the small coterie of “expert” talking heads courted by the foreign press because of the stories they generate?

      There is hope: the author of the article above mentions Katsuya Kodama. In his blog, he talks about how Kodama believes Tsuda is wrong and that the threat from radiation is being highly exaggerated:

      Kodama’s own ideas about cancer may be one reason his theories don’t hold much weight with the authorities, especially the medical community, whose reputation is based at least partly on an aggressive stance toward cancer. Anyone who implies that cancer is overdiagnosed and that doctors are too quick to treat early stages of the disease with powerful drugs and invasive surgery tend to be shouted down, even though such opinions are gaining currency in the global medical community.

      I think Brasor is wrong: people do not get shouted down by medical researchers for pointing out the screening effect. If anything, medical researchers trying to explain the screening effect are being shouted down by people with a vested interest in telling certain stories.

      • Enkidu

        An excellent comment, Sam. In retrospect, I think I may have been a bit harsh in that choice of words (but in my defense I was rushing to get my kids out the door to their last Halloween party of the season!). And I certainly did not mean that it applied to Philip Brasor and this particular article. On the contrary, I generally find his writing on Japan to be interesting and informative.

        As for the broader story of journalists looking for what sells, I’m with you completely. Your critique of the embarrassingly bad AP article on the Tsuda paper, which suffered from many of these faults, was spot-on.

      • Starviking

        I wouldn’t be so kind to Phillip Brasor on the evidence in this article. He mangles timeline to make it look that the Tsuda paper arrived to cast doubt on the Fukushima Caesium study. The only problem, his links show that the Caesium study was reported on after the Tsuda paper.

      • AmIJustAPessimistOrWhat?

        “I think Brasor is wrong: people do not get shouted down by medical researchers for pointing out the screening effect. If anything, medical researchers trying to explain the screening effect are being shouted down by people with a vested interest in telling certain stories.”

        I cannot see this Brasor saying this anywhere in the article. Brasor did however report that the NRA asked Kodama not to make public his viewpoint/findings – but that s an entirely different matter.

      • Sam Gilman

        I was citing Brasor’s blog:

        http://philipbrasor.com/2015/11/01/media-mix-nov-1-2015/

        The NRA aren’t the “medical community”. It’s also not clear exactly what Kodama’s “findings” were. I had difficulty tracking down any medical researcher called Katsuya Kodama, so I searched for the books he’s holding in the blog picture.

        His name is KAZUYA Kodama (Katsuya Kodama is an anti-nuclear sociologist at Mie Uni), and he’s based at Kanazawa Uni. The book he’s holding on the left (放射線被曝の理科・社会) appears to be a critique of the outrageous Oishinbo manga that helped to spread false rumours about nosebleeds in Fukushima. That doesn’t look to be something outside the mainstream. The other book is called ”
        活断層上の欠陥原子炉 志賀原発−はたして福島の事故は特別か” and appears to be a call to end nuclear power in Japan focussing on issues at a power plant in Shiga.

        I’m trying to find his medical research in the topic on google scholar, and I’m not getting anything. His thesis appears to have been about the woodchuck hepatitis virus. I found a couple of articles from 2008 and 2010 on problems with nuclear power (not medical research) and a paper on atmospheric doses after Fukushima. Kanazawa lists very little and it’s all old.

        So I’m beginning to have reservations about what exactly it was that Kodama said that the NRA thought could be misunderstood. In any case, he’s not an established medical researcher in this area by the look of it. It looks like a case of Brasor vetting his sources for their anti-nuclear credentials, rather than their scientific credentials.

  • mokopit

    Can’t tell if it’s a cover up or a cover up ? Hmmmmm

  • mokopit

    No …..really. Everyone has to understand that this has been admitted to be uncontrollable. So these people that seem to be hiding from the truth. DO OSTRICH but it is a waste of time. Start living the rest of your life gracefully. Morally honestly and act like every day is your last because dying is your only guarantee in life and this event is going to help guarantee every living thing die.
    Sorry Mother Nature

    • annebeck58

      Yes. However, do pay attention to the signs and symptoms of cancer(s) and other growths, particularly in and on the thyroid. It controls so many other important bodily functions (like heartbeat, blood-flow, pressure..) Some tumors can grow so large or in such an inconvenient place as to choke the person afflicted. I know this from personal experience.
      I do not think the people of Japan are particularly playing ostrich. I think they are being given contradictory information and can wind up a confused bunch.
      But, in all things, live in grace. This is something I learned only after about fifty years on this planet.

      • mokopit

        I didn’ mean the people of Japan were playing ostrich I was trying to say that the people that are going along with the lies and non urgency of the event that I guess are too uninformed that they also will be consumed by this disaster.

      • mokopit

        PS I hope your medical problems are not problems any longer. Good luck.

  • AmIJustAPessimistOrWhat?

    ” Fifteen Chernobyl children diagnosed with thyroid cancer eventually died, but Kodama believes death was due to the effects of surgery and not the cancer itself.”

    The WHO, United Nations Scientific Committee on the Effects of Atomic Radiation, and NIH National Cancer Institute all report increased thyroid cancer in Chernoboyl related exposed children, above the level which would be due to increased screening. It’s no surprise that NRA asked Kodama to keep quiet – he’s a bit of a loose cannon even if he happens to be one the many people that understand how increased tumor screening leads to increased detection.

    WHO: “…if people had stopped giving locally supplied contaminated milk to children for a few months following the accident, it is likely that most of the increase in radiation-induced thyroid cancer would not have resulted…nearly 5 000 cases of thyroid cancer have now been diagnosed to date among children who were aged up to 18 years at the time of the accident. While a large number of these cancers resulted from radiation following the accident, …(increased screening) has also resulted in the detection of thyroid cancers at a sub-clinical level, … Fortunately, even in children with advanced tumours, treatment has been highly effective and the general prognosis for young patients is good. However, they will need to take drugs for the rest of their lives to replace the loss of thyroid function.”

    UNSCEAR: “Doses to the thyroid received in the first few months after the accident were particularly high in those who were children and adolescents … and drank milk with high levels of radioactive iodine. By 2005, more than 6,000 thyroid cancer cases had been diagnosed in this group, and it is most likely that a large fraction of these thyroid cancers is attributable to radioiodine intake…”

    NIH: “Researchers calculated cancer risk in relation to how much energy from I-131was absorbed by each person’s thyroid, measured in grays … Each additional gray was associated with a twofold increase in radiation-related thyroid cancer risk.”

    • Sam Gilman

      I agree. There is, as noted, an issue of how much the screening effect elevated the Chernobyl count (I can’t find the paper on that right now I found a couple of years ago) but the age profile of Chernobyl victims and biopsies of tumours clearly show the effects of radiation,m. I’ve had a look for Kazuya (note sp.) Kodama’s credentials on this topic, and I can’t find any appropriate ones.

  • VooDude

    Thyroid cancer is astounding common, and only rarely does it cause any problems to the thyroid owner… Studies of people who were lucky enough to make it to autopsy(!) had their thyroids dissected … about a third had papillary carcinoma of the thyroid. These ‘lucky’ people did not have any thyroid disease or problems, and died for, obviously, non-thyroid issues. Granted, most were old. Papillary carcinomas of the thyroid are very common. They are present in 16 year olds at 3% and 21yo at 6%. Very few ever present as “thyroid disease” in a clinical sense … something like 30 in 100,000 present clinical symptoms. Modern ultrasound is being deployed to non-invasively screen for thyroid cancer, and fine-needle aspiration samples show that it is real cancer. Real cancer that, in the vast majority of cases, will cause the bearer no problems.

    A 2009 paper by Guth et al. showed that the better resolution of new 13 MHz ultrasound scanners over older 7.5 MHz ones increased the detection of nodules in one population from 33% to 68% per person.

    ”The prevalence of thyroid nodules in a healthy population is high: in the German Papillon study, nationwide ultrasound screening of more than 90 000 people using 7·5 MHz scanners revealed the presence of thyroid nodules in 33% of the normal population. ”

    ”Using the 13 MHz technology, we found a substantially higher prevalence of thyroid nodules (68%) than the Papillon study (33%). Even if our population is older than in Papillon, the difference remains in comparable age groups. This is due to the higher sensitivity of 13 MHz scanning”

    Guth, S., et al. 2009 “Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination.” European journal of clinical investigation
    *******************

    ”The thyroids from 93 autopsies, performed on children, and young adults younger than age 40 years, … occult papillary carcinoma (OPC), giving a prevalence rate of 14%. The youngest affected patient was a boy aged 18 years. The prevalence rate of individuals between age 18 and 40 years was 27%. The rate appears to be rather constant in adults, although there may be a slight rise in middle age.”

    ”…100 papillary carcinomas from the whole country, there were six patients younger than age 21 years and three of them were younger than age 16 years (unpublished observation).” 6% of kids, age 21 or less

    ”In most of these studies, no correlation was found between the prevalence rate of OPC and the age of the patients. The series have not, however, included almost any children and only few young adults.”

    Franssila, Kaarle O., and H. Rubén Harach 1986. “Occult papillary carcinoma of the thyroid in children and young adults: A systemic autopsy study in Finland.” Cancer

    ********************
    ”Thyroid glands from autopsies on 138 adults, ages 20 to 40 years, with no known clinical or laboratory evidence of thyroid disease, were serially sectioned at 2 mm intervals and microscopically examined for occult thyroid disease and anatomic variations. Occult papillary carcinoma was found in 3% of the glands, …”

    Komorowski, Richard A., and Gerald A. Hanson 1988. “Occult thyroid pathology in the young adult: an autopsy study of 138 patients without clinical thyroid disease.” Human pathology

    sciencedirect com/science/article/pii/S0046817788801758

    ”The incidence of thyroid cancer nearly doubled in Wisconsin between 1980 and 2004, with almost all of the increase occurring between 1990 and 2004, during which an annual change of 4.0% (95% CI: 3.3-4.6) was observed. The bulk of the increase consisted of small, localized cancers of papillary histology. …”

    CONCLUSIONS:

    “The association between thyroid cancer incidence and socioeconomic indicators of health care access is consistent with the hypothesis that the rising incidence trend is attributable to utilization of new diagnostic practices.

    Sprague, Brian L., Shaneda Warren Andersen, and Amy Trentham-Dietz 2008. “Thyroid cancer incidence and socioeconomic indicators of health care access.” Cancer Causes & Control

    ncbi nlm nih gov/pubmed/18240001

  • VooDude

    Thyroid cancer is astounding common, and only rarely does it cause any problems to the thyroid owner… Studies of people who were lucky enough to make it to autopsy(!) had their thyroids dissected … about a third had papillary carcinoma of the thyroid. These ‘lucky’ people did not have any thyroid disease or problems, and died for, obviously, non-thyroid issues. Granted, most were old. Papillary carcinomas of the thyroid are very common. They are present in 16 year olds at 3% and 21yo at 6%. Very few ever present as “thyroid disease” in a clinical sense … something like 30 in 100,000 present clinical symptoms. Modern ultrasound is being deployed to non-invasively screen for thyroid cancer, and fine-needle aspiration samples show that it is real cancer. Real cancer that, in the vast majority of cases, will cause the bearer no problems.

    A 2009 paper by Guth et al. showed that the better resolution of new 13 MHz ultrasound scanners over older 7.5 MHz ones increased the detection of nodules in one population from 33% to 68% per person.

    ”The prevalence of thyroid nodules in a healthy population is high: in the German Papillon study, nationwide ultrasound screening of more than 90 000 people using 7·5 MHz scanners revealed the presence of thyroid nodules in 33% of the normal population. ”

    ”Using the 13 MHz technology, we found a substantially higher prevalence of thyroid nodules (68%) than the Papillon study (33%). Even if our population is older than in Papillon, the difference remains in comparable age groups. This is due to the higher sensitivity of 13 MHz scanning”

    Guth, S., et al. 2009 “Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination.” European journal of clinical investigation
    *******************

    ”The thyroids from 93 autopsies, performed on children, and young adults younger than age 40 years, … occult papillary carcinoma (OPC), giving a prevalence rate of 14%. The youngest affected patient was a boy aged 18 years. The prevalence rate of individuals between age 18 and 40 years was 27%. The rate appears to be rather constant in adults, although there may be a slight rise in middle age.”

    ”…100 papillary carcinomas from the whole country, there were six patients younger than age 21 years and three of them were younger than age 16 years (unpublished observation).” 6% of kids, age 21 or less

    ”In most of these studies, no correlation was found between the prevalence rate of OPC and the age of the patients. The series have not, however, included almost any children and only few young adults.”

    Franssila, Kaarle O., and H. Rubén Harach 1986. “Occult papillary carcinoma of the thyroid in children and young adults: A systemic autopsy study in Finland.” Cancer

    ********************
    ”Thyroid glands from autopsies on 138 adults, ages 20 to 40 years, with no known clinical or laboratory evidence of thyroid disease, were serially sectioned at 2 mm intervals and microscopically examined for occult thyroid disease and anatomic variations. Occult papillary carcinoma was found in 3% of the glands, …”

    Komorowski, Richard A., and Gerald A. Hanson 1988. “Occult thyroid pathology in the young adult: an autopsy study of 138 patients without clinical thyroid disease.” Human pathology

    sciencedirect com/science/article/pii/S0046817788801758

    ”The incidence of thyroid cancer nearly doubled in Wisconsin between 1980 and 2004, with almost all of the increase occurring between 1990 and 2004, during which an annual change of 4.0% (95% CI: 3.3-4.6) was observed. The bulk of the increase consisted of small, localized cancers of papillary histology. …”

    CONCLUSIONS:

    “The association between thyroid cancer incidence and socioeconomic indicators of health care access is consistent with the hypothesis that the rising incidence trend is attributable to utilization of new diagnostic practices.

    Sprague, Brian L., Shaneda Warren Andersen, and Amy Trentham-Dietz 2008. “Thyroid cancer incidence and socioeconomic indicators of health care access.” Cancer Causes & Control

    ncbi nlm nih gov/pubmed/18240001