Long-term strategies for thyroid health monitoring after nuclear accidents: recommendations from an Expert Group convened by IARC

• Published in: The lancet oncology 2018-10, Vol.19 (10), p.1280-1283
• Main Authors: Togawa, Kayo, Ahn, Hyeong Sik, Auvinen, Anssi, Bauer, Andrew J, Brito, Juan P, Davies, Louise, Kesminiene, Ausrele, Laurier, Dominique, Ostroumova, Evgenia, Pacini, Furio, Reiners, Christoph, Shinkarev, Sergey, Thomas, Geraldine, Tronko, Mykola, Vaccarella, Salvatore, Schüz, Joachim
• Format: Article
• Language: English
• Subjects: Child development; Clinical decision making; Consensus; Decision making; Early Detection of Cancer - standards; Humans; International Agencies - standards; Life Sciences; Medical research; Medical screening; Mortality; Neoplasms, Radiation-Induced - diagnosis; Neoplasms, Radiation-Induced - epidemiology; Nuclear accidents & safety; Nuclear power plants; Population; Population Surveillance; Predictive Value of Tests; Professionals; Public health; Radiation Exposure - adverse effects; Radioactive Hazard Release; Risk Assessment; Risk Factors; Thyroid; Thyroid cancer; Thyroid Function Tests - standards; Thyroid Gland - radiation effects; Thyroid Neoplasms - diagnosis; Thyroid Neoplasms - epidemiology; Time Factors; Ultrasonic imaging; Values
• ISSN: 1470-2045; 1474-5488
• DOI: 10.1016/S1470-2045(18)30680-6

The work of the Expert Group was published as IARC Technical Publication No. 46.1 The objective of this Expert Group was not evaluation of the thyroid examination programmes that were implemented after the past nuclear accidents, or recommendations related to thyroid health monitoring activities currently in progress. Since the Chernobyl accident in 1986 in Ukraine, the guidelines for overall preparedness and response to nuclear emergencies have evolved2 and have contributed to the implementation of successful countermeasures against radiation exposure from nuclear accidents and associated potential adverse health effects.3 In view of the established association of thyroid cancer risk with radiation exposure, particularly during childhood and adolescence, appropriate preparedness and response regarding thyroid cancer-related issues are crucial. Because thyroid cancer has a large reservoir of subclinical disease in the population,4 population thyroid screening identifies cancers that would have developed into clinical cases as well as those that would not have been diagnosed if the screening had not taken place or would not have caused symptoms or death during the patient's lifetime. In the context of overdiagnosis and low disease-specific mortality,7 recommendations have been developed by professional organisations to avoid thyroid ultrasonography screening in low-risk, asymptomatic adult populations.8 The Expert Group agrees with this view for populations, of all ages, affected by nuclear accidents, because screening the affected asymptomatic populations irrespective of risk levels (ie, thyroid radiation dose) is also expected to result in the issues related to overdiagnosis without clear public health benefits. [...]we express our gratitude to the Ministry of the Environment, Japan, for their financial support of the project and to the Nuclear Safety Research Association of Japan for managing the grant.