{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T00:09:37Z","timestamp":1790208577251,"version":"4.1.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,7,10]],"date-time":"2023-07-10T00:00:00Z","timestamp":1688947200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Health Fund for Children and Adults Affected"},{"name":"Nuclear Incident"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>In response to concerns about health due to radiation exposure, the Fukushima Prefecture launched the Thyroid Ultrasound Examination program for residents aged 0\u201318\u00a0years at the time of the earthquake. Herein, we considered the confounding factors involved in the regional differences in the development of thyroid cancer. In this study, the 242\u2009065 individuals who participated in both first- and second-round surveys were classified into four groups by address according to their air radiation dose. The number of participants diagnosed as malignant or suspicious for malignancy by cytological examination were 17, 38, 10 and 4 with detection rates of 53.8, 27.8, 21.7 and 14.5 per 100\u2009000 participants in Regions 1, 2, 3 and 4, respectively. Sex (P\u2009=\u20090.0400), age at the time of the primary examination (P\u2009&amp;lt;\u20090.0001) and interval between the first- and second-round surveys (P\u2009&amp;lt;\u20090.0001) were significantly different among the four regions, and these were suspected to be confounding factors affecting regional differences in malignant nodule detection rates. In addition, significant regional differences were observed in the participation rate in the confirmatory examination (P\u2009=\u20090.0037) and the fine needle aspiration cytology implementation rate (P\u2009=\u20090.0037), which could be potential biases. No significant regional differences in the detection of malignant nodules were found in the multivariate logistic regression analysis after adjusting for the survey interval alone or for sex, age and survey interval. The confounding factors and biases identified in this study that may have important impacts on thyroid cancer detection rate should be fully considered in future studies.<\/jats:p>","DOI":"10.1093\/jrr\/rrad044","type":"journal-article","created":{"date-parts":[[2023,6,10]],"date-time":"2023-06-10T11:26:30Z","timestamp":1686396390000},"page":"761-768","source":"Crossref","is-referenced-by-count":5,"title":["Confounding factors and biases involved in regional differences in the detection rate of thyroid cancer in the second-round Thyroid Ultrasound Examination: the Fukushima Health Management Survey"],"prefix":"10.1093","volume":"64","author":[{"given":"Hiroki","family":"Shimura","sequence":"first","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Laboratory Medicine, Fukushima Medical University Fukushima School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susumu","family":"Yokoya","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Thyroid and Endocrine Center, Fukushima Medical University School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoru","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Iwadate","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Surgery, Minamisoma Municipal General Hospital , 2-54-6 Takamicho, Haramachi-ku, Minamisoma City, Fukushima 975-0033 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Matsuzuka","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Otolaryngology, School of Medicine, Asahi University Hospital, 3-23, Hashimoto-cho, Gifu City, Gifu 500-8523, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Suzuki","sequence":"additional","affiliation":[{"name":"Department of Thyroid Therapeutic Surgery, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fumikazu","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Nagao","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuya","family":"Ohira","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Epidemiology, Fukushima Medical University School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seiji","family":"Yasumura","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Department of Public Health, Fukushima Medical University School of Medicine , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Ohto","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenji","family":"Kamiya","sequence":"additional","affiliation":[{"name":"Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , 1 Hikarigaoka, Fukushima City, Fukushima 960-1295 , Japan"},{"name":"Research Institute for Radiation Biology and Medicine, Hiroshima, University , 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8553 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,10]]},"reference":[{"key":"2023092300501411900_ref1","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.resinv.2013.05.007","article-title":"Risk of thyroid cancer after the Fukushima nuclear power plant accident","volume":"51","author":"Yamashita","year":"2013","journal-title":"Respir Investig"},{"key":"2023092300501411900_ref2","volume-title":"UNSCEAR 2020\/2021 Report to the General Assembly with Scientific Annexes","author":"United Nations Scientific Committee on the Effects of Atomic 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Epidemiol"},{"key":"2023092300501411900_ref6","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.2188\/jea.JE20210271","article-title":"A comprehensive review of the progress and evaluation of the thyroid ultrasound examination program, the Fukushima health management survey","volume":"32","author":"Shimura","year":"2022","journal-title":"J Epidemiol"},{"key":"2023092300501411900_ref7","volume-title":"Report of Full-Scale Survey (Second Round Survey)","author":"Fukushima Prefecture","year":"2021"},{"key":"2023092300501411900_ref8","doi-asserted-by":"crossref","first-page":"e17165","DOI":"10.1097\/MD.0000000000017165","article-title":"Association between the detection rate of thyroid cancer and the external radiation dose-rate after the nuclear power plant accidents in Fukushima, Japan","volume":"98","author":"Yamamoto","year":"2019","journal-title":"Medicine"},{"key":"2023092300501411900_ref9","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration","volume":"18","author":"Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"key":"2023092300501411900_ref10","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.clon.2015.12.027","article-title":"Childhood and adolescent thyroid cancer in Fukushima after the Fukushima Daiichi nuclear power plant accident: 5 years on","volume":"28","author":"Suzuki","year":"2016","journal-title":"Clin Oncol"},{"key":"2023092300501411900_ref11","doi-asserted-by":"crossref","first-page":"4629","DOI":"10.3390\/cancers13184629","article-title":"Diagnostic strategies for thyroid nodules based on ultrasonographic findings in Japan","volume":"13","author":"Shimura","year":"2021","journal-title":"Cancers"},{"key":"2023092300501411900_ref12","doi-asserted-by":"crossref","first-page":"12712","DOI":"10.1038\/srep12712","article-title":"The Fukushima health management survey: estimation of external doses to residents in Fukushima prefecture","volume":"5","author":"Ishikawa","year":"2015","journal-title":"Sci Rep"},{"key":"2023092300501411900_ref13","volume-title":"Attachment A-18. Estimates of Effective Dose and Absorbed Dose to the Thyroid of Evacuees in Japan for the First Year after the Accident at the Fukushima Daiichi Nuclear Power Station","author":"United Nations Scientific Committee on the Effects of Atomic Radiation","year":"2021"},{"key":"2023092300501411900_ref14","volume-title":"Attachment A-13. Estimates of Effective Dose to People in Japan for the First Year after the Accident at the Fukushima Daiichi Nuclear Power Station","author":"United Nations Scientific Committee on the Effects of Atomic Radiation","year":"2021"},{"key":"2023092300501411900_ref15","volume-title":"Attachment A-14. Estimates of Absorbed Dose to the Thyroid of People in Japan for the First Year after the Accident at the Fukushima Daiichi Nuclear Power Station","author":"United Nations Scientific Committee on the Effects of Atomic Radiation","year":"2021"},{"key":"2023092300501411900_ref16","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1002\/(SICI)1097-0142(19971201)80:11<2156::AID-CNCR16>3.0.CO;2-Y","article-title":"Characteristics of differentiated thyroid carcinoma in children and adolescents with respect to age, gender, and histology","volume":"80","author":"Farahati","year":"1997","journal-title":"Cancer"},{"key":"2023092300501411900_ref17","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1089\/thy.2021.0361","article-title":"Sex differences in differentiated thyroid cancer","volume":"32","author":"Shobab","year":"2022","journal-title":"Thyroid"},{"key":"2023092300501411900_ref18","volume-title":"Cancer Statistics","author":"Cancer Information Service NCC, Japan (National Cancer Registry, Ministry of Health, Labour and Welfare)","year":"2022"},{"key":"2023092300501411900_ref19","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.canep.2017.10.010","article-title":"Cancer in adolescents and young adults: national incidence and characteristics in Japan","volume":"51","author":"Inoue","year":"2017","journal-title":"Cancer Epidemiol"},{"key":"2023092300501411900_ref20","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1089\/thy.2014.0198","article-title":"Age distribution of childhood thyroid cancer patients in Ukraine after Chernobyl and in Fukushima after the TEPCO-Fukushima Daiichi NPP accident","volume":"24","author":"Tronko","year":"2014","journal-title":"Thyroid"},{"key":"2023092300501411900_ref21","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1210\/jc.2017-01603","article-title":"Findings of thyroid ultrasound examination within 3 years after the Fukushima nuclear power plant accident: the Fukushima health management survey","volume":"103","author":"Shimura","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"2023092300501411900_ref22","doi-asserted-by":"crossref","first-page":"301","DOI":"10.2188\/jea.JE20180247","article-title":"Factors influencing the proportion of non-examinees in the Fukushima health management survey for childhood and adolescent thyroid cancer: results from the baseline survey","volume":"30","author":"Takahashi","year":"2020","journal-title":"J Epidemiol"},{"key":"2023092300501411900_ref23","doi-asserted-by":"crossref","first-page":"1683","DOI":"10.1089\/thy.2021.0072","article-title":"Fine needle aspiration cytology implementation and malignancy rates in children and adolescents based on Japanese guidelines: the Fukushima health management survey","volume":"31","author":"Shimura","year":"2021","journal-title":"Thyroid"},{"key":"2023092300501411900_ref24","doi-asserted-by":"crossref","first-page":"3639","DOI":"10.1038\/s41598-020-60453-0","article-title":"Reconstruction of residents' thyroid equivalent doses from internal radionuclides after the Fukushima Daiichi nuclear power station accident","volume":"10","author":"Ohba","year":"2020","journal-title":"Sci Rep"}],"container-title":["Journal of Radiation Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jrr\/article-pdf\/64\/5\/761\/51724688\/rrad044.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jrr\/article-pdf\/64\/5\/761\/51724688\/rrad044.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T00:50:43Z","timestamp":1695430243000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jrr\/article\/64\/5\/761\/7222151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,10]]},"references-count":24,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,7,10]]},"published-print":{"date-parts":[[2023,9,22]]}},"URL":"https:\/\/doi.org\/10.1093\/jrr\/rrad044","relation":{},"ISSN":["0449-3060","1349-9157"],"issn-type":[{"value":"0449-3060","type":"print"},{"value":"1349-9157","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,9]]},"published":{"date-parts":[[2023,7,10]]}}}