The 13th TUE Subcommittee Document 1-1: Regarding factors related to the results of the

Full-Scale Thyroid Ultrasound Examination (the second round)

1 Detection rates of nodules in the first round (differences by screening year) (from the
10th Subcommittee document)

Figure 1 Proportions of subjects with nodules ≥ 5.1 mm among the primary examination
participants whose results are finalized (age group by age at the primary examination)

【The first round】

[1] FY 2011 [2] FY 2012 [3] FY 2013 All

【The second round】

[1] FY 2014 [2] FY 2014 [3] FY 2015 All

(13 municipalities) (12 municipalities) (34 municipalities)

[1] 13 municipalities: Kawamata, Namie, Iitate, Minamisoma, Date, Tamura, Hirono, Naraha,
Tomioka, Kawauchi, Okuma, Futaba, Katsurao
[2] 12 municipalities: Fukushima, Nihonmatsu, Motomiya, Otama, Koriyama, Kori, Kunimi,
Tenei, Shirakawa, Nishigo, Izumizaki, Miharu
[3] 34 municipalities: Iwaki, Sukagawa, Soma, Kagamiishi, Shinchi, Nakajima, Yabuki,
Ishikawa, Yamatsuri, Asakawa, Hirata, Tanagura, Hanawa, Samegawa, Ono,Tamakawa,
Furudono, Hinoemata, Minami-aizu, Kaneyama, Showa, Mishima, Shimogo, Kitakata, Nishi-
aizu, Tadami,
Inawashiro, Bandai, Kitashiobara, Aizumisato, Aizubange, Yanaizu, Aizuwakamatsu, Yugawa

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Figure 2 Proportions of subjects with nodules ≥ 10.1 mm among the primary examination
participants whose results are finalized (age group by age at the primary examination)

【The first round】

[1] FY 2011 [2] FY 2012 [3] FY 2013 All

【The second round】

[1] FY 2014 [2] FY 2014 [3] FY 2015 All

(13 municipalities) (12 municipalities) (34 municipalities)

＊Created from Table 2 in the FY 2016 supplementary version to the final results of the first round as well as the
final results of the second round.
＊In the first round there are occasions when subjects from FY 2011 municipalities participated in FY 2012 or FY
2013 or subjects from FY 2013 municipalities participated earlier than scheduled in FY 2011 or FY 2012. A similar
phenomenon was seen in the second round. (All 59 municipalities have been assigned to a certain FY, but the FY
assignment does not necessarily correspond to the actual year of participation.)

Summary:
• In the first round, detection rates of nodules ≥ 5.1 mm increased in the order of
[1] < [2] < [3], while detection rates of nodules ≥ 10.1 mm were about the same in
all 3 FY groups. Thus in the first round, detection rates of nodules 5.1–10.0 mm
changed in the order of [1] < [2] < [3].
• In the second round, detection rates of nodules ≥ 5.1 mm have a relationship of [1]
> [2] = [3], suggesting that they are influenced by a change in detection rates of
nodules 5.1–10.0 mm in the first round.

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2 Rates of the B test results in the primary examination and confirmatory examination
participation rates (from the 11th Subcommittee document)

Table 1 Detection rates* of confirmed or suspected cancer in the second round by region
Region 13 evacuated Nakadori2 Hamadori3 Aizu4 Total
municipalities1
# of participants** 32,006 140,582 46,406 27,693 246,687
Age (years) 11.8 11.9 12.6 12.3 12.1
# requiring the confirmatory exam in the 2nd round (B) 329 1135 379 221 2,064
Rate of B in the 2nd round (# of B/# primary exam) 1.03 0.81 0.82 0.80 0.84
nd st
# of B in the 2 round who were B in the 1 round 69 391 161 110 731
nd st
% of B in the 2 round who were B in the 1 round 21.0 34.4 42.5 49.8 35.4
# of participants in the confirmatory examination 281 920 308 144 1,675
Participation rate in the confirmatory examination 85.4 81.1 81.3 75.1 81.2
# of FNAC conducted 38 119 24 9 190
# of FNAC conducted (B in the 1st round) 0 10 14 4 28
nd
FNAC rate (# FNAC/# participants in the 2 round) 13.5 12.9 7.8 5.4 11.3
st
FNAC rate (only for B in the 1 round) 0.0 1.1 4.5 2.4 1.7
FNAC rate (other than B in the 1st round) 13.5 11.8 3.2 3.0 9.7
# confirmed or suspected cancer 17 39 10 4 70
# confirmed or suspected/# participants (per 100,000) 53.1 27.7 21.6 14.4 28.4
Average screening interval (years)*** 2.48 2.07 2.18 1.87 2.12

*Analysis includes data as of June 30, 2017.

**Including subjects who participated in both the first and second rounds.
***Interval between the primary examination in the first round and the primary examination in the second round.

1) 13 municipalities in Evacuation Area: Kawamata, Namie, Iitate, Minamisoma, Date, Tamura, Hirono, Naraha,
Tomioka, Kawauchi, Okuma, Futaba, Katsurao
2) Nakadori: Fukushima, Koriyama, Shirakawa, Sukagawa, Nihonmatsu, Motomiya, Kori, Kunimi, Otama,
Kagamiishi, Tenei, Nishigo, Izumizaki, Nakashima, Yabuki, Tanagura, Yamatsuri, Haniwa, Samegawa, Shirakawa,
Tamakawa, Hirata, Asakawa, Furudono, Miharu, Ono
3) Hamadori: Iwaki, Soma, Shinchi
4) Aizu: Aizuwakamatsu, Kitakata, Shimogo, Hinoemata, Tadami, Minami-aizu, Kitashiobara, Nishi-aizu, Bandai,
Inawashiro, Aizubange, Yugawa, Yanaizu, Mishima, Kaneyama, Showa, Aizumisato

Summary:
• Rate of the B results in the primary examination of the second round was the
highest in Evacuation Area and the lowest in Aizu.
• Participation rate in the confirmatory examination was the highest in Evacuation
Area and the lowest in Aizu.
• Detection rates of confirmed or suspected cancer: Evacuation Area > Nakadori >
Hamadori > Aizu.
• Proportions of the B results in the second round who also had the B results in the
first round: Evacuation Area < Nakadori < Hamadori < Aizu.
• Proportions of the first-round results other than B among subjects who underwent
FNAC: Evacuation Area > Nakadori > Hamadori > Aizu.

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Table 2 Detection rates* of confirmed or suspected cancer in the second round by the first-
round screening year
First-round screening year FY 2011 FY 2012 FY 2013

# of participants** 29,311 114,168 100,578

Age (years) 11.8 12.0 12.2

# requiring the confirmatory exam in the 2nd round (B) 307 919 811

Rate of B in the 2nd round (# of B/# primary exam) 1.05 0.80 0.81

# of B in the 2nd round who were B in the 1st round 60 294 364

% of B in the 2nd round who were B in the 1st round 19.5 32.0 44.9

# of participants in the confirmatory examination 263 733 658

Participation rate in the confirmatory examination 85.7 79.8 81.1

# of FNAC conducted 36 108 45

# of FNAC conducted (B in the 1st round) 2 15 10

FNAC rate (# FNAC/# participants in the 2nd round) 13.7 14.7 6.8

FNAC rate (only for B in the 1st round) 0.8 2.0 1.5

FNAC rate (other than B in the 1st round) 12.9 12.7 5.3

# confirmed or suspected cancer 16 34 20

# confirmed or suspected/# participants (per 100,000) 54.6 29.8 19.9

Average screening interval (years)*** 2.56 2.12 2.02

*Analysis includes data as of June 30, 2017.

**Including subjects who participated in both the first and second rounds.
***Interval between the primary examination in the first round and the primary examination in the second round.

Summary:
• The rate of the B results and the participation rate of the confirmatory examination
were the highest in FY 2011.
• Proportions of the B results in the second round who also had the B results in the
first round: FY 2011 < FY 2012 < FY 2013.
• Proportions of the first-round results other than B among subjects who underwent
FNAC: FY 2011 > FY 2012 > FY 2013.
• Detection rates of confirmed or suspected cancer by the first-round screening
year: FY 2011 > FY 2012 > FY 2013.

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3 Screening interval (From the 11th Subcommittee document)
Table 3 Detection rates of confirmed or suspected cancer by age group (5 years) at the second round and by
screening interval
Age at the second round (years) 0-4 5-9 10-14 15-19 ≥ 20 Total
Screening interval < 2 years
# of participants** 2,928 22,903 20,222 21,286 3,982 71,321
nd
# requiring the confirmatory exam in the 2 round (B) 0 30 99 344 115 588
Rate of B in the 2nd round (# of B/# primary exam) 0.00 0.13 0.49 1.62 2.89 0.82
# of participants in the confirmatory exam 0 26 80 260 91 457
Participation rate in the confirmatory exam – 86.7 80.8 75.6 79.1 77.7
# of FNAC conducted 0 0 8 23 8 39
FNAC rate (# FNAC/# participants in the 2nd round) – 0.0 10.0 8.8 8.8 8.5
# confirmed or suspected cancer 0 0 2 5 3 10
# confirmed or suspected/# participants (per 100,000) 0.0 0.0 9.9 23.5 75.3 14.0
Average screening interval (years)*** 1.72 1.76 1.86 1.76 1.71 1.79
Screening interval ≥ 2 years, < 2.5 years
# of participants** 6,162 40,832 60,363 36,737 6,360 150,454
# requiring the confirmatory exam in the 2nd round (B) 1 47 408 524 195 1,175
Rate of B in the 2nd round (# of B/# primary exam) 0.02 0.12 0.68 1.43 3.07 0.78
# of participants in the confirmatory exam 1 41 344 433 160 979
Participation rate in the confirmatory exam 100.0 87.2 84.3 82.6 82.1 83.3
# of FNAC conducted 0 2 38 61 19 120
FNAC rate (# FNAC/# participants in the 2nd round) 0.00 4.9 11.0 14.1 11.9 12.3
# confirmed or suspected cancer 0 2 14 20 8 44
# confirmed or suspected/# participants (per 100,000) 0.0 4.9 23.2 54.4 125.8 29.2
Average screening interval (years)*** 2.17 2.16 2.16 2.16 2.16 2.16
Screening interval ≥ 2.5 years
# of participants** 811 5,268 7,148 8,077 3,608 24,912
# requiring the confirmatory exam in the 2nd round (B) 1 3 48 149 100 301
Rate of B in the 2nd round (# of B/# primary exam) 0.12 0.06 0.67 1.84 2.77 1.21
# of participants in the confirmatory exam 1 3 40 123 72 239
Participation rate in the confirmatory exam 100.0 100.0 83.3 82.6 72.0 79.4
# of FNAC conducted 0 0 7 19 5 31
FNAC rate (# FNAC/# participants in the 2nd round) 0.0 0.0 17.5 15.4 6.9 13.0
# confirmed or suspected cancer 0 0 1 10 5 16
# confirmed or suspected/# participants (per 100,000) 0.0 0.0 14.0 123.8 138.6 64.2
Average screening interval (years)*** 2.81 2.88 2.77 2.81 3.01 2.84

Summary:
• (From Table 3) Overall, the longer the screening interval, the higher the FNAC rate and
the detection rate of confirmed or suspected cancer.
• (From Table 1) Screening interval was the longest in Evacuation Area and the shortest
in Aizu.
• (From Table 2) Average screening interval between the first and second rounds: FY
2011 > FY 2012 > FY 2013.

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4 FNAC rates (from the 12th Subcommittee document)

(1) FNAC rates and detection rates of confirmed or suspected cancer by size of nodules
detected at the confirmatory examination and by screening year*

Figure 3 Proportions of subjects by size of Figure 4 FNAC and cancer detection

nodules detected at the confirmatory rates by screening year
examination and by screening year
FNAC rates Cancer detection rates

Figure 5 FNAC rates and detection rates of confirmed or suspected cancer by size of nodules
detected at the confirmatory examination****

FNAC rates Cancer detection rates

*Analysis with data as of June 30, 2017.

** FY 2015 includes subjects who were screened in FY 2016.
*** Includes subjects who participated in both the first and second rounds.
****The denominator is the number of subjects diagnosed with nodules at the confirmatory examination.

Summary:
• In the ≤ 10.0 mm and 10.1–20.0 mm groups, FNAC rates and detection rates of
confirmed or suspected cancer tended to be higher in the FY 2014 cohort.

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(2) FNAC rates and detection rates of confirmed or suspected cancer by size of nodules
detected at the confirmatory examination*

Figure 6 Proportions of subjects by size of nodules Figure 7 FNAC and cancer detection
detected at the confirmatory exam and by region** rates by region***

Figure 8 FNAC rates and detection rates of confirmed or suspected cancer by size of nodules detected
at the confirmatory examination****
FNAC rates Cancer detection rates

*Analysis with data as of June 30, 2017.

** Includes subjects who participated in both the first and second rounds.
***The denominator is the number of subjects diagnosed with nodules at the confirmatory examination.

1) Tamura, Minamisoma, Date, Kawamata, Hirono, Naraha, Tomioka, Kawauchi, Okuma, Futaba, Namie, Katsurao, Iitate
2) Fukushima, Koriyama, Shirakawa, Sukagawa, Nihonmatsu, Motomiya, Kori, Kunimi, Otama, Kagamiishi, Tenei, Nishigo, Izumizaki,
Nakashima, Yabuki, Tanagura, Yamatsuri, Haniwa, Samegawa, Shirakawa, Tamakawa, Hirata, Asakawa, Furudono, Miharu, Ono
3) Iwaki, Soma, Shinchi
4) Aizuwakamatsu, Kitakata, Shimogo, Hinoemata, Tadami, Minami-aizu, Kitashiobara, Nishi-aizu, Bandai, Inawashiro, Aizubange,
Yugawa, Yanaizu, Mishima, Kaneyama, Showa, Aizumisato

Summary:
• FNAC rates and detection rates of confirmed or suspected cancer: Evacuation Area >
Nakadori > Hamadori > Aizu.
• In the ≤ 10.0 mm and 10.1–20.0 mm groups, FNAC rates and detection rates of
confirmed or suspected cancer tended to be higher in Evacuation Area and Nakadori.
• In the ≥ 20.1 mm group, no clear regional difference was seen in FNAC rates.

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5 Effects of the first-round FNAC on the second-round FNAC rates

(1) Yearly changes of the first-round FNAC rates (from the 11th Subcommittee document)

Table 4 Results of the first round by screening year

Screening year for the first round FY 2011 FY 2012 FY 2013

# of participants** 38,098 137,336 119,982

Age (years) 10.4 10.7 10.9
# requiring the confirmatory exam in the 1st round (B + C) 186 968 1076
Rate of B+C in the 1st round (# of B+C/# primary exam) 0.49 0.70 0.90
# of participants in the confirmatory examination 170 889 980
Participation rate in the confirmatory examination 91.4 91.8 91.1
# of FNAC conducted 84 267 187
FNAC rate (# FNAC/# confirmatory exam participants) 49.4 30.0 19.1
# confirmed or suspected cancer 13 58 41
# confirmed or suspected/# participants (per 100,000) 34.12 42.23 34.17
*Analysis with data as of June 30, 2017.
**Including subjects who participated in the first round during FY 2011–FY 2013.

Summary:
• FNAC rates in the first round: FY 2011 > FY 2012 > FY 2013.

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(2) FNAC rates and detection rates of confirmed or suspected cancer by size of nodules
detected at the confirmatory examination according to the first-round FNAC status * (from
the 12th Subcommittee document) (Note: “with FNAC” in light gray and “no FNAC” in black in Figures 9 & 10)

Figure 9 Number of subjects by size of nodules Figure 10 FNAC (Lt) and cancer detection
detected at the confirmatory examination rates (Rt) according to the first-
according to the first-round FNAC status** round FNAC status
FNAC
No FNAC

Figure 11 FNAC rates (left) and detection rates of confirmed or suspected cancer (right) by size of
nodules detected at the confirmatory examination***
(Note: Data without the first-round FNAC is shown on the right in each graph.)

*Analysis with data as of June 30, 2017.

** Includes subjects who participated in both the first and second rounds: 122 with FNAC and 1302 without FNAC in the first round.
***The denominator is the number of subjects diagnosed with nodules at the confirmatory examination.

Summary:
• (From Figures 9–11) When FNAC was conducted in the first round, FNAC and cancer
detection rates tended to be smaller in the second round in any size group.
• In the first round, FNAC rates were “FY 2011 > FY 2012 > FY 2013,” while detection
rates of nodules 5.1–10.0 mm were “FY 2011 < FY 2012 < FY 2013.” As a result,
proportions of the B results in the second round who also had the B results in the first
round were “FY 2011 < FY 2012 < FY 2013.”
• Therefore, among subjects who underwent FNAC, proportions of the first-round results
other than B were “FY 2011 > FY 2012 > FY 2013.”
• When FNAC was conducted in the first round, FNAC and cancer detection rates tended
to be smaller in the second round in any size group, suggesting that the first-round
FNAC status affected yearly changes of FNAC and cancer detection rates in the second
round.