Signpost of Reconstruction： Five Years Forward
To screen or not to screen? Patient and parental autonomy should be respected.
“Is it right to keep screening people without knowing how well they understand the program, but knowing that the result may be a diagnosis of cancer?”
Dr. Sanae Midorikawa, a 48-year-old endocrinologist at Fukushima Medical University (FMU), started a traveling classroom program (出前授業) for children last year. She began to wonder if most children in Fukushima had been screened for thyroid disease without understanding how the examination was intended to protect their health. Dr. Midorikawa holds the rank of Associate Professor in FMU’s Department of Radiation Health Management.
Thyroid screening has been performed for residents of the prefecture who were 18 years old or younger when the nuclear plant accident occurred. Cancer cases have been found in this group, but the Prefectural Oversight Committee, consisting of doctors and other experts, maintains that “It is hard to conclude any influence of radiation as yet.” They point out that mass screening with high sensitivity ultrasound equipment can detect abnormalities that would go unnoticed in the course of routine patient care..
With the fear of radiation widespread among parents, most children in the prefecture have been examined at least once. However, Midorikawa thinks, “it is important to make individual decisions about whether or not to continue screening after parents and children understand what screening can and cannot do.”
Generally, thyroid cancer is curable [even when found incidentally by less sensitive means – Editor], so a “reduction in mortality” by screening is unlikely. On the other hand, there are demerits such as the mental health impact of receiving a cancer diagnosis, for which reason comprehensive thyroid screening is not recommended worldwide. “Five years have passed and now is the time to reconsider our way of screening based on current circumstances.”
In the traveling classroom program, Midorikawa explains that there is a possibility of finding cancer by screening. Then she acknowledges that some people don’t want to be told they have cancer. Especially when actual health risks are not apparent, this decision should also be respected.
Owing to the fear of radiation among prefectural residents, sufficient understanding about the demerits of screening and the informed consent process for screening has not advanced enough. Midorikawa reflects: it was natural that residents thought they should be screened when the nuclear plant accident took place; it was also natural to tie the screening result with radiation, and continue to be afraid, but in retrospect, we may have acted unreasonably.
Thyroid screening is just one of the things parents and children in the prefecture have endured. Chiharu Itoh (age 44), Vice Director of the Fukushima Seedling (芽生え) Kindergarten (Fukushima City) set up a counseling room immediately after the accident, where mothers could discuss their anxieties one-on-one. The issues they discuss range from “Should we leave the prefecture?” to “Should we avoid eating prefectural products?”
Five years on, there have emerged opinions to take the experience positively. “Mothers hope to take advantage in the future of what they have experienced in adverse circumstances.”
Dr. Midorikawa hopes that interacting with children through the traveling classroom program will help them think about other health risks and encourage them to make sensible choices in the future. If so, these five years may prove to have informed their decision-making in a constructive way.
The Fukushima Minyu Shimbun Homepage: http://www.minyu-net.com/news/news/FM20160615-084349.php