Urging Support for the 311 Children’s Thyroid Cancer Trial

By Ido Ken’ichi (Attorney)

1. A group of six young people currently aged 17 to 27, who had been living in Fukushima Prefecture at the time of the Fukushima nuclear accident (then 6 to 16 years old) and went on to develop pediatric thyroid cancer filed a suit against Tokyo Electric Power Company Holdings, Inc. (TEPCO) in Tokyo District Court on January 27, 2022, seeking damages ranging from 88 to 110 million yen per person. I am serving as lead attorney for the plaintiffs’ team, so I report on their behalf.
2. Thyroid cancer is not a rare form of cancer among people in their middle years, especially women. Pediatric thyroid cancer, however, is very rare, with only one or two cases per million in a year. In the case of Fukushima Prefecture, where the population aged 18 and under is about 380,000, it would be seen with a frequency of one case every two years, but following the nuclear accident in Fukushima Prefecture, 293 cases have been confirmed just among those that have been discovered (266 in prefectural health surveys and 27 by other means), and of these 266 cases, 222 underwent thyroidectomies. The foremost cause of thyroid cancer is exposure to radiation. Radioactive iodine taken into the body through respiration or food and drink accumulates in the thyroid and causes cancer there. After the nuclear accident at Chernobyl, several thousands of cases of pediatric thyroid cancer occurred in Belarus, Ukraine and Russia. The young people of Fukushima also received considerable radiation exposures as a result of the Fukushima nuclear accident. If we think about it in a straightforward way, only exposures arising from the Fukushima nuclear accident could possibly be the cause of such a large number of cases. Nevertheless, both the Japanese national and Fukushima prefectural governments continue to deny that radiation exposure caused this outbreak.
3. All of the plaintiffs underwent thyroid lobectomy for cancer. Four of them experienced recurrences and had their remaining lobe removed, losing their thyroid glands entirely. Once the thyroid is lost, the person must continue taking thyroid hormones the rest of her or his life. In addition, to prevent recurrences, he or she ironically must also undertake a severe form of therapy called “RAI (Radio-active Iodine)” which involves ingesting radioactive iodine to combat thyroid cancer. Of those four, one has had multiple recurrences and has undergone operations four times. The primary physician of one other has diagnosed metastasis to the lung. Some of the plaintiffs managed to obtain university enrollment but had to withdraw partway through their studies. Others found work they had hoped for, but were forced to resign. All were afraid of recurrences, and lived with the hardship of not knowing what the future might bring them. Pediatric thyroid cancer is in no way a light illness. The patients bear a huge burden even before entering adult society, and can never escape it as long as they live. The plaintiffs have to worry about their medical expenses if their cancer returns, but are no longer able to obtain medical insurance. It is only right that they should seek compensation from TEPCO, who is responsible for harming them. That, however, is not their only reason for filing suit. By raising their voices, they want the nearly 300 other people suffering similarly to take courage, and like the atomic bomb victims, they want a framework for support for future medical expenses to be created. It was with these hopes that they decided to file this suit.
4. Some question why it has taken them 11 years to file this suit. The reason is the severe situation radiation victims face currently in Japanese society, where people widely say things like, “There has been no health damage to citizens from radiation exposure and no problem living in areas not designated as Fukushima Prefecture’s evacuation zones, it is perfectly safe to consume farm and fishery products from Fukushima Prefecture, people who doubt this are trying to pour cold water on Fukushima Prefecture’s recovery and those who openly question it are guilty of spreading harmful rumors.” That is how Japanese society is these days. These societal leanings have been deliberately fostered by the national and Fukushima prefectural governments, some academics and the media. In the midst of that, the pediatric thyroid cancer patients and their families have been unable to express their suspicions that it was exposure to radiation that caused their illnesses. They even hide their own illnesses from those around them, keeping them to themselves. It was not an easy decision for them to file this suit.
5. Both the Japanese national and Fukushima prefectural governments deny a causal relationship between the Fukushima nuclear accident and the large numbers of young people in Fukushima Prefecture afflicted with pediatric thyroid cancer. As reasons for that they point to “screening effect” and “overdiagnosis” hypotheses.

The screening effect hypothesis explains why the cancers are being found, not what the cause of those cancers is. Even if screening (by thyroid ultrasound testing) helped detect the cancers at a somewhat earlier stage, this does not explain why nearly 300 cases of pediatric thyroid cancer arose during these past 11 years.

By contrast, the overdiagnosis hypothesis asserts that screening brought to light cancers that didn’t need to be discovered (because they didn’t require treatment), and proponents of this view even claim that branding nearly 300 children as “cancer patients” and having more than 200 of them undergo unnecessary surgeries is a human rights violation upon these children. To be sure, in the case of adult thyroid cancer it is well known that there are many latent cases (slowly progressing cancer consisting almost entirely of tiny nodules 5 mm or less in size, not discovered until after death). The Fukushima prefectural health survey was designed to take this into account, so even if nodules of 5 mm or less have been discovered through ultrasound scanning, they are not subjected to secondary testing. Even where nodules exceed 5.1 mm, needle biopsies are performed only in limited cases, and even where the biopsy results indicate possible malignancies, decisions on whether or not to operate are made following the Japan Association of Endocrine Surgery’s guidelines, carefully ascertaining factors such as whether or not penetration beyond the membrane or metastasis to lymph nodes has occurred, the speed of progression, and the positional relationship with the laryngeal nerve and trachea. Doctors who perform the surgical procedure assert that there is no need to worry about the risk of overdiagnosis. In addition, the cancers suffered by the plaintiffs were progressive and could not possibly be attributed to overdiagnosis.

6. When the Fukushima nuclear accident occurred, Japan’s government raised the annual exposure limit for the general public from 1 mSv to 20 mSv—a 20-fold increase—and let many citizens continue to reside in contaminated environments. Therefore, the emergence of any harm to citizens’ health resulting from the Fukushima nuclear accident shines the full light of day on the government’s erroneous policies. To them, there should be no health damage to citizens attributable to the Fukushima nuclear accident.

This mindset was revealed in actuality by a commotion over the May 2014 Oishimbo manga, in which nosebleeds were depicted as resulting from radiation exposure. Not only the National and Fukushima prefectural governments, but even Osaka’s governor and mayor reacted vehemently to this, and the major media organs gave it much coverage. Making a theme of “abnormal nosebleeds” in itself was attacked. It was common knowledge in the affected areas that children were experiencing abnormal nosebleeds directly after the Fukushima nuclear accident, but this fact has been erased from social discourse.

On January 27 of this year, five former Japanese prime ministers sent a letter to the European Commission opposing the inclusion of nuclear power in their “taxonomy for sustainable activities” (targets for green investment). In it, they mentioned that in Fukushima there were “many children suffering from thyroid cancer.” The national government, Liberal Democratic Party, some of the opposition parties, the Fukushima prefectural government and others reacted to this with fierce criticism, bringing back vivid memories of the Oishimbo uproar. To them it was wrong to attribute the cause of the multiple occurrences of pediatric thyroid cancer to the Fukushima nuclear accident.

7. The biggest reason for the government’s denial of damage to citizens’ health from the Fukushima nuclear accident is that the exposure doses to the citizens were relatively low compared to those caused by the Chernobyl nuclear accident. However, hardly any effort was made to investigate the citizens’ exposure doses. There are various estimates of fatalities from the Chernobyl nuclear accident, but the lowest among them is IAEA’s estimate of 4,000 people. Even if the amount of radioactive substances released by the Fukushima nuclear accident was one seventh that of Chernobyl’s, that does not mean the citizens suffered zero harm to their health. What the government needs to be doing is making a sound effort to investigate whether or not citizens’ health has been harmed, release the data to the public, discuss it widely and provide sufficient compensation to everyone harmed by exposure to radiation, but the government isn’t showing the slightest inclination to do that.
8. The causal relationship between radiation exposure and pediatric thyroid cancer must not be determined by political considerations, but by objective data and rational thought. I urge passionate support for these young people who have made this big decision to file this lawsuit.