The State of Japan’s Cancer Registries In the Post War Period

A. Incidence and survival trends for childhood cancer in Osaka, Japan, 1973–2001 Sachiko Baba,
1,2 Akiko Ioka, 3 Hideaki Tsukuma, 3 Hiroyuki Noda,1,4 Wakiko Ajiki 5
and Hiroyasu Iso1,6
1 Public Health, Department of Social and Environmental Medicine, and
2 Center for International Relations, Graduate School of Medicine, Osaka University,
Osaka;
3 Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan;
4 Harvard Center for Population and Development Studies, Boston, Massachusetts, USA;
5 Cancer Information Services and Surveillance Division, Center for Cancer Control and
Information Services, National Cancer Center, Tokyo, Japan
(Received June 26, 2009 Revised October 31, 2009 Accepted November 6, 2009 Online publication February 2, 2010)

Cancer Science Volume 101, Issue 3, pages 787–792, March 2010 © 2010 Japanese Cancer Association
Full text download available as link on page at http://onlinelibrary.wiley.com/doi/10.1111/j.1349-7006.2009.01443.x/abstract

The following extracts from the above source are reproduced here for study purposes and to alert interested parties of the findings of Baba et. al regarding the state of nation wide cancer reporting and recording in Japan prior to March 2011. The findings of Baba et al regarding the incidence of childhood cancer in Japan are noteworthy. Does the lack of mandatory reporting of cancer diagnosis, such as existed in Japan from end of Occupation and certainly since pre March 2011 presage future uncertainty regarding the impact of nuclear industry emissions in Japan upon the health of the children of Japan? Are the well known studies of a select and narrow portion of the Japanese Adult population by the Atomic Bomb Casulaty Commission and its successor organisation sufficient to define the actual parameters regarding childhood cancer in post war Japan? Does the existence of such a narrow and specific study preclude the need for mandatory reporting of the diagnosis of childhood cancers to central regristries throughout Japan? What is the current and past incidence of children cancer in Japan? Have there been changes in the rate of incidence of childhood cancer in Japan? What are the causes of any changes in the rate of childhood cancer incidence in Japan? Since 1945 the world has watched as a selected group of Atomic Bomb survivors has been intensively studied. What has happened to the children of Japan since 1945? Does anyone really know?

Quote “In Japan there is no nationwide cancer registry, although a large population is needed to monitor childhood trends of cancer. The Osaka Cancer Registry is one of the few registries in the world that has a long history and covers a large-enough population to monitor trends of childhood cancer. Ajiki et al. described incidence trends for childhood cancer based on 12 major cancer classifications from 1971 to 1988 by using data from the Osaka Cancer Registry.” end quote.

Quote: “This article reports incidence trends for childhood cancer in Osaka from 1973 to 2001 and survival trends from 1978 to 1997 to clarify whether the continuous decline in cancer mortality between 1973 and 2001 was caused by trends for incidence, survival, or both. ” end quote.

Quote from the Abstract of the paper with emphais added: “The age-standardized annual incidence rate of all tumors was highest in 1988–1992: 155.1 per million for males and 135.9 for females. Five-year survival for all tumors improved from 50.1% in 1978–1982 to 73.0% in 1993–1997 for males and from 52.3% to 76.3% for females. Thus, the constant decline in mortality in childhood cancer was primarily due to improved survival between the 1970s and 1980s and reduced incidence after the 1990s.”

Quote: “The Osaka Cancer Registry gathers information from reports from (1) medical institutions in Osaka Prefecture; (2) death records of inhabitants of Osaka Prefecture mentioning
neoplasms; (3) autopsy records of medical institutions in Osaka Prefecture (originally compiled in the Autopsy Records of the Japanese Society of Pathology); (4) information on cancer cases
in Osaka Prefecture extracted from the Nationwide Registry of Childhood Cancer of the Society for Protection of Children with Cancer; (5) records of cancer patients in Osaka Prefecture
extracted from the Childhood Cancer Registry of the Committee for Malignant Tumors of the Japanese Society for Pediatric Surgeons; and (6) information from application forms used in
the Research Project for Pediatric Chronic Severe Diseases.” end quote.

The sources of the data are complex. The data is complied. The data is limited to the area defined by the authors. The authors present the findings as they pertain to Osaka only.

Quote “Analyses for incidence are based on 5960 cases diagnosed between 1973 and 2001.” end quote.

The sample is time limited, apparently, by the availability of the source data.

Quote with emphasis added “The data presented here from the large-scale and long-term cancer : in Osaka showed a unique trend in the incidence of total childhood cancer: an increase until 1988 with an APC of 1.5% for males and until 1992 with an APC of 1.7% for females,
and then successive decrease with declining APCs of 2.0% for males and 1.9% for females. These trends did not change whenneuroblastomas were excluded from this analysis
…..” end quote.

Quote: “The reason why the total childhood incidence in Osaka increased but has declined since 1998 for males and 1992 for females is unknown. That decline is unlikely due to a systematic
drift for collecting data….” end quote.

Quote with emphasis added: “However, the incidence of leukemia, retinoblastoma, central nervous system in males, and hepatic tumors in females did not decline over time, while other tumors such as sympathetic nervous system tumors and germ-cell tumors declined from the middle of the study period for both sexes, a tendency which is not seen in other areas
such as the USA and Europe.” end quote.

Quote: “The survival of childhood cancer patients in the leukemia and other diagnostic groups in Osaka markedly improved between 1978 and 1992, probably due to earlier diagnosis and more effec-
tive therapies.(3,18) The introduction of mass screening for neuroblastomas had no effect on the total tumor survival rates, since the rates excluding and including neuroblastomas were similar…This study was supported in part by a Grant-in Aid for Cancer Research
(14-2) from the Ministry of Health, Labour and Welfare of Japan. Authors
appreciate Ms Miho Imanaka for her assistance with making graphs.” end quote.

B. Childhood cancer in Japan: focusing on trend in mortality from 1970 to 2006

L. Yang1,
J. Fujimoto2,
D. Qiu1 and
N. Sakamoto1,*

+ Author Affiliations

1Department of Maternal and Child Health, National Research Institute for Health and Development
2National Research Institute for Health and Development, Tokyo, Japan

*Correspondence to: Dr N. Sakamoto, The Division of Epidemiology, Department of Maternal and Child Health, National Research Institute for Child Health and Development, 2-10-1 Ookura, Setagaya-ku, Tokyo 157-8535, Japan. Tel: +81-03-3416-0181(4360); Fax: +81-03-5494-7490

source link/ full text download link: http://annonc.oxfordjournals.org/content/20/1/166.full

Quote: ” A population-based study in Osaka prefecture in Japan indicated that death due to childhood cancer declined from 1972 to 1995, while the incidence increased in the same period [1]. In the United States, an estimated 10 400 new cases and 1545 deaths are expected to occur among children aged 0–14 years in 2007 [2]. During recent three decades, the incidence of childhood cancer increased ∼0.6% annually. In contrast, mortality from childhood cancer declined by 1.3% per year during 1990–2004 [3]. A population-based study among European children since the 1970s showed that the overall incidence of childhood cancer has increased by 1.0% per year, while mortality has declined by 3.6% per year in the past three decades” end quote.

Quote “There is no national childhood cancer registry system in Japan, and recent childhood cancer mortality has not been well characterized in terms of temporal and geographic trends. This paper describes the occurrence of death from childhood cancer at the population level over a 37-year period in Japan using official death certification data, which record 100% of deaths in Japan. The aim of this study was to ascertain the general mortality trend for each sex and to study the moment at which a shift in the trend occurred.”

Conclusions: In March 2011 the South Australian Minister for Mines announced that noone would die from the Fukushima disaster.

A cursory study of two papers which address, in part, the deaths from cancers which are accepted by compentant authorities to have a radiogenic component shows that: 1. In general Japanese researchers not the lack of national registry of childhood cancers. 2. Surveys of the incidence of these cancers result from local area compilations of data, including death certificates. Other authors have been rebuked for using death certifications in this manner. IE. Dr Carl Johnson, in the matter of his reporting increases of incidence of childhood cancers in high fallout counties of Nevada and Utah in the 1950s. As in the case of the Japanese researchers, Dr Johnson had no choice due to the lack of specific data held by relevant authorities. 3. In Japan, variations in the rate of increase in the incidence of childhood cancers have been found. The reasons for these changes are unknown. 4. From the evidence presented, the creation of a uniform national and local data set which would enable comparsion in the incidence of childhood cancer before and after the events of March 2011 at the Fukushima Nuclear Powerplant will be a complex task. 5. On the basis of the historical record, nuclear authorities will resist independent cancer surveys in the current era. The authorities will support only their conclusions which will suffer the same difficulties in data collection as noted by researchers who have published relevant papers prior to March 2011. 6. Cancer reporting is inadequate in Japan nationally, with some local exceptions. This has been the case apparently since the recommencement of governmental independence from Occupation in 1952.

The South Australian Minister for Mines in 2011 had and has no basis for his statements pertaining to changes in the incidence of death and disease resultant from the Fukushima nuclear disaster.

When the South Australian Minister of Mines makes statements, he bears the responsiblity of being able to show proof. As the matter stands at present, and has been known for many years, regarding the matter of incidence of radiogenic childhood cancers in Japan, the basis of any proof, one way or the other, is very poor. The proof that does exist does not support the position held by the then Minister of Mines and expressed by him as fact in March 2011.

The matter will not actually be resolved for some decades. And even then, controversy will persist.

The design and establishment of cancer reporting regimes are concious decisions made by government. In 1952 the Japanese government made its decision regarding this matter. As a result, researchers in the 1990s consistently reported on the lack of coherent data, the lack of mandatory reporting and the difficulties which resulted in reporting on the incidence of childhood cancer in Japan. Since that time the Japanese government did not reconsider its position.

Why is this so? By what advise has the Japanese government believed, since 1952, that a central cancer registry was not needed in Japan? A limited registry pertaining to a limited population has been established in regard to the Fukushima nuclear emissions disaster. Does this foresage a process of exclusion similar to that embodied in the original pursuits of the Atomic Bomb Casualty Commission in 1945?

Concurrent with the period of time covered by the childhood cancer surveys cited above, the Japanese government proceeded with the construction of nuclear power plant and fuel reprocessing plants throughout Japan. Today the children of Japan are surrounded by over 50 nuclear power plants. The increasing influence of Japan’s nuclear industry has been noted and reported by the Japanese Diet committees since March 2011. It is not known how the changes in the Japanese nuclear industry in the period from the 1970s to the current time has affected the incidence of disease among children in Japan. The current reactor deployment in Japan is visualised in the following graphic:


Source: Scientific American. http://www.scientificamerican.com/gallery_directory.cfm?photo_id=C524E617-BCFD-9891-2C248AA0C83655F9
In March, 2011, the Japanese government has decided to set up the first national database center for childhood cancers using a cloud computing system at Chiba Cancer Center. This could be linked to the children’s cancer database in other countries in the near future.

Despite the above facts, the government of Japan did not act to establish any sort of central cancer registry system until March 2011 as the following source reveals:

http://siop-asia.com/en/news-letters/12-database-system-launched-in-japan.html
Source: The Asian Society for Paediatric Oncology.
Quote: “The aim of this cloud computing database for childhood cancers:
To make a novel ICT system for a long term follow-up of survivors to improve QOL seamlessly from child to adult.

To make an inter-hospital network of the children’s cancer database which can be used for 100 years.

To make a children’s cancers database utilized for clinical and basic researches, and even for registration.”

The emissions from the Japanese nuclear industry have been characterised and reported upon for many years. eg “Concentration factors for Cs-137 in marine algae from Japanese coastal waters.”, Tateda Y, Koyanagi T.Abiko Research Laboratory, Central Research Institute of Electric Power Industry, Chiba, Japan. This paper establishes that radiologic emissions have continuous occurred from the studied nuclear fuel reprocessing plant for years. It is one of many such sources of these emissions in Japan.

Despite this effectively uncontrolled experiment in nuclear emissions, it is only since 2011, four decades after the establishment of the Japanese nuclear industry, that any sort of coherent childhood cancer registration database has existed in Japan. It is only now, as a result of the Fukushima nuclear disaster that questions regarding the health impacts of nuclear industry have been raised within the Japanese government. I submit that the Japanese government has lost a little of its fear of nuclear experts in Japan, and as a result has, begun to act in the interests of Japan and its people in this one small area. The past remains a mystery. And this is confirmed by the findings of the above papers, which are at best tentative in regard to the past record of children cancer incidence in Japan. This is tragic.

One Response to “The State of Japan’s Cancer Registries In the Post War Period”

  1. CaptD Says:

    Medical knowledge and access to screening will allow Japanese people to seek information (and screening) outside Japan if their own Government continues to deny them care!

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