As with some of the previous committee meetings, thyroid cancer information was apparently leaked to the media the day before the 17th Prefectural Oversight Committee Meeting for Fukushima Health Management Survey, scheduled for December 25, 2014. Since the English edition of the Kyodo news article contained very little information, just as the online Japanese news articles, all based on the same Kyodo post, the paper edition of the Fukushima Minyu post was transcribed and translated as below. (See below the translation for the actual images of the post in the paper edition).
*****
From the December 24, 2014 article in the paper edition of Fukushima Minyu. (The online edition only includes the first three paragraphs and the first sentence of the fourth paragraph).
Thyroid Examination: Four Suspected of Cancer in Second Screening--These Children Had Normal Exam Results in First Screening
In the thyroid examination conducted in all children in Fukushima Prefecture in order to investigate the effects of radiation as a result of the Tokyo Electric Fukushima Daiichi nuclear power plant (NPP) accident, officials revealed on December 23rd that 4 children whose first screening was “normal” were diagnosed with suspect thyroid cancer in the second screening. It is to be reported at the Prefecture Oversight Committee to be held in Fukushima City on December 25th.
If these cases are confirmed to be thyroid cancer, they will become the first cases where the increase in cancer is confirmed after the NPP accident.
Fukushima Medical University (FMU), in charge of the screening examination, will hurry to confirm the diagnoses and carefully ascertain whether these cases were caused by the effects of radiation exposure.
Occurrence of pediatric thyroid cancer cases skyrocketed 4-5 years after the Chernobyl NPP accident in 1986. Because of this, FMU considers the results of the first screening, during the three years after the accident, as baseline data with no radiation effects. FMU plans on investigating the effects of radiation by comparing any increase of cancer cases from the second screening onward.
The first screening targeted approximately 370,000 residents who were 18 and younger at the time of the accident. The second screening targets approximately 385,000 residents, including children born in the first year after the accident. In each screening, ultrasound is used to examine the size and shape of thyroid mass, which is classified as “A1,” “A2,” “B” and “C” assessment categories, in the ascending order of severity. “B” and “C” assessment categories go onto secondary examination with a detailed blood test as well as a cytological biopsy.
According to officials, 4 people who were diagnosed with suspect cancer are men and women whose ages were in the 6-17 range at the time of the accident. In the first screening, they had “normal” test results, with 2 in “A1” and the other 2 in “A2” assessment categories. The four participated in the second screening, which began in April 2014, where they were classified in the “B” category and diagnosed with “suspect cancer” during the secondary examination. The tumor size varies from 7 to 17.3 mm.
External exposure dose estimation for the first four months after March 11, 2011 was available for the three of the four, with the maximum being 2.1 mSv. The places of residence for the four [at the time of the accident] included Okuma Town, Fukushima City, Date City and Tamura City.
In addition, it was newly revealed that the number of children who were confirmed with cancer during the first screening went from 57, as of August 2014, to 84, increasing by 27. The number of children with suspect cancer is now 24 (46 as of August).
Images of the article in the paper edition courtesy of @fukushima_info.
The original Japanese transcript can be found here.
Details of Fukushima Thyroid Cancer Surgical Cases
This is a compilation of the most current information
on Fukushima thyroid cancer surgical cases from 3 different sources (screenshots of the abstracts for 2 & 3 can be seen in this post):
- November 11, 2014 Thyroid Examination Evaluation Subcommittee meeting
- November 14, 2014 Japan Thyroid Association meeting
- August 28, 2014 Japan Society of Clinical Oncology meeting
Due to
the span of the time amongst these 3 sources, they have different numbers for
the cases of thyroid cancer. For clarification, the most updated summary of the
thyroid cancer cases is presented first.
********************************************************************************************************
Summary of
Fukushima thyroid cancer cases as of November 2014
Number of cases
suspected or confirmed of thyroid cancer = 104
Cases that had
surgery = 58
Cases confirmed of
thyroid cancer = 57 (1 of 58 turned out to be benign nodules)
55 of 58 cases
were operated on at Fukushima Medical University (FMU)
- 1 case turned out to be benign nodules
- 52 cases of papillary thyroid cancer
- 2 cases of poorly differentiated thyroid cancer
Pre-operative diagnosis:
42 cases (78%) had
pre-surgical tumor diameter > 10 mm
12 cases (22%) had
pre-surgical tumor diameter ≤ 10 mm:
- 3 cases were suspected to have lymph node or distant metastasis.
- 7 cases with proximity to trachea or recurrent laryngeal nerve, or extrathyroidal extension
- 2 cases of voluntary surgery despite recommendation of non-surgical follow-up
Overall, 17 cases
(31%) had lymph node metastasis and 2 cases (4%) had distant metastasis to the
lungs
Operative methods:
5 cases (8%) had
total thyroidectomy
49 cases (91%) had
hemithyroidectomy
All 54 cases had
lymph node dissection
Post-operative
pathological diagnosis:
15 cases (28%) had tumor diameter ≤ 10 mm,
and 3 (6%) of them had no lymph node metastasis or distant metastasis (pT1a pN0
M0)
37% (?20 cases?) had extrathyroidal extension
74% (?40 cases?) were positive for lymph node metastasis
No post-operative complications (post-surgical hemorrhage, permanent
paralysis of recurrent laryngeal nerve, hypoparathyroidism, or hypothyroidism
after hemithyoidectomy) observed.
Note: 2
cases of lung metastasis were papillary thyroid cancer cases.
*****
Thyroid Examination Evaluation Subcommittee
Information that was released by Shinichi Suzuki at
the Thyroid Examination Evaluation Subcommittee meeting held on November 11,
2014
Regarding
Surgically Indicated Cases
Three years have passed since the disaster struck. Of
1,848 subjects that underwent the secondary examination up to June 30, 2014, 485 had
cytological examinations. Suspicious or malignant cases totaled 104, and 58 of
them were already operated on.
Surgeries on 55 of 58 cases were conducted at the
Division of Thyroid and Endocrine Surgery, Fukushima Medical University. 3
cases were operated on at other facilities. As 1 of 55 cases turned out to be
benign nodule post-operatively, only the 54 thyroid cancer cases were
considered there.
According to the pathological evaluation, 52 cases
were papillary cancer, and 2 were poorly differentiated thyroid cancer.
In pre-operative diagnosis, 42 cases (78%) had tumor
diameter > 10 mm. and 12 (22%) were ≤ 10 mm in diameter. Also, of the 12
cases with tumor diameter of ≤10 mm, 3 (5%) were suspected to have lymph node
metastasis and/or distant metastasis. 9 (17%) cases were not suspected to have
lymph node or distant metastasis (cT1acN0cM0).
Of these 9 cases, 7 were suspected to be close to the
trachea or the recurrent laryngeal nerve, or have extrathyroidal extension. The
remaining 2 cases were operated on based on patients’ wishes, despite the
recommendation of non-surgical follow-up.
Furthermore, 17 cases (31%) were positive for lymph
node metastasis, and 2 cases (4%) were suspected of multiple lung metastasis.
Surgical methods included total thyroidectomy in 5
cases (9%), and hemithyroidectomy in 49 cases (91%). Lymph node dissection was
conducted in all cases, with 67% limited to the central compartment and 33%
including lateral compartment. As much as possible, small-size incisions of 3
cm were used.
Post-surgical
pathological diagnosis revealed 15 cases (28%) with tumor diameter ≤ 10 mm, and
3 (6%) of them had no lymph node or distant metastasis (pT1a pN0 M0).
Extrathyroidal extension, pEX1, was seen in 37%, and 74% was positive for lymph
node metastasis. No post-operative
complications (post-surgical hemorrhage, permanent paralysis of recurrent
laryngeal nerve, hypoparathyroidism, or hypothyroidism after hemithyoidectomy)
were observed.
The 57th Annual Meeting
of the Japan Thyroid Association
November 14, 2014
Identification of gene clusters related to initiation of thyroid
cancer and elucidation of pathogenesis in children and young adults
Shinichi
Suzuki1,
Toshihiko Fukushima1, Michiko Matsuse3, Yudai Hirata1, Hirokazu Okayama 1,
Chiyo Okouchi 1, Toshiyuki Monma 2, Hiroshi Mizunuma
1, Satoshi Suzuki1, Norisato Mitsutake 3, Shunichi Yamashita
3
1Department
of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University,
2Department
of Organ Regulatory Surgery, Fukushima Medical University, 3Department of Radiation
Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University
There has been an increase
in the number of pediatric and young adult patients diagnosed with thyroid
cancer due to the advance in diagnostic ultrasound technology and
implementation of pediatric thyroid ultrasound screening. However, pathogenesis
relating to initiation and development of these cancers is yet to be fully
understood. As it is anticipated the
number of cases will increase in the future, we will identify gene clusters
related to cancer initiation and elucidate the mechanism of pathogenesis in
order to reveal biological features of these cancers. In this study, we
investigated the gene clusters known to be related to thyroid cancer
initiation.
Study subjects: 24 surgical
cases (male:female = 1:2, average age 17.9 years (9-22 years)) in children and
young adults. 23 cases were papillary thyroid cancer and 1 was follicular
cancer. (Note: The actual presentation
referred to 23 cases of papillary thyroid cancer and 1 case of poorly
differentiated thyroid cancer).
Method: DNA and RNA were
extracted from excised tumor tissues and analyzed with direct sequencing and
PT-PCR. Mutation in BRAF, K-, N-, and H-RAS and rearrangement in RET/PTC1 and
RET/PTC3 were investigated.
Results: 67% was positive
for BRAF mutation. Also, 12.5 % had rearrangement of RET/PTC1, but no mutation
was found in RET/PTC3, K-, N-, and H-RAS.
Information
from the transcript of the presentation by Shinichi Suzuki
23 cases were papillary
thyroid cancer (19 cases of classical type, 1 case of follicular variant, and 3
cases of cribriform-morular variant or CMVPTC), and 1 case was poorly-differentiated
thyroid cancer.
23 patients were from the Fukushima
Health Management Survey Thyroid Examination, and 1 case of a 22-year-old
female was unrelated to the survey.
Genetic analysis results:
RET/PTC1: positive in 3
cases or 12.5%(average age 17.8 years)
ETV6/NTRK3: positive in 1
case or 4.2% (16-year-old female)
BRAF (known to be common in
adults): positive in 18 cases or 67%(average age 18 years)
No RET/PTC3, K-, N-, H-RAS,
or TRK detected.
5 cases (all females,
average age 16.7 years) were negative for RET/PTC1, BRAF, or ETV6/NTRK3.
The patient unrelated to Fukushima
Health Management Survey, a 21-year-old female, was RET/PTC1 positive.
BRAF, RET/PTC1 and
ETV6/NTRK3 cases were all classical type papillary thyroid cancer.
Five all-negative cases
included 1 case of follicular variant papillary thyroid cancer, 1 case of
poorly-differentiated cancer, and 3 cases of cribriform-morular variant
papillary thyroid cancer (CMVPTC). CMVPTC cases are under investigation for APC
genetic mutations which are known to be causative. All 3 CMVPTC cases have
family history.
Five all-negative cases had
slightly larger tumor diameter than others. These 5 cases were the only cases
undergoing total thyroidectomy.
BRAF positive cases are said
to be aggressive. RET/PTC1 tends to be seen in older children and associated
with cases unrelated to radiation exposure. RET/PTC3 is seen in younger
children, and seen frequently in Chernobyl, although it is not considered to be
the definitive oncogene for radiation-induced PTC. It is commonly thought gene
rearrangements are more frequently seen in children, whereas point mutations
are seen more in adults.
As a conclusion, BRAF, the
genetic mutation detected most frequently, is what is usually seen in typical
adult PTC. It is highly possible that cases which may not have been detected if
it weren’t for the thyroid ultrasound screening are being discovered in
children and young adults as a result of the screening.
Note 1: Three cases of cribriform-morular variant
papillary thyroid cancer are not consistent with the information from the
August 2014 meeting of Japan Society of Clinical Oncology below, showing 3
cases of diffuse sclerosing variant papillary thyroid cancer. It is likely the
pathological diagnosis was updated after an outside review.
Note 2: Suzuki’s presentation of these details
outside the Thyroid Examination Evaluation Subcommittee, especially before the
information was shared with the Subcommittee and the public, created
controversy as to the handling of data. Suzuki claims the study was accepted by
the ethics committee at Fukushima Medical University, but the thyroid
examination itself is conducted with the money provided by the central
government to Fukushima Prefecture, and the data belongs to the prefecture and
the residents. Suzuki has a track record of not revealing the data to the
Thyroid Examination Evaluation Subcommittee or the Prefectural Oversight
Committee for Fukushima Health Management Survey before presenting it at an
academic meeting in August 2014, as described below.
Note 3: This meeting was
closed to media due to the decision of the conference chair, based on the
wishes of some of the presenters.
Note 4: Shigenobu Nagataki, a mentor to Shinichi Yamashita, revealed the following information during the questions and answers session:
Shigenobu Nagataki was invited to do a presentation
called “Fukushima Daiichi Accident and Thyroid Cancer” at “Meet-the-Professor
Workshop” on October 30, 2014 at the 84th Annual Meeting of the American Thyroid Association.
He
was asked by thyroid specialists attending the meeting if nodule sizes were the
only thing determined in this unprecedented, large-scale screening.
Participants wanted to know how many had Graves’ disease, autoimmune
thyroiditis, goiter, etc. [Note: Fukushima Health Management Survey has not released
hardly any data regarding non-cancer thyroid diseases]. Nagataki referred to
patient privacy in disclosing such information, but he was told patient privacy
meant such things as patients’ names and had nothing to do with how many
patients had Graves’ disease. [Note: Fukushima Medical University cites patient privacy when refusing to disclose details of their findings]. They asked him there must be a rough estimate of non-cancer thyroid diseases made by thyroid specialists conducting
ultrasound screening. Nagataki told them he would get back to them in
writing as he didn’t know what to say.
*****
The 52nd
Annual Meeting of Japan Society of Clinical Oncology
August
28-30, 2014
Organ
Specific Symposium 03, August 28, 2014
10:00-12:00
OS3-5 “Treatment of Pediatric Thyroid Cancer in Fukushima”
Shinichi Suzuki
Division of Thyroid and
Endocrinology, School of Medicine, Fukushima Medical University
Pediatric thyroid cancer has
been considered rare, consisting approximately 1-2% of all thyroid cancer. They
might appear to be advanced at first sight, with lung metastasis or widespread
lymph node metastasis discovered at the time of diagnosis, but long-term
survive is known to be extremely good.
After the Fukushima Daiichi
nuclear power plant accident following the Great East Japan earthquake and
tsunami on March 11, 2011, Fukushima Prefecture was burdened with the prospect
of faces long-term radiation health effects. Fukushima Health Management Survey
was launched in Fukushima Prefecture, with one of the surveys being thyroid
ultrasound examination of residents who were children at the time of the
accident. Initial Screening has already completed, and thyroid cancer cases
have been discovered. We report our experience in treating these asymptomatic
pediatric thyroid cancers detected through ultrasound screening, unlike the
usual symptomatic thyroid cancer.
Study subjects are 269,354
children (participation rate 80.8%) who underwent primary examination from
October 2011 to December 31, 2013. Of these, 1796 required secondary
examination, and 75 of them were diagnosed with malignant or suspicious tumor
as a result of fine-needle aspirational biopsy. 34 already had surgery, and 33
were confirmed to have thyroid cancer. We are reporting here on the 31 cases
operated on in our department.
Average age at the time of
surgery is 16.4 (9-20) years, the male
to female ratio is 14:17, and 9 cases were from Fiscal Year 2011 (from 13
municipalities designated by the government to be evacuation zone), and 22
cases were from Fiscal Year 2012.
Average tumor diameter at
the time of surgery was 14.9 mm (6-13 mm). Pre-operative diagnosis revealed 22
cases of T1 (7 T1a and 15 T1b), 7 cases of T2, and 2 cases of T3. 19 cases
were N0, 12 cases were N1 (4 N1a and 8 N1b), 29 cases of M0 and 2 cases of M1
(lungs). Surgical method was 28 cases of hemithyroidectomy and 3 cases of total
thyroidectomy, and lymph node dissection included 19 cases of central
compartment dissection, and12 cases of lateral compartment dissection.
Post-operative diagnosis revealed 24 cases of papillary thyroid cancer (usual
type), 3 cases of follicular-type papillary thyroid cancer, 3 cases of diffuse
sclerosing papillary thyroid cancer, and 1 case was suspicious of poorly
differentiated thyroid cancer. 21 cases
of pT1 (9 cases of pT1a, 12 cases of pT1b), 3 cases of pT2, 7 cases of pT3
(EX1), 7 cases of pN0, and 24 cases of pN1 (12 pN1a and 12 pN1b). Two cases with
pre-operative suspicion of M1 (lungs),
which had the Tg level in the blood dropping below detection range after total
thyroidectomy, will be scheduled for either CT scan of lungs or I131
scintigraphy.
In all cases, intraoperative
monitoring of the recurrent laryngeal nerve was conducted using NIM. Surgical
incision for neck dissection was limited to small skin incisions of 3 cm in the
central compartment dissection and 3-5 cm in the lateral compartment
dissection. No paralysis of the recurrent laryngeal nerve or hypoparathyroidism
was observed.
A Letter Hand-delivered to the UN and UNSCEAR, Requesting Revision of UNSCEAR Report And a New UN Mandate for UNSCEAR
On October 24, 2014, at the Fourth Committee of the UN General Assembly being held in New York City, representatives from Physicians for Social Responsibility (USA) and Human Rights Now (Tokyo, Japan) hand-delivered a letter to the chairperson of the 4th Committee and the Secretary of UNSCEAR. The letter, co-signed by 43 civil society groups from 9 countries, including 21 Japanese groups, requested revision of the 2014 UNSCEAR report on Fukushima accident as well as a new UN mandate for UNSCEAR.
Physicians from 19 national affiliates of the International Physicians for the Prevention of Nuclear War (IPPNW), including Physicians for Social Responsibility (USA) and IPPNW Germany, have authored/issued/published a Critique of the UNSCEAR report[ii] which calls into question the presumptions and data used by UNSCEAR, and the consequent interpretations and conclusions. This Critique demonstrates how UNSCEAR systematically underestimates and downplays the health effects of the Fukushima disaster.
We appreciate the significant efforts made by UNSCEAR committee members to evaluate the extensive and complex data concerning the Fukushima nuclear catastrophe. However, their conclusion that there is “no discernable effect”, now or in the future, defies common sense and undermines the credibility of UNSCEAR. The Critique notes that based on the UNSCEAR report itself, it can be expected that about 1,000 excess cases of thyroid cancer and between 4,300 and 16,800 other excess cancer cases would occur in Japan due to Fukushima radioactive fallout. We believe that these are very discernable effects for the individuals, families and communities experiencing these cancers, as well as those individuals who will experience other form(s) of radiation induced illness.
Furthermore, the conclusion by UNSCEAR of ‘no discernible health effect’ is misleading the Japanese government to not implement countermeasures for individuals to avoid additional exposure and to have thorough monitoring of health effects, thereby causing serious human rights violations.
This catastrophe was not a singular event that has come to an end, but rather it is an unfolding event with an unknown endpoint. Radioactive elements continue to leak into the biosphere and individuals continue to be exposed to ionizing radiation because they live in contaminated areas, consume contaminated food and water and inhale contaminated air. Additionally, most of the health effects from Fukushima will take decades or generations to be expressed. Thus the UNSCEAR report at hand should be considered a preliminary or initial assessment of the health effects of Fukushima. Ongoing and improved monitoring and updating of the assessment is required for a long time to come. The 2014 UNSCEAR report is a beginning, not an end.
Date: 24
October 2014
To: Members of the Fourth Committee of the UN
General Assembly 69th Session,
Members of UNSCEAR, and
Members of the UN General
Assembly:
Re: Civil
Society groups request revision of the recent United Nations Scientific
Committee on the Effects of Atomic Radiation (UNSCEAR) Report: “Levels and
effects of radiation exposure due to the nuclear accident after the 2011 Great
East-Japan Earthquake and tsunami.”
The 2011
Fukushima disaster made UN oversight of the adverse effects of ionizing
radiation an issue of utmost global importance.
The goals and criteria of oversight should be the protection and
promotion of the human right to health and well-being, which encompasses an
environment as free from exposure to man-made ionizing radiation as
possible. We, the undersigned, urge the
4th Committee to examine critically both the scientific conclusions
in the UNSCEAR report[i] and the
scientific evidence omitted from the report.
Physicians from 19 national affiliates of the International Physicians for the Prevention of Nuclear War (IPPNW), including Physicians for Social Responsibility (USA) and IPPNW Germany, have authored/issued/published a Critique of the UNSCEAR report[ii] which calls into question the presumptions and data used by UNSCEAR, and the consequent interpretations and conclusions. This Critique demonstrates how UNSCEAR systematically underestimates and downplays the health effects of the Fukushima disaster.
We appreciate the significant efforts made by UNSCEAR committee members to evaluate the extensive and complex data concerning the Fukushima nuclear catastrophe. However, their conclusion that there is “no discernable effect”, now or in the future, defies common sense and undermines the credibility of UNSCEAR. The Critique notes that based on the UNSCEAR report itself, it can be expected that about 1,000 excess cases of thyroid cancer and between 4,300 and 16,800 other excess cancer cases would occur in Japan due to Fukushima radioactive fallout. We believe that these are very discernable effects for the individuals, families and communities experiencing these cancers, as well as those individuals who will experience other form(s) of radiation induced illness.
Furthermore, the conclusion by UNSCEAR of ‘no discernible health effect’ is misleading the Japanese government to not implement countermeasures for individuals to avoid additional exposure and to have thorough monitoring of health effects, thereby causing serious human rights violations.
This catastrophe was not a singular event that has come to an end, but rather it is an unfolding event with an unknown endpoint. Radioactive elements continue to leak into the biosphere and individuals continue to be exposed to ionizing radiation because they live in contaminated areas, consume contaminated food and water and inhale contaminated air. Additionally, most of the health effects from Fukushima will take decades or generations to be expressed. Thus the UNSCEAR report at hand should be considered a preliminary or initial assessment of the health effects of Fukushima. Ongoing and improved monitoring and updating of the assessment is required for a long time to come. The 2014 UNSCEAR report is a beginning, not an end.
We
ask that the Fourth Committee take two actions regarding the UNSCEAR report:
1) Return the report to UNSCEAR for revision based on the Critique, taking into consideration the points of concern raised in the Critique, and that UNSCEAR broaden the composition of the committee to include as full-fledged members scientists who are critical of nuclear activities.
2) We also ask that the Fourth Committee urge the General Assembly to pass a new resolution reframing the 1955 UNSCEAR founding mandate to ensure that the UNSCEAR’s primary scientific mission is to promote and protect public health and the right to health of the most vulnerable individuals. The Precautionary Principle should be employed to address the short-term and long-term effects of ionizing radiation upon present and future generations as well as the environment. Likewise, the Precautionary Principle should be employed when determining exposure, cleanup and decontamination regulations and activities after a nuclear disaster, educational measures to minimize and mitigate the risk of individual exposure, and the long-term monitoring of contaminated sites. A new UN mandate is critical for UNSCEAR Committee members to be able to fully utilize their expertise for the purpose of protecting the lives and health of the global community.
This request is supported
by the following organizations:
Physicians for Social Responsibility, USA
International Physicians for the Prevention of Nuclear
War – Germany, Germany
Human Rights Now, Tokyo, Japan
Peace Boat – US, USA
Niji to midori no kai, Japan
Greens Fukushima, Japan
Workers’
Executive Committee For Anti-nuclear Power Movements, Japan
Kai
Fukushima Downwind, Japan
The Nature Conservation of Fukushima, Japan
Friends
of the Earth Japan, Japan
Showa Shell Labour Union, Japan
Chernobyl
Health Survey and Health-care Support for the Victims - Japan Women's
Network, Japan
Nuclear
Disaster Information Center, Japan
Japan
International Volunteer Center, Japan
Campaign for Nuclear-free Japan, Japan
Fukushima Network for Denuclearization, Japan
Hairo
Action Fukushima, Japan
Hairo Fukushima Women Against Nukes, Japan
People
in Fukushima-NPP 30km area, Japan
Refugee
Living with Fukushima in Niigata Prefecture, Japan
Shinshu
3.11 Network, Japan
National Network of Parents to
Protect Children from Radiation, Japa
The
Civil Forum on Nuclear Radiation Damages (CFNRD), Japan
Takagi School, Japan
Association de l'Education Environnementale pour
les Futures Generations, Tunisia
NGO of “Ecolife”, Azerbaijan
Women in Europe for a Common Future
International, Netherlands
Women in Europe for a Common Future, Germany
Women in Europe for a Common Future, France
Irish Doctors' Environmental Association (IDEA), Ireland
Nuclear Information and Resource Service, USA
Nuclear Age Peace Foundation, USA
Nuclear Age Peace Foundation, New York, USA
Nukewatch/The Progressive Foundation, USA
Nuclear Watch New Mexico, USA
Georgia WAND - Women's Actions for New Directions, USA
Physicians for Social Responsibility – Kansas City, USA
Gray Panthers, USA
Center for Safe Energy, USA
Nuclear Energy Information Service, USA
Shut Down Indian Point Now, USA
International Society of Doctors for the Environment,
Switzerland
Beyond Nuclear, USA
[i] UNSCEAR report “Levels and effects of
radiation exposure due to the nuclear accident after the 2011 Great East-Japan
Earthquake and tsunami” at: http://www.unscear.org/docs/reports/2013/13-85418_Report_2013_Annex_A.pdf
[ii] Critical Analysis of the UNSCEAR Report
“Levels and effects of radiation exposure due to the nuclear accident after the
2011 Great East-Japan Earthquake and tsunami: www.fukushima-disaster.de/information-in-english/maximum-credible-accident.html
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