Epidemiology of the Atomic Bomb Survivors and Chernobyl to Fukushima Accidents
Toshiko Kato
natureflow@kcn.jp[ABSTRACT]Four years have passed since the Fukushima nuclear accident. The government releases evacuation order in
the area of radiation dose ≦20 mSv/year, and is trying to return the evacuees to their home town. Nuclear
regulation authority claims “The difficulty to prove the obvious increase in health risk in 100 mSv or less isinternationally recognized” and supports the evacuees return home policy. The Radiation Effects Research
Foundation (RERF) is a scientific organization dedicated to studying health effects of atomic bomb radiation.
The research results have been utilized as a source of basic information for establishing radiation protection
standards. Epidemiology of the atomic bomb survivors is examined, and conclusions are summarized asfollows. 1. If we compare the radiation dose from Hiroshima atomic bomb estimated by DS86 andDS02 and the radiation dose standards, exposure dose of the 100 mSv safety hypothesis is equivalent to the
exposure dose at 1.9 km from the atomic bomb hypocenter (HC). If evacuee in Fukushima return home in theevacuation released area ≦20 mSv/year, they shall have dose, in a year, equivalent to exposure dose at 2.4
km from the HC. Exposure dose of 100mSv and evacuation order release at ≦20mSv/year are not safe forresident’s health. 2. "Matters elucidated thus far by RERF studies" claims that the risk increases inproportion to radiation dose above around 100 to 200 mSv, but association remains unclear below that level( “100 mSv safety hypothesis”). This contradicts the results of the original papers: The dose-response appears
to be linear, without any apparent threshold below which effects may not occur. 3. In the life span study(LSS), the excess risk of survivors who were within 2.5 km of either HC at the time of bombing (Hibakusha)
is derived by comparing with the risk for survivors who were at 2.5-10 km (non-Hibakusha), assuming thatthe exposure of the latter is nonsignificant. However, if the residual radiation and internal exposure are of
considerable amount, non-Hibakusha might have been exposed by the radiation significantly. The excess
cancer risk may have been estimated too low by comparing Hibakusha with non-Hibakusha exposedconsiderably by residual radiation. 4. Excess cancer risk for exposure at 10 years old is higher by morethan 5 times than that at 50. Young family with children can’t go home if evacuation order is released at ≦20mSv/year. 5. Atomic bomb survivors can have ”Exposures Notebook” at around ≦7 km from HC
with dose ≧ 0.5 mSv, and medical expenses are free. Fukushima residents who are exposed 20 mSv/year,
cannot have any support for medical allowance except children. 6. If we compare the evacuation standards
and exposure managements of Chernobyl and Fukushima, human right to health seems not to be protected in
Fukushima. This difference comes from the acceptance of 20 mSv/year dose safety standard based on 100
mSv safety hypothesis. 7. Childhood thyroid cancer in Fukushima seems to increase at comparable speed toor faster than that in Chernobyl. From the good correspondence of the results of thyroid examination and theextent of radioactive I-131 deposition, childhood thyroid cancer may probably caused by radioactive
exposure.
1. Radiation dose standards and the radiation dose from Hiroshima atomic bomb
Radiation from Hiroshima atomic bomb is estimated by DS86 and DS02 and it is shown in HP of
MHLW (1). Exposure dose of 100mSv of 100 mSv safety hypothesis is equivalent to the exposure dose at
1.9km from the Hiroshima atomic bomb hypocenter (HC). Evacuation order in Fukushima nuclear
accident is released in the area 20mSv/year. If they return home they shall have dose in a year equivalent
to exposure dose at 2.4 km from HC, and have dose 100 mSv in 5 years at most. For those exposed within
about 3.5km from atomic bomb HC (dose≒1 mSv), atomic bomb diseases, such as solid cancer, leukemia,
and hyperparathyroidism, are authorized in principle by MHLV (11). Residents who were within 2.5km
1from HC are defined as Hibakusha in the Life Span Study (LSS) of RERF, because they had “significant”
radiation exposure. Radiation standard of 20 mSv/year for evacuee returning home, equivalent to the
exposure dose at 2.4 km from HC, can never be safe.
Fig. 1 Radiation dose from Hiroshima atomic bomb (1) and radiation protection standards

2. The 100 mSv safety hypothesis
We find the following guide in Matters elucidated thus far by RERF studies (2). The risk of dying
from solid cancer increases in direct proportion to radiation dose above around 100 to 200 mSv, but
association remains unclear below that level. We name this “100 mSv safety hypothesis”.
Fig. 2 Cancer risk and radiation dose from RERF studies
The same kind of guide for cancer risk and radiation dose
relation is given by NIRS (National Institute of Radiological
Sciences) and REA (Radiation Effects Association) (3).

3. Increased cancer risk by exposure 100 mSv or less is statistically significant
The 100 mSv safety hypothesis is based on LSS in RERF, and the result of important LSS researches isthat “Increased cancer risk by exposure 100 mSv or less is statistically significant”.
Fig. 3 Excess relative risk (ERR) of all solid cancer deaths in relation to radiation dose
① The first of three examples are the most recent andcomprehensive research is introduced in Ref. (4a).
Studies of the Mortality of Atomic Bomb Survivors, Report 14,
1950–2003 (5). The data are shown left.
The abstract by RERF, that the dose range with a significant
ERR was more than 200 mSv, contradicts with the result of theoriginal paper as follows. The reason for this modification seems
to be in the report of the United Nations Scientific Committee on
the Effects of Atomic Radiation (UNSCEAR) 2010 (6). It is
written in section 25 that statistically significant elevations in risk are observed at doses of 100 to 200 mSv
and above. Correction of the result of LSS study by RERF follows UNSCEAR.
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ABSTRACT by authors
The estimated lowest dose range with asignificant ERR for all solid cancer was 0
to 200 mSv, and a formal dose-thresholdanalysis indicated no threshold; i.e., zerodose was the best estimate of the threshold.

ABSTRACT by RERF
The best estimate of the threshold of alinear dose–response relationship was zero,but the dose range with a significant
ERR was more than 200 mSv.

② Solid cancer incidence in atomic bomb survivors: 1958-1998. D. L. Preston et al. Radiation Res.
Jul;168(1):1-64 (2007) (7). The data were consistent with a linear dose response over the 0-2 Sv range.
There is a statistically significant dose response when analyses were limited to 150 mSv or less.
③ Cancer risks attributable to low doses of ionizing radiation: David J. et al. PNAS: 2003 Nov 100(24)13761–13766. ( 8) Excess relative risk of the mortality from solid cancers in the LSS study is shown in
Fig. 4 Excess relative risk of solid cancer mortality Fig. 4. The first two data points (in blue) are not statisticallysignificant compared with the comparison population
who were exposed to 5 mSv, whereas the remaining four
points of 34-86 mSv (in red) are statistically significant( <0.05).
Results of all the papers ①②③ of epidemiology of theatomic bomb survivors contradict with the 100 mSv safety
hypothesis.

4. Is the radiation exposure of non-Hibakusha in RERF definition truly no significant?
In the LSS of atomic bomb survivors, Hibakusha, who were within 2.5km of either hypocenter at thetime of bombing, is considered to have been under “significant” radiation exposure, and radiation
exposure of survivors who were 2.5-10km (non-Hibakusha) is considered to be “no significant”. The
excess cancer risk is derived by assuming that the excess risk of non-Hibakusha = 0.
Let’s see Fig. 5, the map showing the power of the Hiroshima atomic bomb by MHLW (9). Almost all
people died at distance from HC R≦1 km, all buildings burned down and collapsed in 1 km≦R≦2 km
range, and spontaneous combustion occurred at R≦3 km. Definition of Hibakusha who were exposed atless than 2.5 km, and non-Hibakusha exposed at 2.5 km≦R≦10 km are shown in the figure. People whoare exposed by 100 mSv and Fukushima evacuees who are going back home at ≦20 mSv/year area
correspond to Hibakusha in RERF definition. Non-Hibakusha who were within 3.5 km and have somedisease can be certified promptly as atomic bomb disease (11).
Fig. 5 Map showing the power of theHiroshima atomic bomb
A part of "black rainfall area including
radioactivity” in the north west ofHiroshima city was designated"physical check-up special case area",but the area which isn't designated yet
is left (Fig. 6). The Peace declaration ofHiroshima city demands expansion of the “black rain areas” (10).
3Fig. 6

Black rain areas and authorized black ran area including radioactivity
If the residual radiation and internal exposure
were of considerable amount, non-Hibakusha
might have been exposed significantly. The
excess cancer risk may have been estimated too
low by comparing Hibakusha with
non-Hibakusha exposed considerably by residual
radiation.

5. Radiation dozes and medical expenses of atomic bomb survivors and Fukushima residents
Radiation doze, medical expenses and allowance of atomic bomb survivors are compared with those of
Fukushima residents. In Fukushima, evacuation order is released at space radioactivity below 20 mSv/year.
Health check service and allowance for medical expenses are not provided for the residents except
children. On the other hand, atomic bomb survivors in Hiroshima and Nagasaki can have ”Exposures
Notebook” at around ≦7km from HC with dose ≧ 0.5 mSv, and medical expenses are free (11). For
those exposed within about 3.5km from HC with dose ≧ 1 mSv, certification of atomic bomb diseases isgranted promptly (12).
Table1. Radiation dozes and medical expenses of atomic bomb survivors and Fukushima residents
In the table, radiation dose of atomic
bomb survivors are estimated from Ref.
4b and Appendix 9 of Ref. 12b.
The 100 mSv dose safety hypothesis andthe release of evacuation order in the area
≦20 mSv/y in Fukushima, completely
contradict the reality for the healthdamage of atomic bomb survivors. Whatis the reason for this contradiction? Is theequality under the law protected?
6. Cancer risk for exposure at 10 years old is higher by more than 5 times than that at 50 years old
Excess risks of solid cancer incidence (7) and mortality (5) indicate that higher risks are associated withyounger age at exposure.
Fig. 7 Excess relative cancer mortality risk (ERR)
Table 2 Excess lifetime cancer risk of LSS cohort
by age at exposure and attained age (5)by RERF (13)In Fig. 7, ERR's, 20 years after exposure at 10 and 50 years old are in the ratio 2.7/0.5≒5.4. In Table 2,
excess lifetime cancer risk for exposure at 10 and 50 years old are in the ratio 7 for men and 5.5 for
4women. Is it safe for a family with pregnant woman and children to live in≦20 mSv/year area?
7. Evacuation standards and exposure managements of Chernobyl and Fukushima nuclear accidents
In the precedent chapters, we have discussed if it’s safe to live in the area of radioactivity ≦20mSv/year
by comparing Fukushima with the radiation dose of atomic bomb survivors. Here, evacuation standards ofChernobyl (14) and Fikushima are compared.
Table 3 Evacuation standards: Chernobyl law vs. Fukushima
By Chernobyl law, people do notlive in the area of radioactivity ≧5
mSv/year. They have rights to live or
immigrate in 1-5 mSv/year zones. In
Fukushima, evacuee must go back totheir home town of dose ≦20
mSv/year. Public exposure limit is
kept at 1 mSv/year in Chernobyl, but in Fukushima, it is raised to 20 mSv/year. Ukrainian government
revealed the serious health damage in the 2,360,000 inhabitants in the contaminated area of 1~5 mSv/year(14).
Table 4 Radiation exposure control Ukraine & Belarus versus Japan (15)The difference between Chernobyl and
Fukushima is clear. According to the
Ukraine Law Article 16, Ukrainian
government formed a database of
2,300,000 victims. The database is used tosupport the detailed examination andmedical security of victims. Special
Rapporteur on the right of health byAnand Grover of UN (Ref. 16, 46.47) reported as follows: In Ukraine, the 1991 law ‘On the status andsocial protection of the citizens who suffered as a result of the Chernobyl catastrophe’ limited radiationdose for living and working without limitations to 1 mSv/year. Is the right to health protected in Japan?
What have we learnt from Chernobyl accident?
8. Childhood thyroid cancer in Fukushima and in Chernobyl
A. Childhood thyroid cancer in Fukushima
Fukushima prefecture carries out thyroid gland supersonic examination to watch health of children forlong term (17). The reports of thyroid examination is given for the preceding examinationⅠ(2011.10～
2014.3) in Ref. (18) and for the full scale study Ⅱ(2014.4～2016.3) in Ref. (19).
The results of the thyroid check-up are divided into four categories. ‘A1’ means no nodule or cyst.
‘A2’ means that the size of the nodule present is less than 5.0 mm and/or the cyst is less than 20.0 mm. ‘B’indicates that the nodules and cysts are larger than 5.1 mm and/or 20.1mm respectively. ‘C’ indicates anurgent need for secondary examination. When cancer cells were detected in fine needle aspiration insecondary examination cytology for ‘B’ and ‘C’, the patient was followed and operated on at an
appropriate time (28). We define thyroid cancer cases detected by fine needle aspiration cytology as casesof “thyroid cancer”. Among thyroid cancer suspected 138 children, 105 underwent surgery, 104 were
found cancer, hence the proportion was more than 99% and possible error may be negligible.
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Let’ see the number of children of thyroid cancer in Fukushima reported in thyroid gland examination
published on 2015.8.31. (18, 19)
Fig.8 Number of children of thyroid cancer and the morbidity in each area (20).
Morbidity of childhood thyroid cancer inJapan was stable at 0~3 in 1,000,000
children in 1986~2002, after the
Chernobyl accident (20). The morbidity is
1/1000 in 6 areas in Fukushima, c.a.
300~1000 times of the natural morbidity.
Two big cities Fukushima and Koriyama
outside evacuation zone have 20 and 26
patients of thyroid cancer, respectively,
with the morbidity 1/2000～1/3000.
Thyroid evaluation subcommittee
pointed out that the morbidity of thyroid cancer in Fukushima is high by tens of times of order of theprevalence estimated from statistics. The reason was considered to be "over diagnosis or caused byexposure"(21). However, out of the total 96 surgery cases in Fukushima Medical University Hospital,
Extra thyroid infiltration (pEX1) 39%, Lymph node metastasis 74%, Metastasis to the lung 3% (23). Veryhigh morbidity seems not to come from over diagnosis. Tsuda et al. found that an excess of thyroid cancer
detected by ultrasound among children in Fukushima within 4 years of the release, is unlikely to be
explained by a screening effect. (28).
Outside Fukushima, 3 thyroid cancer patients are found in Kitaibaraki city of Ibaraki, with morbidity
1/1000 (22). Only 21% and 37 % children are healthy ‘A1’ in Matudo city Chiba (24) and in Kantou
region (25), respectively. To see the possibility of thyroid cancer caused by radioactive exposure, twomaps are shown below. (Figs. 9 and 10)
Fig.9 Amount of radioactive iodine I-131 deposition(26) Fig.10 Simulated amount of radioactive iodine
I-131 deposition (27)Highly contaminated area around F1 nuclear plant expands to south over Kantou area. This corresponds to
the results of thyroid check-ups in Kitaibaraki, Matudo, and Kantou area, which are shown by circles.
Areas of high I=131 deposition extend widely from Fukushima prefecture to the surrounding area
(southern Tohoku, Kanto, and eastern Chubu). From the good correspondence of the results of thyroid
check-ups and the extent of radioactive I-131 deposition, thyroid cancer of children is possibly caused byexposure of the nuclear accident, internal exposure of radioactive I-131.
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It is very important to remember the Report of the Special Rapporteur on the right of everyone by Anand
Grover : The fallout from the accident seems to have reached prefectures other than Fukushima, he also
urges the Government to expand the health monitoring to other affected prefectures, where radiation
exposure is higher than additional 1 mSv/year (16).
B. Thyroid cancer morbidity in Fukushima is comparable to the one in Chernobyl
In order to see if the high morbidity of childhood cancer in Fukushima is the result of the screening effect,
as it is often claimed, results of thyroid gland supersonic examination in Fukushima (18,19) and
Chernobyl (29) are compared in Table 5. Morbidity of thyroid cancer per 10,000 children in Fukushima is
4.2 (2011-13) and 3.9 (2014-16). Among 51 children discovered in second check-up 2014-15, 47 werecancer free ( A1 or A2) and ‘B’ were only 4, which shows that their thyroid cancer grew in two years. Thisstrongly suggests that childhood thyroid cancer in Fukushima comes from exposure in the accident.
The period of thyroid gland supersonic examination in Chernobyl was 5-9 years after the accident, whenthyroid cancer increased explosively as shown in Fig. 11. The morbidity/10,000 of childhood cancer 8.1
1-5 years after the accident in Fukushima and the one of 8.3 in in Kitaibaraki (Table 5A), are comparable
to or higher than the morbidity 5-9 years after Chernobyl accident (mean value 5.3). Number of thyroid
cancer patients in Japan may possibly increase explosively.
Table 5. Results of thyroid gland supersonic examinations in Fukushima and Chernobyl
A. The result of the examination 1-5 years after
the Fukushima accident.
B. The result of the examination 5-9 years after
Chernobyl accident by S. Yamashita (29).

Fig.11 Number of thyroid cancer children in
Gomel Belarus (29) and thyroid glandsupersonic examination periods after nuclear
accidents in Chernobyl and Fukushima. The
examination in Chernobyl was 5-9 years after
accident, when thyroid cancer increased
explosively.

9. Radiation diseases by atomic bomb and by Chernobyl & Fukushima nuclear accidents
Diseases due to radiation dose are summarized in Table 6. For atomic bomb survivors, 7 diseases such as
solid cancers, leukemia, hyperparathyroidism, hypothyroidism, etc. are recognized as atomic bomb
diseases (12) 25 years after Chernobyl nuclear accident, Ukrainian government revealed the serious
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health damage, leukemia, cataracts, childhood thyroid cancer, myocardial infarction, to inhabitants in thecontaminated area with exposure dose ≦5 mSv/year (14). However, UNSCEAR recognized only thyroid
cancer of children to be the effect of exposure, and did not admit the other health hazards as the effect of
exposure. Assertion of UNSCEAR is that Ukrainian government’s claim has not been scientifically
proven in epidemiological methods. Thyroid cancer was recognized as the effect of exposure without
epidemiological proof, because the half-life of radioactive iodine I-131 is only 8 days, and effect ofradiation disappears in a month. The morbidity of thyroid cancer of children who were born before theaccident was very high, but no patients were observed among those who were born after the accident.
UNSCEAR denied the relationship between thyroid cancer and radiation exposure for five years after theaccident, but 10 years after the accident, childhood thyroid cancer was recognized as the effect of
exposure by UNSCEAR, ICRP, IAEA, by the decisive fact that no children born after the accident became
thyroid cancer.
Table 6 Radiation diseases by atomic bomb and by Chernobyl & Fukushima nuclear accidents

Fig. 12 Number of thyroid cancer children in Ukraine after Chernobyl accident (14), and the process ofrecognition by UNSCEAR as the effect of radiation dose.
Thyroid cancer was the special case caused by theradioactive iodine I-131, half-life of which is very short, only
8 days. Hence there was another way to prove that thyroid
cancer is the effect of exposure. It is generally difficult toprove that a disease is caused by exposure by epidemiologicalway, because it is almost impossible to know the exposure
dose of each people in Chernobyl and Fukushima. This may
also be true of atomic bomb survivors except initial strong
exposure dose. By imposing impossible epidemiological way,
it becomes quite easy not to recognize a lot of health damages
as the effect of exposure. As a result, international consensus
comes out among UNSCEAR, IAEA, WHO, that only
childhood thyroid cancer is the influence of the radiation
exposure by Chernobyl nuclear accident. Policy of theJapanese government follows this consensus. Famous
pollution diseases, ex. Itai-itai disease, Minamata disease, andMesothelioma could never identified as coming from
Cadmium contamination, Alkyl mercury compoundcontamination in the sea, Asbestos exposure, respectively, if
the proof of statistically significant Morbidity-Cause relation
were imposed as a necessary condition.
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It should be noted from this graph that sum of thyroid cancer children 107 in Ukraine, 5 years after theaccident, became 6072 in following 19 years. We should prepare for more cases expected in the future.

Conclusive remarks
Effect of radiation dose of ex. 100 mSv or 20 mSv/year, should first be determined by recognizing what
occurred among atomic bomb survivors exposed at 1.9 km or 2.4 km from HC, respectively. The radiationdose of 20～100 mSv corresponds to the dose of Hibakusha, and can never be considered to be safe. The
result of the LSS of atomic bomb survivors, the dose of which is estimated by DS86 and DS02 model,
showed that the estimated lowest dose range with a significant ERR for solid cancer was 0 to 200 mSv.
However, a paragraph “but the dose range with a significant ERR was more than 200 mSv” was added by
REEF so as to justify the 100 mSv safety hypothesis.
Is the radiation exposure of non-Hibakusha in RERF definition truly not significant? If the residual
radiation and internal exposure were of considerable amount, statistical dispersion of the linear ERR-dose
relation may have been very high around low dose range 0~100 mSv, which may help to create the 100
mSv safety hypothesis. The excess cancer risk may have been estimated too low by comparing Hibakushawith non-Hibakusha exposed considerably by residual radiation.
Increasing number of childhood thyroid cancer patients in Fukushima is comparable to or higher thanthat in Chernobyl. From the good correspondence of the results of thyroid check-ups in Fukushima andoutside, and the extent of I-131 deposition, childhood thyroid cancer is possibly caused by exposure. We
should expand the health monitoring to other affected prefectures, where fallout from the accident seems
to have reached.
In order for an epidemiological study to be significant in the sense of UNSCEAR, the number of patientsand that of deaths must be extraordinary large as in the case of LSS study of atomic bomb survivors.
Result of the researches is carefully modified so as to justify the 100 mSv safety hypothesis. Statisticaldispersion from linear ERR-dose relation in LSS, which is constituted from the agonies of so many atomic
bomb survivors, is then used to force evacuees in Fukushima accident to go back to highly contaminated≦20 mSv area. This kind of epidemiology is against humanity. We need epidemiological study which
protects people’s right to health.
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