成人甲状腺乳头状癌可能源于儿童期——福岛儿童甲状腺癌筛查的启示

Papillary thyroid microcarcinoma in adults may initiate from childhood

福岛核泄漏发生后1-3年，当地298 577名18岁以下人口接受甲状腺癌筛查。细针穿刺细胞学检查证实甲状腺癌110例（直径〉5 mm），并有87例接受甲状腺手术治疗，甲状腺癌患病率为36.8/10万。其中16-18岁甲状腺癌的患病率高达120/10万，而同年龄组在日本甲状腺癌登记库的发病率是0.8/10万。2016年第五届辐射与健康国际专家研讨会在日本福岛召开。会议认为福岛的高甲状腺癌检出率与核辐射无关，而是规范筛查的结果。福岛的筛查结果再次证明隐匿型甲状腺癌在儿童的高存在率。剑桥大学Williams据此提出了甲状腺癌发生发展的三阶段学说，即初始突变期、限制性生长期和无限制生长期。大多数成人的甲状腺癌可能是发生在儿童期。成人的甲状腺微小癌是儿童期甲状腺癌停止在限制性生长期的结果。这个学说有待于儿童甲状腺癌长期随访的证实。

A total of 298 577 children aged〈 18 years old in Fukuaka in Japan were screened for thyroid cancer after less than 3 years after nuclear accident. 110 children were diagnosed as thyroid cancer by fine needle aspiration cytology （FNAC） and 87 eases received thyroid operation. The prevalence of thyroid cancer was 36.8/100 000 in population of〈18 year old and 120/100 000 at age of 16-18 years old. The 5th international expert symposium in Fukushima on radiation and health concluded that the high prevalence of thyroid cancer was not related with nuclear accident but to the screening. According to the findings, Willimas propsed a hypothesis ： thyroid cancer in adults might originate from childhood. They had three stages for initiation and development of thyroid cancer： initial mutation stage, constraint growth stage, and non-constraint growth stage. The growth of thyroid cancer were stopped in the constraint stage, which was thyroid microcarcinoma.