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Fukushima: 1-year on
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Little more than a year has passed since three reactors at the Fukushima Daiichi Nuclear Power Plant complex went into meltdown. Today, all but two of Japan’s 54 nuclear reactors stand shut. Germany has announced it is to give up nuclear energy. During his Asian tour this week, David Cameron offered Japan help with decommissioning and clean-up. On April 2, 2012, Emergency Radiation Preparedness experts from all over the world convened in Geneva to define the European response to a major nuclear incident. Last month, experts with the International Agency for Atomic Energy met to revise safety recommendations in light of Fukushima. The meeting’s chairman, Richard Meserve, noted that “the Three Mile Island and Chernobyl accidents brought about an overall strengthening of the safety system, it is already apparent that the
Fukushima accident will have a similar effect”. In Japan itself, Human Rights Watch noted, “many residents of Fukushima Prefecture still lack basic information and clear answers about the level of radiation in their food and environment”. “People are very concerned about contaminated water; there’s been some testing in Fukushima prefecture but not in any consistent and transparent way”, explained Human Rights Watch’s Jane Cohen. The prefecture government plans to offer thyroid gland tests for all residents younger than 18 years of age, but Human Rights Watch contends that there are few details on how this system will work. Residents complained of not being able to secure radiation testing for their children. “Testing needs to be ramped up and the government has to ensure that information is getting
to the public in an accurate and accessible way”, Cohen concluded. In fact, according to Kathryn Higley (Oregon State University, Corvallis, OR, USA), people may well be reassured by this information. “There is no doubt they have released a lot of radioactive material into the environment”, she said. “But what determines its impact is the dosage people receive and how quickly they receive it.” 160 000 people were rapidly evacuated after the reactors were breached. Preliminary results—the UN will publish a comprehensive report next year—point to dosage levels that are too low to suggest a future spike in radioactivity-induced cancer. “Even in the cases of the most exposed workers, we’re looking at increases in cancer risks only in the order of a few percentage points”, Higley told The Lancet Oncology.
Talha Khan Burki
Norimitsu Masuda/AP/Press Association Images
Fukushima: 1-year on
Published Online April 13, 2012 DOI:10.1016/S14702045(12)70161-4 See Editorial Lancet Oncol 2011; 12: 409 See Comment Lancet Oncol 2011; 12: 416–418 For more on the Emergency Radiation Preparedness meeting see http://www.ebmt. org/Contents/Resources/ Mediacorner/Pressreleases/ Documents/Press%20Release_ EBMT%20Nuclear%20 Accident%20Committee.pdf
Expensive US cancer care: value for money? US cancer care is markedly more expensive than European care, but yields longer patient survival times, US researchers report. Between 1983 and 1999, spending on US cancer care per patient increased by 49%, to US$70 000, while costs in ten European countries climbed by 16%, to $44 000, reports a team led by Tomas Philipson (University of Chicago, Chicago, IL, USA). Cancer patients diagnosed between 1995 and 1999 survived an average of 11·1 years in the USA, compared with 9·3 years in Europe. Those additional months of life represent US$598 billion for the US economy, Philipson’s team estimates. “The value of survival gains greatly outweighed costs”, they conclude. Faster US adoption of new drugs and technology might explain both higher US costs and survival rates, Philipson suspects. But critics question the use www.thelancet.com/oncology Vol 13 May 2012
of survival rates rather than mortality rates in the comparison, and suggest the analysis exaggerates US oncology’s value-for-money. “We screen like crazy in the US”, notes Otis Brawley (American Cancer Society, Atlanta, GA, USA). “We find things in people who do not need to be cured or treated.” Analyses that include patients with subclinical tumours can exaggerate the clinical benefits of treatment costs, Brawley and Louise Davies (Dartmouth University, Hanover, NH, USA) both tell The Lancet Oncology. “Survival statistics are based on when cancer is detected”, says Davies. “So if it’s detected early, it looks like you survived longer.” Much of the cost of US cancer care is “wasteful”, driven by unnecessary testing and unproven medical procedures, Brawley cautions.
Cancer mortality rates in Europe are comparable to those in the US, Brawley says. But mortality rates for prostate and breast cancers have declined more rapidly in the US than in other countries, notes Samuel Preston (University of Pennsylvania, Philadelphia, PA, USA). Mortality rates can be affected by prevention efforts, like tobacco control, in ways survival is not, adds Philipson. His team’s sensitivity analysis shows that conversion of declines in mortality rate to life expectancy estimates, suggests US prostate cancer patients survive 1·8 years longer than European patients, on average, and breast cancer patients survive 0·8 years longer, he notes. Treatment advances, not earlier detection, explain US survival rates, Philipson believes.
Published Online April 13, 2012 DOI:10.1016/S14702045(12)70162-6 For the 2011 National Academies of Sciences analysis of international differences in mortality at older ages see www.nap.edu/catalog/ php?record_id=12945 For more on the US reimbursement system, fraud, and overutilisation see News Lancet Oncol 2009; 10: 937–38 For the analysis of cancer care spending and survival in the US and Europe see Health Affairs 2012; 31: 667–75
Bryant Furlow e193
Little more than a year has passed since three reactors at the Fukushima Daiichi Nuclear Power Plant complex went into meltdown. Today, all but two of Japan’s 54 nuclear reactors stand shut. Germany has announced it is to give up nuclear energy. During his Asian tour this week, David Cameron offered Japan help with decommissioning and clean-up. On April 2, 2012, Emergency Radiation Preparedness experts from all over the world convened in Geneva to define the European response to a major nuclear incident. Last month, experts with the International Agency for Atomic Energy met to revise safety recommendations in light of Fukushima. The meeting’s chairman, Richard Meserve, noted that “the Three Mile Island and Chernobyl accidents brought about an overall strengthening of the safety system, it is already apparent that the
Fukushima accident will have a similar effect”. In Japan itself, Human Rights Watch noted, “many residents of Fukushima Prefecture still lack basic information and clear answers about the level of radiation in their food and environment”. “People are very concerned about contaminated water; there’s been some testing in Fukushima prefecture but not in any consistent and transparent way”, explained Human Rights Watch’s Jane Cohen. The prefecture government plans to offer thyroid gland tests for all residents younger than 18 years of age, but Human Rights Watch contends that there are few details on how this system will work. Residents complained of not being able to secure radiation testing for their children. “Testing needs to be ramped up and the government has to ensure that information is getting
to the public in an accurate and accessible way”, Cohen concluded. In fact, according to Kathryn Higley (Oregon State University, Corvallis, OR, USA), people may well be reassured by this information. “There is no doubt they have released a lot of radioactive material into the environment”, she said. “But what determines its impact is the dosage people receive and how quickly they receive it.” 160 000 people were rapidly evacuated after the reactors were breached. Preliminary results—the UN will publish a comprehensive report next year—point to dosage levels that are too low to suggest a future spike in radioactivity-induced cancer. “Even in the cases of the most exposed workers, we’re looking at increases in cancer risks only in the order of a few percentage points”, Higley told The Lancet Oncology.
Talha Khan Burki
Norimitsu Masuda/AP/Press Association Images
Fukushima: 1-year on
Published Online April 13, 2012 DOI:10.1016/S14702045(12)70161-4 See Editorial Lancet Oncol 2011; 12: 409 See Comment Lancet Oncol 2011; 12: 416–418 For more on the Emergency Radiation Preparedness meeting see http://www.ebmt. org/Contents/Resources/ Mediacorner/Pressreleases/ Documents/Press%20Release_ EBMT%20Nuclear%20 Accident%20Committee.pdf
Expensive US cancer care: value for money? US cancer care is markedly more expensive than European care, but yields longer patient survival times, US researchers report. Between 1983 and 1999, spending on US cancer care per patient increased by 49%, to US$70 000, while costs in ten European countries climbed by 16%, to $44 000, reports a team led by Tomas Philipson (University of Chicago, Chicago, IL, USA). Cancer patients diagnosed between 1995 and 1999 survived an average of 11·1 years in the USA, compared with 9·3 years in Europe. Those additional months of life represent US$598 billion for the US economy, Philipson’s team estimates. “The value of survival gains greatly outweighed costs”, they conclude. Faster US adoption of new drugs and technology might explain both higher US costs and survival rates, Philipson suspects. But critics question the use www.thelancet.com/oncology Vol 13 May 2012
of survival rates rather than mortality rates in the comparison, and suggest the analysis exaggerates US oncology’s value-for-money. “We screen like crazy in the US”, notes Otis Brawley (American Cancer Society, Atlanta, GA, USA). “We find things in people who do not need to be cured or treated.” Analyses that include patients with subclinical tumours can exaggerate the clinical benefits of treatment costs, Brawley and Louise Davies (Dartmouth University, Hanover, NH, USA) both tell The Lancet Oncology. “Survival statistics are based on when cancer is detected”, says Davies. “So if it’s detected early, it looks like you survived longer.” Much of the cost of US cancer care is “wasteful”, driven by unnecessary testing and unproven medical procedures, Brawley cautions.
Cancer mortality rates in Europe are comparable to those in the US, Brawley says. But mortality rates for prostate and breast cancers have declined more rapidly in the US than in other countries, notes Samuel Preston (University of Pennsylvania, Philadelphia, PA, USA). Mortality rates can be affected by prevention efforts, like tobacco control, in ways survival is not, adds Philipson. His team’s sensitivity analysis shows that conversion of declines in mortality rate to life expectancy estimates, suggests US prostate cancer patients survive 1·8 years longer than European patients, on average, and breast cancer patients survive 0·8 years longer, he notes. Treatment advances, not earlier detection, explain US survival rates, Philipson believes.
Published Online April 13, 2012 DOI:10.1016/S14702045(12)70162-6 For the 2011 National Academies of Sciences analysis of international differences in mortality at older ages see www.nap.edu/catalog/ php?record_id=12945 For more on the US reimbursement system, fraud, and overutilisation see News Lancet Oncol 2009; 10: 937–38 For the analysis of cancer care spending and survival in the US and Europe see Health Affairs 2012; 31: 667–75
Bryant Furlow e193