of Japan where there is, in general, no such large-scale screening,”. Wakeford's criticism was one of seven other author's letters that were published criticizing Tsuda's paper. According to Takamura, another epidemiologist, who examined the results of small scale advanced ultrasound tests on Japanese children not near Fukushima, "The prevalence of thyroid cancer [using the same detection technology] does not differ meaningfully from that in Fukushima Prefecture". In 2016 Ohira et al. conducted a study cross-comparing thyroid cancer patients from Fukushima prefecture evacuees with rates of Thyroid cancer in from those outside of the evacuation zone. Ohira et al. found that "The duration between accident and thyroid examination was not associated with thyroid cancer prevalence. There were no significant associations between individual external doses and prevalence of thyroid cancer. External radiation dose was not associated with thyroid cancer prevalence among Fukushima children within the first 4 years after the nuclear accident." A 2018 publication by Yamashita et al. also concluded that Thyroid cancer rate differences can be attributed to the screening effect. They noted that the mean age of the patients at the time of the accident was 10–15 years, while no cases were found in children from the ages of 0–5 who would have been most susceptible. Yamashita et al. thus conclude that "In any case, the individual prognosis cannot be accurately determined at the time of FNAC at present. It is therefore urgent to search not only for intraoperative and postoperative prognostic factors but also for predictive prognostic factors at the FNAC/preoperative stage." A 2019 investigation by Yamamoto et al. evaluated the first and the second screening rounds separately as well as combined covering 184 confirmed cancer cases in 1.080 million observed person years subject to additional radiation exposure due to the nuclear accidents. The authors concluded "A significant association between the external effective dose-rate and the thyroid cancer detection rate exists: detection rate ratio (DRR) per μSv/h 1.065 (1.013, 1.119). Restricting the analysis to the 53 municipalities that received less than 2 μSv/h, and which represent 176 of the total 184 cancer cases, the association appears to be considerably stronger: DRR per μSv/h 1.555 (1.096, 2.206). The average radiation dose-rates in the 59 municipalities of the Fukushima prefecture in June 2011 and the corresponding thyroid cancer detection rates in the period October 2011 to March 2016 show statistically significant relationships. This corroborates previous studies providing evidence for a