Health Risks of Ionizing Radiation: - Clark University

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elationship was not significant for the whole cohort but it was significant for the subjects younger than 30 at exposure using internal controls; the ERR for this group was 8.65 (0.81-11.47) 8 . In all cases (male or female, internal or external controls) the ERR estimate declined with age. The results of this study are suggestive of some effect but they are not clear and they contrast with the conventionally held view that radiation exposure in adulthood is unlikely to lead to cancer. The rate of thyroid cancer has clearly increased, and it may also be the case that these radiationinduced cancers are different than background thyroid cancers. Ukrainian surgeon S. J. Rybakov and colleagues (2000) operated on over 339 children between 1981 and 1998, 330 of these after the Chernobyl accident. They report that cancers in children who had been exposed to high levels of radiation were more extensive, more highly invasive, and more likely to be accompanied by nodal metastases. Similar findings had been reported by Pacini et al. in 1997. They found that post-Chernobyl thyroid cancers in Belarus were more likely to affect younger subjects, were less influenced by gender, were more aggressive, and were more frequently associated with autoimmunity when compared to naturally occurring cancers in Italy and France. Several studies have investigated thyroid cancer rates outside of the immediate vicinity of Chernobyl. Cotterill et al. (2001) studied northern England and found that there was an increase in incidence immediately following the Chernobyl accident. The excess in Cumbria, the region receiving the heaviest fallout in England, was particularly high (rate ratio of 12.2, 1.5-101, comparing 1968-1986 to 1987-1997), but this was based on 1 case before the accident and 6 cases after the accident 9 . A study of Turkish children did not find any cancers in exposed or unexposed regions (Emral et al. 2003). A French risk assessment dealt with children in eastern France where thyroid doses ranged from 1-10 mSv; these are ~100 times lower than doses in exposed areas of Belarus and are comparable to average background radiation doses (Verger et al. Nuclear Power Accidents 135 2003). This was not an epidemiological study but it did present dose estimates and is worth considering as a reference point. These authors concluded that a small excess of thyroid cancer, 1-20 cases, may have been caused by the Chernobyl accident. Tukiendorf et al. (2003) compared thyroid cancer incidence in Opole province, Poland (1994-1998) to levels of cesium isotopes on the ground. Deposited cesium in fallout decays slowly and can therefore be used as a rough guide to the pattern of iodine deposition that occurred immediately after the accident. Thyroid cancer proportional mortality rates (thyroid cancer mortality as a fraction of total cancer mortality) were correlated with cesium deposition for females (94 cases) but not for males (27 cases) 10 . Increased levels of radiation were detected as far away as Connecticut, where one researcher noted that childhood and adult thyroid cancer incidence had increased 4-7 years after the accident (Mangano et al. 1996). 11.2.4 Childhood leukemia Leukemia rates following Chernobyl appear to have increased, and like thyroid cancer this effect is seen in children. Exposure at young ages, including prenatal exposure, has been investigated to determine the influence of age at exposure and dose. Petridou et al. (1996) compared leukemia rates in Greek children who were born in 1986-1987 (in utero at the time of the accident) to rates in children born 1980-1985 and 1988-1990. Leukemia in the first year of life was more than twice as likely in the exposed (in utero) group (rate ratio 2.6, 1.4- 5.1) 11 . Infant leukemia rates for the in utero cohort were also shown to increase with surface soil measurements of fallout radioactivity. Michaelis et al. (1997) used the same time windows to study in utero exposure in Germany and found a rate ratio of 1.48 (1.02-2.15) but did not find a correlation with ground deposition of Cs-137. A study of childhood leukemia across Europe (the European Childhood Leukemia-Lymphoma Incidence Study, ECLIS) found that childhood leukemia risk was related to 8 Using external controls (Russian rates) the ERR estimate for this group was 0.74 (-2.69-4.21). 9 The rate ratio was 12.2 (1.5-101) comparing 1968-1986 to 1987-1997. 10 It was unclear what the ages of exposure or diagnosis were in this study. 11 Leuekemia rates were also observed for ages 1-4 but no effect was seen (Petridou et al. 1996).
136 Nuclear Power Accidents average fallout dose for each country (Hoffmann 2002) and was roughly compatible with the in utero exposure results from Greece and Germany. In all of these cases the doses received by the developing fetuses were low (less than 1 mSv; Michaelis et al. 1997, Hoffmann et al 2002). Noshchenko et al. have published two papers that describe a link between Chernobyl and leukemia in the Ukraine. The first paper (2001) found an increase in all leukemias, and in lymphocytic leukemias specifically, when comparing the Zhitomir (exposed) and the Poltava (unexposed) regions of the Ukraine. The exposed and unexposed groups in this study were comprised exclusively of the 1986 birth cohort in order to focus on effects of exposure in utero. The second paper by Noshchenko et al. (2002) reports on a case-control study based in Zhitomir and Rivno regions. 272 cases of leukemia were identified in people that had been age 0-20 at the time of the accident (72 more cases than predicted based on pre-accident leukemia rates). Bone marrow doses were estimated for these cases and for controls matched by age, gender, and type of settlement. Increased risks of leukemia generally, and acute, acute lymphocytic, and acute myeloid leukemias specifically, were observed for males and for both genders combined. The authors found their risk estimates to be similar to the estimates of Stevens et al (1990) with residents downwind of the Nevada Test Site 12 . There was also a distinct age effect in this study with the earlier ages at exposure showing a higher risk. 11.2.5 Non-cancer effects in children When Schwenn and Brill wrote their review in 1997, it appeared that the increase in thyroid cancer was the only significant health effect of the accident. Since that time, a few new findings have suggested that other health effects have developed. One effect is thyroid autoimmune disease, a condition where the immune system attacks the thyroid. An associated condition is an underactive thyroid (hypothyroidism). Pacini et al (1998) looked at 287 children from the village of Hoiniki who were up to 10 years old when they were exposed to radiation from the Chernobyl accident (13 children were in utero at the time of the accident). When compared to a control group from a less-exposed province a significant elevation of circulating thyroid antibodies was found. This is thought to indicate a higher probability of disease development, although at the time of the study disease rates were similar. A study of 53 Ukrainian children found elevated levels of thyroid-stimulating hormone (TSH), a sign that the pituitary gland is stimulating the thyroid in response to underactivity (Vykhovanets et al. 1997). Elevated TSH was also found in girls from Belarus, Russia and Ukraine who had moved to Israel (Quastel et al. 1997). Goldsmith et al. (1999) studied 160,000 children from Belarus, Russia and Ukraine who were exposed to Chernobyl fallout before age 10. These authors defined hypothyroidism by elevated TSH and reduced thyroid hormone (thyroxin) and compared hypothyroid incidence to individual body burdens of cesium-137 (Cs-137), a rough proxy for thyroid I-131 dose. They found that hypothyroidism (148 cases) was correlated with Cs-137 although the correlation was only significant for boys. Radiation can cause mutations in sperm or egg cells, also called germ cells, and these mutations can be passed on to children as ‘germline mutations’. Exposure of parents prior to the conception of a child can therefore lead to effects in the children. This is discussed briefly above in relation to Chernobyl cleanup workers and in our chapter on preconceptional exposure (appendix C). Studies of families living downwind of Chernobyl have demonstrated that germline mutations did occur as a result of the accident although it is not clear what the health implications of these mutations might be. Dubrova et al. (1996) collected blood samples from 79 families in Belarus and 105 families in the U.K. (controls) and looked for genetic mutations in children born in 1994. If the particular mutation was not present in either parent then it was assumed to have been a germline mutation. In this study the rate of germline mutation in Belarus was twice as high as in the U.K. Furthermore, the rate of mutation in parts of Belarus with high cesium deposition was 1.5 12 Noshchenko et al found an odds ratio for acute lymphocytic leukemia of 3.1 (1.5-6.4) when comparing bone marrow doses >10 mSv to doses
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Health Risks of Ionizing Radiation:
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Contents List of Tables ...........
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Contents iii Rocky Flats ..........
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Contents v APPENDIX A .............
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List of Figures Figure 1-1 Average
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We are indeed grateful to those who
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2 Introduction 1.2 A brief history
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4 Introduction Figure 1-2. The evol
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6 Introduction Figure 1-5(a). Alpha
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8 Introduction In epidemiological s
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10 Introduction precision to detect
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12 Introduction available informati
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14 Background Radiation Figure 2-1.
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16 Background Radiation Figure 2-3.
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18 Background Radiation
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20 Medical Exposures Fi
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22 Medical Exposures
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24 Medical Exposures with national
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26 Medical Exposures localized expo
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28 Medical Exposures (2.1-28.7). Th
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30 Medical Exposures posed 2.69 tim
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32 Medical Exposures with diagnosti
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34 Medical Exposures Table 3-1. Stu
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44 Atomic Bomb Survivors Figure 4-2
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46 Atomic Bomb Survivors
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48 Atomic Bomb Survivors approximat
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50 Atomic Bomb Survivors (ALL), acu
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52 Atomic Bomb Survivors of the 8 t
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5 Nuclear Weapons Testing Over 500
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60 Nuclear Weapons Testing by disti
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62 Nuclear Weapons Testing Figure 5
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64 Nuclear Weapons Testing near the
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66 Nuclear Weapons Testing
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68 Nuclear Weapons Testing
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6 RADIATION WORKERS Introduction Th
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72 Radiation Workers • 50 rem (0.
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74 Radiation Workers work, reports
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76 Radiation Workers Figure 6-5. A
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78 Radiation Workers Figure 6-8. To
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80 Radiation Workers Figure 6-10. A
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82 Radiation Workers Feed Material
Page 95 and 96: 84 Radiation Workers by Beral et al
Page 97 and 98: 86 Radiation Workers Figure 6-14. A
Page 99 and 100: 88 Radiation Workers Table 6-1. Leu
Page 101 and 102: 90 Radiation Workers No
Page 103 and 104: 92 Radiation Workers N
Page 105 and 106: 94 Radiation Workers S
Page 107 and 108: 96 Radiation Workers ERR estim
Page 109 and 110: 98 Mayak Workers Table 1. Dose (Gy)
Page 111 and 112: 100 Mayak Workers workers at the ra
Page 113 and 114: 102 Mayak Workers
Page 115 and 116: 104 Uranium Miners enrichment facil
Page 117 and 118: 106 Uranium Miners Samet et al. (19
Page 119: 108 Uranium Miners were selected 12
Page 122 and 123: Uranium Miners 111
Page 124 and 125: 9 RADIATION EXPOSURE IN FLIGHT The
Page 126 and 127: DNA damage (a chemical change in DN
Page 128 and 129: 10 PRECONCEPTION EXPOSURES Several
Page 130 and 131: of risk in the lowest dose groups,
Page 132 and 133: found elevated solid cancer risk wi
Page 134 and 135: preconception doses between 2.5 and
Page 136 and 137: Table 10-1. Preconception irradiati
Page 138 and 139: Preconception Exposures 127
Page 140 and 141: Tracheoesophageal fistula and conge
Page 142 and 143: cancer were both associated with th
Page 144 and 145: 0.10-4.71) while respiratory system
Page 148 and 149: times higher than in less-contamina
Page 150 and 151: Nuclear Power Accidents 139
Page 156 and 157: 12 COMMUNITIES NEAR NUCLEAR FACILIT
Page 158 and 159: levels (this could not in itself be
Page 160 and 161: Figure 12-3. Native Americans from
Page 162 and 163: of leukemia was measured over a lar
Page 164 and 165: (RR 1.06; 1.00-1.11) and risks of s
Page 166 and 167: more that we can say about this app
Page 168 and 169: Communities Near Nuclear Facilities
Page 176 and 177: 54 observed vs. 46.1 expected death
Page 178 and 179: 13 DISCUSSION Our intention in crea
Page 180 and 181: myeloid leukemia) was significantly
Page 182 and 183: 0.1-3.5 WLM; this is roughly equiva
Page 184 and 185: adon (Lubin et al. 1997). These res
Page 186 and 187: Leukemia Leukemia, a general term t
Page 188 and 189: vical cancer. The doses to these pa
Page 190 and 191: England have found it convenient to
Page 192 and 193: Thyroid disease Thyroid cancer is a
Page 194 and 195: 1986 through 1995. These workers sh
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dence of this disease includes elev
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Analysis of preconception exposure
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Paternal age, education, drinking O
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Gardner et al. 1990 Employed at Sel
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we consider this group of a few hun
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Leukemia risk (excluding CLL) among
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Glossary of Terms for Epidemiology
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Glossary 199 Beta radiation: Stream
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Dosimetry: Measurement or estimatio
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Glossary 203 Hypothyroidism: The cl
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Glossary 205 Metastasis: 1. Movemen
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Glossary 207 waves, ultra violet (U
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Glossary 209 Thyroid Disease: disea
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Bibliography ATSDR. Public Health A
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Bhatia S, Sklar C. Second cancers i
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Bibliography 215 Cavallo D, Tomao P
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Bibliography 217 Department of Ener
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Bibliography 219 Gardner MJ, Hall A
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Haldorsen T, Reitan JB, Tveten U. C
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Bibliography 223 Howe GR, Nair R, N
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of Mayak, A comparison of numerical
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Bibliography 227 Laird NM. Thyroid
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control population. International J
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Bibliography 231 Neel JV, Schull WJ
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2003.160:381-407. Bibliography 233
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Bibliography 235 Saccomanno G, Auer
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Bibliography 237 analysis of cancer
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Bibliography 239 Tokarskaya ZB, Sco
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Journal of Epidemiology 1987.125(2)
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Actinium, 84 Acute lymphocytic leuk
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and Nevada Test Site, 60-61, 62 nuc
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Hashimoto’s thyroiditis, 185 Heal
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studies, 101-2 Medical exposure, 19
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(RERF), 43 Radiation Exposure Compe
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Viruses, 118, 154, 193 West Germany
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