Excerpt

On January 27, 1951, the United States began a program of atmospheric testing of nuclear weapons-related devices in Nevada that continued intermittently until August 5, 1963, when the Limited Test Ban Treaty was signed. For nearly fifty years now, the extent and effects of fallout from those tests have generated much political debate and stimulated numerous scientific investigations. The findings of one extended, Congressionally mandated investigation were reported in October 1997 when the National Cancer Institute (NCI) published the two-volume report Estimated Exposures and Thyroid Doses Received by the American People from Iodine-131 in Fallout Following Nevada Atmospheric Nuclear Bomb Tests.

As the NCI was preparing to release its report, the Secretary of the Department of Health and Human Services (DHHS) asked the Institute of Medicine (IOM) and the National Research Council (NRC) to initiate an independent assessment of the public health and medical implications of the iodine-131 (sometimes referred to here as I-131) doses received by the American people and to identify steps that might be taken in response. After consultation, the IOM and the NRC agreed to establish an expert panel to undertake this assessment beginning in October 1997.

This report presents the results of that study.

Contents

• INSTITUTE OF MEDICINE COMMITTEE ON THYROID CANCER SCREENING
• COMMITTEE ON EXPOSURE OF THE AMERICAN PEOPLE TO I-131 FROM NEVADA ATOMIC BOMB TESTS
• BOARD ON RADIATION EFFECTS RESEARCH
• INSTITUTE OF MEDICINE BOARD ON HEALTH CARE SERVICES
• COMMISSION ON LIFE SCIENCES
• Preface
• Acknowledgments
• Executive Summary
  • HISTORICAL CONTEXT
  • ASSESSMENT OF THE NCI DOSE RECONSTRUCTION
  • ASSESSMENT OF THE NCI ESTIMATES OF CANCER RISK
  • IMPLICATIONS FOR CLINICAL PRACTICE AND PUBLIC HEALTH
  • COMMUNICATING ABOUT IODINE-131 EXPOSURE AND CANCER RISK
  • FURTHER RESEARCH
• 1. Introduction
  • BACKGROUND AND CONTEXT
  • HISTORICAL OVERVIEW
  • ORIGINS OF STUDY
  • OVERVIEW OF TECHNICAL APPROACH AND REPORT CONTENTS
  • CONCLUSIONS
• 2. Review of the NCI Radiation Dose Reconstruction
  • BASIC ASSESSMENT
  • DOSES AND RISKS FROM OTHER RADIONUCLIDES
  • PATHWAYS TO EXPOSURE OF HUMANS
  • SOURCES OF INDIVIDUAL VARIABILITY IN I-131 DOSE
  • ESTIMATING THE RELEASE AND DEPOSITION OF I-131
  • FROM I-131 DEPOSITION ON THE GROUND TO COWS' MILK
  • FROM FRESH MILK TO HUMAN INTAKE
  • FROM INTAKE TO THYROID DOSE
  • VALIDATION AND UNCERTAINTY IN COLLECTIVE OR AVERAGE DOSE ESTIMATES
  • CONCLUSIONS
• 3. Health Risks of I-131 Exposure
  • THYROID GLAND BIOLOGY
  • RADIATION AND THYROID CANCER
  • NONMALIGNANT THYROID DISEASE ASSOCIATED WITH RADIOIODINE EXPOSURE
  • THYROID CANCER RISK BASED ON NCI ESTIMATES OF I-131 DOSES
  • CONCLUSIONS
  • ADDENDUM 3 UNDERSTANDING RADIATION RISK FACTORS AND INDIVIDUAL RISK
• 4. Implications for Clinical Practice and Public Health Policy
  • PRINCIPLES FOR SCREENING RECOMMENDATIONS
  • BURDEN OF ILLNESS
  • THYROID CANCER SCREENING AND DIAGNOSTIC OPTIONS
  • ACCURACY OF SCREENING AND FOLLOW-UP TESTS
  • BENEFITS AND HARMS OF SCREENING FOR THYROID CANCER
  • INFORMATION AND DECISIONMAKING
  • RECOMMENDATIONS OF OTHERS
  • COMMITTEE FINDINGS AND RECOMMENDATIONS
  • CONCLUSIONS
  • ADDENDUM 4A: INTERPRETING SENSITIVITY AND SPECIFICITY
  • ADDENDUM 4B: INTERPRETATION OF INDETERMINATE AND UNSATISFACTORY FNA SAMPLES
• 5. Communicating with the Public about Exposure to Iodine-131
  • CHARACTERISTICS OF RISK COMMUNICATION
  • CAN RISK BE COMMUNICATED EFFECTIVELY?
  • SOME IMPORTANT COMMUNICATION ISSUES
  • PUBLIC INVOLVEMENT IN EXPLAINING RISK
  • CONCLUSIONS
  • ADDENDUM 5: EXAMPLE OF A METHOD TO ASSIST INDIVIDUALS IN ESTIMATING THEIR PERSONAL THYROID CANCER RISK
• 6. Research Needs
  • EPIDEMIOLOGY
  • BIOLOGY OF RADIATION-INDUCED THYROID CANCER
  • CLINICAL PRACTICE
  • RISK COMMUNICATION
• References
• Glossary
• APPENDIXES
  • Appendix A Study Activities
  • Appendix B Copy of the Memorandum from Dr. Charles Land to Dr. Richard Klausner
  • Appendix C Calculation of Collective Thyroid Dose to the U.S. Population from the Release of ¹³¹I from the Nuclear Weapons Tests in Nevada
  • Appendix D Thyroid Cancer in Idaho 1970-1996
  • Appendix E Applicable Radiation Exposure Standards and Guides: Past and Present
  • Appendix F Screening for Thyroid Cancer: Background Paper
• Committee Biographies

Support for this project was provided by the U.S. Department of Health and Human Services (Contract Number N01-OD-4-2139, TO 35).

The views presented are those of the National Research Council and Institute of Medicine committees and are not necessarily those of the funding organization.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.