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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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SPACE RADIATION
and Astronaut Health

Managing and Communicating Cancer Risks

Committee on Assessment of Strategies for Managing Cancer Risks
Associated with Radiation Exposure During Crewed Space Missions

Board on Health Sciences Policy

Board on Health Care Services

Health and Medicine Division

Nuclear and Radiation Studies Board

Division on Earth and Life Studies

A Consensus Study Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and the National Aeronautics and Space Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-47966-0
International Standard Book Number-10: 0-309-47966-5
Digital Object Identifier: https://doi.org/10.17226/26155

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

Copyright 2021 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2021. Space radiation and astronaut health: Managing and communicating cancer risks. Washington, DC: The National Academies Press. https://doi.org/10.17226/26155.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×

Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×

COMMITTEE ON ASSESMENT OF STRATEGIES FOR MANAGING CANCER RISKS ASSOCIATED WITH RADIATION EXPOSURE DURING CREWED SPACE MISSIONS

HEDVIG “HEDI” HRICAK (Chair), Chairman, Department of Radiology, Memorial Sloan Kettering Cancer Center

R. JULIAN PRESTON (Vice Chair), Special Government Employee (Expert), Radiation Protection Division, U.S. Environmental Protection Agency

AMY BERRINGTON DE GONZÁLEZ, Branch Chief and Senior Investigator, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health

ANN BOSTROM, Weyerhaeuser Endowed Professor in Environmental Policy, Daniel J. Evans School of Public Policy and Governance, University of Washington, Seattle

CASEY CANFIELD, Assistant Professor of Engineering Management and Systems Engineering, Missouri University of Science and Technology

HARRY M. CULLINGS, Consultant, Radiation Effects Research Foundation

LAWRENCE T. DAUER, Attending Physicist, Memorial Sloan Kettering Cancer Center

BERNARD A. HARRIS, JR., Chief Executive Officer, Vesalius Ventures

ALEJANDRA HURTADO DE MENDOZA, Assistant Professor, Georgetown University

JEFFREY KAHN, Andreas C. Dracopoulos Director, Johns Hopkins Berman Institute of Bioethics

GUILLERMINA LOZANO, Hubert L. Olive Stringer Distinguished Chair in Oncology, Professor and Chair, Department of Genetics, The University of Texas MD Anderson Cancer Center

GIOVANNI PARMIGIANI, Associate Director for Population Sciences, Dana Farber/Harvard Cancer Center; Professor, Department of Data Sciences, Dana-Farber Cancer Institute, and Department of Biostatistics, Harvard T.H. Chan School of Public Health

ROBERT L. SATCHER, Associate Professor, Orthopaedic Oncology, The University of Texas MD Anderson Cancer Center

CAROL SCOTT-CONNER, Professor Emeritus of Surgery, University of Iowa Carver College of Medicine

IGOR SHURYAK, Assistant Professor of Radiation Oncology, Center for Radiological Research

GREGORY R. WAGNER, Adjunct Professor of Environmental Health, Harvard T.H. Chan School of Public Health

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×

GAYLE E. WOLOSCHAK, Professor, Department of Radiation Oncology, Feinberg School of Medicine, Lurie Comprehensive Cancer Center, Northwestern University

LYDIA B. ZABLOTSKA, Professor of Epidemiology, Salvatore Pablo Lucia Chair in Preventive Medicine, University of California, San Francisco

Study Staff

REBECCA ENGLISH, Study Director

OURANIA KOSTI, Senior Program Officer

LEAH CAIRNS, Program Officer

CLAIRE GIAMMARIA, Associate Program Officer (until May 2021)

RUTH COOPER, Research Associate (from January 2021)

CYNDI TRANG, Research Associate (until January 2021)

KENDALL LOGAN, Senior Program Assistant

MICHAEL K. ZIERLER, Science Writer

SHARYL NASS, Senior Director, Board on Health Care Services

ANDREW M. POPE, Senior Director, Board on Health Sciences Policy

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by ELI Y. ADASHI, Brown University, and JOE W. GRAY, Oregon Health & Science University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×

Preface

Understanding and mitigating the health effects of exposure to space radiation has challenged scientists and engineers for decades. While science has advanced our knowledge of the effects of radiation on the human body on land and in space, uncertainties remain regarding how best to assess, manage, and communicate radiation risks to those affected.

The present study—focused on space radiation and astronaut health—occurs at a time when plans are being developed for long-duration spaceflight missions beyond low Earth orbit to the Moon and Mars. These missions, particularly to Mars, could introduce health risks and challenges unlike others experienced by previous astronauts and their space agencies. Our study committee took on the task of providing advice to the National Aeronautics and Space Administration (NASA) on the space radiation health standard with enthusiasm and a sense of significance, as the implementation of the standard will have a measurable impact on astronaut health, opportunity for spaceflights, and overall mission viability.

The committee worked to develop this report in an objective manner based on the options and suggested approaches for updating the space radiation standard provided by NASA, available scientific evidence, and individual committee member expertise and knowledge. During this process we were specifically attendant to the considerable importance of the uncertainties and developing knowledge around radiation and cancer risks, as well as the uniquely complex and challenging mission of NASA. As astronaut Ellison Onizuka’s words are memorialized on the last page of every U.S. passport, “Every generation has the obligation to free men’s minds for a look at new worlds … to look out from a higher plateau than the last generation.”

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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NASA has many tools and resources for continued evaluation and reconsideration of health standards. It is the committee’s hope that this report provides an incremental step forward for NASA and its astronauts in the planning of space travel farther afield.

Hedvig “Hedi” Hricak, Chair
R. Julian Preston, Vice Chair
Committee on Assessment of Strategies for Managing Cancer Risks Associated with Radiation Exposure During Crewed Space Missions

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×

Acknowledgments

The committee thanks the National Aeronautics and Space Administration (NASA) for sponsoring this study and engaging with the committee in public meetings and providing thoughtful, timely responses to the committee’s questions and requests for information throughout the study process. We are appreciative of NASA’s willingness to engage with external experts on a complex issue such as space radiation as the safety and success of space travel is of national interest. We especially thank NASA staff—David Francisco and Edward Semones—for providing a technical review of portions of this report describing NASA programs and processes. The committee is also grateful to members of the International Commission on Radiological Protection Task Group 115 on Risk and Dose Assessment for Radiological Protection of Astronauts—particularly presenters Marco Durante and Werner Rühm—for sharing information with the committee during the April 2021 public webinar on international space radiation dose limits. The speakers provided valuable information and perspectives on the complex work of considering standards for spaceflight across international agencies.

It was our great privilege to work with such dedicated committee members, each of whom thoroughly engaged in the study, generously shared their expertise, and contributed significant time and effort to this endeavor. This was a complex task, and the committee members truly stepped up to meet the challenge. Their reasoned and thoughtful discussions made this report possible.

We were all fortunate to work with a diligent and outstanding team of National Academies of Sciences, Engineering, and Medicine staff, and

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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we deeply thank Rebecca English, Ourania Kosti, Leah Cairns, Claire Giammaria, Ruth Cooper, and Kendall Logan, led by Sharyl Nass and Andrew Pope, senior board directors in the Health and Medicine Division. We also sincerely thank Michael Zierler for his thoughtful writing and editing work, Rebecca Morgan of the National Academies Research Center staff for her assistance with fact-checking the report, and Michael Berrios for his thoughtful Japanese-English translation.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Acronyms and Abbreviations

ALARA as low as reasonably achievable
ARS acute radiation syndrome
DDREF dose and dose-rate effectiveness factor
DREF dose-rate effect
EAR excess absolute risk
ERR excess relative risk
ESA European Space Agency
GCR galactic cosmic rays
HMTA Health and Medical Technical Authority
HZE high-energy (particles)
ICRP International Commission on Radiological Protection
ISS International Space Station
JAXA Japanese Space Agency
LD50 lethal dose to 50 percent of the human population
LDEF low dose effect
LEO low Earth orbit
LET linear energy transfer
LSS Life Span Study
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
×
mGy milligray
mSv millisievert
NASA National Aeronautics and Space Administration
NCRP National Council on Radiation Protection and Measurements
NSCR NASA Space Cancer Risk
OSHA Occupational Safety and Health Administration
PMD permissible mission duration
RADS radiation-attributed decrease of survival
RBE relative biological effectiveness
REIC risk of exposure-induced cancer
REID risk of exposure-induced death
RSA Russian Space Agency
SPE solar particle event
SPEL space permissible exposure limit
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2021. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks. Washington, DC: The National Academies Press. doi: 10.17226/26155.
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Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks Get This Book
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Astronauts face unique health-related risks during crewed space missions, and longer-duration missions that extend to greater distances in our solar system (including to the Moon and Mars) will likely increase those risks. Cancer risks due to ionizing radiation exposure are one of these health-related risks. Assessing, managing, and communicating radiation-induced cancer risks associated with spaceflight are challenging because of incomplete knowledge of the radiation environment in space, limited data on radiation-induced cellular damage mechanisms, lack of direct observations from epidemiological studies, and the complexities of understanding radiation risk.

At the request of the National Aeronautics and Space Administration (NASA), an ad hoc committee of the National Academies of Sciences, Engineering, and Medicine convened to provide advice on NASA's proposed updates to their space radiation health standard, which sets the allowable limit of space radiation exposure throughout the course of an astronaut's career. Space Radiation and Astronaut Health: Managing and Communicating Cancer Risks provides the committee's recommendations and conclusions regarding the updated space radiation health standard, NASA's radiation risk communication strategies, and a process for developing an ethics-informed waiver protocol for long-duration spaceflight missions.

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