Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
-REFERENSE COPY FOR LIBRARY USE ONLY Report of Panel on Feasibility and Desirability of Performing Epidemiological Studies on U. S. Veterans of Hiroshima and Nagasaki epg tl o Fan oo ee 5 of M oAlcas ~ oO ACO YS. pre Asseiré oo Live Sciences NRC . aN boda en B,C. Natrerce Kian wong ef 5 CFEC 19%) ~ . Nm em
P)-O/ 657 wy a, /
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. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The National Research Council was established by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and of advising the federal government. The Council operates in accordance with general policies determined by the â Academy under the authority of its Congressional charter of 1863, which established the Academy as a private, nonprofit, self-governing membership corporation. The Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in the conduct of their services to the government, the public, and the scientific and engineering communities. It is administered jointly by both Academies and the Institute of Medicine. The National Academy of Engineering and the Institute of Medicine were established in 1964 and 1970, respectively, under the charter of the National Academy of Sciences. The work presented in this report was supported by the Defense Nuclear Agency, under Contract No. DNAQ01-80-M-0353.
Panel on Feasibility and Desirability of Performing Epidemiological Studies on U. S. Veterans of Hiroshima and Nagasaki _ Dr. Brian MacMahon J Chairman Department of Epidemiology Harvard School of Public Health Dr. Robert E. Anderson Department of Pathology University of New Mexico Dr. John A. Auxier Industrial Safety & Applied Health Physics Oak Ridge National Laboratory Dr. Stuart C. Finch Department of Medicine Cooper Medical Center Rutgers University Medical School Mr. Alun R. Jones Chalk River Nuclear Laboratories Atomic Energy of Canada Limited Dr. Arthur C. Upton Department of Environmental Medicine New York University Medical Center Medical Follow-up Agency Staff Seymour Jablon C. Dennis Robinette - eo - â__â~â- oe a oe cote nt NO wh Cameron oe bee oe eer oe ee we te IR 2 ds ae : Whale). aes re hee A Ree No net = A a Re eee ed cece
21 August 1981 PREFACE The Director of the Defense Nuclear Agency requested that the National Academy of Sciences advise him concerning the feasibility and desirability of performing epidemiologic studies of veterans who served in the occupation forces in Hiroshima or Nagasaki, Japan, immediately following the end of World War II. The request arose from suggestions by certain veterans groups that long-term health effects, due to residual radiation from the atomic weapons used in these cities, were occurring among former members of these forces. A panel was convened and a workshop held at NAS on May 13 and 14, 1981. The charge to the panel did not include risk assessment but covered only the feasibility and desirability of performing studies on this group of veterans. The panel felt that the data available were sufficiently firm to enable an evaluation of the problem. Invitations to participate were sent to a number of veteransâ organizations.* Representatives of the Committee for U. S. Veterans of Hiroshima and Nagasaki and the National Veterans Law Center accepted the invitation and provided information and participated in discussions together with representatives of the Defense Nuclear Agency, and Science *Committee for U. S. Veterans of Hiroshima and Nagasaki; Environmental . Policy Center; National Association of Atomic Veterans, Inc. ; National Veterans Law Center; American Legion National Organization; American Veterans of World War II, Korea, and Vietnam; American Veterans Committee; Disabled American Veterans; Veterans of Foreign Wars of the United States. women ee +e wl e- ~~ â~ oem
~2= Applications, Inc. Expert testimony was received from staff members of âthe Radiation Effects Research Foundation and the National Cancer Institute. - Representatives of the American Veterans Committee and the Disabled American Veterans were present as observers. In the report that follows, the panel provides conclusions based upon this information and makes suggestions about future research in this area.
21 August 1981 Report of Panel on Feasibility and Desirability of Performing Epidemiological Studies on U. S. Veterans of Hiroshima and Nagasaki The Panel met to consider the feasibility and desirability of epidemiologic studies to assess the possibility of radiation effects in U. S. servicemen who served in the occupation forces in Hiroshima or Nagasaki, Japan, in late 1945 and early 1946. The Panel reviewed infor- mation on the health problems of former servicemen, historical aspects of the occupation of Japan, radiation-dose reconstruction in both cities,â epidemiologic data on the Japanese atomic bomb survivors, and the statistical power of various comparisons. The Panel was briefed by representatives of the Defense Nuclear Agency and its contractor, Science Applications, Inc. (SAI). The briefing included information on troop assignments and estimates of radiation-dose distribution in the two cities.} Data on environmental radiation-dose distributions in Hiroshima and Nagasaki measured in 1945 by Japanese and American survey teams were taken directly from 3,4 these publications in refereed journalsâ and technical reports; data were considered sufficently reliable for the Panel's use. Available records do not indicate that U. S. troops were stationed in Hiroshima (although they entered the city from nearby quarters), but it is clear that Marines landed and were billeted in Nagasaki.â Specific military units that had the greatest potential for exposure to residual radiation were defined. Engineer units in Nagasaki were so designated, because of possible inhalation of dust from road and airfield construction and maintenance.
-2- The movement of military personnel in the contaminated areas is a major source of uncertainty -- it is not always known how many men there were, where they went, and how long they stayed. It is clear that SAI has chosen the situation of men working in the locale of greatest radiation density, the fallout area around Nishiyama Reservoir, under conditions of maximum dust production so as to overestimate exposures. There were no known military objectives in that area, and there was no known repair work there in which U. S. engineer units were involved. Doses in the Nishiyama area were said not to exceed approximately 1.0 rad. The probability of exposure was greater for troops exposed to activation products near ground zero, but the highest dose there was much lower than that in the Nishiyama area -- i.e., about 0.1 rad. Panel members agreed that, on the basis of the 1945 measurements of residual radiation, the SAI estimates are, indeed, worst-case values for possible radiation doses received by occupation troops.* The Panel believes that it is extremely unlikely that any detectable disease due to exposure to residual radiation has occurred in the occupation troops who were stationed in or near Hiroshima or Nagasaki. This opinion is based principally on information on: (a) the doses received, which were small because of the nature of troop activities in the bombed areas (i.e., times of arrival and departure, billet locations, military precautions, types of duty, etc.): Marines did not enter Nagasaki until more than six weeks after the bombing, by which time induced radiation had decayed to very low levels; (b) the small possibility of radiation-related disease in any given person *Dr. Auxier and Mr. Jones participated in this evaluation.
-3- (worst-case estimates of doses received); and (c) the absence of any increase in cancer mortality in Japanese early entrants into Hiroshima and Nagasaki (their involvement in the areas of residual radioactivity was earlier,. more intimate, and more prolonged than that of the occupation troops).° However, the Committee for U. S. Veterans of Hiroshima and Nagasaki has alleged, albeit on rather uncertain grounds, that the prevalence of multiple myeloma has been disportionately high among U. S. Hiroshima and Nagasaki veterans who have filed claims for compensation. Other populations exposed to large doses of ionizing radiation -- for example early American radiologists and Japanese A-bomb survivors -- have been reported to have an increased frequency of this disease. It has not been established, however, that there is actually an increase in the incidence of this or other potentially radiation-related diseases in the early-entrant veteran population. The Panel believes that a scientifically valid study of mor- bidity among Hiroshima and Nagasaki veterans would be impractical, because systematic information on hospitalization is lacking and it is difficult to locate veterans 35 years after the fact. But a study of mortality among these veterans would be feasible, albeit costly. Representatives of the military services indicated that it would be feasible to abstract service records for individual veterans who might have been in contaminated areas, but the costs that were quoted seem for- midable. The difficulties arise because, following the end of the war, troops with long service were replaced and rotated back to the U. &. Therefore, individual service records would have to be reviewed for tens of thousands of men in order to determine the possible. exposure for each \
-4- man. If a study is undertaken, the Panel recommends that detailed service records not be abstracted initially, but that entire rosters of units with potential for exposure (such as the Second Marine Division or selected subunits thereof) form the study cohort and that deaths in that cohort be identified through the Veterans' Administration. For control purposes it would be imperative to study simultaneously other units with no potential, or much less potential, for exposure (the Fifth Marine Division or components thereof might constitute such a unit). As a second phase of such a study, detailed service histories of men who died of specified causes could be abstracted; the causes of death would be selected on the basis of either apparent excess in the potentially exposed cohort or known relationship to radiation exposure. Suitable controls could be selected from the veterans who did not die of the selected causes. The comparison of the service records of the cases and controls would permit a conclusion as to whether any excess mortality was likely to be attributable to radiation exposure. Before a decision with respect to implementation of such a study, the attendant logistics should be explored. The Panel stresses that no study of this population could detect effects that would be predictable from existing knowledge of health hazards associated with radiation exposure, because the expected number of radiation-induced cancers would be very small, relative to the number of spontaneous tumors. For example, a population of 20,000 exposed to 100 mr would be expected, over its lifetime, to have no more than one fatal cancer in excess of the approximately 4,000 "spontaneous" cancers which may be expected to occur. Hence, such a study should be considered only if serious credence can be given to the possibility that the radiation doses received were far higher than is now estimated, to the possibility that
-5- the effect of a given dose is much greater than is now believed, or to the possibility that health effects of other aspects of these veteransâ experience are erroneously being attributed to irradiation. From a different viewpoint, such a study might be justified if it were thought desirable to attempt to demonstrate the absence of an increase in the risk of particular diseases. The results of any such study could be of potential interest to a broad spectrum of scientific groups, as well as to the veterans then- selves and their families. Therefore, the results should be presented in the open literature in refereed journals. The absence of associations between environmental or other influences and specific disease entities should receive the same emphasis as the presence of associations, inasmuch as such negative results might be expected to provide a measure of reassurance to the veterans and their relatives. . In summary, the Panel concludes that: (1) Scientifically sound studies of morbidity among military personnel who entered Hiroshima or Nagasaki soon after the bombings are impractical. Records of morbidity in this population are just not available nor could they be assembled in any objective or systematic fashion. (2) Studies of mortality among these men are feasible. However, from a strictly scientific point of view, such studies appear to carry inordinate cost in relation to the potential benefit. (3) No study of the population in question could detect effects that would be predictable from existing knowledge of health hazards associated with radiation exposure. \
(4) Oe Fe A Te 8 tom WR + ger nae -6- The possibility that multiple myeloma is occurring in excess in these veterans, as has been alleged, should be explored. This should not at first involve a full-scale _ epidemiologic study. The number of confirmed cases of the disease in this population should first be determined, and an evaluation made as to whether this is excessive before any further studies are recommended. As we have implied earlier in this report, even if an excess number of cases of multiple myeloma is present in this population, it is unlikely to be attributable to ionizing radiation.
