Unexplained Discrepancies in Fukushima Thyroid Cancer Age-Gender Distribution Graphs

The Twelfth Fukushima Prefectural Oversight Committee convened on August 20, 2013, reporting the latest findings of the health survey.  The thyroid examination result showed an increase in the number of children confirmed or suspected of thyroid cancer from 28 to 44, as reported in the previous post: http://fukushimavoice-eng2.blogspot.com/2013/08/18-thyroid-cancer-cases-confirmed-in.html

The information was almost instantly available to the Twitter and social network communities, thanks to the independent journalists attending the committee meeting.  Some members of the public, as well as the journalists attending the meeting noticed a strange discrepancy looking at the age and gender distribution graph of the 44 cases confirmed or suspected of cancer, as shown below.



The June 5, 2013 report showed the graph below for the 28 cases.
(This can be seen on page 32 of the comprehensive report here: http://www.pref.fukushima.jp/imu/kenkoukanri/250625siryouikkatu.pdf. It can also be seen on page 11 of the official English translation of the June report here: http://www.fmu.ac.jp/radiationhealth/results/media/11-2_ThyroidUE.pdf).


In comparing the two graphs, the following observations are made:
1. Both graphs show age as of March 11, 2011, so the basic age distribution should not differ between the two graphs.
2. In age 11, the June graph shows 3 males, yet the August graph shows none.
3. In age 15, the June graph shows 4 females, yet the August graph shows only 2.
4. In age 17, the June graph shows 4 females, yet the August graph shows only 3.
5. In age 18, the June graph shows 2 males, yet the August graph shows only females, totally flipping the gender.

According to the astute observation of a freelance journalist, Mako Oshidori, the Committee released the revised June graph on August 20, 2013, as shown below.
(This can be seen on page 11 of the thyroid examination result file here: http://www.pref.fukushima.jp/imu/kenkoukanri/250605siryou2.pdf).


Comparing the original and revised June graphs, it appears as if the age of the patients, in addition to gender, was categorized totally wrong.

According to Mako Oshidori, who was present at the committee meeting on August 20, 2013, an announcement was made in the beginning of the meeting, in regards to the change that had been made in average age and standard deviation on page 5 of the thyroid examination report.  Apparently, some discrepancies were pointed out by one of the committee members who reviewed the material prior to the meeting.  The announcement was intended to notify the committee members that the material distributed at the meeting contained the corrected version.

Investigation by Mako Oshidori revealed that an official at the Health and Welfare Department of Fukushima Prefecture government, in charge of the Prefectural Health Management Survey, stated that "the original data was handled incorrectly due to the counting error by Fukushima Medical University."

For information, the corrected information that was distributed at the meeting is shown below:

① Results of cytological examination


*****

Apparently, after making the correction, The committee wondered if the previous report in June needed corrections, and it did indeed need corrected.

Here's the June 5, 2013 results prior to the correction:


The revised June 5, 2013 results, published online on August 20, 2013 is shown below, with the correction inserted by the author in red for clarification in this post:


Going back to the discrepancies in the age and gender distribution graphs, the original graph was online for over two months without anybody noticing the discrepancies until the new August data was released.  The gender ratio in thyroid cancer cases is drawing a lot of attention, as can be seen in the July 20, 2013 post of the English translation of the June 9, 2013 article by Mako Oshidori: http://no-border.asia/archives/12034.  

In children who developed thyroid cancer after the Chernobyl nuclear accident, the ratio of females with thyroid cancer was higher than males.  In general population, adult thyroid cancers are found in more females than males.  The June results showed an even male to female ratio at 14:14 overall, but the FY 2012 result had a male to female ratio of 9 : 7, with slight dominance of males, which appears to be an anomaly.  Now the number of cases confirmed or suspected of thyroid cancer has increased from 28 to 44, and the male to female ratio is 18 : 26.  This change in gender ratio might be explained by more cases being discovered and the gender ratio approaching a natural ratio expected of thyroid cancer.  However, the fact that "the original data was handled incorrectly due to the counting error by Fukushima Medical University." raises questions about the integrity of the thyroid examination process itself, especially considering the continued denial by Fukushima Medical University of a possibility that any of these cancer cases could be related to radiation exposure due to the Fukushima nuclear accident.  The committee has repeatedly refused to reveal the exposure dose information for the cancer cases, citing confidentiality.






18 Thyroid Cancer Cases Confirmed in Fukushima Children: Preliminary Results of FY2011-2013 Thyroid Ultrasound Examination

For complete translation of the the thyroid examination results published this time, please refer to this post.


Total number of children examined as of June 7, 2013: 216,809

Total number of children whose initial examination results are confirmed: 192,886
Assessment A1 106,823 (no nodules or cysts found)
Assessment A2 84,783 (nodules 5.0 mm or smaller or cysts 20.0 mm or smaller)
Assessment B 1,279 (requiring secondary examination)

Secondary examination results as of July 31, 2013
(including blood and urine tests, more detailed ultrasound examination, and fine-needle aspiration biopsy if needed)
18 papillary thyroid cancers confirmed after surgery (18 boys, 26 girls, age 8-21)
25 suspected of thyroid cancer, awaiting surgery
1 benign nodule

  The youngest confirmed of cancer is a girl who was 6 years old at the time of the nuclear accident.

1,280 are eligible for secondary examination
771 have actually undergone secondary examination
625 finished the secondary examination





① Results of cytological examination



Shocked UNSCEAR members in Belgium protest "It even goes back behind the lessons of Chernobyl and other studies."

Original post:
Les délégués belges indignés: "On minimise les conséquences de Fukushima" by Marc Molitor
http://www.rtbf.be/info/societe/detail_les-delegues-belges-indignes-on-minimise-les-consequences-de-fukushima?id=8042566

English translation by Alex Rosen, M.D., Vice-chairman, German IPPNW
(posted here with his permission)

*****

Shocked UNSCEAR members in Belgium protest,
"It even goes back behind the lessons of Chernobyl and other studies."

Discussions continue in UNSCEAR, the organization of the United Nations responsible for assessing the consequences of nuclear disasters and radiation. The committee prepared a report submitted for discussion amongst experts from different countries at a recent meeting in Vienna - a report that has aroused the indignation of the Belgian delegation: "Everything seems to be written, its members say, to minimize the consequences of the Fukushima disaster. It even goes back behind the lessons of Chernobyl and other studies." The Belgian delegation includes several experts in the study of nuclear energy. UNSCEAR must submit its report to the General Assembly of the United Nations next fall.

Back in Brussels, the head of delegation, Hans Van Marcke delivered his critical impressions on UNSCEAR's conclusions in a presentation to the ABR, the Belgian Association for Radiation Protection. According to our information, the discussions were so tense and the Belgian were so shocked that they threaten not to sign the report and some thought even of leaving the conference. They were offered to include their objections and those of others, mainly English experts in a new, revised document. But the past has shown that it is the secretariat and the rapporteurs who lead the agenda and who give the text its final orientation, and that the greatest vigilance is needed to see to it that the final versions adequately reflects the discussions.

In general, everyone agrees: Japan has been lucky. An important part of the contamination has gone to the ocean, the population was evacuated fairly quickly, and control of food contamination is satisfactory. The impact will therefore probably be lower than in Chernobyl.

But the impacts on soils are not to be underestimated, nor are impacts on health in the future. And these effects involve an area with densely populated cities like Fukushima or Koriyama (300,000 people).

Much data of the UNSCEAR report is incomplete or presented in a questionable way. Estimates of doses received by populations are diluted by irrelevant mean values, as are those received by the tens of thousands workers on the site of the plant accident. The Japanese government and TEPCO refused to disclose details. It is also obvious that iodine tablets have not been distributed and thyroid exams were performed too late, which prevents some effects from being found.

The analysis of the UNSCEAR automatically excludes a priori any potential risk to the fetus or the genome. For cancer risk, it considers that there is not too much of a risk as the radiation doses are too low to generate a discernible effect. Such assumptions have led to the anger of  experts from Belgium because, on the one hand, as mentioned above, the doses are poorly presented and secondly, the lessons of Chernobyl as well as extensive research in recent years show that low doses can affect health. UNSCEAR is obviously trying to backtrack on these developments in the science of radiation. On several occasions in recent years, and even in the current discussions, representatives of different countries want to convey the idea of a threshold of 100 millisieverts, below which no health effects are to be expected. As a reminder, international ICRP recommendations speak of 1 mSv per year for the population and 20 mSv per year for workers, not to be exceed in the current situation.

Recent studies show that, in several areas, lower doses between 10 and 100 mSv can have effects. It is not only cancer, but also damage to the embryo, hereditary disturbances, cardiovascular disease and cataracts.

Several reports are on the table nearing completion. One for children, a population to protect and monitor, especially in the case of radiation. This report was supported by an American team, led by Professor Fred Mettler. He is an author of the Chernobyl Forum report, which was highly controversial and criticized because it minimizes the effects of the Chernobyl disaster. In any case, in his report on children, he dismisses a priori a number of areas of study and findings that show the different effects of low doses on children. He did not even read the reports from the Euratom panel.

Another serious issue that is denied or misrepresented in the report concerns the question of the relevance of internal contamination of an organism. Indeed it appears increasingly that the effects may be different when radionuclides are dispersed evenly throughout the body, or when they rather are concentrated in certain areas. A similar dose will therefore not have the same effects depending on where it occurs. This is consistent with assumptions by the Belarusian scientist Yuri Bandajevski in the study of the many effects of Chernobyl.

Hereditary effects of chronic low-dose contamination are difficult to study in humans because it takes several generations of observation. One way to approach this is to observe these effects in animals. Several studies have shown that effects do occur (Mousseau and Moller studies show the loss of biodiversity in Chernobyl, for example, or the studies of Goncharova). But they are not taken into account either, nor are important studies of French IRSN, which showed many cardiac and neurological alterations in rats.

Where do the attempts to minimize the consequences of Fukushima (and Chernobyl) and to backtrack on the recent achievements of the various studies in radiation come from? Mostly from experts from Russia, Belarus, U.S. Poland and Argentina. Many of them are working for both UNSCEAR and the IAEA and ICRP. One of them, the Argentine Abel Gonzales has so many different hats on (also in the Argentine nuclear industry) that in a previous session, a Belgian expert criticized the conflict of interest in a letter that UNSCEAR has refused to represent in the minutes. Gonzales, Mettler and the Russian Balanov (retired IAEA member, editor of UNSCEAR reports), together with some Polish scientists, are in direct line with the trend represented by the French Professor Tubiana who firmly rejects any idea of negative effects of low dose radiation. Together they formed a vibrant international center to defend this thesis. And they occupy strategic places in the secretariat of the IAEA and UNSCEAR (UNSCEAR holds its meetings on the premises of the IAEA). The Japanese today share that view, anxious to limit the impact of the disaster and restart nuclear reactors.

Representatives of other countries such as China or India are silent. The French experts from CEA and IRSN expressed little objections, while in the past they deplored the information policy by the Japanese. Swedish and German are also silent. It is obviously tempting to draw a parallel between the results of UNSCEAR and the geopolitics of nuclear power, although in each country different trends can occur among experts.

The Belgian experts, supported by British and Australian members and some Euratom members attending the meeting, are more concerned about the effects of low dose radiation.

Where is the discussion and the scientific doubt in all this? In any case, those who deny the impact of low doses would love to see their position recorded in the UNSCEAR report and endorsed by the UN this fall. For others, including Belgium, it would be an unacceptable regression on recent advances in knowledge in radiation protection.

Marc Molitor




Steve Wing's Critique of Congenital Hypothyroidism Study after Fukushima Accident by Mangano and Sherman

Steve Wing, an epidemiologist from University of South Carolina was asked by a third party to review a manuscript by Mangano and Sherman, “Elevated airborne beta levels in Pacific/West Coast US States and trends in hypothyroidism among newborns after the Fukushima nuclear meltdown,” after it had been accepted for publication on January 29, 2013.  It was not the actual published version in the March 2013 issue of Open Journal of Pediatrics, shown in the following link, http://www.scirp.org/journal/PaperInformation.aspx?PaperID=28599, that Wing reviewed. 

Wing’s critique, dated February 27, 2013, was sent to the authors, but there appeared to be no direct response from them, except the manuscript seemed to have been published with some corrections, as some of the issues brought up by Wing could not be identified in the final published version.

The journal that published this study, the Open Journal of Pediatrics, apparently is a ‘predatory journal’ that is for-profit and does not have a serious scientific peer-review process.  This information might be of interest to some of the readers.

Wing's critique is published below with his permission.  He requested that the details surrounding his critique be mentioned as above.

A related post, "A Letter to the Editor Regarding the Congenital Hypothyroidism Study by Mangano and Sherman" by Alfred Körblein, can be found in the following link.
http://fukushimavoice-eng2.blogspot.com/2013/05/a-letter-to-editor-regarding-congenital.html

*****
Comments and questions on “Elevated airborne beta levels in Pacific/West Coast U.S. states and trends in hypothyroidism among newborns after the Fukushima nuclear meltdown” by Joseph J. Mangano MPH MBA, and Janette D. Sherman MD 

Steve Wing

This article compares the ratios of congenital hypothyroidism (CH) cases between time periods in 2010 and 2011 for five western US states and 36 other US states.
The authors propose that the five western states were more exposed to I-131 fallout from Fukushima than other states, and that, if this impacted CH, the ratios of 2011/2010 CH cases would be elevated for several months after the deposition of fallout in these states compared to the others.  The principle of this comparison appears to be logical as it makes use of both spatial and temporal variation to evaluate the effect of an environmental exposure, however the data collection and analyses are unclear and internally contradictory.

Introduction
The introduction includes results of a comparison of CH cases in four counties around the Indian Point reactor to US rates. Two time periods are compared, however there is no information about whether there was a change in exposure or another reason for choosing these periods. It is stated that Indian Point, from 1970-1993, had the fifth-highest airborne I-131 releases out of 72 US reactors. It is not clear why the authors present emissions data from a period that ended 4 to 13 years before the time of the CH analysis; clearly CH cases from 1997-2007 could not have been exposed to I-131 from 1970-1993. The authors should explain, if their interest is in whether nuclear reactor releases cause CH, why not use release estimates from a time period close to the CH data and analyze records around the nuclear facilities with highest releases rather than the fifth highest?

Methods
The first of two tables labeled “Table 2” presents 77 measurements of I-131 in U.S. precipitation following the Fukushima meltdowns. The url for the source given in the bibliography did not work, but I-131 precipitation at another EPA url provides 157 measurements. Were the omitted values non-detects? If average levels by state are of interest, non-detects should be included in mean values under some assumption, for example, half the detection limit. The authors note that some of the highest measurements came from Florida, which is classified as a “control” state (better described as “lower fallout”) in the later CH analysis, and from Massachusetts, which is omitted from the CH analysis. No rationale is provided for these decisions.

I-131 in precipitation is relevant to the milk pathway for iodine uptake, which dominates thyroid dose estimates for U.S. populations. Why are the exposure groups for the CH analysis based on gross beta in air, which would be influenced by beta-emitting gasses such as xenon and krypton that were not only present in Fukushima emissions but are also routinely present in emissions from U.S. reactors? In the second Table 2, how are non-detects treated? What was the limit of detection?

The authors state that they requested “monthly numbers of CH cases” in a telephone survey. If birth dates for individual cases were not obtained, how could they be classified according to day of birth in subsequent analyses? In the Results the authors state that data from small states were not available due to confidentiality concerns; how were such concerns handled if individual birth dates were acquired for March cases? Furthermore, several of the omitted states, including New York, are not small. This part of the data collection is unclear, and it is important for anyone interpreting the results to know clearly how the more and less exposed groups were formed and whether missing data relate to exposure.

“State programs were also asked to confirm that there was no change in CH definitions between 2010 and 2011 that would bias any temporal comparison.” Did any respond that they had changed their definition, and if so, which ones? In the next sentence, “intra-state” should be “inter-state.” Counts in many surveillance systems are provisional until some closing date for investigation. Were the figures reported in the phone interviews all final? If not, the counts may differ from those that will be reported in official documents, which could lead to inability to replicate the current analysis with final data.

Results
One strength of the study design is the use of time-windows, therefore the choice of dates for CH incidence is important. Is it plausible that CH cases on March 17, 2011, could be caused by Fukushima I-131 that arrived on that same day, essentially with no lag? The milk pathway certainly could not be involved in exposures for some time period. One question is whether CH from Fukushima fallout would be prompted by an initial dose or by cumulative doses over days or weeks. In any case, because March 17 (or March 15, as in one row of Table 3) is the earliest possible beginning of the exposed period, the choice of that time for counting exposed cases deserves discussion and justification.

Table 3 presents the main results, however the labels and counts are confusing. Why use March 15 in the first row rather than March 17? Why are there more cases from March 15 – April 30 than for March 17 – June 30 or March 17 – December 31? The counts in the 5 western states in the two latter periods sum to the first row, suggesting labeling errors, however the values for the other states do not sum up in the same way. The p-values in Table 3 do not match those in the Discussion and it is not sufficiently clear what they refer to and how they were derived.

Discussion
The authors make a number of good points in this paragraph, which could be used as a basis for improving the manuscript: “There are technical improvements that may be made to the data in this report. One of these is to obtain more precise temporal and geographic data on environmental levels of specific radionuclides in the U.S. after Fukushima, including I-131. Moreover, estimating specific exposures to humans as a consequence of the fallout would also be helpful in any future analyses of health risk. In addition, there are technical changes that may be made to data in this report, such as using a period greater than just 2010 as a baseline; including data on CH cases after 2011; and conversion of trends in cases to rates when official numbers of 2010-2011 live births by state and month become available.”

"Health impacts of radiation release from nuclear facilities: Lessons past and present" by Steve Wing


Transcription of a lecture by Steve Wing, Three Mile Island epidemiologist, at the March 11-12 New York symposium sponsored by the Helen Caldicott Foundation


Steve Wing, Ph.D.



The Medical and Ecological Consequences of the Fukushima Nuclear Accident

The Helen Caldicott Foundation
March 11-12, 2013
Video archives

Video can also be viewed here:


I think my title may be able to have been used by any of the speakers at this whole symposium.  I wanted to pick something that I can fit into, but a little bit more specifically I would like to talk about how we approach estimating health impacts of radiation releases from nuclear facilities.  

And there are two general approaches which you already heard about.  I want to identify them and their logical bases and compare them.  One approach is risk assessment.  That means that we use some estimates of dose and we multiply the estimates of dose to people by some dose-response curve which gives us the estimated number of effects, number of events, or cases of disease for each amount of dose.  And the other method is epidemiology, which means that there is some kind of surveillance for disease.  And we look at the differences in the rates of disease between exposed and unexposed populations.

So I want to begin with talking about risk estimation or projection and this may be obvious, but I think it’s worth noting or repeating something that we all know is that “Randomized human experiments, looking at the long-term consequences of exposure to various forms of ionizing radiation, are not possible.”  So we can’t conduct experiments.  We can’t conduct human experiments.  So we have to either extrapolate from cellular or animal studies, or conduct non-randomized human studies which are epidemiologic studies.  And both of these approaches suffer from problems of bias and selection; measurement errors and selection, which of course experiments also suffer from biases, but we won’t go into that today.

So just recently this document came out of the World Health Organization, and it’s already been referred to, most recently by Ian Fairlie.  

 

And it is a risk assessment or risk estimation.  It is based on the dose estimates produced in a previous report last year on Fukushima. 

 

It’s also based on data from the Life Span Study of A-bomb survivors, which you heard about and you will hear about more in just a moment. This dose assessment I want to emphasize just a few of the things Ian Fairlie already has said is that there are a number of components of the doses that are ignored.  The committee chose not to assess doses within 20 km of Fukushima nuclear plant.  They chose not to assess the radioactive gases such as xenon.  They did not assess fetal doses.  And I think Dr. Wertelecki has already given us a great introduction to why we might care very much about the fetal doses.

What I want to start out is talking about the Lifespan studies.   I am going to show you a little bit of the information that has been around for a long time from a volume that came out in the 1970s as well as very recent information that has just appeared within the last 90 days from Radiation Effects Research Foundation and from our group at University of North Carolina.

These graphs show the immediate casualties at Hiroshima and Nagasaki in relation to the distance from the hypocenters of the atomic explosions.  

 

And I want to make the point that the study upon which all our risk estimates are based did not begin until more than five years after the bombings, and many people did not survive to be in the study.  If mortality from the immediate effects of the bombings is related at all to frailty and to longer-term risk, there would have been a harvesting of the most radiosensitive from this population.  It’s a very important thing to remember, especially because of the destruction of the physical infrastructure of these cities, food supplies, water supplies, hospitals, Hiroshima was hit by a typhoon, so there are lots of forces selecting for healthier people.  

I also would note that the study of cancer incidence, which you already heard about in this symposium, did not begin until 1958.  So any estimates of cancers following exposure to radiation based on the LSS, cancer incidence, omit all cancers that occurred within 13 years of exposure.  And we know from many other studies that lots of cancers occur in less time than that.  And this is something that is routinely omitted when risk estimates from the LSS are applied to the populations including the population of Fukushima and the population of Japan.  And especially important in the shorter-term effects are the impacts of in-utero exposure and also shorter-latency cancers such as leukemia and lung cancers.

Now a few other, uh, a little bit more information from the 1970s volume on the Physical, Medical and Social Effects of the Atomic Bombings. This is the depiction of the radiation from the atomic bombing of Nagasaki.

 

We have the epicenter or hypocenter, and gamma and neutron radiations coming from the blast, all of which were gone within seconds.  But there are other sources of radiation as depicted by the arrows coming from the ground below the blast, gamma and beta induced radiation from neutron activation.  And then here in the Nishiyama District, a particular radioactive fallout.  Now the RERF, which is responsible for the A-bomb studies, has chosen not to estimate any of the radiation doses due to these two other sources, residual radiation being composed of either induced radiation or fallout.  

Fallout was also a problem in Hiroshima.  You can see in this map the drawings of where the fallout, so-called Black Rain, came in Hiroshima. 

 

Note that in both of these depictions, the fallout is not primarily at the hypocenter.  Who is more affected here?  People who live at some distance.  So this is important in the epidemiologic study because it means that the fallout is disproportionately affecting people with the lowest doses directly from gamma and neutron blasts.

What happened after the blasts?  Who was near the ground zero?

Oh, first let me finish with the fallout, the Black Rain.  So this report just came out in December from the RERF.  And they asked people about exposure to the Black Rain.  They asked the survivors.  And of the 86,671 survivors in the primary analyses, they give us our risk estimates, 12,000 approximately said “Yes,” but over 21,000 there is no information.  This is something I want to emphasize is that the lack of data, missing data, is a big problem in the LSS, that could be investigated more but has been ignored for a half century.  



RERF has also reported this December on the mortality rates between 1950 and 2003, on the left, and between 1962 and 2003, on the right, in Hiroshima and Nagasaki.



And the Excess RR which zero indicates the referent group that’s not exposed to fallout, that the group reporting exposure to Black Rain in both cities has no difference in mortality over either time period.  But the unknown group in both cities have an excess mortality.  It’s 27% in Hiroshima and 46% in Nagasaki.  And if you look at the difference between 1950 to 2003, those estimates I just cited, there is basically no difference in the period 1962 to 2003.  This means that during the period 1950 and 1962, there was a very large excess mortality among people who provided no information on their exposure to Black Rain.  And that’s a very important time period that I will come back to in a minute.

Now let’s talk about the early entrants, the people who could have been exposed to induced radiation near the hypocenter.  Here are some dose estimated for Days 2 and 3, for people who had spent 12 hours from RERF.  We don’t have any estimates for them from Day 1, but we know that induced radiation fell off very rapidly.  



These are photographs from Yosuka Yamahata, taken the day after the bombing of Nagasaki. 

 

And what I want you to notice is that people are there.  And these are not the people who were exposed to the hypocenter.  These are people who are coming in from other areas.  They are going through the city.  Some of them are looking for their relatives.

When I was in Nagasaki, I had the opportunity to tour the museum there with a survivor who knew the woman on the left, on the right side of this photograph and explained to me that she was still living.  This was just about five years ago.  And in this photograph she found her mother.  

 

But people were there.  And they were not the people who were most exposed to the blast.  They tended to be people who were from farther away.  So that’s a differential exposure again to the type of radiation that’s not counted in the Life Span Study.

And the next few slides I want to share from our group at University of North Carolina.  

What they show for Hiroshima and Nagasaki are the distances from Hypocenter of three groups of people:  the proximal survivors in the first panel; the distant survivors in the second panel; and the survivors with missing dose in the third panel.  And you can see that only proximal survivors can have missing dose.   That’s because the RERF did not require detailed interviews with distal survivors to produce the dose estimate.  They were all assigned the lowest dosing category.  This forces a relationship between missing dose and exposure.  You can only have a missing dose if you are exposed.  Here’s the same situation that occurs in Nagasaki.



Now what does it mean in terms of the Life Span Study?  This table shows us that in the 1950s, there were higher rates of mortality among survivors of unknown doses from all causes, from all cancers and from leukemia.  So here we are taking out of the high-dose group, people with high mortality rates.  What does that to the dose response estimates, if we remove the high mortality individuals from the groups with higher doses?  I think it’s obvious.



So let me move on.  And first remind you, oh, I must mention one other thing about this period between 1950 and early 1960s.  In 1950, all survivors were entered into a follow-up on October 1, 1950.  However, all survivors had not completed sufficient interviews to be assigned a dose at that time.  Interviews needed to assign a dose continued until 1965.  Yet RERF in all their analyses to estimate these risk coefficients that are applied to populations around the world, have entered people on October 1, 1950, who could not be in the study until later.  It’s a phenomenon that an epidemiologist calls, “immortal person time.”  What this does is, it inflates the denominator of the rates, of the cancer rates for the proximal survivors.  So this is another phenomenon that causes an underestimate of the cancer rates for the proximal survivors.  So we have another source of bias.  I am not aware if this has been written about, but you can find it in our recent paper in the American Journal of Epidemiology. 

Now, there are a couple of other things to say about the Life Span Study.  We don’t have information about the carcinogenic effects of in-utero exposures, which are clearly and very important.  The embryo and fetus are much more sensitive to carcinogenic effects of radiation, probably much more so than the children.  But the Life Span Study doesn’t give us information on that at all.  And therefore that effect is left out of many of the dose estimates that we typically see.

So now I want to talk quickly about four epidemiologic studies.  My message here is what is projected based on the Life Span Study of A-bomb survivors, and what has been seen in epidemiologic studies.  

This is a graph from David Brenner who spoke yesterday on estimated number of people who would need to be followed for life to detect an increase in cancer mortality based on the Life Span Study estimates.  And you can see that at low doses under 50 mGy or so, we are talking about 100’s of thousands to millions of people, according to these estimates.  



So I learned about this first when I started working on radiation in 1998 when I was assigned to lead the study of the mortality in workers from the Oakridge National Laboratory whose radiation doses had been monitored from very early on with individual badges.  

You can see here workers putting their radiation meters in proper boxes.



And I was told we would not find any effect of radiation in this population because it was too small and the doses were too low.  So my first encounter with the dominant wisdom in this field was when we found that, only after about 20 years latency, we were seeing dose response relationships:  the higher the readings in the badges, the higher the cancer rates in the workers.  

But this was impossible, I was told.

Chernobyl, you heard a great deal about.  I want to call your attention to this passage from a 1991 document, five years years after the accident, by IAEA, International Atomic Energy Agency.  “On the basis of the doses estimated by the Project teams and currently accepted radiation risk estimates, future increases over the natural incidence of cancers or hereditary effects would be difficult to discern, even with large and well designed long term epidemiological studies.”  



And you’ve seen a plethora of information today and yesterday, that this turned out not to be so.  

This is one graph, I won’t dwell on it, from a thyroid cancer study which has individual dose estimates including information from thyroid scans.



Another nuclear event where we were told there were no cancer effects possible was the Three Mile Island nuclear accident in 1979.  I have just a few photos here from Bob Del Tredici’s book, The People of Three Mile Island, to give you a sense of what the area was like in 1979.  



People lived quite close to the plant.  Many reported the symptoms such as reddening of the skin, deaths of pets and animals, nausea and vomiting, and hair loss, and they were told that this was due to stress.  Now, I started working on this because of lawsuit involving several thousand people, and I first did look into stress.  

I think stress is very important and I am sure the people of the TMI were under tremendous amounts of stress.  However my assessment of medical literature was their reports did not fit the scenario of stress-induced acute effects, sometimes called mass hysteria in medical literature.  

So we conducted a reanalysis of data on cancer incidence that were collected from local hospitals during the period 1975 to 85, and the dose estimates made by the investigators, and we found, and I want to point out one thing is that this study was designed to avoid a problem that’s a big concern in any well-publicized event, which is that there is detection bias.  People report sooner, they get more diagnostic tests.  So we expect there to be an effect of detection bias on the disease incidence rate following an event like this.  Everyone in this study was within 10 miles. They were all exposed to the same detection bias.  

This is a graph showing our results.  Radiation levels in the area are shown from very low in the green to high in deep red, and bars indicate relative rates of lung cancer which occurred between two and seven years after the event.  And what’s very clear is that the lung cancer incidence rates rose dramatically in the direction of the plumes where the plumes from the emissions were estimated to have traveled in the first days of the accident.  

 

Again, the risk projections said there would be no effects.

Next I want to mention studies of routinely operating NPP, which is the topic of the current interest in the National Academy of Science.  Tim Mousseau who spoke yesterday has been on their panel.  This is also a situation where the projection is that no cancers will be observed among people who were exposed to routinely operating reactors.  

So studies like European studies have never been done in the U.S.  I brought one example of a study of childhood leukemia in Germany.  These are the study areas around the 16 nuclear plants.

  

This table shows that in the 0 to 5 age group, the rate ratio, relative risk or odds ratio, all equivalent here, in the 0 to 5 km zone, it’s more than a doubling of childhood leukemia incidence in these areas collectively, compared to the areas that are further away.  In each case the comparison group is not from some other place.  They are also in the same areas, cases and controls in the study.  So the authors conclude, “radiation exposure near German nuclear power plants is a factor of 1,000 to 100,000 times less [than annual average exposure from medical exams, therefore] the observed positive distance trends remain unexplained.”  

 

And I feel that I’m repeating in some ways what we heard this morning from Dr. Wertelecki, that we are not able to conclude anything from studies that have been done because they don’t comport with the projections from the A-bomb survivor studies.  

Yesterday Dr. Brenner compared the radiation risks to deaths from violence and earthquake and tsunami in Fukushima.  And I think he has a point.  

But I would ask the question, what’s the difference between these, energy generation and medical irradiation for that matter.  Energy generation is highly profitable.  And it’s a public decision made by politicians who are in many cases tied to nuclear companies and weapons contractors that created the nuclear energy industry in the first place.  There has been a discussion of public education, and I would argue, yes, we need public education.  Not only about radiation but about science and about civic life, because our science is affected by our political system.  

In Fukushima, there will be extra challenges to epidemiologic studies when we compare the situation to the others I mentioned today and have been mentioned here earlier.  And some of those challenges involve the fact that there was an earthquake and the tsunami.  And there were huge disruptions of living conditions.  There was a lot of relocation.  People were moving around,  

Estimating doses for individuals, which is important and critical in epidemiological studies, will be made very much more difficult.  Ian Fairlie showed just recently time trends in infant mortality, and we could look for other time trends.  Let’s remember that the radiation was not the only thing going on that was different after this event.  People were moving, they were relocating, their diets were affected, their medical services were affected, and people died.  Many, many thousands of people died.  This is all going on at the same time, and it’s going to be difficult to separate out the radiation effects from this.  

One of the things I think is very important is that there are risks from conducting research.  Some research can be designed in such a way that it is unable to detect an effect even if the effect is there.  This is something that the exposed populations need to understand.  Because if they come to count on science to help them, they need to know science isn’t perfect and it’s never done in perfect conditions.

There were also comments yesterday and earlier today about biases and objectivity in science.  

I would like to leave you with the idea that the main threat here is the lack of critical thinking, and this includes self-critical thinking.  

In this area that we are interested in here at this symposium is that one primary problem is the failure to question authority.  And that is a great example to me is the Life Span Study, which is applied all the time, every day, from legal situations to workers compensations, to estimating health effects of the Fukushima event.  And authority is very important because authorities control access to jobs, to research funding, professional meetings and journals.  Tim Mousseau talked about this yesterday.  

What we are trying to do is very difficult.  It’s not easy.  But as we proceed to get more information on the effects of Fukushima to learn more about the population impacts, one of the things that I would ask is that we not confuse narrowly constructed research hypotheses, meaning that there would be an excess of some condition in exposed population, let’s not confuse that with systemic analyses that we are also interested in.  

Things like, “Is nuclear power a good policy?”  

That’s a different question.  

If nuclear power is a bad policy, it doesn’t mean that every study has to find an excess cancer.  

That’s a different question.  

So, with that I will thank you for your attention and maybe talk to you later.






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