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THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine Division on Earth and Life Studies Board on Radiation Effects Research 500 Fifth Street, NW Washington, DC 20001 Phone: 202 334–2232 Fax: 202 334–1639 www.nationalacademies.org June 24, 2003 Vanessa Hooker Program Director Radiation Exposure Screening and Education Program Health Resources and Services Administration 4350 East-West Highway, 9th Floor Bethesda, MD 20814 Dear Ms. Hooker: In response to a request from the Health Resources and Services Administration (HRSA), the National Research Council1 convened a committee to assess the recent biologic, epidemiologic, and related scientific evidence associating radiation exposure with cancers or other human health effects. On the basis of that information, recommendations will be made to HRSA in the final report regarding: technical assistance to HRSA and its grantees on improving accessibility and quality of medical screening, education, and referral services; the most recent scientific information related to radiation exposure and associated cancers or other diseases, with recommendations for improving services for exposed persons; and whether other groups of people or additional geographic areas should be covered under the Radiation Exposure Compensation Act (RECA) program. 1 This interim report was prepared by the Committee to Assess the Scientific Information for the Radiation Exposure Screening and Education Program, appointed by the National Research Council. This interim report should be referenced as follows: “Assessment of Scientific Information for the Radiation Exposure Screening and Education Program: Interim Report (National Research Council, 2003).”
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In addition, HRSA requested that the National Research Council committee provide an interim report to the agency and its grantees as preliminary guidance on the conduct of the ongoing and proposed activities. The emphasis here is on interim guidance and not on final recommendations. It is in the context of initial guidance that the committee provides this interim report. At the initial meeting of the National Research Council’s committee in Washington, DC, on November 19–20, the committee heard presentations by HRSA and its grantees. The presentations dealt with screening of persons covered by RECA.2 HRSA asked the committee to review and provide early feedback needed to revise HRSA guidelines for future grant requests. This interim report is based on the committee’s review and assessment of the HRSA Bureau of Primary Health Care (BPHC) Policy Information Notice 2002–173 (see Appendix A) and its current grantees’ proposals.4 It provides the committee’s findings related to the most recent scientific information about radiation exposure and cancer (item b above) and advice on improving access and quality of screening, education, and referrals (item a above). These two items will be discussed in more detail in the final report. Issues related to compensation of other groups of people and additional geographic areas that should be covered under RECA (item c above) are not addressed in this interim report but will be included in the final report. Recommendations on these issues will be included in the final report after considerable debate and review by the committee, and after consideration of input from additional experts. The intent of this interim report is to assist the Radiation Exposure Screening and Education Program (RESEP) staff to develop an action plan that is consistent with best medical and educational practices and the current state of science. The potential impact of recent developments in radiation dosimetry, radiation biology, and radiation epidemiology on the risk-assessment process is discussed for the purposes of establishing whether the RECA populations5 (see Appendix B) are likely to be at greater or less risk of cancer as the result of prior exposure to radiation than is currently estimated. The committee’s interim report is organized around items a and b listed in the statement of task above as follows: Section 1 presents items related to risk assessment; Section 2 discusses screening; and Section 3 discusses improving accessibility and quality of medical care, education, and referral services. 2 The Department of Justice administers RECA as codified by 28 CFR 79. 3 Policy Information Notice on the Radiation Exposure Screening and Education Program (RESEP) that is being implemented by the Health Resources and Services Administration. This document includes the application guidance for the FY 2002 funding opportunity. It can be accessed via the following Web link: ftp://ftp.hrsa.gov/bphc/docs/2002pins/2002–17.pdf. 4 The grant program is administered as the Radiation Exposure Screening and Education Program (RESEP). Six grantees were funded under this program. The grantees are from St. Mary Hospital and Medical Center, University of New Mexico Health Sciences Center, Northern Navajo Medical Center, Utah Navajo Health System, Inc., Miners’ Colfax Medical Center, and Mountain Park Health Center. 5 The exposed population includes uranium miners, uranium millers, ore transporters, downwinders, and onsite nuclear-test participants.
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On the basis of the committee’s knowledge of current scientific information and peer-reviewed publications related to radiation exposure and associated cancers (see Section 1), the committee’s preliminary assessment is that At this time, there is no new physical, biologic, or epidemiologic evidence to suggest a need to revise the estimates of risk for radiogenic cancers among populations previously exposed to ionizing radiation as identified in relation to RECA or the fundamental procedures used to estimate them (UNSCEAR 2000a, b; NCRP, 2001, NRC, 1999a). The excess relative risk of lung cancer from exposure to radon decay products decreases with age and time after the last exposure. Similarly, excess relative risks for most of the cancers associated with onsite participants’ and downwinders’ exposure decrease with age and time since exposure. Thus, the excess relative risks among the surviving population for developing cancers that may be attributed to radiation are lower today than they were when the exposures occurred several decades ago. On the basis of its deliberation on the issue of medical screening (see Section 2), the committee finds that Currently, there is no evidence to support the notion that screening for radiogenic diseases in this population will result in measurable health benefit for eligible participants. In fact, a screening program could be harmful because of false-positive test results (for example, the physical risks that their work-up entails and the psychological and social consequences of labeling individuals as potentially affected), as well as other factors. In cases where populations involved in the RECA screening program may be medically underserved or reluctant to make contact with the medical system, it might be more beneficial to provide additional resources to facilitate such contact rather than to devote resources to enhanced screening. The RECA legislation provides compensation for radiogenic and nonradiogenic diseases. We recognize that people may wish to be evaluated to establish eligibility for compensation. Informed decision-making by them acting with a physician is needed because these evaluations have potential benefits and harms. An explicit statement on a plan for appropriate follow-up services for compensable and noncompensable diseases is needed. Finally, on the basis of its deliberation thus far on education and referral services (see Section 3), the committee believes that The most effective educational, organizational, psychosocial, and public-policy interventions for achieving the objectives of the RECA legislation could best be directed toward medical and social professionals who provide service to the RECA community, including people who might be eligible for compensation.
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This interim report reflects the consensus of the committee and has been reviewed in accordance with the procedures of the National Research Council. The list of reviewers is given in Appendix C. Sincerely, R.Julian Preston Chairman Committee to Assess the Scientific Information for the Radiation Exposure Screening and Education Program
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