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Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
×

ASSESSMENT OF THE SCIENTIFIC INFORMATION FOR THE RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM

Committee to Assess the Scientific Information for the Radiation Exposure Screening and Education Program

Board on Radiation Effects Research

Division on Earth and Life Studies

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W. Washington, DC 20001

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 study was supported by contract DHHS 232-02-0004 between the National Academy of Sciences and the Health Resources and Services Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

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Copyright 2005 by the National Academy of Sciences. All rights reserved.

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Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized 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 advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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COMMITTEE TO ASSESS THE SCIENTIFIC INFORMATION FOR THE RADIATION EXPOSURE SCREENING AND EDUCATION PROGRAM

R. JULIAN PRESTON (Chair),

Environmental Carcinogenesis Division, National Health and Environmental Effects Research Laboratory, US Environmental Protection Agency, Research Triangle Park, NC

THOMAS B. BORAK,

Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO

CATHERINE BORBAS,

Health Care Evaluation and Research Foundation, St. Paul, MN

A. BERTRAND BRILL,

Radiology Department, Vanderbilt University School of Medicine, Nashville, TN

THOMAS E. BUHL,

Health Safety and Radiation Protection Division, Los Alamos National Laboratory, Los Alamos, NM

PATRICIA A. FLEMING,

College of Arts and Sciences, Creighton University, Omaha, NE

SHIRLEY A. FRY,

Indiana University School of Medicine, Indianapolis, IN

RICHARD HORNUNG,

University of Cincinnati, Cincinnati, OH

KATHLEEN N. LOHR,

RTI International, Research Triangle Park, NC

STEPHEN G. PAUKER,

Tufts-New England Medical Center, Boston, MA

CONSULTANT

ELAINE RON,

National Cancer Institute, Bethesda, MD

NATIONAL RESEARCH COUNCIL STAFF

ISAF AL-NABULSI, Study Director

COURTNEY GIBBS, Program Assistant

DORIS E. TAYLOR, Staff Assistant

NORMAN GROSSBLATT, Senior Editor

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
×

BOARD ON RADIATION EFFECTS RESEARCH

S. JAMES ADELSTEIN (Chair),

Harvard Medical School, Boston, MA

HAROLD BECK,

Environmental Sciences Division (ret.), New York, NY

JOEL S. BEDFORD,

Colorado State University, Fort Collins, CO

JAMES E. CLEAVER,

University of California San Francisco Cancer Center, San Francisco, CA

SARAH S. DARBY,

University of Oxford, Oxford, United Kingdom

SARAH S. DONALDSON, (member until 7/31/2004),

Stanford University Medical Center, Stanford, CA

SHARON L. DUNWOODY,

University of Wisconsin, Madison, WI

EDWARD R. EPP, (member until 7/31/2004), Professor Emeritus,

Harvard University, Boston, MA

DANIEL KREWSKI,

University of Ottawa, Ottawa, Canada

C. CLIFTON LING,

Memorial Sloan-Kettering Cancer Center, New York, NY

WILLIAM F. MORGAN, (member until 7/31/2004),

University of Maryland, Baltimore, MD

THEODORE L. PHILLIPS,

University of California, San Francisco, CA

FRANKLYN G. PRENDERGAST, (member until 7/31/2004),

Mayo Clinic Cancer Center, Rochester, MN

ANDREW M. SESSLER,

Lawrence Berkeley National Laboratory, Berkeley, CA

JOHN C. VILLFORTH,

Food and Drug Law Institute (ret.), Derwood, Maryland

PAUL L. ZEIMER,

Purdue University, West Lafayette, IN

NATIONAL RESEARCH COUNCIL STAFF

EVAN B. DOUPLE, Director,

Board on Radiation Effects Research

ISAF AL-NABULSI, Senior Program Officer

RICK JOSTES, Senior Program Officer

CATHERINE S. BERKLEY, Administrative Associate

COURTNEY GIBBS, Program Assistant

DORIS E. TAYLOR, Staff Assistant

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
×

Acknowledgments

During the committee’s deliberations, several people provided information to the committee. Their contributions invigorated committee deliberations and enhanced the quality of this report. The committee expresses its appreciation to the Health Resources and Services Administration (HRSA) for sponsoring the study.

The committee and the staff of the Board on Radiation Effects Research (BRER) are grateful for the information provided by invited speakers, who generously contributed their time and participated in the committee’s information-gathering meetings: Rebecca Barlow, Alfred Berg, Evelyn Bromet, Douglas M. Brugge, Teresa Coons, Regan Crump, Gerard W. Fischer, David S. James, Richard Kerber, Kiyo Mabuchi, Parthiv Mahadevia, Kimberly Mohs, Karen Mulley, Linda Nelson, Lynne Pinkerton, Regina Ponder, Neil R. Powe, Nettie Prack, Kandace Romero, Steve Simon, Stephanie Singer, Sylvia Echave Stock, Bruce Struminger, Kathleen Taimi, Robert Ursano, and Steven H. Woolf.

The committee is especially grateful for the information provided by downwinders and uranium miners throughout its work. They provided records, explained their concerns, and assisted us in understanding the conditions surrounding the nuclear-weapon tests and the mines. The committee and the BRER staff are appreciative of the information, feedback, and background materials for review provided by invited speakers, the public, the Department of Justice, and HRSA and its grantees. We hope that our work will help to generate changes in the Radiation Exposure Screening and Education Program and Radiation Exposure Compensation Act programs that will make them both more effective.

Finally, the committee thanks the National Research Council staff who worked directly with us, especially Study Director Dr. Isaf Al-Nabulsi for her expertise, dedication, and hard work; for keeping the committee focused and assisting in the writing and preparation of our report; and for her enormous effort in producing a clearly written, well-organized report that reflects the thought of the committee. Dr. Al-Nabulsi was well assisted in the administration of the committee’s work by Courtney Gibbs, Doris E. Taylor, and Danielle B. Greene, Banneker-Anderson intern.

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Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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Reviewers

This report has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Council’s Report Review Committee. The purposes of this review are to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards of 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 wish to thank the following for their participation in the review of this report:

John C. Bailar III, The University of Chicago, Washington, DC

Harold L. Beck, Environmental Sciences Division, New York, NY

Joel S. Bedford, Colorado State University, Ft. Collins, CO

Alfred O. Berg, University of Washington School of Medicine, Seattle, WA

Bernard L. Cohen, University of Pittsburgh, Pittsburgh, PA

Kenneth J. Kopecky, Fred Hutchinson Cancer Research Center, Seattle, WA

Jonathan D. Moreno, University of Virginia, Charlottesville, VA

Robert S. Lawrence, Johns Hopkins University, Baltimore, MD

Fred A. Mettler, The University of New Mexico, Albuquerque, NM

Jonathan M. Samet, Johns Hopkins University, Baltimore, MD

Daniel O. Stram, University of Southern California, Los Angeles, CA

John E. Till, Risk Assessment Corporation, Neeses, SC

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Robert A. Frosch, John F. Kennedy School

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
×

of Government, Harvard University (Senior Research Fellow) and William J. Schull, University of Texas, School of Public Health (Ashbel Smith Professor Emeritus). Appointed by the National Research Council, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the National Research Council.

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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A Note on the Units of Measurement Used in this Report

It has been the custom of the Board on Radiation Effects Research to use the International System of Units (SI) in its reports. The relationships between the units used in this report and the corresponding traditional units and special names are shown below. Decimal multiples and submultiples of the units also are used, for example, kilo (K = 1,000 or 103), mega (M = 1 million or 106), milli (m = 1/1,000 or 10−3), micro (µ = one millionth or 10−6), nano (n = one billionth or 10−9), and pico (p = one trillionth or 10−12).

Concept

Symbol

Dimensions

Units

Conversion

SI

Traditional

Radioactivity

A

Decays/time

(Bq) Becquerel

(Ci) Curie

1 Ci = 3.7 × 1010 Bq

Absorbed dose

D

Energy/mass

(Gy) Gray

Rad

1 rad = 10−2 Gy

Equivalent dose

H = Dwr

Energy/mass

(Sv) Sievert

Rem

1 rem = 10−2 Sv

Effective dose

E = HwT

Energy/mass

(Sv) Sievert

Rem

1 rem = 10−2 Sv

Working level

WL

Energy/volume

Jm−3

WL

1 WL = 2.08 × 10−5 Jm−3

Working level month

WLM

Energy time/volume

Jsm−3

WLM

1 WLM = 12.7 Jsm−3

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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5

 

EXPANDING RECA ELIGIBILITY: SCIENTIFIC ISSUES

 

122

   

 Probability of Causation,

 

125

   

 Tools for Determining PC/AS,

 

131

   

 Use of PC/AS in Adjudication,

 

136

   

 Application of PC/AS for Fallout from Atmospheric Weapons Testing,

 

138

   

 Concerns with Using PC/AS in Compensation Programs,

 

139

   

 Conclusion,

 

141

   

 Annex,

 

143

6

 

EXPANDING RECA ELIGIBILITY: IMPLEMENTATION

 

148

   

 Probability of Causation/Assigned Share,

 

148

   

 Exposure to Fallout Radiation,

 

151

   

 Implementation and Anticipated Impact of the Recommendation To Expand the Scope of RECA to Additional Geographic Areas,

 

164

   

 Uranium Miners, Millers, and Ore Transporters in Other Geographic Areas,

 

168

   

 Conclusion,

 

169

7

 

DISEASES, POPULATIONS, AND OTHER ISSUES OF PUBLIC CONCERN

 

172

   

 Malignant Diseases,

 

173

   

 Nonmalignant Diseases,

 

188

   

 Psychologic Consequences of Radiologic Threats,

 

196

   

 Additional Populations Occupationally at Risk for Radiation Exposure,

 

198

   

 Additional Populations Environmentally at Risk for Radiation Exposure,

 

199

   

 Defined Intervals for Which Compensation Is Granted,

 

202

   

 Groups at Risk of Exposure Outside RECA’s Time-Since-Exposure Intervals,

 

203

   

 Other Issues of Public Concern Regarding Eligibility for Compensation,

 

203

8

 

ETHICAL FRAMEWORK

 

205

   

 The Ethics of a Compensation Program: Rectificatory and Distributive Justice,

 

206

   

 The Ethics of Medical and Compensational Screening

 

214

   

 Conclusion,

 

218

Suggested Citation:"Front Matter." National Research Council. 2005. Assessment of the Scientific Information for the Radiation Exposure Screening and Education Program. Washington, DC: The National Academies Press. doi: 10.17226/11279.
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The Radiation Exposure Compensation Act (RECA) was set up by Congress in 1990 to compensate people who have been diagnosed with specified cancers and chronic diseases that could have resulted from exposure to nuclear-weapons tests at various U.S. test sites. Eligible claimants include civilian onsite participants, downwinders who lived in areas currently designated by RECA, and uranium workers and ore transporters who meet specified residence or exposure criteria. The Health Resources and Services Administration (HRSA), which oversees the screening, education, and referral services program for RECA populations, asked the National Academies to review its program and assess whether new scientific information could be used to improve its program and determine if additional populations or geographic areas should be covered under RECA. The report recommends Congress should establish a new science-based process using a method called "probability of causation/assigned share" (PC/AS) to determine eligibility for compensation. Because fallout may have been higher for people outside RECA-designated areas, the new PC/AS process should apply to all residents of the continental US, Alaska, Hawaii, and overseas US territories who have been diagnosed with specific RECA-compensable diseases and who may have been exposed, even in utero, to radiation from U.S. nuclear-weapons testing fallout. However, because the risks of radiation-induced disease are generally low at the exposure levels of concern in RECA populations, in most cases it is unlikely that exposure to radioactive fallout was a substantial contributing cause of cancer.

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