ANALYSIS OF CANCER RISKS IN POPULATIONS NEAR NUCLEAR FACILITIES

Phase 1

Committee on the Analysis of Cancer Risks in Populations near Nuclear Facilities—Phase 1

Nuclear and Radiation Studies Board
Division of Earth and Life Studies

NATIONAL RESEARCH COUNCIL
          OF THE NATIONAL ACADEMIES

The National Academies Press
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Committee on the Analysis of Cancer Risks in Populations near Nuclear Facilities—Phase 1 Nuclear and Radiation Studies Board Division of Earth and Life Studies

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This study was supported by Contract/Grant No. NRC-04-10-152 between the National Academy of Sciences and the U.S. Nuclear Regulatory Commission. 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 organiza- tions or agencies that provided support for the project. International Standard Book Number-13: 978-0-309-25571-4 International Standard Book Number-10: 0-309-25571-6 Cover images: Regional maps of northeastern (front cover) and northwestern (back cover) states and populations living in census tracts within 30 miles of nuclear power plants. See Figures 4.4a-d for more information. Maps were created by com- mittee member Lance Waller (Emory University, Atlanta, Georgia). Additional copies of this report are available for sale 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 2012 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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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 Acad- emy 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 en- gineers. 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 engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent 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 Insti- tute 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 Sci- ences 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 Coun- cil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON THE ANALYSIS OF CANCER RISKS IN POPULATIONS NEAR NUCLEAR FACILITIES—PHASE 1 JOHN E. BURRIS, Chair, Burroughs Wellcome Fund, Research Triangle Park, North Carolina JOHN C. BAILAR, III, University of Chicago (retired), Washington, DC HAROLD L. BECK, Environmental Measurements Laboratory (retired), New York, New York ANDRE BOUVILLE, National Cancer Institute (retired), Bethesda, Maryland PHAEDRA S. CORSO, University of Georgia, Athens PATRICIA J. CULLIGAN, Columbia University, New York, New York PAUL M. DELUCA, JR., University of Wisconsin, Madison RAYMOND A. GUILMETTE, Lovelace Respiratory Research Institute, Albuquerque, New Mexico GEORGE M. HORNBERGER, Vanderbilt Institute for Energy and Environment, Nashville, Tennessee MARGARET KARAGAS, Dartmouth College, Hanover, New Hampshire ROGER KASPERSON, Clark University (retired), Worcester, Massachusetts JAMES E. KLAUNIG, Indiana University, Bloomington TIMOTHY MOUSSEAU, University of South Carolina, Columbia SHARON B. MURPHY, University of Texas Health Science Center (retired), Washington, DC ROY E. SHORE, Radiation Effects Research Foundation, Hiroshima, Japan DANIEL O. STRAM, University of Southern California, Los Angeles MARGOT TIRMARCHE, Institute of Radiological Protection and Nuclear Safety, Fontenay-aux-Roses, France LANCE WALLER, Emory University, Atlanta, Georgia GAYLE E. WOLOSCHAK, Northwestern University, Chicago, Illinois JEFFREY J. WONG, California Environmental Protection Agency, Sacramento Staff KEVIN D. CROWLEY, Study Director OURANIA KOSTI, Program Officer TIMOTHY A. BOULEY, Research Associate TONI GREENLEAF, Administrative and Financial Associate SHAUNTEÉ WHETSTONE, Senior Program Assistant ERIN WINGO, Communications Liaison JAMES YATES, JR., Office Assistant v

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NUCLEAR AND RADIATION STUDIES BOARD JAY DAVIS (Chair), Hertz Foundation, Livermore, California BARBARA J. MCNEIL (Vice Chair), Harvard Medical School, Boston, Massachusetts JOONHONG AHN, University of California, Berkeley JOHN S. APPLEGATE, Indiana University, Bloomington MICHAEL L. CORRADINI, University of Wisconsin, Madison PATRICIA J. CULLIGAN, Columbia University, New York ROBERT C. DYNES, University of California, San Diego JOE GRAY, Lawrence Berkeley National Lab, Berkeley, California DAVID G. HOEL, Medical University of South Carolina, Charleston HEDVIG HRICAK, Memorial Sloan-Kettering Cancer Center, New York THOMAS H. ISAACS, Stanford University, Palo Alto, California ANNIE B. KERSTING, Glenn T. Seaborg Institute, Lawrence Livermore National Laboratory, Livermore, California MARTHA S. LINET, National Institutes of Health, Bethesda, Maryland FRED A. METTLER, JR., New Mexico VA Health Care System, Albuquerque BORIS F. MYASOEDOV, Russian Academy of Sciences, Moscow RICHARD J. VETTER, Mayo Clinic, Rochester, Minnesota RAYMOND G. WYMER, Oak Ridge National Laboratory, Oak Ridge, Tennessee (retired) Staff KEVIN D. CROWLEY, Senior Board Director JENNIFER A. HEIMBERG, Senior Program Officer OURANIA KOSTI, Program Officer TONI GREENLEAF, Administrative and Financial Associate LAURA D. LLANOS, Administrative and Financial Associate SHAUNTEÉ WHETSTONE, Senior Program Assistant ERIN WINGO, Senior Program Assistant JAMES YATES, JR., Office Assistant vi

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Acknowledgments The committee wishes to acknowledge and thank a number of individu- als and organizations for their valuable contributions to this study: • The U.S. Nuclear Regulatory Commission (USNRC) for its spon- sorship of this study, and especially USNRC staff members Brian Sheron, Terry Brock, Vered Shaffer, Marilyn Diaz, John Tomon, Scott Burnell, Dave McIntyre, Richard Conatser, John Cassidy, and Don Stearns. Dr. Brock, the USNRC’s designated liaison to the committee, served as a guide to the USNRC’s regulatory programs and the agency’s vast collection of technical documents. • The presenters at the committee’s information-gathering meetings, who are listed in Appendix C. • Members of the public and nongovernmental organizations who shared their perspectives and concerns about cancer risks associ- ated with living near nuclear facilities. Some submitted extensive written information, notably: Beyond Nuclear, the Erwin Citizens Awareness Network, Inc., the C-10 Foundation, and Anthony and Ipatia Apostolides. Their comments helped to shape the epidemio- logic study designs that are recommended in this report. • The Electric Power Research Institute (especially Phung Tran), Raid Amin, University of West Florida, and Steve Wing, University of North Carolina at Chapel Hill, for providing written advice on epidemiologic study designs. • Willie Harris and Robert Osgood, Dresden Nuclear Power Station, Kathy Yhip and Mike Russell, San Onofre Nuclear Generating Sta- vii

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viii ACKNOWLEDGMENTS tion, and Marie Moore and Mark Elliott, Nuclear Fuel Services, Inc (NFS), for supporting facility visits by subgroups of committee members. Ms. Moore also provided information about NFS’ efflu- ent release records. • Rosanne Aaberg (Pacific Northwest National Laboratory [PNNL]) and David Baker (PNNL, retired) for assistance in obtaining PNNL’s archived data on nuclear plant effluent releases. • Ralph Andersen and Andrew Mauer, Nuclear Energy Institute, for providing information about operating practices and effluent release records at nuclear power plants. • Robert Anderson, National Center of Health Statistics, Centers for Disease Control and Prevention (CDC), Christie Eheman, National Center for Chronic Disease Prevention and Health Promotion, CDC, Kevin Ward, Georgia Center for Cancer Statistics, and Scott Boggess, U.S. Census Bureau, for guidance on sources of health and population data. • Directors and staff of state departments of public health, can- cer registries, and vital statistics offices for providing information about the availability and release of health data (see Appendixes K-M). The committee extends special thanks to the staff of the National Research Council for supporting this study. Study director Kevin Crowley and program officer Ourania Kosti organized the committee meetings and assisted the committee with report writing and review. They also provided valuable insights and perspectives on many aspects of the study. Shaunteé Whetstone managed the logistics of the meetings, report review, and pub- lication. Erin Wingo led the public communication efforts with help from Catherine Allen-West. Jennifer Walsh led the media communication efforts. Timothy Bouley assisted with information gathering and analysis. Roger Herdman, Institute of Medicine, provided guidance on identifying surveil- lance systems that collect information on population characteristics over time. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with proce- dures approved by the Report Review Committee of the National Research Council. The purpose of this independent review is to provide candid and critical comments that will assist the National Research Council in making its published report as sound as possible and will ensure that this report meets institutional standards for 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 participation in the review of this report:

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ix ACKNOWLEDGMENTS • John Applegate, Indiana University • John Boice, International Epidemiology Institute • Christie Eheman, Centers for Disease Control and Prevention • David Hoel, Medical University of South Carolina • David Kocher, SENES Oak Ridge, Inc. • Martha Linet, National Cancer Institute • Paul Locke, Johns Hopkins Bloomberg School of Public Health • Fred Mettler, New Mexico VA Healthcare System • Beth Mueller, Fred Hutchinson Cancer Research Center • Donald Pierce, Oregon Health and Science University • Daniel Strom, Pacific Northwest National Laboratory • John Till, Risk Assessment Corporation • Richard Vetter, Mayo Clinic (retired) Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the contents of this report, nor did they see the final draft of the report before its release. The review of this report was overseen by Lynn Goldman, George Washington University, and Jon Samet, University of Southern California. Appointed by the National Research Council, Drs. Goldman and Samet 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 considered carefully. Responsibility for the final content of this report rests entirely with the authorizing committee and the institution.

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Contents SUMMARY 1 1 INTRODUCTION 11 Background on the Study Request, 13 Previous Studies of Cancer Risks, 25 Strategy to Address the Study Charge, 27 Information Gathering and Report Organization, 32 2 EFFLUENT RELEASES FROM NUCLEAR POWER PLANTS AND FUEL-CYCLE FACILITIES 35 Effluent Releases from Nuclear Plants, 36 Effluent Releases from Fuel-Cycle Facilities, 67 Environmental Monitoring, 73 Availability of Meteorological Data, 90 Findings and Recommendations, 91 3 RADIATION DOSE ASSESSMENT 97 Background on Dose Assessment and Dose Reconstruction, 97 Reported Radiation Doses around Nuclear Plants, 104 Reported Dose Estimates around Nuclear Fuel-Cycle Facilities, 114 Approaches for Estimating Doses for an Epidemiologic Study, 118 Other Risk Factors, 129 xi

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xii CONTENTS Characterizing and Communicating Uncertainties, 135 Findings and Recommendations, 137 4 EPIDEMIOLOGIC STUDIES 143 Background on Epidemiologic Studies, 143 Study Designs Considered, 147 Data Sources and Methods, 206 Findings and Recommendations, 246 5 RISK COMMUNICATION AND PUBLIC ENGAGEMENT 253 Public Perceptions about Nuclear Power, 254 Risk and Communication, 254 Public Engagement in Phase 1 Study, 258 Public Engagement in Phase 2 Study, 264 Recommendation, 267 APPENDIXES A Radiation as a Carcinogen 271 B Biographical Sketches of Committee and Staff 331 C Presentations and Visits 343 D Origin of Radioactivity in Nuclear Plants 347 E Origin of Radioactivity in Fuel-Cycle Facilities 351 F Regulation of Effluent Releases 355 G Radiological Effluent Technical Specifications (RETS) 359 H Radiological Environmental Monitoring Program (REMP) 367 I Radiation Dose Assessment 371 J Modeling Incidence and Mortality Data in an Ecologic Study 389 K Letter Template to State Cancer Registry 395 L Letter Template to State Vital Statistics Offices 397 M Letter Template to Departments of Public Health 399 N Glossary 401 O Acronyms 409