Potential Radiation Exposure in Military Operations Protecting the Soldier Before, During, and After (1999) / Chapter Skim
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7 Follow-up of Persons with Known or Suspected Exposure to Ionizing Radiation
7 Follow-up of Persons with Known or Suspected Exposure to Ionizing Radiation
Pages 88-107
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From page 88... ...
assumes the rode for health care in certain circumstances after discharge from active duty. The current list of exceptions to complete coverage of health care responsibility, such as for the National Guard or the National Reserves when they are not actively deployed, is expected to grow as DoD moves to outsource much of its medical care and VA changes its eligibility criteria.
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From page 89... ...
In this chapter, the committee uses the following definitions with respect to prior known or suspected exposures to radiation: · medical assessment: early postexposure basic health evaluation; · medical monitoring: the screening of asymptomatic populations; · medical testing: the testing of an individual when judged to be necessary by a clinician on the basis of a clinical examination, history, and risk factors; and · medical care: the management of clinically apparent injuries, diseases, or conditions. Although there may be a concurrent or future benefit to the individuals involved, the purpose of epidemiologic follow-up is to identify deviations from normal health parameters among defined groups of people over the short and the long term.
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From page 90... ...
or other detriments to an individual's performance during a military operation that carried a risk of exposure to radiation. Personnel are not likely to develop symptoms of acute radiation exposure at the dose range considered in this report (50 to 700 millisievert [mSv]
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From page 91... ...
In this report, the committee considers these and other issues of concern associated with medical monitoring programs in general and, specifically, as they relate to persons exposed to radiation. Medical Monitoring for Delayed Deterministic and Stochastic Effects of Radiation Because the effective dose range of interest for this report 50 to 700 mSv is unlikely to cause delayed acute or chronic deterministic effects, the committee concentrates its discussion of medical monitoring or screening on malignant disease, which is the main long-term effect of radiation exposure.
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From page 92... ...
They are · all forms of leukemia except chronic lymphocytic leukemia · cancer of the thyroid, breast, lung, bone, liver, skin, esophagus, stomach, colon, pancreas, kidney, urinary bladder, ovaries, salivary gland, rectum, brain, and central nervous system; multiple myeloma; and lymphomas other than Hodgkin's disease; · posterior subcapsular cataracts; · nonmalignant thyroid nodular disease; and · parathyroid adenomas. Effective September 24, 1998, VA added both the broad category of "any other cancer" and the specific diagnosis of prostate cancer to this list of radiogenic conditions, despite the weakness of current scientific evidence for this conclusion.
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From page 93... ...
that occurred spontaneously. The latent period between radiation exposure and the development of a clinically detectable tumor may have an effect on the design of a screening program.
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From page 94... ...
There must also be an intervention or a therapy that is effective, available, and acceptable to the patient. A number of screening programs have found smaller tumors in high-risk populations (e.g., chest x rays of smokers)
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From page 95... ...
At present genetic testing is used only in the clinical management of families with well-defined inherited cancer syndromes. Screening for Specific Cancers Although certain types of leukemia and some cancers are generally accepted as having a scientific basis for their designation as "radiogenic cancers," to date screening programs have been shown to effectively reduce mortality only for cancers of the female breast and colon among this group of potentially radiogenic tumors.
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From page 96... ...
On the basis of the risk from the dose range considered in this report (50 to 700 mSv) and the lack of effective screening tests for neoplasms such as leukemia, radiation exposure should not play a significant role in the decision to test individuals.
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From page 97... ...
In evaluating the effects on health of radiation released by the detonation of nuclear weapons or the dispersion of nuclear materials, DoD has concentrated its preparedness planning and extensive research efforts on the acute deterministic effects of radiation, including the acute radiation syndrome and the associated bone marrow depression. Events in which these types of radiation-induced injuries have occurred have been documented and reviewed extensively and have been presented together with the current recommendations for evaluation, medical care, and follow-up of exposed individuals (Mettler et al., 1990; Reeves et al., 1998~.
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From page 98... ...
After higher but sublethal whole-body doses, males will experience a low sperm count with a nadir at about 45 days postexposure or an absence of sperm postexposure for a period that is directly proportional to the dose. Females may experience a period of amenorrhea after acute radiation exposure.
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From page 99... ...
However, the committee agrees that routine monitoring programs established specifically for persons with known or suspected exposure to radiation would not be useful at this time, given the limitations of current cancer screening programs. The follow-up obligation is directly applicable to soldiers who were at risk of exposure, and for whom the increased risk of long-term adverse health effects is known or reasonably suspected.
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From page 100... ...
with which study subjects can be enrolled; · magnitude and distribution of exposure to the hazard being studied; · accuracy including the unbiased collection of data and adherence to a defined time frame with which the exposure can be measured (measurement of absorbed dose, as in the atomic bomb survivors, is extremely important since the most compelling evidence of causality is the demonstration of a dose-response relationship) ; · accuracy including the unbiased collection of data and adherence to a defined time frame-of disease identification (history of disease should be confirmed from hospital records, and causes of death should be determined by obtaining copies of death certificates)
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From page 101... ...
Problems specific to the measurement of radiation exposure are discussed in Chapter 2 of this report. The quality of the exposure data tremendously influences the feasibility and usefulness of such studies.
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From page 102... ...
For example, in conducting a mortality study of military participants in Operation CROSSROADS, a nuclear test series done in 1946, researchers (Johnson et al., 1996) required records maintained by the VA's health and benefits components; DoD ship logs and morning reports, which are now stored in paper files in cartons at numerous facilities of the National Archives and Records Administration; National Personnel Records Center in St.
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From page 103... ...
Most veterans, however, do not go to VA for health care, and those who do are predominantly those who have service-connected disabilities or who are eligible for coverage because of low income. Hence, any study findings limited to VA health care databases could not easily be generalized beyond those groups.
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From page 104... ...
Examples of different study populations include veterans (or their records) who actively respond to active VA or DoD requests for volunteers, veterans whom VA or DoD identifies passively through administrative records, and scientifically designed samples or groups of veterans with either a common exposure or a common adverse health outcome who are systematically followed for appropriate data collection.
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From page 105... ...
In this brief section of its report, the committee raises the issue of psychological effects, including stress; this report is not the setting for a complete discussion of the complex components of that subject. Usually, the perception of the risk from radiation exposure is much greater than the actual risks described in the scientific literature.
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From page 106... ...
Stress can generally be defined as adverse mental experiences that have negative effects on bodily functions; it can be measured by physiological indices (Lee, 19961. Delayed and incomplete transfer of information from responsible authorities to potentially exposed persons has been a major cause of psychological stress in many radiation exposure situations (Lee, 19961.
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From page 107... ...
FOLLOW-UP OFIONIZING RADIATION EXPOSURE 107 Particular attention should be paid not only to relieving the stress of the individuals involved but also to the social task of reestablishing support and mutual understanding between individuals. The social stigmatization of exposed persons such as after the atomic bombings of Hiroshima and Nagasaki as well as after Chernobyl results in prejudice and cuts off social contact and communication (Lee, 19961.
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