DOE Field Task Proposal/Agreement: Medical Studies of the People of the Marshall Islands Accidentally Exposed to Fallout

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}vORK PACKAGE NUMBER 2 TASK NO 3. REV No 4 PROJECT NO 5 DATE PREPARED G cow \f~_~ToRN~B= TASK TITLE Medical Stud~es of the People 8 WORKPACKAGE TITLE BUDGET ANO REPORTING COOE 10 TASK TERM 11 contractor NAME /12 CODE The primary objective is the determination of the ~ife-tfie effects of fallout radiation on the Marshallese uho were accidentally exposed to radioactive fallout on March 1, 1954. ?tedical surveys of these people have been conducted at quarterly intervals. In the future, surveys will be semiannual in view of the improving medical care by Marshall Island Health Service under the direction of the Seventh Day Adventists (SDA) and the impending implementation of the Burton Bill- In the event that either or both fail to perform as expected, it will be necessary to revert to quarterly surveys. h unexposed Rongelap population is examined for comparison. The surveys, carried out jointly by Brookhaven National Laboratory under the auspices of the Department of Energy, and the Trust Territory of the Pacific Islands, are of great importance in. view of ~he development in this population of growth impairment in some exposed children, Lhyroid lesions, and one case of acute leukemia. 19. Contractor TASK MANAGER

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TASK REQUIREMENTS FOR OPERATING/E CIUIPMENT OBLIGATIONS AND COSTS Associated Universities, Inc. b TOTAL OPERATING COSTS d TOTJ. L EQUIPMENT COSTS

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TITLE Medical Studies of the People of the Marshall Islands Accidentally c Exposed to Fallout BUDGET AND REPORTING CODE DATE PREPARED Although the Liktanur II does not fulfill all the requirements for the BITT medical team, the Marshall Island Airline will be able to transport personnel to Rongelap and Utirik commencing in N’81 and, in part, fulfill the necessity of having a larger ship. Since there is adequate air transportation from Kwajalein to Ftajuro, the Liktanur 11 will not be required after a Hedical Facility is built on !4ajuro next to the new hos; ital site. Recent discussions with Marshall Island Government officials indicate that the new hospital will not b{: constructed for at least three years. Since its laboratories and x-ray facilities will be used, the services of Liktanur 11 will be required to provide laboratories and x ray until the new hospital and the BNL Medical Facility are constructed. None in 171’1980. In the interest of economy, the 25th year Report will be combined with the 26th year Annual Report and published in FY 1981. c Post-exposure surveys in the Marshall Islands have been conducted for 26 years. In addition to the 244 persons originally exposed, a group of unexposed ?larshallese are examined for a “comparison population” to assess late effects of radiation from fallout. The continuing development of thyroid neoplasms, biochemical hypothyroi.dlsm, and the appearance of one case of acute leukemia indicate the need for frequent examinations. In addition to routine physical, hematology.cal, and other laboratory examinations, the surveys involve special studies related to aging, malignancy, reproduction, and measurement of body burdens of radionuclides resulting from the slight contamination remaining on the islands. Patients with thyroid nodules are returned to the United States for hospitalization and surgical treatment as indicated. In view of the diverse medical problems and their management, a physician, a Marshallese nurse-practitioner , and a laboratory technician are in residence at Kwajalein and make intermittent trips to Rongelap, Majuro, and Utirik to supervise care and perform interim examinations of the exposed Marshallese. The work is conducted in conformance with generally accepted methodology for investigations of this character.

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T?TLE Medical Studies of the People of the Marshall Islands Accidentally Exposed to Fallout 20. Detail Attachments. Cent , BUDGET AND REPORTING CODE DATE PREPARED I TASK NO. REV. NO Fiscal control will be exercised in the fom of monthly comparisons, over the task term, of actual costs incurred against corresponding line items of the budget. Technical results shall be mol~itored through a periodic review, by the Contractor Task Manager, of accomplishments by measuring actual performance as compared to expected progress. All work shall be conducted in conformance with generally accepted standards for R&D and other investigative or analytic procedures , as observed by universities and large independent research facilities including Brookhaven National Laboratory. Technical Progress in FY 1980. In FY’80 there were two surveys: a September-October 1979 and a Hay-June 1980. The first survey vas primarily pediatric with consideration of those adults not Eeen in last survey, parasitologic, and dental examinations. The Hay-June survey considered adult exposed and non-exposed persons with emphasis on hematology and endocrinology. During FY’80 6 patients werr transported to BNL for general workup and thence to Cleveland for thyroid surgery. One patient had adenopapillary carcinoma and the others benign lesions. Dental, ophthalmologic, and parasitologic studies were continued. The incidence of spontaneous thyroid tumors in the unexposed Marshallese is still not known with any degree of certainty and, until this is established, the significance of the thyroid tumors seen in the Utirik population remains Pediatric Sick Call 1 25 17 43 Adult Sick Call 9 5 11 43 68 Thyroid, Lab, X tiy 9 33 4 19

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Medical STudies of the People BUDGET AND REPORTING CODE DATE PREPARED (,. of the Marshall Islands Accidentally Exposed to Fallout 20. Detail Attachments. cont. f. Technical Progress. cont. Technical Progress in FY 1980. cent . Utirik Rongelap Utirik Exposed Unexposed Unexposed Sick Group Group Group Call c Anthilminthic therapy (Vermox) continues. Dr. Krotos,ki, USPHS, Few Orleans supervises this and either he or an associate makes surveys annually. The BIW technician in residence has been exceedingly valuable in assisting the resident physician to continue to deliver improved medical care to the exposed populations and to consult with the Marshall Island Fealth Services. The revision to Liktanur 11 improved the ship considerably, although it is still not large enough to really supply the needs of the medical program. In addition, its sailing characteristics even in moderate seas induce a high incidence of severe seasickness in susceptible personnel. Expected Progress in H 1981. The Tabershaw contract for an epidemiological survey of Likiep was not implemented. The problem of disease on Likiep, asserted by others to be The educational activities of Dr. Naidu in 1979 were very helpful in bettering an understanding of the Marshallese and improving their attitudes towards the medical team. No untoward encounters were experienced although the political and legal activities of the Marshall Island Atomic Testing Litigation Project are beginning to stir Up further unrest. Tne survey of October-November 1?80 was completed. Four thyroid tumors were di>,covered. !%ree are in exposed persons (1 Ailinginae, 2 Utirik, and 1 an

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llTLE Medical Studies of the People of the Marshall Islands Accidentally Exposed to Fallout 20. Detail Attachments. Cent . 8UDG13 AND REPORTING CODE DATE PREPARED f. Technical Progress. cont. Expected Progress in FY 1981. cont. unexposed person from Wotje). The three exposed were brought to BNL on January 6, 1981 and were operated on in Cleveland the week of January 12th. Two tumors were benign,- and one was an adenocarcinoma. To date, suurnaries of Fertinent diagnoses of all exposed personnel cmnpleted arid will be forwarded to the resident physician and to Majuro exposure history and other pertinent data are microfiche. The examination of lerge numbers of Bikini people and extension of Wotje, Likiep, and other atolls cannot be undertaken without additional for BNL. It is probably unwise for BNL to undertake such epidemiologic The study of the Bikini people resident at Ejit and Ebeye is reasonable ahead. The entire BNL program should be revised if and when the Burton implemented , to assure that there is no duplication and that the programs complement each other. Expected Progress in FY 1982. In view of the serious late effects of fallout exposure, continued medical surveillance of the exposed populations is mandatory as the studies are still in the latent period of a number of significant carcinomas. Special examinations for the thyroid abnormalities, as well as for neoplasia of other organs and tissues, and other late effects, must be continued. In light of the recent renewal of interest of long-term effects of “low level” radiation, the data from this study, even though the population is small, should serve as one of the longest prospective studies of the effects of both acute high level and long–tern low level external and internal radiation. Other studies to be pursued include: a) thyroid comparison studies with thyroid surgery in the United States on unexposed Rongelap and Utirik people in the extended comparison study where such surgery is indicated; b) reevaluation of dosimetry of the Utirik people, including thyroid doses; c) study of the nature and the treatment of diabetes in Marshallese to include trace element ar.alysis of the people and the ecosystem; d) studies with Dr. R>ymond A. Popp of Oak Ridge for frequency of isolucine substitution in hemoglobin of Marshallese blood as an index of somatic mutations associated with radiation exposure and aging; and e) studies of polymorphism and rare protein variance in the blood cells of children of exposed and unexposed parents—Dr. James V. Neel at the University of Michigan has expanded his battery of tests for these variants and has agreed to continue these studies on Marshallese children. Expected Progress in FT 1983. Continuation of the medical surveys and limited primary care of the Marshallese is anticipated on an indefinite basis. Emphasis will be placed on examinations for thyroid abnormalities , the previously-mentioned cancers,

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TITLE Medical Studies of the People 8UDGET AND REPORTING CODE DATE PREPARED of the Marshall Islands Exposed to Fallout hematologic disorders, and other possible effects of radiation exposure. tion with the patient and ecosystem rmnitoring teams from the Safety and mental Protection Division will continue. The scope of this program will revised as the Burton Bill is implemented. Data obtained from this study will continue to provide baseline statistics for all studies of human health effects of acute high level and long-term low lr:vel internal and external radiation. h. Relationships to Other Projects. The studies of the exposed Marshallese are closely related to the Radiation Effects Research Foundation studies in Japan and to the studies of the 23 Japanese fisherman exposed at the same time as the Marshallese to fallout. Acute and long-term, low-level radiation ranks as one of the most important hazards that must be considered in the DOE medical programs. The effects of fallout exposure in the Marshallese provides valuable i.nfo~ationj particularly with regard to thy– roid effects from radioiodine exposure, that may relate to future reactor accidents. The longitudinal Marshallese data have been used in the analysis of such accidents. The data are also quoted in other reports such as those of the NCRP, ICRP, BIER, and the United Nations. The Safety and Environmental Protection Division of this Laboratory conducts radiological personnel and environmental surveys of contaminated Marshall Islands and their inhabitants. These studies are closely coordinated with the medical Work done under this task proposal has either no environmental impact or has impacts similar to those described in and covered by BNLs Environmental Impact Capital Equipment Requirements for FY 1983. A thyroid scanning system for combined x-ray fluorescence and radionuclide imaging studies is necessary CO identify nodules of interest. The system employs a large germanium detector (6 cm diameter, 2 cm thick) in a vertical mount; the duced and available at BSL in high purity and in large amounts. The system uses

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‘TLE Medical Studies of the People 8UDGET AND REPORTING CODE DATE PREPARED of the Marshall Islands Accidentally 20. Detail Attachments. cont. Capital Equipment Requirements for A’ 1983. cent . pulse-stepping motors driving a precision machine tool scanning table, under computer control, acquiring counts from characteristic x and gamma rays in CAt4AC scalers and storing. these in an LSI-11 in the CAMAC controller. Data can be archived on floppy discs for analysis and image production, A monitor display will be included, but final high quality images will be produced in the nuclear medicine general purpcse This system will provide high quality diagnostic images that scale precisely to the anatomical size of the neck. Nodules can then be marked on the image to con– pare precis?ly what is felt by the physician and what is detected by the imaging procedure. The x-ray fluorescence scan provides information on the iodine content of the thyroid that can be differentiated from findings on solid tumors by ultraThe x-ray fluorescence method yields data with low false negative rate; conveys very low radiation dose to the subject (< 100 mrem/study-–thyroid dose, essen– tially O whole body dose); and should be used in populations in which the risk of thyroid cancer is high and where there is reason to minimize radiation exposure. One-half the cost of the system ($20,000) is requested for studies of Marshallese patients. The balance of the cost will be requested in the Nuclear Medicine Program A portable x-ray unit ($7,000) is required to replace a device that is expected to be beyond economical repair. The unit currently in use by Yedical Team surveyors is exposed to salt air and water. It is essential that the survey team have equip– ment that is reliable and as maintenance free as possible.