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Machine-read from the scan, so expect some errors. Lines that couldn’t be read are left out.
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The GeneimaI Manager has requested that the attached memorandum of May 4, 1966 from the Di,rector of Biology and Medicine, w’ith attachments, be circulated for consideration by the Commission at the Information Meeting scheduled for Dir. of Regulation Asst. GM for Reactors Reactor Dev. & Tech.
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ATOMIC ENERGY COMMISSION f SUBJECT: CURRENT STATUS OF THYROID NODULES AMONG THE MARSHALLESE EXPOSED TO FALLOUT FROM THE BIKINI TEST OF MARCH 1, 1954 In our last memorandum on this subject, October 11, 1965, it was noted that a cumulative total of 11 instances of nodular thyroid glands had been found in the 69 surviving Marshallese who had been exposed to fallout from the subject test while on Rongelap and on Ailingnae. All but one of these cases were in young people who were less than 10 years old at the time of exposure. The single exception was in a 41-year-old woman (approximately 30 at time of exposure) who was found to have a carcinoma of the thyroid at operation. Dr. Robert A. Conard of the Medical Department of Brookhaven National Laboratory, and leader of the annual (or more often) medical surveys of these people, has just returned from the latest survey conducted during February and March of 1966. He reports that an additional five cases of nodular thyroids have been diagnosed in this group. The present cumulative incidence is shown in the following table. Age at Number Total Incidence of Nodules Exposure Exposed Through March 1966
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Fifty-five of the 69 were on Rongelap Island and received estimated whole body doses of 175 R plus possible doses of 700 to 1400 rem to their thyroids from the radioiodines. The remaining 14 (six were 1-10 years of age) were visiting on Ailingnae, a nearby island, and received estimated doses of 69 R whole body exposure, plus less certain but probably small thyroid doses. None.of the six children who were on Ailingnae have thus far developed nodules$ so that the incidence of nodules among the 19 more heavily exposed on Rongelap when 1-10 years old is 13/19 or 68 percent. Two of the three adults were on Rongelap and one was on Ailingnae. Thus far only six of the above, including the adult found to have cancer, have been subjected to surgery. The current plans are to bring five of the remaining 10 cases to Brookhaven for further diagnostic study and possible surgery during May 1966. One is z 46-year-old adult woman and the others are girls presently 13, 13, 13 and 20 years old. They will be accompanied by the Rongelap schoolteacher who will act as interpreter. The travel and treatment of these people has been developed with the cooperation of the Honorable Wilfred Goding, High Commissioner, Trust Territory of the All these Marshallese presumably have been taking tetraiodothyronine, a synthetic thyroid hormone, for the last seven months. The intent of the therapy is to prevent and/or cause regression of the nodules. Some success has been seen, but it is too soon to draw conclusions. Forty children who were on Utirik at the time and received estimated doses of 14 R plus proportionately smaller internal thyroid doses were examined for nodular thyroids; none were found. Among 194 unexposed controls who are now living on these islands,
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OPTIONAL FORM NO, ,0 5010-107 ,bivision of Public information PEOPLE WHO HAVE THYROID NODUIJ3S Attached for your approval are a proposed to inquiries on circumstances surrounding detected in the Marshallese people during Two upcoming events are likely to receive public announcement and responses five new cases of thyroid nodules the March, 1966, medical survey. news media attention: the arrival, this month, of five Rongelap people in this country for clinical examination and possible surgery; and the appearance of an article, in June, in the New England Journal recommend that the announcement be approved for issuance by Brookhaven National Laboratory just before the arrival of the five Marshallese. The questions and answers are for use to the extent necessary in response to telephone inquiry only, or for guidance before interview with media repreGeneral Manager Date
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FIVE MARSHALL ISLANDERS TO BE EXAMINED AT BROOKHAVEN MEDICAL CENTER Upton, New York, May , 1966. Five people from Rongelap Atoll in the Marshall Islands of the Pacific will be brought to the Medical Research Center of AEC$S Brookhaven National Laboratory at Upton, L.I., N.Y., this month for clinical examination and possible surgery. They have nodules -- a thickening or hardness -- in their thyroid glands which appear to be the result of exposure to fallout radiation from an atmospheric nuclear detonation at Bikini 12 years ago. Of the five, one is a mature woman, three are girls in their early teens, and one is a young woman under”21 years of age. The five additional cases, noted early this year during the continuing annual medical surveys of the islanders, bring the total number of thyroid cases to 16 out of the original 82 Romgelap people who were exposed. The thyroid nodules were first detected in March, 1964, during the tenth annual medical survey of the people of Rongelap and Utirik Atolls. Thirteen of 19 children in the more heavily exposed group, all of whom had been exposed at less than ten years of age, had nodules. All nodules of those children who were examined or treated surgically were found to be benign. Only one person, a woman of 40 years, had cancer of the thyroid, for which she received surgery a year ago, and is now doing well. In addition, there were two boys with hypothyroidism in the exposed group who had previously shown growth retardation. These boys have improved as a result of the thyroid hormone therapy instituted six months ago.
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Of interest among the twelfth annual medical survey observations was t!heabsence of thyroid abnormalities in the were of the same ages as the high-incidence Rongelap. The Utirik children had received Following the detonation of 40 Utirik children examined who group of exposed children on considerably less radiation a thermonuclear device on March 1, 1954, during atmospheric tests in the Pacific Proving Grounds, an unpredicted shift in winds caused deposition of significant amounts of fallout on four inhabited atolls east of Bikini. These were Rongelap, Ailinginae, Rongerik and Utirik Atolls. Rongelap received the largest radiation exposure. Eighty-two people of Rongelap Atoll were accidentally exposed to fallout radiation where the average whole body exposure was approximately 175 roentgens. Additional amounts of radiation resulted from absorption of radioiodine in the thyroid glands. Since that time the U.S. Atomic Energy Commission and the Trust Territory of the Pacific Islands have sponsored annual medical surveys of the exposed people. The surveys are carried out by a Brookhaven National Laboratory team, headed by Dr. Robert A. Conard from the Laboratory’s Medical Immediately after the 1954 exposure the people were evacuated to Kwajalein Atoll for treatment and were subsequently on Majuro Atoll until 1957 when they were recurncd to RonCelap. On their retu,rnto their home atoll the United States provided ~hem with a new village and other facilities to assist their re-est,?blishmcnt. The current population of about 229 persons. Last yenr Con~ress appropriated $950,000 relief$ipayment to the exposed population.
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PROPOSED RESPONSES TO INQUIRIES 1. Q. What is new in the recent Brookhaven announcement on five Marshallesc A. It notes that thyroid gland nodules were diagnosed in an additional five people during the twelfth annual medical survey of the Marshall Islanders which was conducted early (February-March) this year. 2. Q. What is the total A. There have been a number of thyroid nodules cases detected in Marshallese total of 16 cases in the 69 people now living of the original 82 people exposed. The past twelve years were among elderly be radiation-connected. Thirteen of deaths that occurred during the people and were not considered to the 19 young people, or 68 per cent, in the more heavily exposed group on Rongelap had nodules. All had been exposed at less than ten years of age. 3. Q. Are thyroid nodules malignant or benign? A. In all of the children examined surgically the thyroid been benign. Those not operated on yet are assumed to be benign. The possibility of an One of the people the thyroid which occasional malignancy cannot be ruled out, however. in the exposed group, an adult woman, has cancer of has been treated surgically. in the thyroid radiation-connected? Since they have been found in the exposed population much more frequently than in the urlcxposed~roup, we must assume that the increased frequency of the nodules is radiation-connected.
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How many Marshallese have had surgery to Six Rongelap people with thyroid nodules to date. Five were children in whom the one adult woman had a thyroid malignancy She is doing well. have been treated surgically nodules proved to be benign; which was removed last year. What is being done for the additional five Marshall Islanders in whom Arrangements have been at Brookhaven National When were these people A total of 82 Rongelap made to bring the five to the Medical Department Laboratory for further examination and exposed to radiation and how many were people (64 on Rongelap Atoll, and 18 visiting on nearby Ai.linginaeAtoll) and 157 on Utirik who were accidentally exposed to fallout radiation from a nuclear device tested on March 1, Were there people on the same, or an adjacent, atoll who were less exposed? What were their radiation dose estimates? Yes. The 18 Rongelapese who were visiting on Ailinginae Atoll were lightly exposed. They received an estimated whole body dose of 69 R, and a proportionately smaller thyroid dose. About 40 children on Utirik who were mildly exposed to fallout radiation (14 R) have shown no thyroid gland abnormalities. These children on Utirik are in the same age range as those in the heavily exposed Rongelap popu-
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Some 200 unexposed people now living on Rongelap, including 75 children, are examined as part of the annual medical surveys for How many children were in the heavily exposed group? There were twenty-five between 1 and 10 years of age at the time of the incident. What was the estimated dose to the thyroid glands of the children? Their thyroids received doses largely from radioiodine. possibly between 200 to 1400 rem What kind of shape are these people in now; and what other delayed effects, besides the nodules, have been observed? The general health and death rate of the exposed population on Rongelap have been about the same as for the comparison group. Other possible residual radiation effects noted in the 82 exposed Rongelapese were: slight retardation of statural growth and bone maturation in two boys exposed at less than 5 years of age; possibly a higher incidence of miscarriages in exposed women during the first four years; slower recovery of some of the peripheral blood elements, and non-malignant changes in somieof the areas of previous beta tion bvrns of the skin. No definite radiation effects on birth aging, or leukemia have been noted. The numbers of people here far too small for statistical analysis except in the thyroid nodule
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13. q. What were the circumstances surrounding radiation exposure of these A. On March 1, 1954, a thermonuclear weapon of about 15 megatons total yield was detonated on a coral surface at Bikini Atoll in the Marshall Islands. Because of an unexpected shift in wind direction, the fallout pattern differed slightly from the one predicted. As a result, radioactive particles fell on Rongelap Atoll about 100 miles east of Bikini. As soon as it was learned what had happened, the Rongelap population was evacuated to Kwajalein, 300 miles away. A naval medical team flew to Kwajalein from Washington to examine and care forthem. 14. Q.” What was the estimated whole body dose received? A. The average whole body dose was approximately 175 roentgens. 15. Q. What medical assistance has AEC given? A. Since the time of the incident the U.S. Atomic Energy Commission and the Trust Territory of the Pacific Islands have sponsored annual medical surveys of the exposed people and have collaborated in seeing that their medical needs have been met. Center at AzC’s Brookhaven National Laboratory. 17. Q. W%at was the thyroid dose received by the exposed A. The dose to the thyroid ~lands of t!leadults from the Medical Research
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18. Q. What were Che effects of the beta radiation burns? A. There were some losses of skin pigment and occasional mild scarring of the skin as a result of the beta burns received by some of the Marshallese exposed to fallout. The dust particles adhered CO exposed damp skin around the neck, head, arms, and feet during the first day o-f stances, did not the fallout. These places received burns The burns healed but the pigment, in some 19l Q. What is the extent of the present New England Journal of Medicine A. The present report summarizes the medical findings over a twelveyear period relating to the people of Rongelap Island who were exposed. The initial findtngs are only briefly reviewed; more attention is given to the more recent examinations. 20. Q. Are there public reports on the medical surveys in addition to the current article in the Journal of the New England Medfcal Soci.cty? A. Yes. Sec list below:
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List of Reports of Previous Surveys of Ionizing Radiation on Human Beings,” AEC report TID-5358,U.S. Government Printing Office, July 1956. ($1.50). Marshallese Exposed to Fallout Radiation,” AEC report BNL-S84 R. A. Conard, et al, “Medical Survey of Marshallese Two Years After Exposure to Fallout,” AEC report BNL-1+12 (T-80), March 1956. R.’A.Conard, et al, “March 1957 Medical Survey of Rongelap and Utirik People Three Years After Exposure to Radioactive Six Years After Exposure to Fallout,” AEC report “Medical Survey of Rongelap
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in Marshalleee People Exposed to Fallout Radiation,” MC report Eleven Years After Exposure to Fallout Radiation of Rongelap Island, Exposed to Fallout Radiation, Results from a Ten-year Study,” Journal of the American Medical Association (JAMA), May 10, 1965,