Letter to H I Kohn, Subject: Risk Estimates in Our Bikini Book Were Calculated (Encl: Letter to W J Bair, Subject: re the Same, Dated 1/26/82; Report re the Same)

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Pacific Northwest Laboratories Box No wgy - Enclosed is a description of how the risk estimates in our Bikini were calculated. Included are estimates based on BEIR-I which we since BEIR-111 had not yet been accepted by the U.S. Government. fact at the time we wrote the Bikini book only a type set copy of 111 was available, which was not identical to the version eventually published. We used this type set version to calculate estimates based on BEIR-111 for comparison purposes. This also is enclosed. Because of your question about the origin of the values for the dose to the highest individual I’ve included a table in the appendix of actual dose data for individuals. Also included is a copy of the Trust Territory of the Pacific Islands, Five Year Comprehensive Health Plan, dated February 1979. As I mentioned to you on the phone this was our only source of population data on the M~:-shallese people. Tt.e enclosure if all of the report that D-. Wachholz received from Mr. Ted Mitchell, a lawyer who was with the Micronesia Legal Service and who represented the Enewetak people. You’ll note that it appears incomplete. Also, there is a part which is labeled Chapter Four, VI Demography. I don’t know whether this is a part of the Marshall Islands Five Year Plan or whether it is from another report. The data in this Chapter Four is not quite in agreement with the data in the Five Year Plan. For example, in Table IV-6, page 63 the annual growth rate for the Marshallese is given as 4.4%. From the data in Table III-1 of the Five Year Plan, the annual growth rate seemed to be less than 4%; we used 3.8%. Please call if ycw have any questions.

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Letter to Dr. Kohn Environment, Health and Safety Research Program Enclosures as stated

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~n your letter of December 29th, you were good enough to say that you would send us a copy of a summary of the risk calculations, on the Bikini problem, I wonder if that summary has been completed, ~d if so, could it be sent to us now. It would be very helpful, since we are being pressed to comment on them.

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BASES FOR Calculation! OF RISK ESTIMATES USED IN “THE MEANING OF RAOIATION AT BIKINI ATOLL” Estimates of cancer and birth defect risks for the Bikini populations were based on a number of assumptions. Some of these assumptions resulted from consultation with other scientists including members of the,, 1. Risk coefficients from BEIR-I were used because BEIR-111 had not been accepted by any U.S. government agency. We elected to use the values as given in BEIR-I rather than the revised values based on increased age of the population shown in Table V-4 of BEIR-111. 2. For estimates of carlcer risk both the relative risk coefficient and the absolute risk coefficient were used to give a range of estimated risk. The absolute risk coefficient gives a lower value, is less variable with the population and is not dependent upon the spontaneous cancer incidence, which is nc)t known for the Bikini population. The relative risk coefficient gives a high value, but since it is based on the spontaneous cancer incidence, which is unknown for the Bikini population, it is probably less reliable than the estimates calculated from the absolute risk coefficients. 3. For estimating increased cancer incidence, the bone marrow dose was Used because it was slightly higher than the whole body close. This probably introduced a small element of conservation. 4. For estimating birth defects neither BEIR-I or BEIR-111 is very clear about what is meant by parental dose, thus it is not clear whether birth defects should be based on the dose to one parent or both parents. In the latter case, the 30-year whole body dose would be doubled. We assumed the BEIR-I risk of 0.2% rem was based on both parents being irradiated. Also because we believed the risk coefficient from BEIR-I

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was already conservative to use the 30-year whole based on comparisons with BEIR-111, we elected body dose as provided us--not doubled. 5. For the 140 persons who returned to Bikini and were removed in August 1978, it was assumed that no children will be conceived by persons above age 40, that 300 children will be born after August 1978, and that all children born will be offspring of parents, both of whom returned to Bikini . The parental dose was obtained as follows: Average dose to males < 40yea~s old = 1.36 rem Average dose to females < 40 years old = 1.08 rem Parental dose used in calculations = 1.22 rem 6. The average dose values for persons who lived on Bikini were calculated from individual dose data (whole body and bone marrow) for 50 males and 49 females. These values are tabulated in the appendix. 7. The spontaneous incidence of birth defects was taken to be 10.7% of all live births from BEIR-111. 8. The normal incidence of cancer deaths was assumed to be 15%. A value less than the approximately 20% given for the U.S. population was used because the Bikini people have been and will probably be exposed to much lower limits of environmental carcinogens than people living in the U.S. and because of limited medical services and prevalence of other risks such as drowning, poisoning, etc. Other causes of death are probably higher in the Bikini population than also suspected the average life span was less lation, which might tend to reduce the number occur in the elderly. in the U.S. population. We of cancers that would 9. The largest dose a person might receive in a year was estimated to be three times the average dose. Data in the appendix for individuals show that the highest individual dose is more than twice the average but less than three times.

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To estimate the number of births, deaths and the magnitude of the Bikini population after 30 years, information was used from the final draft of the Marshall Islands Five Year Health Plan prepared by the Trust Territories’ Department of Health Services’ Office of Health Planning and the Resources Department. The doc’Jment is undated, but the presence of data from 1976 indicates that it must have been pr$pared in the period of 1977 to 1979 when we received it. It was noted that there are apparent inconsistencies among several of the different tables. For example, Table III-1 gives data for the Marshall Islands for the period 1955-1975 and Table III-5 gives data for the infant mortality rate for 1976. In Table 111-1, the infant death rate per 1000 births for 1970 through 1975 is given as 28.3, 33.6, 25.4, 46.4, 21.l:and 37.0. However, Table III-5 indicates the infant mortality rate to be only 17.04. We used the data of Table III-1 in the following estimates; because it is more complete and it provides a self-consistent set of data. However, in view of the discrepancies, the results can only be considered as approximations. This probably makes litt’e real difference in view of the uncertainties in the risk coefficients that were used. There is also a bias built into the data because of the inclusion of Ebye and Majuro in the overall Marshall Island rates. This arises from the different death rates (particularly infants) at these two locations. In many respects the population of Ebye and Majuro are quite dissimilar from the Bikini population because they have the advantages and disadvantages of a more For the estimates the last 5 or 6 year average of the data were used because they are probably the most representative of current conditions. From this, the following were obtained: 1. Rate of increase of the population has been about 3.8%jyear. 2. Infant death rate is about 3.2% per birth. 3. Overall death rate is 0.54% per year. 4. Birth rate is 4.2% per year.

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summing. This gave 8949 rads for the total population including the original 550. The total dose received by the original 550, assuming that all live for the 30 years, is For those born after the return, the population would be the difference between the total population in 30 years, the number of deaths and the original 550 people or 1134. Thus, ,,theper capita dose for this group is 8949/1134 = 7.9 rads. For the original 550, the per capita dose is 11,902/550 = 22 rads. The ratio of these two to give an estimate of the fraction of the full 30 year dose received by the children is 0.36. The assumption of nc)deaths in the original 550 returning was made for simplicity and the lack of good death rate data. We also compared the age characteristics of the Marshallese from Table IV-3 and the U.S. population in 1970. This comparison is given in the attached curve. The slopes are similar above age 35 but the magnitudes are distorted by the high birth rate in the Marshall Islands. However, in terms of the relative risk the similar slopes suggest that if the natural cancer rates in the two populations are similar, the relative risk for people above 35 in both populations would be similar because most of the cancer occurs at ages from about 40 and above. However, the magnitude of the relative risk in the U.S. used for the Marshallese will be high by a factor of somewhere around 2-3 because of the distortion caused by the very high proportion of young people who have a relatively low natural cancer incidence. Using the preceding calculations for a population of 550, calculations were made for other population sizes. For a population of 550 (from Births in 30 years = 1277= 1300 For a population of 140 (the number that returned to Bikini):

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A population of 550 wiis assumed for the one that might move back permanently to Bikini Atoll. Values for other initial populations were obtained by ratios of the results. The total population at the end of 30 years is given by the compounding The number of births’in 30 years are given by: where x is the time between O and 30. This gives Similarly, the number of deaths in the 30 year period would be: One other datum needed is the reduction in 30 year dose to those born after the return because of the decrease in radiation levels and the smaller amount of t,ime in the 30 year period that is spent on the island. For this, the total population dose for those born after returning assuming an initia~l dose rate of 1 rad/year is given by: ~ is the half-life of decrease of the radiation dose, taken here as 30 Because this integral cannot be solved analytical, an approximate solution was obtained by calculating this function for each of 30 years and

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For a population of 235: For a population of 350: III. RISK COEFFICIENTS At the time the Bikini book was prepared no agency in the U.S. government had accepted the risk coefficients in BEIR-111. Thus we were constrained to use risk coefficients from BEIR-I. While not included in the printed book, risk estimates based on BEIR-111 were calculated for comparison purposes. The following gives the origin of the risk coefficients used.

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From the above the minimum estimate of cancer risk would be given by a risk coefficient of [37/106 person rem and the maximum by 458/106 person rem. Thus, these two risk coefficients were used to define a range of estimated cancer deaths. 2. Genetic Effects (from Page 1 & 2 BEIR-1) generation would cause in the first generation 100-1800 cases of dominant diseases and defects per year (3.6 million births/year) or 5 times this amount at equilibrium. The 1800 cases represent an increase of 0.05% incidence per year first generation and 0.25% at equilibrium. In addition there would be a few chromosomal defects and recessive cliseases and a few congenial defects due to a single gene defect and chromosome aberrations. The total incidence at equilibrium is 1100 to 27,000/year. These at equilibrium, the maximum would be 0.75% or 0.15% in the first These are equivalent to 0.15% per rem at equilibrium and 0.03%/rem in the first generation. b. Based on overall ill health. Overall ill health: 5% - 50% of ill health is proportional to the mutation rate using 20% and doubling dose of 20 rem, 5 rem per generation would eventually lead to a 5% increase in ill health. Thus the rate of overall ill health is I%/rem at equ For estimating the potential genetic derived health Bikini population it was decided to use a risk coefficient of 0.2% per rem in the first generation recognizing that it was probably

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1. Cancer (Table V-4 of Typescript Edition) Lifetime Risk of Cancer Death Single exposure to Continous xposure Model Absolute Relative Absolute Relative—— * In printed version these were 169 and 403, respectively. We used the risk coefficierlts that were derived for continuous exposure. 2. Birth Defects--pages 166-169 (mean parental age = 30 Years) 1 rem per generation (1 rem parental exposure) per 106 live offspring 5 to 75 birth defects, this is 0.0005--0.0075%--First Since the spontaneous rate is given as 10.7%, in the U.S. population, 1 rem will increase the rate from 10.7% to 10.7005--10.7075%. In terms of the spontaneous rate 1 rem per generation gives ~= . Iv. CALCULATIONS OF RISK Table 1 gives the radiation dose values provided by Dr. Robison for use in developing estimates of increased health risks in the Bikini population. A. Risks for 14 Different Living Conditions Table 3 shows the calculations for estimates of increased cancer risk for 14 different living conditions.

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2. Birth Defects Risks Table 3 gives the calculations for the estimates of birth defects. Table 4 gives risk estimates based on BEIR-111 risk coefficients. These were calculated for comparison purposes~only and were not used in the Bikini book. The highest estimates~for cancer risk result from using the linear relative risk model and are about the same as those given in Table 2 for the rel~~tive risk model. The lowest estimates result from the linear-quadratic absolute risk model and are slightly less than those for the absolute model in Table 2. Thus, as far as estimates of cancer risk are concerned, those obtained using risk coefficients from BEIR-I are in the same general range as those obtained using risk coefficients Risk estimates for birth defects obtained using the risk factor from BEIR-I gives values about three times those obtained using the upper value of the range of risk factors given in BEIR-111. If BEIR-111 risk factors for birth defects represent a more enlightened assessment of this potential consequence of radiation exposure than the factor taken from BEIR-I for overall health defects, then the estimates in the Bikini book may be conservative by a factor of three.

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Identification Number Age Total Whole Body Dose (mrem) Total for all 49 females = 54,710

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Estimates of Radiation Doses Received By Person Who Visited at Bikini for About 10 Years Until August 1978 …