A Dose of Reality

["Peter G. Crane" <pgcrane@erols.com>]

Jaroslav Franta deserves thanks for posting, on March 16, the Reuters 
news story describing the recent study, published in the American Cancer 
Society's journal "Cancer", of childhood thyroid cancer in Belarus, 
resulting from Chernobyl.  The study indicates that the greatest hazard 
of radioiodine-caused thyroid cancer is in children under two years old, 
who are more likely than older children to develop the disease, and in 
whom the disease is more likely to have spread.  The cancer had spread 
beyond the thyroid in 62% of the patients under two years old.

Also on March 16, RADSAFER James Muckerheide of the Massachusetts 
Emergency Management Agency, faxed to the Massachusetts Advisory Council 
on Radiation Protection, of which he is a member, his reasons for 
believing that the stockpiling of potassium iodide for thyroid 
protection is unnecessary and undesirable.  His statement including the 
following:

"5. Thyroid cancer is readily and commonly treatable, without long term 
consequences other than taking thyroxin to provide the necessary thyroid 
hormone.  This is a common condition.  The few deaths from thyroid 
cancer were caused by failing to provide adequate medical care.
6.  Even with these high doses, primarily to children exposed from about 
5 months before birth to 5 years old, with most of the remaining cases 
in children that were below about 10 years old, the increase in thyroid 
cancer is small.  The reported factor of 3 to 4 increase is from 1 case 
in about about 300,000 children, results in 3 or 4 cases in 300,000, or 
about 1 additional case in 100,000+ children."

As an old thyroid cancer patient, I beg to differ.  I recall years ago, 
when I was being treated at the National Institutes of Health for a 
recurrence that required 700 millicuries of I-131 to eradicate, I met an 
NIH doctor who was himself a thyroid cancer patient.  I mentioned to him 
that at my agency (the NRC, from which I have since retired), there were 
those who thought that it was not worth having KI to protect against 
thyroid cancer, because the disease was not that big a deal.  He turned 
red with anger in an instant and snapped, "They ought to have it!"  

I've known many thyroid cancer patients, and I can't think of a single 
one who would agree with Jim Muckerheide's characterization of the 
disease.  Granted, it doesn't often kill -- though there are exceptions, 
like Senator Tom Harkin's brother, or the young professor of Russian at 
Cornell whom my brother remembered from summer camp (like me, the 
professor was part of the group that received radiation treatments to 
the head and neck at Chicago's Michael Reese Hospital in childhood).  In 
fact, there are about 1000 such exceptions in the United States each 
year, and they are not all dying for want of adequate medical care. 

I once mentioned to an NRC colleague, who was also a thyroid cancer 
patient, the propaganda about how inconsequential the disease was.  He 
laughed:  "Right!  I used to climb stairs on all fours for the fun of 
it."  I knew exactly what he was talking about:  the exhaustion and 
weakness, almost unbelievable to anyone who has not experienced it, that 
patients feel when they are taken off all thyroid hormone in advance of 
an I-131 treatment.  (To ensure maximum uptake of the I-131, the patient 
is made extremely hypothyroid, beginning several weeks before 
treatment.)

Like Jim Muckerheide, I am no physician.  But I have talked with many 
physicians who have treated thyroid cancer.  In England, at the 
Cambridge University conference on radiation and thyroid cancer where I 
gave a paper in 1998, I met a doctor who was marveling -- if that is the 
word -- that there were people trying to make the case that the disease 
was of minor significance.  "If they had they seen the children I have 
seen, and some of them could not be saved...."  He shook his head.

Jim Muckerheide began his comments to the Massachusetts Advisory Council 
on Radiation Protection by saying that Mary Lampert, an advocate of KI 
stockpiling, had provided negligible new scientific information about 
the drug.  He continued:  "However, since the previous science 
literature review, there have been additional studies.  They confirm the 
initial results."  Perhaps he could give RADSAFERS a clarification on 
this point:  what additional studies is he referring to, and what 
initial results do they confirm?  

Peter Crane, pgcrane@erols.com
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