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Re: A dose of reality, continued [thyroid cancer thread]
FYI,
A little while ago I came accross this bit of information from an August 9
1986 Montreal Gazette article about another case of fallout contamination -
that of a 1954 South Pacific hydrogen bomb test - it talked of "a
non-medical complication that bemused and confounded the doctors:"
"Because the discovery and removal of a thyroid nodule is worth
money to the islanders (under federal law, the United States must pay each
exposure victim $25,000 in compensation for the problem), having a thyroid
nodule is almost considered a stroke of good fortune in a place where few
people earn wages. One middle-aged man ... is heard to complain bitterly
that among his immediate family members only one nodule has been found."
However, I also seem to recall from reading the BNL reports (I think) that
every thyroid that looked even the slightest bit suspicious was removed,
just in case... ...perhaps a somewhat overzealous strategy there ?
Jaro
PS. sorry about the length of this posting, but I thought it worthwhile to
append these previous postings...
> From: PAMS718@aol.com[SMTP:PAMS718@aol.com]
> Reply To: radsafe@romulus.ehs.uiuc.edu
> Sent: Thursday March 30, 2000 5:50 PM
> To: Multiple recipients of list
> Subject: Re: A dose of reality, continued
>
> I have been out of touch (away on vacation) and only recently caught up on
> this thread... I would like to add two or three cents worth of thoughts on
> this issue...
>
> 1. I think that we all agree that cancer, any cancer, is scary, and
> serious. I don't think that anyone who has written to Radsafe on this
> issue would take exception to that statement. We are compassionate and
> caring human beings. But the fatality rates do vary depending on the
> type of cancer, and it is a fact that thyroid cancer has a low fatality,
> high cure success rate. If fate had determined that I would get cancer,
> (and it did) then I would choose thyroid cancer as an adult, rather than
> the reproductive cancer I had as a young woman. I think that is the point
> that some contributors have tried to make..that in this case, perhaps, it
> is not an "ounce of prevention is better than a pound of cure", but
> rather, due to the low mortality rates implementing such a KI policy may
> be "a pound of prevention vs an ounce of cure". (and I understand to the
> affected person, it doesn't feel like an ounce of cure..)
>
> 2. We know that children are highly dependent upon their thyroids for
> normal growth and development. we know that impacting the function of a
> child's thyroid gland can have profound effects on the child's development
> (mental and physical), hence a disease such as childhood thyroid cancer is
> serious.
>
> 3. we do not know the real rate of thyroid cancer in children,
> pre-Chernobyl. As such, the rate of increase in thyroid cancers due to
> Chernobyl in uncertain. How much has the rate increased? we really don't
> know and we are speculating using expected values based on U.S. and
> western European populations. we also know that certain ethnic groups
> have higher rates of certain types of cancers due to genetic factors...and
> thryoid cancer is one of those cancers linked to genetic factors within
> these ethnic groups.
> So we must tread carefully as we look at these statistics.
>
> 4. we know that iodine deficient diets will lead to greater iodine uptakes
> by the thyroid gland. we know that in America, we consume a tremendous
> amount of iodized salt in our diets and as such we, in America, do not
> live with iodine deficient diets. In the U.S., most thyroids are about 40%
> blocked due to our love of (iodized) salt.
>
> 5.It appears, based on sampling of biota,air,food, water, etc, that the
> primary exposure pathway to the children of Belarus was via ingestion. we
> know that food, water and milk supplies were not interdicted in the areas
> surrounding the Chernobyl accident until well after the accident. How
> useful is a single dose of KI without concommitant interdiction of food,
> milk, water supplies? What are the effects from long term, multiple doses
> of KI in children? We do know that neonates are susceptible not only to
> the effects of radioactive iodines, but also sensitive to functional
> thyroid blocking caused by an overload of stable idodine.
>
> 9. In the US, an infrastructure exists to: 1)evacuate and 2) interdict
> food supplies where necessary (interdiction of food occurs almost
> routinely within the US... think E.coli, salmonella, etc)
>
> 10. While we can certainly learn from the experiences of the Chernobyl
> accident, does it make sense to base public policy for the United States
> on events that happen in other countries that are so vastly different than
> our own? Are there other instances where we (the US) make sweeping policy
> decisions for large numbers of the population based on events that occur
> in countries that are so different than our own? I don't know the answer
> to that question.. and would certainly appreciate input from others on
> that query.
>
> These are just my thoughts...
>
> Patricia M. Sullivan
> pams718@aol.com
>
> From: Peter Crane[SMTP:pgcrane@erols.com]
> Reply To: radsafe@romulus.ehs.uiuc.edu
> Sent: Friday March 24, 2000 5:59 PM
> To: Multiple recipients of list
> Subject: A dose of reality, continued
>
> I am very happy for Jim Muckerheide and for his daughter that her
> experience with thyroid cancer has been, so I gather from his message, a
> mild one, and I sincerely hope that all her problems are behind her.
> Likewise, the cases of the American triathlete and the Canadian rower
> described in the NPR story are good news -- to the extent that any case
> of a young person with cancer can be called good news.
>
> However, I was disappointed by Jim's response to my suggestion that he
> identify for RADSAFERS the scientific studies that he was relying on.
> His answer was that I should look them up for myself and discount those
> that are deficient.
>
> Is it really so much to ask, Jim, that you give us a citation for the
> following statement in your letter to the Massachusetts Advisory
> Committee:
>
> "Even with these high [Chernobyl] 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."
>
> It was less than a year ago -- July 24, 1999, to be exact, in a message
> entitled "Thyroid Cancer and I-131", that you wrote to RADSAFE the
> following:
>
> "It is also important to acknowledge that the rad-effects are shown to
> indeed be very much greater to infants from -6 months (fetus) to +5
> years. And are still only about 4 deaths, and only then due to
> emergency response and medical treatment failures. But the uncertainty
> of how high the dose actually was to these infant thyroids, and related
> biological influences, is very great."
>
> Am I alone in seeing a disparity between the two statements?
>
> I can't help thinking, Jim, that you are missing several points,
> including but not limited to the following:
>
> 1. Childhood thyroid cancer, which is what we are seeing in the
> aftermath of Chernobyl, is considerably more serious than cancer that
> develops in adulthood.
>
> 2. Even in the United States, there are 1000 deaths from thyroid
> cancer each year.
>
> 3. Granted that the fatality rate from thyroid cancer is low, the
> measure of the whether a disease is worth preventing is not limited to
> the probability of its being fatal.
>
> 4. 493 childhood thyroid cancers in Belarus alone (the study in the
> American Cancer Society journal was based on that number of cases) is a
> whopping number. My understanding is that in Russia, Belarus, and
> Ukraine combined, the total of childhood thyroid cancers now exceeds
> 2000 cases. Is it your claim that this represents no more than three or
> four times normally expected rates?
>
> -- Peter Crane (pgcrane@erols.com)
>
> From: Jim Muckerheide[SMTP:jmuckerheide@delphi.com]
> Reply To: radsafe@romulus.ehs.uiuc.edu
> Sent: Friday March 24, 2000 3:14 PM
> To: Multiple recipients of list
> Subject: Re: A Dose of Reality
>
> "Peter G. Crane" wrote:
> >
> > 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!"
>
> Nonsense from a Dr. is still nonsense. From the rest of my statement,
> I-131
> exposure from LWRs (I plates out in wet environment; inside a
> containment),
> with evacuation (AND not eating contaminated food/milk), by people who are
> not
> I-deficient, provides no basis to link Chernobyl experience at all. But
> EVEN
> the Chernobyl experience has minimal effect from removing the containment
> and
> burning the core for 4 days, not evacuating people, allowing consumption
> of
> contaminated food/water/milk - where MOST of the dose came from (who are
> severely I-deficient), etc.
>
> > 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.
>
> My daughter - and her medical advisors and support group!
> She's waited till after her recent 4th child to schedule removal of the
> remainder of her thyroid etc.
>
> 'See' a segment on NPR "All Things Considered" aired yesterday:
> "Cancer Athlete (14.4 | 28.8) -- Noah speaks with Karen Smyers, a
> triathelete
> who is postponing cancer treatment so that she can participate in the
> Olympic
> trials next week in Hawaii. She joins us today from her home in Lincoln,
> Massachusetts.(3:00)"
>
> She's 38, thyroid cancer, surgically removed, on thyroid hormone
> replacement
> (hit it just right on the first try), with doctors approval is deferring
> radiation treatment until as late as May in Australia to train/compete for
> the
> women's triathalon (training includes swimming 25,000 yards/week :-) since
> subsequent problems are "low-risk," "slow growing," etc. She describes
> communications with a Canadian woman rower: Diagnosed in Nov 98; Surgery
> Jan
> 99; Radiation in March; New world record in June.
>
> The segment is at:
> http://search.npr.org/cf/cmn/cmnpd01fm.cfm?PrgDate=03/23/2000&PrgID=2
> The next to last segment in the 3/23 program; just 3 minutes, about half
> related to the cancer, etc. (Can order a transcript if you can't get
> RealAudio.)
> [Also, you should listen to the last segment on an HMO experience if you
> have
> a minute. There's a certain parallel to the rad protection experience :-)]
>
> >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.)
>
> Normally, one I-131 treatment shortly after removal; not necessary to go
> to
> extremes in going off thyroid hormone! Once in your life after original
> treatment? Otherwise normal?
>
> > 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.
>
> And most Dr's were 'marveling' at this Dr. making it out to be of great
> significance? Vested interest? More than 3 that 'could not be saved?' Due
> to
> extreme conditions and inadequate intervention, from days of dry releases
> from
> burning graphite, to no evacuation, to consuming contaminated food, to
> inadequate medical attention and intervention. What would be the prognosis
> here?
>
> > 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?
>
> Easy. Go to PubMed and search on "Chernobyl" and "thyroid." Discount a
> few
> polemical sources dredging for funds. Review papers that provide hard data
> on
> real patients, from various medical centers, etc.
>
> > Peter Crane, pgcrane@erols.com
>
> You really should consider more facts and less polemics, even as only a
> lawyer
> :-) Despite your training, 'winning' by rhetoric should not be paramount
> in
> sound public policy. But, from the experience of working for/dealing with
> government agencies I can see why that isn't very clear to most of us any
> more
> :-)
>
> Regards, Jim
> muckerheide@mediaone.net
>
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