Re: 16th Anniversary of Chernobyl accident

["R. William Field" <bill-field@UIOWA.EDU>]

Jim,



I am not sure I accept your claim that there were no thyroid cancer related

deaths related to the Chernoby accident.  Did I read your post correctly?



It is my understanding that approximately 1,800 thyroid cancers have been

diagnosed in individuals who were children at the time of the accident

(could someone verify this estimate?).  It is also my understanding that

following Chernobyl there has been a higher incidence of differentiated

thyroid carcinomas which are much more aggressive than the common type of

thyroid cancer.  I  would expect that approximately 10 - 15% of all the

thyroid tumors would be classified as differentiated thyroid carcinoma.

Approximately 10% of differentiated thyroid carcinomas result in death



A few papers of interest.



World J Surg 2000 Nov;24(11):1446-9

Thyroid cancer in children of Ukraine after the Chernobyl accident.



Rybakov SJ, Komissarenko IV, Tronko ND, Kvachenyuk AN, Bogdanova TI,

Kovalenko AE, Bolgov MY.



Department of Surgery, Institute of Endocrinology, 69 Vyshgorodskaya

Strasse, 254114 Kiev, Ukraineraine.



The results of treatment of 330 children (< 14 years) and adolescents (15-18

years) with thyroid cancer who were operated on at the Institute of

Endocrinology after the Chernobyl accident in 1986 were analyzed. The number

of young patients increased after 1986 (1981-1985, 9 cases; 1986-1990, 37

cases; 1991-1995, 177 cases; 1996-1998, 116 cases). Most of these children

and adolescents were younger than 8 years at the time of the accident

(84.2%). More than half of the children (58.1%) lived in areas receiving the

highest radiation exposure. These thyroid cancers developed after a short

latent period, were more aggressive at presentation, and expressed regional

(57.3%) or distant (14.5%) metastasis. Solid papillary cancers were present

in 93.1%. Coexisting thyroid conditions were common (thyroid hyperplasia,

25.1%; nodular goiter, 18.8%; chronic thyroiditis, 10.2%). Most patients

were treated by total thyroidectomy with intraoperative visualization of

recurrent laryngeal nerves and parathyroid glands. When lymph node

metastases were identified, a modified neck dissection was performed. Such

operations were done in 277 (84.1%) patients. Postoperatively, the patients

were treated with radioiodine and thyroid-stimulating hormone suppressive

therapy. Postoperative complications included recurrent nerve palsy in 12.3%

and permanent hypoparathyroidism in 6%. Operations for local recurrence of

cancer were performed in 2.8% cases and for regional metastasis in 4%. The

general mortality was 2%.  We anticipate that there will be more patients

with thyroid cancer during the next few years. Therefore this high risk

population for thyroid cancer must be carefully monitored and evaluated

during the next several decades.



Baillieres Best Pract Res Clin Endocrinol Metab 2000 Dec;14(4):667-77



Post-Chernobyl thyroid carcinoma in children.



Leenhardt L, Aurengo A.



Service Central de Medecine Nucleaire, Groupe Hospitalier Pitie-Salpetriere,

47-83 Bd de l'Hopital, Paris, 75013, France.



The dramatic increase in childhood thyroid carcinoma observed in Belarus and

Ukraine as early as 4 years after the Chernobyl nuclear accident, is well

recognized as being a consequence of exposure to radioactive iodine fallout.

Uncertainties persist concerning the contamination and the dosimetric data.

Thyroid nodule, cervical lymph nodes or systematic ultrasound thyroid

screening in exposed children led to the diagnosis. The carcinomas affected

younger subjects, were less influenced by gender, and were more aggressive

at clinical and histological presentation than in the case with naturally

occurring carcinoma. Total thyroidectomy and radioiodine treatment remain

the treatment of choice. The prognosis is good but further studies are

needed to evaluate the prognosis of children presenting with pulmonary

metastasis. The project of the Newly Independent States Chernobyl Tissue

Bank will facilitate molecular genetic research into this important public

health issue. Nevertheless, clinicians must keep in mind the simplicity and

the effectiveness of iodine prophylaxis. Copyright 2000 Harcourt Publishers

Ltd.





Eur J Cancer 2001 Apr;37(6):775-9

Survival of children with thyroid cancer in Europe 1978--1989.



Storm HH, Plesko I.



Cancer Registry -- Danish Cancer Society, Strandboulevarden 39, DK 2100,

Copenhagen, Denmark.



Thyroid cancers are rare in childhood with between 0.4 and 1.5 cases per

million, 2--3 times as frequent in girls as in boys. However, following the

Chernobyl accident, a remarkable incidence increase was observed in children

exposed to radioactive iodine fall-out. Survival after thyroid cancer in

childhood is thus of interest. In the EUROCARE II study, excluding most of

Eastern Europe, a total of 165 childhood thyroid cancers were reported

during the period 1978--1989, of which 134 were aged 10--14 years. The

childhood cancer registry in England and Wales contributed 39% of the cases,

and another 24% came from the Nordic countries, the rest from other parts of

west, south, east and central Europe. The 5-year survival was for both

genders combined 97% (95% confidence interval (CI): 93--99), 98% (95% CI:

91--100) for boys and 97% (95% CI: 91--99) for girls, with no significant

difference between the genders. Survival was high during the entire study

period, and variations influenced by the small numbers. As for adults,

long-term follow-up beyond 10--20 years is needed to clearly demonstrate

excess mortality as a consequence of the cancer.





J Endocrinol Invest 2001 Jun;24(6):445-7

Post-surgical ablation of thyroid residues with radioiodine in Ukrainian

children and adolescents affected by post-Chernobyl differentiated thyroid

cancer.



Oliynyk V, Epshtein O, Sovenko T, Tronko M, Elisei R, Pacini F, Pinchera A.



Institute of Endocrinology and Metabolism, Kiev, Ukraine.



Post-surgical ablation of thyroid residues with 131-iodine (131-I) is

usually recommended after near-total thyroidectomy in high-risk patients,

including children, with differentiated thyroid cancer (DTC). We report here

the results of post-surgical radioiodine thyroid ablation in 249 children

and adolescents of Ukraine with post-Chernobyl DTC initially treated with

near-total thyroidectomy at the Institute of Endocrinology and Metabolism in

Kiev, during a 2-year period. The patients' age at the time of the Chernobyl

accident (1986), ranged from <1 to 14 yr in 223 subjects (children) and from

15 to 18 yr in 26 subjects (adolescents). Six weeks after surgery a

diagnostic 131-I whole body scan revealed the presence of residual thyroid

tissue in all cases. All patients received one or more courses of

radioiodine therapy, for a total of 468 courses. One hundred and twenty-nine

out of 249 patients (51.8%) were successfully ablated. The total number of

treatment courses needed in these patients was 219. Most patients required

multiple doses of radioiodine, only 63 required a single dose. One hundred

and twenty patients (48.2%) treated with radioiodine were not ablated and

are still under treatment program. The clinical features and the amount of

thyroid residue were not different in ablated or not-ablated patients. Our

results indicate that in this particular population of post-Chernobyl

thyroid carcinomas, thyroid ablation is a rather difficult task. Only 51.8%

were successfully ablated. Possible explanation for this finding may be the

young age of the patients, other particular features of post-Chernobyl

thyroid carcinoma or technical aspects, such as less radical surgical

procedures.





Arkh Patol 2001 Jul-Aug;63(4):3-9

[Radiogenic (Chernobyl) thyroid cancer]



Abrosimov AIu, Lushnikov EF, Frank GA.



Thyroid carcinoma is a documented medical consequence of the Chernobyl

accident, but medicobiological and other aspects of this problem are not yet

understood completely because Chernobyl thyroid carcinoma (CTC) is not a

single nosological entity but an integrated notion including various groups

of population of different age and sex, pollution of the territory, various

histogenesis (A-, C-cells) and morphogenesis, latent period (minimal 4

years, maximal not yet known), variable clinical and morphological

manifestations. Further CTC studies are needed on a special long-term

program.





Int J Radiat Biol 2001 Aug;77(8):891-9

Instability of microsatellites in radiation-associated thyroid tumours with

short latency periods.



Lohrer HD, Braselmann H, Richter HE, Jackl G, Herbeck J, Hieber L, Kellerer

AM, Bauchinger M.



Radiobiological Institute, University of Munich (LMU), Schillerstrasse 42,

D-80336 Munich, Germany. lohrer@gsf.de



PURPOSE: To determine the instability of microsatellite sequences in

post-Chernobyl thyroid tumours from children and young adults, and to

ascertain whether they correlated with the age of the patient at the time of

the accident and the tumour latency period. MATERIALS AND METHODS: The

stability of 26 microsatellite markers was investigated in 122

radiation-associated thyroid tumours (96 children, 26 adults) from Belarus

and 39 spontaneous thyroid tumours (adults) from Munich without radiation

history. RESULTS: A significant correlation between patient age at the time

of the accident and the instability of microsatellite sequences was

established. Also, a high instability of microsatellite sequences was found

in 28 early thyroid tumours from Belarus with latency periods of 6-8 years,

in contrast to a low instability of microsatellites in 94 tumours emerging

9-11 years after the accident. Microsatellite instability in the reference

group from Munich proved similar to the early thyroid tumours from Belarus.

CONCLUSION: Early, fast-growing and aggressive post-Chernobyl thyroid

tumours are characterized by an increase in microsatellite instability.



Bill Field



----- Original Message -----

From: Jim Muckerheide <jmuckerheide@cnts.wpi.edu>

To: Dukelow, James S Jr <jim.dukelow@PNL.GOV>; maury <maury@WEBTEXAS.COM>;

Radiation Safety <radsafe@list.vanderbilt.edu>

Sent: Thursday, March 21, 2002 8:13 PM

Subject: RE: 16th Anniversary of Chernobyl accident





> Name one. I gave you have the documents. Where is there a thyroid cancer

death? The "three" reported in 1996 were rejected by the Russians because 2

weren't exposed, and the third, in a low dose area, was victim of medical

failures. See Annex J of the UNSCEAR 2000 report, and the sources you chose

to <snip> from the msg.

>

> But I meant the "early deaths" from the accident. None. From the most

egregious, extreme, radiological event, from criticality transient producing

additional short-lived radionuclides ejected instantaneously and directly

through the building into the environment, then to burn for 10 days, beyond

our contemplation. No evacuation. But NO deaths or injuries!

>

> Whether thyroid cancers are a result is accepted but very debatable, but

the combination of short-lived radionuclides and the failure to stop eating

local produce and milk should have caused vast consequences (unless you

actually consider the 100 million+ medical exposures to I-131). But even

then, there are about 1 out of 100,000 exposed children (virtually all from

5 months before birth to 5-7 years old), with POOR correlation with dose, a

highly treatable effect, uncertain effects from just the heightened

screening for thyroid conditions that exist is an essentially trivial

consequence. It's less than what we take as normal operation for fossil

fuels; perhaps less than exposures from chemical plants, fires, accidents

etc if we bothered to put >$100+ million into following such exposures.

>

> But since our jobs are to "protect the public from radiation," we must

continue to misrepresent the magnitude, and even the nature, of the hazard,

to continue to extract our blood money from the gullible public that we are

so committed to misinform. But it's a good-paying job.

>

> Regards, Jim

>

>

> -----Original Message-----

> From: Dukelow, James S Jr [mailto:jim.dukelow@pnl.gov]

>

> Jim Muckerheide wrote:

>

>     <snip>

>

> The false premise of radiation hazards from nuclear power, 'dirty bombs,

> etc. is becoming ever more clear. :-) Let's remember that NO ONE in the

> public was injured or killed by CHERNOBYL, with NO evacuation, compared to

> the hysterical consequences claimed by the regulators and politicians!

>

> Regards, Jim

>

> ======================

>

> To this generally sympathetic semi-naive observer, the thyroid cancer echo

> of Chernobyl seems pretty well established.  My understanding is that

there

> have been a few deaths.  Further, thyroid cancer itself seems pretty

clearly

> to qualify as an injury.

>

> Best regards.

>

> Jim Dukelow

> Pacific Northwest National Laboratory

> Richland, WA

> jim.dukelow@pnl.gov

>

> These comments are mine and have not been reviewed and/or approved by my

> management or by the U.S. Department of Energy.

>

>

>

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