Re: Background on Epi Studies - REPLY Morbidity of Nasal Radium Irradiation

[RADPROJECT@aol.com]

______________________________________
a message dated 98-06-15 20:04:54 EDT, James Barnes writes:

<< Subj:	 Background on Epidemiology Studies
 Date:	98-06-15 20:04:54 EDT
 From:	mail15077@pop.net (James G. Barnes)
 Sender:	radsafe@romulus.ehs.uiuc.edu
 Reply-to:	radsafe@romulus.ehs.uiuc.edu
 To:	radsafe@romulus.ehs.uiuc.edu (Multiple recipients of list)
 
 Good afternoon, everyone.
 
 I need some background regarding epidemiology studies.
 
 It is my understanding that most (if not all) of the epidemiology on 
 radiation is based on mortality studies (i.e., "who died of what").
 
 Can anyone direct me to any studies where radiation exposure was studied 
 and morbidity (i.e., "got sick but didn't die") was the basis of the 
 epidemiology.  I'd prefer material that has been peer reviewed, but would 
 be interested in anything reasonably reputable.
 
 
 Thanks,
 
 
 Jim Barnes, CHP
 Radiation Safety Officer
 Rocketdyne / Boeing
 mail15077@pop.net
 818-586-5766
  >>
______________
Dear Radsafers:
A paper was published recently as noted below related to the health effects of
nasal radium irradiation (NRI),  which was used on children from post-WWII
until well into the 1970s in some places like Maryland where it persisted due
to entrenched use by Johns Hopkins trained physicians. A best estimate of
1,000,000 children [per a CDC review presented at a CDC/VA sponsored workshop
"The Public Health Response to Nasopharyngeal Radium Irradiation - A Workshop"
on the issue in Aug. 1995) received NRI in the US. NRI  use involved the
insertion of 50 mg Ra-226 Monel metal encapsulated irradiators (0.3 mm wall
thickness to maximize beta dose) through the nose [bilateral] to the rear of
the nasopharynx for 12 minutes, with three to four treatments per course of
therapy. A course of treatment was repeated "as necessary" and some people
received 10 or more courses.

The 1996 paper referred to above by Dr. Peter G. Verduijn, "Late health
effects of radiation for eustachian tube dysfunction: Previous results and on-
going study in the Netherlands", Otolaryngology -Head and Neck Surgery, Vol.
115, No. 5, Nov. 1996 reported the following results based on morbidity, not
mortality end points:

ABSTRACT
"A statistically significant difference was noted ....for cumulative all-site
cancer incidence, with the exposed having twice as many verified canceers as
the nonexposed. This excess risk was caused mainly by head and neck tumors and
other tumors (lung, digestive tract, and urogenital system).....These findings
corroborate the hypothesis that there is some risk of tumor induction involved
with nasopharyngeal radium irradiation at the dose level applied to this
population."


Note that the Verduijn, 1996 study followed up on 2,510 children treated in
the Netherlands who received average radium doses 3.5 times less that the
typical treatment protocol used in the U.S. as studied and reported by
Sandler, 1980; Sandler, 1982; and Matanoski, 1980.  In the Netherlands,
treatments were generally unilateral, not bilateral; a 25 mg irradiator was
used, not 50 mg of Ra-226, and fewer treatments were given on average to young
children.

The cited publications by Johns Hopkins researchers based on a Ph.D thesis by
Dr. Dale Sandler of Johns Hopkins who during 1978-79 tracked the health
outcomes of 667 children treated in Hagerstown, MD in a hearing clinic run by
Johns Hopkins reported excess cancer mortality of the head and neck (RR= 2),
excess brain cancer mortality (RR= 5.3 based on Sandler, 1980 as reviewed by
BEIR-V report); and excess rates of Graves disease (RR= 8.6, p=<<0.01). The
findings of a high rate of the non-malignant endpoint of Graves disease, a
type of hyperthyroidism normally considered autoimmune in origin was never
published in the open medical literature by Johns Hopkins. The CDC has
continued to ignore this research about the 8.6 fold Relative Risk for Graves
disease [apparently related to intense pituitary irradiation and upset of TSH
production] while putting out unsupported statements regarding  NRI risk that
state: "Current studies do not indicate substantial risks for neoplastic or
other disease among those who received NP radium treatments." This statement
is completely unsupported by the medical and epidemiological literature on NRI
treatment but this has not stopped the CDC from misrepresenting the facts of
the matter to the nation's physicians in Morbidity and Mortality Weekly
Reports, and in Congressional Briefings about nasal radium irradiation.

For detailed information on the subject of NRI, and to see an annotated
bibliography and complete citations for the above publications, and links to a
number of popular press and medical journal articles [scroll to the bottom of
the web page] refer to the web address below for the Radium Experiment
Assessment Project.



Stewart Farber, MS Public Health
Director - Radium Experiment Assessment Project
19 Stuart St.
Pawtucket, RI 02860

Phone: (401) 727-4947   Fax: (401) 727-2032   E-mail: radproject@usa.net
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The Radium Experiment Assessment Project is a project 
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