Re: Leukemia in Astronauts -Other unusual radiation exposure?

[RADPROJECT@aol.com]

In a message dated 98-07-23 10:50:24 EDT, Mike McKinnon writes:

<< Fellow Radsafers,
 
 With the recent passing of Alan
 Shepard, one of the original seven
 astronauts, who died of Leukemia, one
 might wonder whether his increased
 exposure to cosmic radiation had any
 relevance.  Cause for discussion. >>

There is another potential, and more likely, contributor to radiation health
effects in early astronauts like Alan Shepard. Each of the original 7 were
military personnel and  test pilots during the period when Nasal Radium
Irradiation (NRI)  was commonly used on pilots and military personnel for
problems with pressure equalization from the nasopharynx to the middle ear.
Alan Shepard was reported to have had extensive problems with middle ear
infections which interfered with some of his flights in space. Test pilots
also had to undergo training where they were subject to explosive
decompression and ability to equlize pressure in these trainees would be
critical.

The NRI procedure involved the insertion of encapsulated 50 mg Monel metal
filtered sources ( 0.3 mm wall thickness) through the nose to the opening of
the eustachian tube. Each treatment typically lasted 12 min and 3 to 4
treatments, delivered bilaterally in the US, constituted a course of treatment
which would be repeated as needed.  Contact doses to the nasopharynx for a
four treatment course averaged about 2,000 rad [see Farber, S. "Radium
exposure in U.S. Military personnel", New England Journal of Medicine, Vol.
326. No. 1, pp. 71-72, Jan. 2, 1992 which reviews NRI use on an estimated
5,000 to 10,000 submariners]. The CDC, now that it has been forced to evaluate
the NRI issue, recently estimated that between 570,000 and 2.6 million
children in the US received NRI treatment from 1946 to 1961. However, the
practice continued well into the 1970s in places like Maryland where it had
become so entrenched because of the number of physicians trained at Johns
Hopkins. Last fall the REAP project was contacted following some local news
coverage by about 1,000 Maryland residents who received NRI and this gave a
better time line to the use of NRI.

Several studies of children who received NRI have documented elevated rates of
various health effects. A 1989 study in the Netherlands [Verduijn, PT,
Mortality after nasopharyngeal radium irradiation for eustachian tube
dysfunction", Ann Otol Rhinol Laryngol, Vol. 98, pp. 839-844, 1989] observed 4
lymphatic/hematopoietic cancer deaths in 1, 448 males followed for about 25
years on average where 0 were observed in a control group of 1,257 males.
Because the numbers were small, this excess relative risk was "statistically
significant" at the p= 0.07 and was not at the time given much note. The
overall cancer death RR for males was 2.78 but was not judged statistically
significant. Verduijn in 1996  published an update to his 1989 publication
reporting on a new review of the original data looking at cancer incidence not
cancer mortality. {see Verduijn, "Late health effects of radiation for
eustachian tube dysfunction: Previous results and ongoing study in the
Netherlands", Otolaryngology-Head and Neck Surgery, p. 417-421, Nov. 1996].
This updated report noted" "A statistically significant difference was noted
only for cumulative all-site cancer incidence, with the exposed having twice
as many verified cancers as the nonexposed....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: In the Netherlands, the children were treated with 25 mg
irradiators vs. 50 mg in the U.S.,  they were treated in one nostril vs. 2 in
the US, and for shorter periods of time on average.--Overall, this lead to the
total mg-min of radium exposure being 3.52 times lower in the Netherlands than
in the U.S."

The one study of NRI in the US [a study of only 667 children followed treated
in Hagerstown, MD at a clinic run by Johns Hopkins] documented a statistically
significant excess of brain cancer mortality, which the BEIR V report reviewed
as being equal to a Rel. Risk of  5.3. This is based on Sandler, DP,
"Neoplasms following childhood radium irradiation of the nasopharynx", J. Nat.
Can. Inst., Vol. 68, p. 3-8, 1982. The Ph. D. thesis resulting in the report
cited also found a doubling of benign and malignant tumors of the head and
neck and an 8.6 fold RR of Graves disease which was highly statistically
significant (p <<0.01).

More information on this subject can be found at the web site for the Radium
Experiment Assessment Project noted below. It should be noted that NRI
experiments conducted on school children in Baltimore by Johns Hopkins and
experiments on WWII submariners and aviators was reviewed by the Presidents
Advisory Committee on Human Radiation Experiments (ACHRE) in its Final Report
to President Clinton in Oct. 1995. NRI treatment of children in the study
reviewed was judged to have had the highest risk to health [8.4 cancer deaths
of the head and neck per 1,000 individuals treated vs. a threshold for notice
of 1 excess death per 1,000]  of any of the 4,000 human experiments reviewed
and was the only experiment reviewed which exceeded the threshold for medical
notice and followup. Nevertheless the ACHRE, chaired by Dr. Ruth Faden a
world-renowned Professor of Bioethics at Johns Hopkins School of Public
Health, failed to recommend medical notice and followup of the experimental
group of children in question for reasons that were ethically and  morally
challenged to say the least. One reason cited was that "Most of the risk [of
excess cancer mortality] has probably already been expressed"!!!! [emphasis
added -therefore ignore the issue]

The web page for REAP below includes a link [scroll to bottom of page for
testimony ["Nasal Radium Irradiation and The Advisory Committee on Human
Radiation Experiments - A Failure of Process"] on this point I presented in
March 1996 to the U.S. Senate Government Affairs Committee Hearing on Human
Radiation Experments. There are also links to a number of articles in the
medical literature and some background investigative news stories recently
published on NRI.

It should also be recognized that another eartly astronaut, Deke Slayton died
of brain cancer, an outcome linked to NRI. Having heard from about 1,500
individuals treated with NRI, I'm aware of another case where a [non-Oriental]
test pilot for Grummen Aircraft had NRI treatments and later developed and
died of nasopharyngeal cancer.

Overall it appears that the potential use of NRI on test pilots [as well as
submariners and other cohorts where NRI was commonly used at various times]
should be carefully documented as part of any investigation of  health status
and outcomes.

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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