What took so long? Scientists consider long-term health monitoring after radiation exposure
It’s been 40 years since the partial meltdown of the Three Mile Island (TMI) Unit 2 reactor in 1979 and more decades still since the first above ground atomic bomb explosions. Our atomic history is littered with assorted spills, releases, leaks, some secret, some not. Any of these national or local exposure events should have spurred our federal agencies to establish proper health registries. Such registries should have assessed health impacts not just in the short term, but also over lifetimes. Yet establishing functional and accessible registries for monitoring health of civilian individuals following radiation releases has been challenging. A meeting, attended by Beyond Nuclear and requested by the Centers for Disease Control, and hosted by the National Academy of Sciences, examined what needs to be considered when establishing a registry.
Better late than never? Yes and no. Gaping holes still exist between the science the experts prefer to study and the science we need them to study. The intractable conflict persists between valuing theoretical representations or assumptions of exposure, over the lived reality of those exposed.
Three Mile Island mystifying silence
“No one really thought about bringing public health to the table until about two years ago” – Andrew Pickett, Pennsylvania Department of Public Health
The most glaring omission in a meeting on long-term health monitoring after radiation exposures in the U.S. was the near silence on Three Mile Island – the U.S.’s only admitted civilian reactor meltdown. At the very least, the meeting should have examined what went so very wrong for the residents around the facility when federal agencies incorrectly denied the population was exposed to high radiation levels; and then denied their responsibility for health investigations in the area. Was there a registry created? If not, why not? If so, what did it show and did it fall short? These questions were not addressed at this meeting. Instead, Andrew Picket, Pennsylvania Department of Public Health, contended that “[n]o one really thought about bringing public health to the table until about two years ago.” The communities around the ruined reactor thought about it. They asked for proper health investigations. Repeatedly. Loudly. They were continually patronized, belittled and rebuffed.
Instead of the health registry they deserved, the under-resourced public around TMI was left to the mercy of the courts to decide the question of harm. The court hamstrung health research so that even well-designed epidemiological studies couldn’t associate health impacts with radiation exposure. It was, in part, this misuse of health data that left those around TMI unrecognized and uncompensated; and the rest of the world deceived about what really happened. Increases of lung cancer and leukemia were associated with radiation exposure through blood evidence. Current research has found that thyroid cancers in the TMI community carry a biological mark specific to radiation exposure[1], are more aggressive and appear earlier[2], than thyroid cancers outside of the TMI community, indicating that the long-term impacts of TMI are still with us. Without understanding the myriad of missteps surrounding the TMI health investigations, we are being set up to repeat them.
Theory versus life: Gaping holes remain
Science has shown that all radiation doses carry risk. Individuals who were exposed to low doses should be included in any registry, despite the concerns over cost that were voiced at the meeting. Women, children and pregnancy are at highest risk, so their exposure circumstances, particularly for any pregnant or potentially pregnant person and offspring, should be meticulously recorded. Although some at the meeting contended that the type of contamination event should matter for inclusion in the registry, it should be dose level that matters. Dose levels for inclusion should remain the same across all such events.
A registry needs to not only focus on the initial exposure’s impact over the long term, but also must account for continuing new exposures that often follow. This accounting is especially important since people are often forced to live in radiologically contaminated environments and eat contaminated food. While this meeting refreshingly moved past the “no immediate danger” trope into a desire to examine long-term impacts, it did not specifically consider impact of lower, chronic doses that societies have been asked to endure for the “benefit” of nuclear technology.
Ongoing exposures occur directly, but some of the damage they cause can be carried across generations. While a dose (internal or external) may be considered low to each generation, calculating only the dose to each individual generation may result in underestimating the total damage future generations will have to endure. This is another reason why even individuals exposed to so-called “low” doses should not be excluded from any registry. The concept of compounding generational dose was not present at this meeting, yet needs to be a consideration when building a health registry.
Radiological emergencies come in many forms. While the meeting focused on civilian meltdowns and atomic bomb explosions, many live with radiological contamination not just from single events, but from small releases over the long-term like those that have contaminated uranium mining and milling sites. For this reason, health registries should focus on the exposed, not only single events.
Any health registry should focus on radiation’s impact on the human body, not just theoretical re-creation of doses that may or may not represent actual health damage. To its credit, this meeting featured two presenters who research the marks radiation leaves in exposed humans. These marks or “bioindicators” can play a large role in reliably reconstructing dose even years after exposure has occurred. Some bioindicator tests have been around since the mid-20th century, but have rarely been used to reconstruct radiation exposures to the public. While the meeting highlighted these techniques, concluding remarks were vague on future application.
Although a summary is forthcoming, recommendations will not be given
The meeting offered some positive steps forward for establishing radiation health registries, like the desire to include low doses and the highlight of bioindicators. However, major issues still need to be addressed to establish a robust registry that will serve the public: the willful ignoring of public concerns at TMI and the ensuing setbacks, the struggle to account for enhanced susceptibility, the impacts of low-dose radiation across generations. The NAS expects to release a summary report of the meeting in Fall 2019, but by design, no recommendations will be forthcoming. To see the meeting in its entirety, visit the NAS webcast archive site.
[1]Goldenberg, D. Altered molecular profile in thyroid cancers from patients affected by the Three Mile Island nuclear accident. Laryngoscope. 2017 Jul;127 Suppl 3:S1-S9.
[2] Presentation of Renu Joshi, M.D. Nuclear Hotseat Podcast: This Week’s RETURN TO TMI at 39 – SPECIAL.
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