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Current information is available through the Hanford Community Health Project, which is updated by the Agency for Toxic Substances and Disease Registry of the U.S. Centers for Disease Control and Prevention.

A PUBLICATION OF THE
Hanford Health
Information Network
An Overview of Hanford
and Radiation Health Studies

HERE YOU'LL FIND...
What Happened at Hanford

Hanford Radiation Studies Began

Radiation Health Effects:
How Radiation Causes Harm

Cancer

Thyroid Disease

Other Radiation Health Effects

Downwinder Perspective

Conclusion

Notes


Hanford is the name of a former nuclear weapons production site located in south central Washington state. Established in 1943, Hanford released radioactive materials into the air, water and soil. The releases occurred mainly as the result of routine operations but were also due to accidents and intentional releases. Many of those who lived in the areas downwind from Hanford or who used the Columbia River downstream from Hanford received doses of radiation. Those doses may have caused health problems or might cause them in the future. The basic assumption of radiation protection is that any dose of radiation poses a health risk.

This publication presents some basic information about Hanford, the radiation it released and how people were exposed to the radioactive contamination. It also provides an introduction to the possible health effects from radiation exposure. Because the largest estimated exposure from Hanford could affect the thyroid gland, this publication includes a special section on thyroid disease. Also included are descriptions of HHIN publications that offer further information.

 

WHAT HAPPENED AT HANFORD

Because of the secrecy surrounding nuclear weapons production, the public did not know much about Hanford's operational details until 1986. By February of that year, citizen pressure had forced the U.S. Department of Energy to release 19,000 pages of Hanford historical documents that had been previously unavailable to the public. These pages revealed there had been huge releases of radioactive materials into the environment that contaminated the Columbia River and more than 75,000 square miles of land. Many people were outraged at the four decades of secrecy and deception.1 They felt they had been betrayed by their own government. They demanded to know how the government could have kept such dangers secret for so long.

The documents revealed that Hanford was key to U.S. participation in the nuclear arms race. In 1943 the federal government had selected Hanford as the site for the world's first large-scale nuclear production plant. Hanford produced the plutonium for the bomb dropped on Nagasaki, Japan, during World War II. About half of all U.S. nuclear weapons were made with plutonium from Hanford. Hanford officials cited national security considerations as a justification for the secrecy.

For More Information

The following publications can give you more information about the topics discussed in this section.

The Release of Radioactive Materials from Hanford: 1944-1972 --- Discusses what is known about how much radiation was released from Hanford into the air, water, and soil. It also describes the December 1949 "Green Run," Hanford's largest single release of radiation.

Potential Health Problems from Exposure to Selected Radionuclides: Plutomium, Strontium, Cerium and Ruthenium --- Presents details of the release of Hanford's radiation in the form of particles (iodine-131 was released as a gas). Also described are some of the health effects that have been linked to specific radioactive elements.

Hot Spots: Weather and Hanford's Radiation Releases to the Air --- Many people in the Northwest remember the 1980 Mount St. Helens eruption and how the ash settled in distinct patterns as carried by the changeable winds. Many downwinders wonder how the winds may have carried Hanford's radiation that went into the air. This publication describes the wind patterns and how they might have affected the doses people received.

Radionuclides in the Columbia River: Possible Health Problems in Humans and Effects on Fish --- Describes how Hanford released radioactive materials into the Columbia River, 1944-1971. It also discusses some of the health effects that have been linked to exposure to specific radioactive elements. Included is a summary of studies that have been conducted on fish and other aquatic creatures to determine Hanford's impact on them.

Contained in the documents were descriptions of how Hanford operations had released radioactive materials. The plutonium was produced in nuclear reactors along the Columbia River. The reactors needed large amounts of water from the river for cooling. Materials in the river water were made radioactive when they passed through the reactors. After passing through the reactors, the water and the radioactive materials it carried were put back in the river. The radiation contaminated the water and aquatic animals downstream as far as Pacific oyster beds along the Washington and Oregon coasts. The highest releases to the Columbia were from 1955 to 1965.

After the plutonium was removed from the reactors, it had to be separated and purified for use in nuclear weapons. Separating the plutonium resulted in radiation being released into the air. Winds carried Hanford's airborne radiation throughout eastern Washington, northeastern Oregon, northern Idaho and into Montana and Canada. Food grown on contaminated fields, and milk cows grazing there, transferred the radiation to people who ate the food and drank the milk. The years of highest releases to the air were 1944 through 1951, with 1945 being the largest.

HANFORD RADIATION STUDIES BEGUN

Because of public concern and anger over the once-secret information, a scientific panel, the Hanford Health Effects Review Panel, was convened in September 1986 to examine the newly released documents. The panel recommended that two studies be done to determine (1) how much radiation people had been exposed to and (2) if there was an unusually high rate of thyroid disease among those exposed. Thyroid disease was selected because the type of radiation that caused the highest exposures downwind from Hanford, iodine-131, concentrates in the thyroid gland. In previous studies of other populations, exposure to radiation has been shown to cause thyroid disease, including cancerous and non-cancerous thyroid growths.

To determine how much radiation people were exposed to, the U.S. Department of Energy began the Hanford Environmental Dose Reconstruction Project (HEDR) in 1987. Funding for HEDR was transferred to the Centers for Disease Control and Prevention (CDC) in 1992. The reason for this transfer was the Department of Energy's conflict of interest since the Department also is in charge of Hanford operations. Some people remained skeptical because CDC kept Battelle Memorial Institute as the contractor to do most of the HEDR work. Battelle has been a Hanford contractor since 1965.

For More Information

Readers interested in learning about how radioactive materials function once they are inside the human body can request a copy of Radioactivity in the Body. This HHIN publication lists which organs in the body received the largest dose from nearly a dozen radioactive materials.

By analyzing the 19,000 pages and other historical documents and by using computers, HEDR estimated how much radiation Hanford released and how much people were exposed to based on where they lived and what they ate and drank. For most of those exposed, the greatest part of their total dose came from drinking milk and eating food that was contaminated with radioactive materials from Hanford. For certain people, such as Native Americans, the largest contributor to dose was probably eating contaminated fish. Between 1944 and 1972, according to HEDR's estimates, about 2 million people were exposed either through the air or the Columbia River.

In addition to the HEDR project (to determine how much radiation people were exposed to), the federal government sponsored a second study, the Hanford Thyroid Disease Study (HTDS). CDC began HTDS in 1989 and plans to complete it in late 1998. CDC has contracted with the Fred Hutchinson Cancer Research Center in Seattle to carry out the study. The HTDS is investigating whether thyroid disease, including thyroid cancer, is increased among people who were exposed as infants and children to iodine-131 from Hanford. By its completion, the study will have examined over 3,000 people for thyroid disease.

RADIATION HEALTH EFFECTS: HOW RADIATION CAUSES HARM

To understand why cancer and thyroid disease are of concern, it is useful to know how radiation can cause harm to the body. When radiation enters the body and hits a cell, one of four things can happen:

    (1) radiation may pass through the cell without doing damage;
    (2) it may damage the cell, but the cell may be able to repair the damage before producing new cells;
    (3) it may damage the cell in such a way that the damage is passed on when new cells are formed; or
    (4) it may kill the cell.

Internal and External Exposure to Radiation

Radiation exposure may be internal or external. Internal exposure comes from eating or drinking contaminated food or water, or from breathing contaminated air. A radioactive substance can also enter the body through cuts in the skin. Alpha and beta radiation contribute to internal exposure. External exposure can come from beta, gamma and X-ray radiation that penetrates the body. Both internal and external radiation can directly harm cells. Exposure to Hanford's radiation was primarily internal. Exposure from the atomic bombings in Japan was primarily external.
If the radiation passes through the cell without doing damage or the cell repairs itself successfully (numbers 1 and 2 above), there is no lasting damage or health effect. If the damage is passed on when new cells are formed (number 3 above), there may be a delayed health effect, such as cancer or genetic effects. Any dose of radiation may produce a delayed health effect. Delayed effects from radiation exposure may occur months, years or decades later. It is not possible to predict if or when these effects will occur.

If the damage to a cell is not repaired and is passed on to new cells (number 3 above), a cancer can begin to grow. It may take years or even decades for a cancer to grow large enough to be discovered. This period between exposure to radiation and the discovery of cancer or other health effects is called the latent period. The latent period varies for different types of health effects and different types of radiation doses.

When radiation kills a cell (number 4 above), there will be acute (immediate) health effects if the dose is high and many cells die. An example of an acute effect is death within days or weeks from radiation sickness, as happened to the highly exposed people in the atomic bombings in Japan. Other acute effects include vomiting and loss of hair. From what is currently known, doses to people from Hanford's environmental releases were not enough to produce immediate or direct effects.

Difference Between Exposure and Dose

"Exposure" refers to how much radioactive material entered a person's body. Not all radiation entering the body stays there. Much of it is flushed out through breathing or along with other waste products.
"Dose" refers to the amount of radioactive energy that is actually absorbed by tissues in the body. For instance, about a third of the iodine-131 entering the body is absorbed by the thyroid. Traces of it are absorbed by other body organs. The rest is flushed from the body.

CANCER

Radiation can cause most types of cancer. Some cells or organs - breast tissue and the thyroid, for example - are very sensitive to radiation. Others, such as bone cells, are not as sensitive.

Whether or not exposure to radiation will cause cancer depends on a variety of factors. These include: the amount and type of radiation dose; individual characteristics that make some people more susceptible to cancer than others; age; gender; whether the exposure occurred over a short or a long time; and the presence of other substances that enhance the cancer-causing power of radiation.

There has been much controversy over the extent to which low-dose radiation causes cancer. One of the more widely-known reports was published in 1990 by the Fifth Committee on the Biological Effects of Ionizing Radiations (known as BEIR V).2 BEIR V concluded that information from scientific studies about people receiving low doses was insufficient to determine cancer risk.

Overall, BEIR V concluded that cancer risk from radiation exposure is higher than regulatory and advisory groups had previously described. BEIR V estimated cancer risk but acknowledged uncertainty concerning these risk estimates. BEIR V estimated that for every 10,000 adults exposed over a short time period to 1 rem of radiation, eight would die from radiation-induced cancer.3 If the exposure took place during childhood, the risk for fatal cancer was estimated to be twice as high. BEIR V also concluded that when the dose was received over a long time, the lifetime risk of death from cancer was lower by a factor of 2 or more than if the same dose had been received over a short time. Most Hanford exposures occurred over long times (months, years or decades).

Other scientists have drawn quite different conclusions, arguing that BEIR V either overestimated or underestimated the risk of radiation-caused cancer. For instance, a team of scientists found that radiation doses received by survivors of the atomic bomb dropped on Hiroshima were higher than current estimates.4 If this is true, BEIR V cancer-risk estimates may be too high, as they are strongly influenced by the Japanese survivor studies.

Others argue that the BEIR V report underestimates the risk of radiation-caused cancer. Among these scientists is Dr. John Gofman. He concluded that for every 10,000 adults exposed to 1 rem of radiation, 26 would die from radiation-induced cancer.5 Gofman pointed out that about 2,200 of these 10,000 adults will die from cancer induced by all causes. Gofman also said that the risk is even higher for children.

Contrary to BEIR V, Gofman believes that receiving a low dose of radiation over weeks or months (such as in the Hanford situation) does not lower the risk for radiation-induced cancer. In fact, he argues that a dose of radiation given over a longer time will produce a greater cancer risk than the same dose given over a short time.

Additionally, two other scientists have been sharply critical of BEIR V. Rudi H. Nussbaum and Wolfgang Kohnlein have pointed out a number of inconsistencies within the BEIR V report. They also argue that studies published after BEIR V support the position that there is a greater risk of health effects from chronic low doses than is reflected in current radiation protection regulations.6

Why There Aren't Clear Answers

Scientists are unable to determine with certainty the relationship between cancer and radiation exposure. Many people find this frustrating. However, it is important to know

For More Information...

The Network offers two publications that explore some of the problems in the study of radiation-induced cancer and the resulting controversy.

Epidemiology: Understanding Health Studies explains the basics of studying disease in human populations. It also summarizes five past studies on the possible health effects of Hanford's releases on the public.

Health Risk Viewpoints: Radiation and Cancer presents the opinions of three scientists. Each was asked to comment on whether people exposed to radiation released from Hanford have an increased risk for developing cancer.

that there are three key factors that complicate this scientific research. First, there are many things that can cause cancer besides exposure to radiation, making it difficult to measure which ones were caused by radiation exposure. Cigarette smoking, exposure to pesticides and other toxic chemicals, and random genetic mutations also can cause cancer. Second, people receive radiation from sources other than Hanford, such as background radiation and medical procedures. Third, not everyone exposed to radiation gets cancer.

THYROID DISEASE

The type of radiation that caused the highest doses downwind from Hanford, iodine-131, concentrates in the thyroid gland. Exposure to some types of radiation has been shown to cause thyroid disease, including cancerous and noncancerous thyroid growths. The HTDS is gathering information on all types of thyroid disease, whether or not previous studies have suggested links between radiation exposure and thyroid disease. While the HTDS will not be completed until late 1998, thyroid disease studies from other types of radiation exposures may offer some comparisons to the Hanford situation.

Studies of Environmental Exposure to Iodine-131

Because people downwind from Hanford were exposed to airborne releases of iodine-131, studies of other people who were exposed to airborne releases of iodine are of interest. The situations of the Nevada-Utah downwinders, the Marshall Islanders and children exposed as a result of the Chernobyl accident have some similarities with the Hanford situation (mainly exposure to iodine-131). However, there are also some important differences that limit comparisons with Hanford, including:

  • the other thyroid doses were received over a relatively short time period;
  • other isotopes of iodine were part of the releases in the other areas; and
  • people were exposed to external radiation sources as well as internal ones.

Nevada-Utah Downwinders

People who lived downwind (downwinders) from the Nevada Test Site were exposed to nuclear fallout, including iodine-131, caused by atmospheric testing of nuclear weapons. A study of these downwinders suggests a dose-response relationship between the occurrence of thyroid growths (nodules and cancer) and iodine exposure. In this setting, a "dose-response relationship" means that the risk of having a thyroid growth (the response) increases as the dose increases. In other words, people with higher doses have greater risk than people with lower doses. The scientists who did the study concluded that the radioactive iodine exposure "probably caused" between one and 12 of the 19 cases of thyroid growths among the study population of about 2,500.7

Marshall Islanders

In 1954 Marshall Islanders were exposed to radioactive fallout from a nuclear weapon test in the South Pacific. They were exposed to some iodine-131, but most of the thyroid exposure came from other radioactive forms of iodine. The Marshall Islanders suffered both acute and delayed effects from radiation. Eight years after the blast, some Marshall Islanders developed thyroid disease. After 27 years, the Marshall Islanders had an increased rate of hypothyroidism (underactive thyroid gland) and both noncancerous and cancerous thyroid growths. It is difficult to say that it was the iodine-131 or the other radioactive iodines alone that caused these thyroid problems because the Marshall Islanders also received external radiation.

Children Living Near Chernobyl

In 1995 scientists reported that the rates of thyroid cancer were significantly increased among young people who were exposed to Chernobyl's radioactive fallout.8 Before the 1986 accident, childhood thyroid cancer in the areas around Chernobyl was rare. The current rates are up to 200 times higher than normal. The rates in the table below are the number of thyroid cancers per million people. Childhood thyroid cancers are those thyroid cancers diagnosed before the children turn 15 years old.

Most (about 85 percent) of the Chernobyl thyroid dose came from iodine-131 and was received over a short time. The rest of the thyroid dose came from other radioactive isotopes of iodine. At Hanford, nearly all of the thyroid dose was from iodine-131 and was received over a number of years. HEDR estimated that children living downwind from Hanford received total thyroid doses in the range of 3 to 235 rad for the period 1944 through 1951. Because of uncertainties, the estimated dose could have been as high as 870 rad.10

Until further studies around Chernobyl are completed, it is not clear if radioactive iodine was the only cause of the high rates of thyroid cancer. Among other possible contributors were an iodine deficiency in the exposed population before the accident and a higher than normal sensitivity to the harmful effects of radiation exposure among some of those exposed.11 Another contributor could have been the greatly increased number of thyroid examinations after the accident.12

Childhood Thyroid Cancer Near Chernobyl9
(before and after the 1986 accident)
1981-1985 1986-1990 1991-1994
No. of
Cases
Rate* No. of
Cases
Rate* No. of
Cases
Rate* Thyroid Dose
Estimate
Gomel region, Belarus 10.52110.514396.415 to 570 rad
Northern Ukraine 10.1212.09711.55 to 200 rad
Bryansk and Kaluga
regions, Russia
0031.22010.06 to 180 rad
* number of thyroid cancers per million people

Medical Exposures to Iodine-131

Much of what is currently known about the health effects of iodine-131 comes from studies of the medical uses of iodine-131. One group of people exposed to iodine-131 received a one-time high dose (thousands of rad) to treat hyperthyroidism (an overactive thyroid gland). Another group received a one-time low dose (50-100 rad) of iodine-131 for tests to diagnose thyroid disease. Studies of these two groups of people do not show any link between iodine-131 and thyroid cancer.

For More Information...
The Network has developed a Health Bulletin that presents summary information about Hanford's radioactive releases along with a brief screening and assessment guidelines for thyroid disease.

However, the length of time people were studied varied. The longest study followed people an average of 20 years. Scientists believe that the latent period for thyroid cancer can range from five to more than 40 years. They believe that the very high doses of iodine-131 used to treat people with hyperthyroidism result in killing off cells so that cancer cannot develop.

External Gamma and X-ray Radiation of the Thyroid

While there is not conclusive evidence linking iodine-131 and thyroid cancer, there is a link between thyroid cancer and exposure to X-rays and gamma radiation. Studies of people who received X-ray treatments of the head and neck show that X-rays can cause thyroid cancer. Thyroid cancer was the first solid tumor to show an increased rate in Japanese atomic bomb survivors who were exposed to gamma radiation.

Parathyroid Disease

Parathyroid glands help maintain the level of calcium in the body and are located around the thyroid. Studies of people receiving X-ray treatments to the head and neck have demonstrated a higher rate of hyperparathyroidism than expected. Further, those people who had hyperparathyroidism and a history of radiation treatments also had a greater frequency of thyroid disease than those who had hyperparathyroidism but did not have radiation treatments.13 Radioactive iodine in the thyroid exposes the parathyroid which may cause tumors in the parathyroid glands. The Hanford Thyroid Disease Study is investigating whether hyperparathyroidism is increased among people exposed to Hanford's radioactive releases.

OTHER RADIATION HEALTH EFFECTS

Although cancer is the most studied of all radiation health effects, exposure to radiation can harm the human body in other ways. The following are brief summaries of some other radiation health effects. Publications are available from the Network on some of these health effects.

Immune System

The immune system is a complex network in the body that helps fight diseases and foreign substances. Studies have shown that radiation exposure can weaken the immune system. Autoimmune diseases are those in which a person's own immune system attacks one or more tissues or organs. These diseases include multiple sclerosis and lupus. While there have not been any studies concerning Hanford and autoimmune diseases, some Hanford-area residents are concerned that their exposure to radioactive materials has triggered such diseases. They believe that there are a higher than normal number of autoimmune disease cases among those who were exposed. For more information on the immune system and radiation's effects on it, see Immune System and Radiation.

Genetic Effects and Birth Defects

Genetic effects of radiation exposure occur when radiation damage to a parent's DNA code is transmitted to a child. (The DNA code contains information required for the development and maintenance of all organisms.) Genetic effects caused by radiation fall into two categories: (1) effects that appear in the children of an exposed parent and (2) effects that appear in later generations.

Health problems present at birth are called birth defects. These can arise spontaneously or through harm to normal developmental processes by radiation or by other toxic exposures.

For more information about these health effects, see HHIN's Genetic Effects and Birth Defects from Radiation Exposure. This publication includes a summary of a birth defects study of children born in the Hanford area. The study found an increase in one kind of birth defects, neural tube defects. But the study's scientists did not attribute this increase to Hanford radiation exposure.

Nervous System

The nervous system coordinates and regulates the body's activities. It consists of the brain, the spinal cord and other nerves. HHIN's The Nervous System and Radiation describes the nervous system and past studies on radiation effects involving this system. It also includes a collection of opinions on what information would be needed to determine if a link exists between Hanford's radiation and health effects of the nervous system. The people presenting opinions include scientists and members of the public.

Other Effects on the Lives of Those Who Were Exposed

The secrecy surrounding the Hanford releases, the involuntary nature of the exposure and the lack of information about radiation health effects have left some people understandably frustrated, mistrustful and angry. Many people report feeling that the emotional and economic toll has been great. This is especially true for those who have thyroid diseases and other illnesses and whose family members, friends and neighbors are ill or have died. For additional reading on these aspects, see HHIN's Coping with Uncertainty and Illness: Concerns of Hanford Downwinders.


downwinder perspective

Many callers to the Hanford Health Information Lines have reported concerns about their health. Scientific research has not - or at least not yet - related health problems to exposure to radiation released from Hanford. However, some downwinders do have health problems and believe that these problems are related to Hanford. The following personal perspective is offered to help readers understand these experiences and concerns.

"When I arrived in Richland in 1954, I was healthy, happy, full of energy and a bride of two weeks. It wasn't long before I began having horrific migraines, and unexplained attacks of vomiting and diarrhea that sent me to the hospital because I was dehydrated. Tests could not explain my symptoms - yet they persisted. I was weak to the point of exhaustion. And I lost an alarming amount of weight.

Within a few years it became impossible for me to participate in family and social events. More often than not, I stayed home and on more than one occasion, my husband and children went on vacation trips without me. Two of my pregnancies ended in miscarriages. By my early 30s, I was a semi-invalid. I was diagnosed with endometriosis (growth of uterine tissue outside the uterus). When I was 35, I was rushed to the hospital unconscious and hemorrhaging. An emergency hysterectomy saved my life. Seven years ago, I was diagnosed with fibromyalgia. Was it connected to living there (near Hanford)? The doctors didn't connect it - yet?

Both of our children were born with immune dysfunctions. A simple cold was an alarming matter. They were often anemic and our pediatrician tested them for leukemia. Both had skin cancer. My adult daughter has endometriosis. Connected? I wonder...

Without warning, my husband was diagnosed with prostate cancer. It had already metastasized to his kidney, then to his liver. He died in 1990. His question was, 'Are our medical problems because we lived in Richland for 25 years?' It weighs heavily upon my heart. Is there a connection? Studies and medical monitoring may one day answer his question. We greatly miss his loving presence in our lives."

- Name withheld by request.


NOTES

1 - For further reading about Hanford, secrecy and deception, see Atomic Harvest: Hanford and the Lethal Toll of America's Nuclear Arsenal by Michael D'Antonio (Crown Pub. 1993); The Dragon's Tail: Radiation Safety in the Manhattan Project, 1942-1946 by Barton C. Hacker (University of California 1987); On the Home Front: The Cold War Legacy of the Hanford Nuclear Site by Michele Stenehjem Gerber (University of Nebraska 1992); and Sordid Sorcery: The History of Hanford's Deception by the Hanford Education Action League (HEAL 1992).

2 - National Research Council (BEIR V). Health Effects of Exposure to Low Levels of Ionizing Radiation. National Academy Press, 1990. BEIR V was a committee of 17 scientists from the National Academy of Sciences. The chair of BEIR V was Arthur C. Upton.

3 - BEIR V, p. 162.

4 - T. Straume, et al. "Neutron Discrepancies in the DS86 Hiroshima Dosimetry System." Health Physics, October 1992, Vol. 63, No. 4, pp. 421-426. In 1992, Straume was with Lawrence Livermore National Laboratory. His colleagues were from SAIC in San Diego, the University of Rochester (N.Y.) and Hiroshima University.

5 - J.W. Gofman. Radiation-Induced Cancer from Low-Dose Exposure: An Independent Analysis. Committee for Nuclear Responsibility, 1990, chapter 25, p. 15. Gofman is Professor Emeritus of Molecular and Cellular Biology at the University of California, Berkeley.

6 - R.H. Nussbaum and Wolfgang Kohnlein. "Inconsistencies and Open Questions Regarding Low-Dose Health Effects of Ionizing Radiation." Environmental Health Perspectives, Vol. 102, No. 8, August 1994, pp. 656-667. Nussbaum is Professor Emeritus of Physics and Environmental Sciences at Portland (OR) State University. Kohnlein is professor and director of the Institute for Radiation Biology at the University of Munster in Germany. See also "Health Consequences of Exposures to Ionizing Radiation from External and Internal Sources: Challenges to Radiation Protection Standards and Biomedical Research," Medicine and Global Survival, Vol. 2, No. 4, December 1995, pp. 198-213.

7 - R.A. Kerber, et al. "A Cohort Study of Thyroid Disease in Relation to Fallout From Nuclear Weapons Testing." Journal of the American Medical Association, Vol. 270, No. 17, November 3, 1993, p. 2082.

8 - V.A. Stsjazhko, et al. "Childhood Thyroid Cancer Since Accident at Chernobyl" (letter). British Medical Journal, Vol. 310, March 25, 1995, p. 801.

9 - Table is adapted from V.A. Stsjazhko, et al. "Childhood Thyroid Cancer Since Accident at Chernobyl" (letter). British Medical Journal, Vol. 310, March 25, 1995, p. 801.

10 - Technical Steering Panel of the Hanford Environmental Dose Reconstruction Project. Representative Hanford Radiation Dose Estimates, Revision 1. April 21, 1994, p. 2.

11 - M. Balter. "Children Become the First Victims of Fallout." Science, Vol. 272, April 19, 1996, p. 359.

12 - E. Ron, J. Lubin, and A.B. Schneider. "Thyroid Cancer Incidence." Nature, Vol. 360, November 12, 1992, p. 113. Ron and Lubin are with the Epidemiology and Biostatistics Program at the National Cancer Institute. Schneider is with Humana and Michael Reese hospitals at the University of Illinois.

13 - A. Katz and G.D. Braunstein. "Clinical, Biochemical, and Pathologic Features of Radiation-Associated Hyperpara-thyroidism." Archives of Internal Medicine, Vol. 143, January 1983, pp. 79-82.



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