MODULE 12
After studying this module, the reader will be able to
Prior to 1986, few people knew about the radiation released from the Hanford Nuclear Reservation from 1944 to 1972. Over the last decade, however, public awareness of Hanford's releases has increased. Today, many health care professionals are seeing patients who have questions and concerns about the significance of their exposure to Hanford's radioactive releases and about the possible link of this exposure to the health problems they may experience.
Exposure to radiation brings with it great uncertainty. Radiation is an invisible contaminant - it is not seen, felt, heard, smelled, or tasted. While acute exposures that result in high whole-body doses of radiation (50 rad or above) will cause certain immediate health effects ranging from mild nausea to death, chronic low whole-body doses have unpredictable health effects that are often medically invisible for long periods of time.
When a person develops an illness or disorder, it is usually not possible to determine whether radiation or other agents caused or contributed to the problem. In spite of these uncertainties, both the provider and patient benefit from open discussions about the possibility of a link between radiation exposure and a downwinder's health problem.
The following case histories represent four of the approximately two million people exposed to radiation from Hanford. Some people had more exposure to Hanford's radioactive releases than the people in these case studies, while other people had less exposure.
Each case history was developed by telephone interviews with a downwinder who was identified by the outreach staff of the Hanford Health Information Network. The written description of each case was sent to the downwinder for review. A copy of the case was also given to a health care provider identified by the downwinder for technical review; however, not all providers chose to comment on the cases. Lab work relevant to the downwinder's primary health problems was requested and included in the case history when available.
Each case begins with a residence history and a brief description of lifestyle factors that would have contributed most to the individual's radiation dose from Hanford. This is followed by a summary of health care problems, medications, and family history. There is a discussion of the associations between the kinds of health problems the individual has experienced and current radiation health effects research. Each case history concludes with a synopsis of the person's own reflections which include questions and beliefs about the possible connections between exposure to radiation from Hanford and the person's health.
This individual was conceived in Richland, Washington, and born there in January 1949. She lived in Richland until 1952.
During pregnancy, her mother drank locally produced milk and ate locally grown fruits and vegetables. As an infant, this woman was breast fed for just one week. She is uncertain if she received formula or canned milk in her first year of life. The family bought milk from local dairies which she drank while still in Richland. The family also bought and ate locally grown fruits and vegetables, but did not eat fish from the Columbia River. The family did not use the Columbia River for recreational purposes and drank city water, which, at that time, was not from the Columbia River.
History of Problems
Hypothyroidism: In September 1989, this woman became pregnant for the first and only time. Within days of becoming pregnant she developed a cold which progressed to pneumonia. Although the pneumonia resolved after treatment with antibiotics, she feels she never really got well. Her pregnancy was confirmed two months after conception, but she miscarried two days later. She continued to feel tired all the time and eventually went to an endocrinologist. A goiter the size of a golf ball was discovered in March 1990. She was diagnosed with hypothyroidism and has taken medication since that time. She had infertility problems and wonders if they were related to undiagnosed thyroid disease.
Immune System Dysfunction: As a high school student she had mononucleosis and missed six months of school. During the time this individual was ill with pneumonia in 1989, she was diagnosed with immune system dysfunction. She has been told by different physicians that she has systemic lupus erythematosus, fibromyalgia, and/or chronic fatigue syndrome. These varying diagnoses are representative of her more general immune system dysfunction. She has had a positive ANA, but a negative anti-DNA and lupus panel.
At one time she took prednisone and other medications for her immune system disorders. She discontinued the medications after experiencing side effects. By limiting her activity and monitoring her diet she feels better. Nonetheless, she experiences episodes of illness which she describes as feeling like a truck hit her: Her limbs feel like lead, she has crushing fatigue, and getting up is difficult. These episodes can last days to weeks.
1969, 1981, 1989: Pneumonia
1989: Osteoarthritis of the spine
1989: Miscarriage
1991: Interstitial cystitis with recurrent flare-ups
Levothyroxine sodium (Synthroid) .125 mg qd
Liothyronine sodium (Cytomel) .10 mg qd
Use of both medications began in March 1990.
Cigarette smoking: Never.
Alcohol use: Drinks wine on weekends, two to three glasses. Rare martini. Drank more in early 20s.
Pesticide exposure: None.
Occupational exposure: None. Other radiation exposure:
Radionuclide scan for evaluating thyroid gland.
Mother: Alive and well.
Father: Had a thyroidectomy in 1953 for thyroid nodules.
Sister: Has chronic fatigue syndrome and endometriosis. She is ten years younger than this patient and never lived in the Hanford area.
During the years this downwinder resided in the Hanford area, 1949-1952, air releases of iodine-131 diminished from the high levels released from 1944 to 1947. Nonetheless, there were periodic high releases (such as the release known as the Green Run on December 2 and 3, 1949, and during the period from April to July, 1951).
This downwinder had an in utero exposure to radiation through her mother's consumption of local milk and produce. The downwinder herself also consumed local milk and produce during her years of residence in the Hanford area.
Laboratory Data February 1990 Results Reference Range T3U 26.4 26-36 T4(RIA) 9.5 5.0-13.4 TSH 1.1 0.9-4.6 Antithyroid microsomal AB less than 20 25 or less Anti-thyroglobulin AB less than 10 20 or less ANA (FANA) Positive Anti-DNA Negative March 1990 Radionuclide Scan (iodine-123 and Technetium 99): Slightly low uptake with normal sized and uniformly labeled gland, consistent with mild hypothyroidism. April 1993 Results Reference Range T4 2.0 0.71-1.85 TSH 0.3 0.9-4.6 Consumption of locally produced milk is the main way that people received doses of iodine-131 from Hanford's radioactive releases. This is also a route of exposure to other radionuclides. Consumption of locally grown fruits and vegetables is the next most significant route for receiving doses of iodine-131.
Large doses (greater than 350 rad) of iodine-131 or external radiation can produce hypothyroidism by destroying thyroid tissue. Studies of humans exposed to a wide range of doses, primarily from external radiation, have shown conflicting results ranging from no effect to increases in autoimmune thyroiditis, Graves' disease, adenomatous goiter, and nodules without specific diagnoses. There is still controversy over whether radiation can cause these diseases and, if so, at what doses and by what mechanisms.
Thyroid blood tests on this downwinder were negative for thyroid antibodies, indicating that this is not a case of autoimmune hypothyroidism, a thyroid disease that one study has associated with exposure to radiation from the atomic bomb in Nagasaki, Japan.1 It is unlikely that this patient's hypothyroidism was related to her pregnancy which ended in the first trimester. However, thyroid dysfunction, including toxic nodular goiter, thyroiditis, and Graves' disease, are known to occur during pregnancy.
There is little research on people exposed to low doses of radiation and its effects on their immune systems. High doses of radiation weaken the immune system. Although low-dose radiation has been shown to cause mutations and chromosomal aberrations in the lymphocytes of children and adults, its effect on immune function is not clear. At this time, there is no known association between exposure to radiation and fibromyalgia, chronic fatigue syndrome, or systemic lupus erythematosus.
She is concerned that in utero exposure to radiation and living near Hanford for the first three years of life contributed to her illnesses, particularly her thyroid disease. She recognizes that her sister, who never lived in the Hanford area, has some similar problems, notably chronic fatigue syndrome. She wonders, however, if her parents' radiation exposure contributed to both her and her sister's illnesses.
This individual was born August 19, 1945. She lived in various places until her family settled in the Hanford area in 1953. Then, from 1953 to 1963, she lived across the Columbia River from Hanford near Ringold. Between 1963 and 1965 she lived in Pasco, Washington. She lived in eastern Oregon from 1967 to 1969.
From 1953 to 1963, this person lived with her family on a farm. She drank an average of one-half gallon of milk a day from the farm's cows. The family grew most of its vegetables and some fruit and ate other locally grown produce. The garden and the farm's crops were irrigated with Columbia River water. Cattle raised for beef were fed these crops. The family also raised and ate pigs, chickens, and rabbits.
For three years before running water was available, she remembers swimming in the irrigation ditches and ponds as a way of bathing. The family's drinking water was always from a well. The family ate small quantities of Columbia River fish.
Fibromyalgia: The patient remembers having symptoms of fibromyalgia as far back as 1961. She has chronic pain from her neck to her sacrum. Myelograms failed to provide a definitive diagnosis. She started on pain medication in 1971 and attained some relief. Her primary provider referred her to a rheumatologist for evaluation and, in 1976, she was diagnosed as having fibromyalgia.
Deterioration of the vertebrae: She had two neck fusions using bone grafts in 1984. She had right thoracic outlet surgery in 1985 and an anterior fusion with a titanium plate in 1988. The anterior fusion was repeated later that year. She has limitations on bending her neck and has chronic pain there and in her shoulders, as well.
Chronic Fatigue Syndrome: Initially diagnosed as having an infection with Epstein-Barr virus in the late 1980s, she was diagnosed in 1990 with chronic fatigue syndrome.
1980: Duodenal ulcer secondary to anti-inflammatory drug use
1993: Bleeding of duodenal ulcer with blood transfusion
Hepatitis B contracted from blood transfusion
Osteoarthritis of the hands and feet for eight to ten years
Cyst removed from right breast
Cysts (two) removed from lower back
Cigarette smoking: Began at age twenty-six when pain was difficult to cope with and stopped ten years later. Smoked one pack per day on average.
Alcohol use: Occasional.
Pesticide exposure: Some pesticides were used in the area but not on her family's farm.
Occupational exposures: None.
Other radiation exposures: She may have received an exposure in utero to fallout from the Trinity test of the first nuclear device in July 1945. Her parents lived in Clovis, New Mexico, about 250 miles northeast of the Trinity site.
Mother: Osteoarthritis; fibromyalgia diagnosed within the last ten years.
Father: Multiple sclerosis ten to twelve years.
Daughter: Born in 1966; fibromyalgia.
Son: Stillborn in 1969.
Son: Born in 1970, two months premature with immune system and respiratory problems.
This downwinder's years of residence in the Hanford area coincide with the years of highest releases from Hanford to the Columbia River. Releases to the air were lower after 1948, although there were episodic releases of concern through 1957. According to the Hanford Environmental Dose Reconstruction Project (HEDR), Ringold was in the area which received the highest concentrations of Hanford's iodine-131 emissions. Ringold was usually downwind from Hanford.
The consumption of milk from a family cow is the exposure that would result in the highest dose of iodine-131 from the radioactive releases from Hanford. However, this woman's period of Hanford-area residence was during a time of comparatively small air releases. The consumption of locally grown fruits and vegetables is the second most significant pathway for exposure to iodine-131.
HEDR estimated that the contribution to dose from eating crops irrigated by Columbia River water was so small that dose estimates were not calculated for this pathway. If the irrigation water in which she swam for three years came from the Columbia River below Hanford, then exposure was from external whole-body radiation. HEDR estimated that this external whole-body exposure made a small contribution to dose. HEDR estimates a dose less than 5 mrem EDE for the years 1956-1965 for a typical representative individual living in Pasco, Washington. Drinking radioactively contaminated water and eating radioactively contaminated fish were the main sources of dose from the Columbia River. (HEDR estimates a maximum dose of 4 rem EDE for the years from 1944-1971.)
This downwinder's primary health problems are fibromyalgia and chronic fatigue syndrome. These are considered to be immune system disorders of unknown etiology. There is little research on people exposed to low doses of radiation and its effects on their immune systems. High, acute doses of radiation weaken the immune system. Although low-dose radiation has been shown to cause mutations and chromosomal aberrations in the lymphocytes of children and adults, its effect on immune function is not clear. Except for evidence of a relation between radiation exposure and autoimmune thyroiditus, no association has been made between such changes and immune disease in humans. At this time, there is no known association between exposure to radiation and fibromyalgia or chronic fatigue syndrome.
This person feels she has always had poor health, even as a child. When she lived near Hanford, she recalls concerns about Hanford being voiced by neighbors. She became aware of the radioactive releases from Hanford in 1987 or 1988. She has always questioned why she was so sick. Her father's illness made her wonder about connection to Hanford even more. She was referred from one doctor to another. One doctor decided her pain was due to depression and referred her to a psychotherapist. She felt her depression was due to pain. Now she looks at Hanford as a possible source of her health problems and those of her family.
This individual was born on December 5, 1944, in Spokane, Washington, where she lived for five years. She then moved to a small town southeast of Spokane where she has lived ever since.
As a baby, this person had a lactose intolerance. She was given specially prepared milk that was either canned or store-bought. Her family moved to a farm when she was five and kept a cow in the yard. She drank this cow's milk with each meal. The cow's milk was also consumed in home-made ice cream and cooked foods. Her mother grew most of their vegetables and berries. When they moved to the farm, they picked fruit in the area. The family also produced its own meat, eggs, dairy products, pigs, and chickens, along with some wheat.
The family did not eat fish from the Columbia River, drink its water or use the river for recreational purposes.
History of the Present Problems
Thyroid Disease: This woman says her symptoms of thyroid disease began when she was in the hospital after delivering her daughter in January 1966. She had heat intolerance which progressed over the course of months. She experienced excessive thirst, felt very stressed, and had heart palpitations. Her family physician tested her in mid-1966 and diagnosed hyperthyroidism. She took medication four times a day for at least a year. She is unsure of the name but it was a small white pill. Finally, she was tapered off the medication and had no problems until 1983.
While singing in 1983, she felt like she was getting laryngitis. She initially thought it was related to a cold, but it persisted over time. One day she noticed a mass in her neck and felt a lump the size of a pea. She had no other symptoms.
At the time, her TSH was very high. A radionuclide scan indicated decreased activity in the right thyroid lobe. Results of a needle biopsy indicated cancer. Pathology of the tumor revealed papillary carcinoma, chronic thyroiditis, and Hashimoto's thyroiditis. She underwent surgical removal of all but a portion of the left side of the thyroid.
1978: Cholecystectomy
1988: Hysterectomy and right salpingo-oophorectomy
1994: Esophageal reflux
Levothyroxine sodium (Synthroid) .2 mg qd
Cigarette smoking: Never smoked.
Alcohol use: None.
Pesticide exposure: There was some DDT spraying in the area and possibly a limited amount on the family acreage. Their farm was at a higher elevation than many other farms so the water source and fields were above where most spraying would have occurred.
Occupational exposures: None.
Other radiation exposures: Radionuclide scan; routine X-rays.
Mother: Alive and well.
Father: Died in a car accident.
Brother: Hiatal hernia and gall bladder disease.
Daughter: Born 1966, is well.
Daughter: Born in 1970, diagnosed with Hashimoto's thyroiditis at age seventeen or eighteen.
Aunt: Died from breast cancer in the past year. Lived southwest of Spokane.
Laboratory Data December 1983 Pathology Report from Thyroid Surgery: Papillary carcinoma of the thyroid, right lobe; chronic thyroiditis, Hashimoto's type; thyroiditis of the left lobe. April 1990 Pathology Report from Hysterectomy: Late proliferative phase endometrium; adenomyosis uteri, marked; benign leiomyomata; chronic cystic cervicitis with focal squamous metaplasia of the distal endocervical canal; small follicular cysts of the right ovary; parovarian cyst. Aunt: Diagnosed with lupus within the last six to eight years. Lived in the Spokane area.
Consumption of locally grown fruits and vegetables was the second most important way persons were exposed to iodine-131. This person consumed these foods during the years of the largest air releases from Hanford.
A likely diagnosis of this patient's hyperthyroidism in 1966 is Graves' disease, which accounts for 10 percent of all post-partum cases of hyper-thyroidism. It is possible that the hyperthyroidism was caused by an adenoma, although this is a rare condition. In 1983, this patient was diagnosed with thyroid cancer. This is seen in some people with Graves' disease. Both Graves' disease and tumors are associated with exposure to radiation.
As discussed in the introduction, thyroid cancer and benign neoplasms are associated with exposure to iodine-131. This downwinder had papillary carcinoma of the thyroid. In a study conducted between 1965 and 1986 of 2,473 Nevada Test Site downwinders, fifty-six had thyroid nodules. Of these, thirty-eight had non-neoplastic nodules, eleven had benign neoplasms, one had both papillary carcinoma and a non-neoplastic nodule, and eight subjects had papillary carcinomas. Despite the small number of cases of papillary carcinoma, the dose-response trend achieved marginal statistical significance.2
Radioactive fallout from a nuclear weapons test in 1954 exposed Marshall Islanders to external gamma radiation, iodine-131, and three other forms of radioactive iodine. They experienced an increased rate of hypothyroidism and both malignant and benign thyroid tumors. It is difficult to say whether it was iodine-131 or the radioactive iodines alone that caused the thyroid problems because the Marshall Islanders also received gamma radiation.
The pathology report included in this case history documents the presence of both thyroiditis and Hashimoto's thyroiditis. Thyroiditis may result from large doses of external radiation. The radiation may be indirect, as when children received X-ray therapy in the past for skin and scalp diseases. Direct external radiation to the area of the thyroid gland can also cause thyroiditis. There is nothing in this person's history that indicates large doses of external radiation.
Hashimoto's thyroiditis involves autoimmune factors. The lab data available do not indicate that evaluation for autoimmune thyroiditis was conducted. This would be interesting information in view of the 1994 report by a team of Japanese scientists. They found an increased risk for antibody-positive spontaneous hypothyroidism (a form of autoimmune hypothyroidism) among survivors of the atomic bombing of Nagasaki who received external exposure to radiation. Patients with Hashimoto's thyroiditis are commonly antibody positive. In the Hanford situation, nearly all of the dose was internal. The Hanford Thyroid Disease Study (HTDS) is including an assessment of autoimmune thyroid disease in its study, as well as an assessment of hyperthyroidism and thyroid neoplasms.
She is concerned that her thyroid disease is related to the radioactive releases from Hanford. She has been surprised by the information she has read about Hanford and believes that a large number of people have died of cancer in the area where she has lived for thirty-one years. She wonders if these deaths are related to Hanford.
This individual was born in January 1949 in Sunnyside, Washington. She resided with her family in Grandview, Washington, from 1949 until 1952. Between 1952 and 1956, she lived in Coeur d'Alene, Idaho. She moved to Othello, Washington, in 1956, where she lived until 1968.
This person's milk source was either a backyard cow or milk bought from a local farmer. She recalls drinking large quantities of milk, but cannot specify how much. Her family always had a garden and ate other local produce which included lots of leafy green vegetables.
She recalls eating fish her father caught in lakes and in the Columbia River (more from lakes than the river). She cannot recall the type or quantity of fish they consumed. Her drinking water was either city water or well water. She did not use the Columbia River for recreational purposes.
Thyroid Disease: In the spring of 1966, she saw a doctor when she found a lump in her neck and had trouble swallowing. She was diagnosed as having tonsillitis. She returned to the physician in July of that year when the lump got bigger and she gained weight. Although the doctor assessed her clinically as being hypothyroid, tests indicated she had a toxic goiter and was hyperthyroid.
From July 1966 to September 1966, she received medical treatment and when medication failed, underwent surgical removal of 90 percent of her thyroid. She required no thyroid medication following surgery.
In 1974, she developed hyperthyroidism again. She was quite surprised given that most of her thyroid gland had been removed. She was treated medically for four years until 1978. At that time, she received iodine-131 to destroy the remaining thyroid tissue. A physician at a military hospital where she sometimes receives treatment recently told her she has Graves' disease. Despite taking thyroid medication, she continues to be fatigued and has cold sensitivity.
Infertility: This individual's experience with infertility may have been secondary to her thyroid disease. She used birth control for only one month between her first and second pregnancies, nine years apart. She became pregnant after treatment with iodine-131 for thyroid disease.
1967: Undiagnosed gait disturbance
1986: Vasculitis of the left brain MRI revealed three earlier "mini-strokes"
Current Medication
Levothyroxine sodium (Synthroid) .15 mg daily.
Cigarette smoking: None.
Alcohol use: Occasional.
Pesticide exposure: Area crops were dusted with pesticides. Her father grew wheat and alfalfa and she played in the fields.
Occupational exposure: None.
Other radiation exposure: Radionuclide scan for diagnosis of thyroid disease in 1970s and iodine-131 treatment in 1978. Also, her mother spent part of her pregnancy in the Hanford area after moving from a mid-western state, so this woman received some in utero exposure.
Father: Deceased; had hypertension and heart problems.
Mother: Alive and has hypotension.
Sister: Had thyroid surgery with a portion of the gland removed five years after the subject's surgery (sister is older by fourteen months and was born in a mid-western state). Also on thyroid medication following surgery.
Brother: Aneurysm, age twenty-nine.
Daughter: Born 1971 and has mild scoliosis.
Son: Born 1980 with a meningomyelocele, died at twenty-two days old.
Daughter: Born 1983 with anencephaly at thirty-two weeks gestation, deceased at one and one-half hours.
This downwinder resided in the Hanford area after the period of the largest air releases from December 1944 through 1947. Air releases, however, continued to be a concern through 1957, with intermittent high releases such as the Green Run experiment on December 2 and 3, 1949. Sunnyside and Grandview were usually upwind from Hanford which would result in a lower exposure to radiation compared to residents of communities equidistant, but downwind, of the Hanford Site.
This downwinder drank milk from a backyard cow, the most important source of a dose of iodine-131. Locally grown vegetables and fruit, which she also consumed, were the second most important source of exposure to iodine-131.
The late 1950s and early 1960s were the years of peak releases to the Columbia River. Eating fish from the Columbia was one of the two most important ways that people could be exposed to radioactivity from this source. This person did not drink Columbia River water, the other important exposure route.
Radiation-induced thyroid disease is generally considered to encompass hypothyroidism and thyroid neoplasia. Hyperthyroidism has been reported in persons with external exposure to ionizing radiation and there is no reason to believe that exposure to iodine-131 would not produce similar effects. Thyroid nodules, which can be caused by external radiation or iodine-131, can cause hyperthyroidism. No laboratory data were obtained for this downwinder, so it is unknown if she had nodules at the time of her thyroidectomy in 1966, or when she had recurrent hyperthyroidism in the late 1970s. HTDS will assess the relationship between iodine-131 doses to the thyroid and thyroid diseases including hyperthyroidism.
Sever et al 3 reported an association between neural tube defects and the paternal pre-conception dose of Hanford workers. This effect was observed in children whose fathers received low doses (10 rem or less) of external whole-body radiation while working at Hanford. This study covered the years 1957-1980.
Sever et al 4 also conducted a study of neural tube defects in Washington's Benton and Franklin counties (near Hanford) between 1968 and 1980 and reported a higher-than-expected rate of neural tube defects. The county rates were compared to rates from Washington, Oregon, and Idaho. This study has many limitations, including the years examined and the way in which doses were estimated. The period studied did not include the time of highest releases to the air.
Currently, Sever is the principal investigator of a case-control study of childhood leukemia and the relationship between parental preconception occupational exposure to radiation. Hanford is one of the sites included in the study.
This woman considers it very likely that her thyroid disease is related to her exposure to the radioactive releases from Hanford. She is quite concerned about the genetic effects of the radioactive releases because each of her three children had some sort of neural tube defect ranging from mild to severe.
She received genetic counseling after her second pregnancy and was advised that there was a five percent chance another child would have a neural tube defect. She was also advised to take vitamins and folic acid before becoming pregnant again, which she did. She and her husband adopted a child after her third pregnancy rather than risk having another child with neural tube problems. Her daughter has a child who appears to be well, which greatly relieved her concerns about passing on this problem to yet another generation.
These case histories illustrate the residence background and lifestyle factors that help determine the radiation doses from Hanford for four individuals who were exposed to Hanford's radioactive releases via the air and river pathways. Each downwinder lived in various parts of HEDR's study area during different years of Hanford's operations. Each has a particular set of lifestyle factors that affect the radiation dose received. Each case demonstrates a different set of health problems and concerns. To date, there are only a few studies that have been conducted on the relationship between radiation from Hanford and health effects in the general public. None of these has produced clear-cut results. However, according to the International Commission on Radiological Protection, the basic assumption of radiation protection is that any exposure to radiation poses a health risk. One study of Hanford now underway may add to our knowledge of the health effects of Hanford's radioactive releases. HTDS is investigating:
A team of investigators at the Fred Hutchinson Cancer Research Center is conducting the study under a contract with the Centers for Disease Control and Prevention. The study is scheduled to be completed in 1998.
Recent findings from studies of other populations suggest relationships between exposure to iodine-131 and thyroid disease. An article published in the August 3, 1994, issue of the Journal of the American Medical Association reports an increase in the number of Japanese atomic bomb survivors with autoimmune thyroiditis. This study is the first to detect the link between autoimmune disease and external radiation exposure among the atomic bomb survivors.
The rate of thyroid cancer has increased dramatically in the areas most affected by the 1986 Chernobyl nuclear accident.6 Before the 1986 accident, the rate of thyroid cancer in the areas around Chernobyl was similar to rates in other parts of the world. Now the rate is up to 200 times higher than before the Chernobyl accident. The major contribution to thyroid dose in this population is from iodine-131.
There are still many unanswered questions about the health effects of the radioactive releases from Hanford. The preceding case histories include Hanford downwinders who have been diagnosed with diseases that have been associated with radiation exposure in other populations. The case histories also include people diagnosed with diseases such as fibromyalgia and chronic fatigue syndrome which have not yet been linked to radiation. The cases also demonstrate how some people encounter problems or delays in receiving a proper diagnosis for thyroid disease.
This monograph includes recommendations for screening and assessment of thyroid disease in people exposed to Hanford's releases [see Module 7]. Briefly, these recommendations include the following:
At this time, there are no other recommendations for screening and assessment guidelines specific to people exposed to radiation from Hanford. However, routine periodic health maintenance and prevention activities should be conducted. This will minimize the possibility of a disease going undiagnosed and also provide reassurance to people who are well.
The psychological effect of an invisible trauma such as exposure to radiation can be devastating. The invisible nature of radiation brings with it a set of concerns that Vyner7 refers to as a typology of uncertainty. Vyner studied atomic veterans (military personnel exposed to the atomic bombings in Japan or atomic bomb tests in the United States). Health care providers often hear Hanford downwinders discuss many of the same uncertainties that Vyner identified in atomic veterans.
The uncertainties relevant to Hanford downwinders are as follows:
1. Previous exposure uncertainty: Whether or not one has been exposed to an invisible contaminant in the past and, if exposed, whether any dose was received.
2. Present exposure uncertainty: Whether or not one is in the process of absorbing invisible contaminants and, if so, what is absorbed.
3. Boundary uncertainty: What are the geographical limits of an invisible exposure?
4. Dose uncertainty: How large a dose a person received is often in question if the person was not monitored (or if there was no technology to conduct monitoring).
5. Significance-of-dose uncertainty: If the dose received is known, whether that dose will result in disease.
6. Latency uncertainty: If there is a known exposure, what amount of time will elapse between exposure and the onset of detectable symptoms or disease?
7. Etiological uncertainty: It is difficult to determine whether a specific disease or disorder was caused by an exposure to the suspected agent.
8. Diagnostic uncertainty: Symptoms that arise after an exposure to an invisible contaminant may be difficult to diagnose as a specific medical problem.
9. Prognostic uncertainty: People experience apprehension about their future health when they believe or know they have been exposed to a toxic agent.
10. Treatment uncertainty: When a diagnosis cannot be made, a provider does not know what type of treatment to recommend.
11. Coping uncertainty: The inability to know what to adapt to or what is the proper adaptation.
12. Financial uncertainty: The question of who may be morally or legally responsible for the financial losses and costs caused by the invisible contaminant.
Scientists, health care providers, and downwinders alike have many unanswered questions about how exposure to Hanford's radioactive releases may have affected human health. Some of these questions are now under investigation. Other questions have yet to be explored. Many may never be answered.
Health care professionals who acknowledge downwinder concerns will earn the respect and appreciation of their clients. Acknowledging these concerns, along with providing regular health screening and indicated treatment, will help health care professionals forge good working relationships with downwinders.
