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. Scientific research into the health effects has not yet definitively described the effects of, for example, chronic low-dose radiation exposure. This monograph presents basic information about radiation health effects, specifically in relation to Hanford. The eleven following modules provide health care professionals with up-to-date knowledge concerning radiation health effects, discuss the status of current scientific studies, and importantly, address frequently asked patient questions.
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By February of that year, citizen pressure had forced the U.S. Department of Energy to release 19,000 pages of Hanford historical documents that had been previously unavailable to the public.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 a history of huge releases of radioactive materials into the environment, contaminating the Columbia River and more than 75,000 square miles of land. The documents also disclosed 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.
Contained in the documents were descriptions of how Hanford operations had released radioactive materials. Module 3 describes, in brief, the history of the radioactive releases at Hanford.
As a result of the 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 conducted 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 largest estimated radiation exposure downwind from Hanford included Iodine-131 which is known to concentrate in the thyroid gland. In previous studies of other populations, exposure to radiation has been shown to cause thyroid disease, including cancerous and noncancerous 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 is in charge of Hanford operations. Some people remained skeptical because the CDC kept Battelle Memorial Institute as the contractor to do most of the HEDR work. Battelle has been a Hanford contractor since 1965. Module 6 discusses the details of the dose reconstruction data. In addition, Module 11 focuses on information concerning the contamination to the Columbia River.
In addition to HEDR, the federal government sponsored a second study, the Hanford Thyroid Disease Study (HTDS). CDC began the 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. Modules 2 and 7 cover the mandate and status of the HTDS.
Any dose of radiation may produce a delayed health effect months, years, or decades later. Current knowledge does not enable us to predict if or when these effects will occur. When so much is so uncertain, discussing radiation health effects with patients and with colleagues can be difficult. Module 2 provides a clear, simple explanation of the basics of radiation: what it is and why it can cause harm in the human body. Modules 4 through 10 cover epidemiology, known specifics of cancer and thyroid disease risks, and the health effects of specific radionuclides released into the air and into the Columbia River from Hanford. In addition, Module 12 presents four case histories that may provide models for discussing the possibility of a link between radiation exposure and health problems.
Approximately two million people were exposed to environmental releases of radiation from Hanford's nuclear weapons operations from 1944 to 1972. It is not yet known what the health impact has been from the Hanford releases. And Hanford is only one example of the legacy of radiation releases worldwide. Primary care practitioners everywhere are discovering the need for assessment tools, scientific research updates, and patient information tools to help them help patients who lived downwind or downstream of the releases ("downwinders"). Much is yet to be understood; assessing, treating, and counseling downwinders is a challenge.
Throughout this monograph, information is presented in a format intended to help health care professionals talk with their patients who have been exposed to releases of radiation and who have questions about possible health effects. Both the provider and the patient benefit from open discussion of epidemiological studies and the status of scientific research. A primary objective of this monograph is to aid providers in this open discussion by presenting information they can pass on to their patients who are concerned about radiation exposure.
