ORRHES Meeting Minutes
September 22, 2005

Update: Collecting Information About Communities Surrounding the ORR

Ms. Horton provided a brief update on collecting information about communities surrounding the ORR. (She explained she had been unable to present an update at the June meeting.) She referred to the table that had been handed out, which discussed reviewing articles, the literature review, and entering concerns into the Community Concern Database.

Ms. Horton referred to the first task on the table, noting that it had already been completed. Under this task, 190 newspaper articles were reviewed and identified concerns were put directly into the database. There were 138 community concerns entered; these came from 65 of the 190 articles. The other 125 articles either discussed sites not related to the ORR, raised only worker concerns, or identified no concerns. Concerns from surveys and reports were also entered.

Referring to the second task, Ms. Horton said that she and Maria Teran-MacIver had attended several meetings, some with Ms. Vowell. These included a Tennessee Public Health Association meeting, a meeting of the Cancer Coalition (Nashville), and a meeting with Ms. Vowell and some of her counterparts at TDOH. Ms. Horton expressed her belief that they had been able to make some great contacts and obtain some resourceful information leading up the ACI.

The third task entailed interviewing key representatives. The list of people contacted included:

• Breast and Cervical Cancer Program for Tennessee



• UT, Department of Health and Safety Sciences



• Baptist Regional Cancer Center



• UT Extension and Community Based Health Initiatives



• Vanderbilt-Ingram Cancer Center



• Tennessee Department of Health



• National Cancer Institute, Cancer Information Center



• Knoxville Better Health Initiative

Ms. Horton explained that they have already made these contacts, gathered brochures, and collected literature. If the budget allows and if it is appropriate when the report is released, they might have some meetings in the future where these agencies and individuals can come with their information.

The fourth task, which was not on the table, was related to education training. In April, ATSDR had Dr. Robert Brent make two presentations, one in Oak Ridge and the other in Kingston. Notes were taken during the meetings, and community concerns collected from those sessions were entered in the Community Concerns Database. In addition, DVDs were made of those sessions. Mr. Hanley clarified that two DVDs have been made, but they are having difficulty with one of them because of lighting. They are still working on this issue.

Dr. Cember confirmed that they had not seen these DVDs yet. Mr. Hanley said this was correct, noting that they needed to get multiple copies made.

Mr. Lewis asked if they would ever be able to see and read the concerns. Ms. Horton expressed her belief that they could be printed out. Mr. Hanley said he believed this could be done. Ms. Horton noted that it could be a future agenda item. In his opinion, Mr. Lewis said, at a minimum they should be able to read these, look at them, and get a feel for what was said. In addition, he expressed his belief that whoever is working here needed to have the issues and concerns that have been raised before. He suggested that the list be printed out so someone has an idea of what has been said so they never have to do this again. Mr. Hanley explained that the appropriate concerns will be taken, placed into the appropriate PHAs, and addressed. Mr. Lewis expressed concern that they did not even know if all of the PHAs would be finished. Thus, he said, someone should have a repository of the issues raised. Dr. Charp asked if Mr. Lewis was referring to a data dump of the file similar to what Melissa Fish had. Mr. Lewis indicated that he wanted to have this somewhere so that if ATSDR does not complete these reports, they will be able to go back and know the issues that are out there and not have to deal with this again.

Mr. Hanley explained that if ATSDR can get funding, then most of the PHAs could be finished. He added that the portion of the document containing just the concerns and responses is pulled out separately on the Web site. Mr. Lewis said that this was what he had liked about the TSCA Incinerator PHA.

Dr. Davidson asked if the Community Concerns Database would be available on the Web site so the public could search it. Mr. Hanley said it would not be.

Overview of the National Academy of Sciences Biological Effects of Ionizing Radiation VII Committee’s Report

Dr. Charp explained that in 1998, several agencies (EPA, DOE, the U.S. Department of Defense, HHS, and the National Institute of Standards and Technology) asked the National Academy of Sciences (NAS) to look at radiation risk that had been developed earlier and present the findings as the Biological Effects of Ionizing Radiation (BEIR) V report. Jon Richards indicated that the Nuclear Regulatory Commission (NRC) was also one of the agencies. Dr. Charp said that was correct. He explained that NAS had been asked to review all of the new radiation low-dose studies that have been released since the BEIR V report and come up with a modification or some new information, which was what they would discuss today.

Dr. Charp explained that the BEIR VII's Phase 2 was released over this past summary; Phase 1 was conducted to determine whether it was feasible to do this report. He indicated that nearly every sheet had the header "Prepublication Copy Uncorrected Proofs" when it was released this summer. He explained that this means the information is subject to change, and therefore what he was going to tell them is subject to change. Dr. Cember pointed out that the report should not be quoted or cited. Dr. Charp said he was not quoting and not necessarily citing either; he said a lot of what he would say came from the report.

According to Dr. Charp, when the report was released, the newspapers picked up the executive summary (which is available and may be quoted and cited) and blew it out of proportion by saying that the radiation risk is a lot lower than previously thought and there are a lot more diseases associated with it. After the newspapers came out, ATSDR received phone calls, e-mails, and letters asking if the news was going to change how ATSDR does business and its health calls regarding hazardous waste sites.

Dr. Charp explained that Dr. Cibulas had asked him to review BEIR VII and present it at this meeting. The primary task, as quoted by the report, was "to develop the best possible risk estimate for exposure to low-dose, low-LET (linear energy transfer) radiation in human subjects." The next question was to decipher "low-dose" and "low-LET" and evaluate how they could determine what human subjects would be relevant to these studies.

Dr. Charp indicated that the report focused on low-dose radiation, which it defined as any radiation below 1/10 Gray (Gy) (1 rad or 1,000 millirad). For low-dose LET, he said, this would be below 1,000 millirem (mrem), plus or minus a few percentages. Dr. Cember noted a correction that 1/10 Gy is 10 rad. Dr. Charp stated this was his mistake, noting that they were talking about 10 rad, 10,000 millirad, and 10,000 mrem.

Dr. Charp explained that low-LET radiation does not impart a lot of secondary radiation. He noted that this ionization inside a cell is by definition called sparsely ionizing radiation. He said it is strongly associated with beta particles, x-ray, or gamma rays, so NAS did not look at any reports that talked about neutron radiation or alpha particle radiation. According to Dr. Charp, the other question is how NAS determined what data were relevant; they will go through some of the studies to see what NAS determined to be relevant. Essentially, Dr. Charp said, NAS decided a study was not relevant if it did not meet the standards for number of subjects, power of the study, and so on.

Dr. Charp stated that the study was supposed to come out in 2001, but came out in 2005. According to Dr. Charp, the study was delayed for a couple of reasons. First, some new low-dose studies were coming out, such as the cohort study reported at the end of last year by Cartis and others that looked at nuclear workers in 15 countries. NAS primarily wanted to see this main study, but also some of the other low-dose studies. Second, NAS was also looking at radiation that the group determined to be chronic, meaning it developed over a short period of time (a couple of months) to a lifetime of exposure.

Dr. Charp presented and explained a graph showing the schematic curves of incidence versus absorbed dose. Curve A was the linear quadratic curve, which had four points. Dr. Charp said this curve was first defined in about 1946. He indicated that you end up with this odd curve because you have a regular term and then a term that is squared. He added that no one has been able to prove this curve exists, but it is fairly close to what many people think the data actually look like.

Dr. Charp noted that Curve B is a linear, no-threshold slope. It is also fitted to those four data points, but the curve is forced to go through no points when the x and y coordinates cross. In his opinion, Dr. Charp said, you could probably eyeball it and say maybe that line is not exactly right. The problem then, he said, is to figure out how to define the function that compares the linear quadratic Curve A with Curve B. Something called the Dose and Dose Rate Effectiveness Factor (Curves C and D) was developed based on atomic bomb survivors. According to Dr. Charp, the problem is then to figure out where you start to look at low-dose effects on the curve of absorbed dose and induced incidence. Dr. Charp explained that the curves are fairly close together as you get up to the high end of the curves. However, he said at the lower end, no one knows the right answer regarding whether radiation is protective of health or if it is worse for health. According to Dr. Charp, there is a statement about this in the report. He indicated that one of the issues is that no one has been able to prove the true curve or linear quadratic, and no one has been able to prove or disprove the linear no-threshold curve either.

Dr. Charp discussed post–BEIR V studies. He said that the BEIR V defined the results down to about 0.2 Gy (20 rad or 20,000 mrem). BEIR VII, however, planned to improve this and get to about 0.1 Gy or less using a five-step process. Dr. Charp said he would not go through this in detail, but he would provide information on the five steps.

The first step was to determine if the risk is absolute or relative. The second step was to determine if there was a causal relationship between exposure and dose. If no relationship were found, NAS would throw out the study. If there was a relationship, NAS would try to look at any confounding factors (such as smoking and radon exposure). NAS determined a study to be good if all of the causal relationships withstood these tests. The third step involved looking at confidence intervals regarding the uncertainty of the study. NAS evaluated how strong the data were, for example by seeing whether the number of people in a study was large enough for a small confidence interval. Once they had a confidence interval and felt comfortable that the study was good, NAS tried to look at multiple studies (step four). NAS looked at multiple relationships to see how closely all of these studies matched up. For example, if one study finds a relationship with leukemia and another one does not, how do you know which study is right? Thus, NAS tried to find studies that provided similar results. The fifth step involved assessing the relationship between all of the studies and trying to determine what the risk numbers would be.

Dr. Charp said he would go over the five major studies that NAS reviewed. The 2002 atomic bomb survivor cohort study, called DSO2, is the most recent dose assessment that came out of the atomic bomb survivors. It modified and improved the doses a little bit. According to Dr. Charp, this cohort continues to be a major source of information on human effects from exposure to radiation. This group has been followed for more than 50 years now, since about 1946 or 1957. It is a large cohort, probably consisting of close to 100,000 or more people today. The cohort includes all sexes and ages, and people exposed at various ages (in utero, at young age, infants, elderly, and others). NAS is pretty confident, Dr. Charp said, that it has good mortality and cancer incidence data because medical professionals have studied these people in depth.

Dr. Charp explained an atomic bomb summary graph. For leukemia, he said, the data support curvilinear–not a linear no-threshold–as shown by the little curve between 0.1 and 0.2 sieverts. He expressed his belief that this was a linear curve for all other solid tumors. He pointed out the dotted line beneath the solid line, noting that it curves up. Nonetheless, he said, it is linear. According to Dr. Charp, in the low-dose range, NAS showed that there is very little difference between curves that are linear at that low dose range based on how you draw the line.

Dr. Charp stated that NAS reviewed specific sites in medical studies, including the lung, breast, thyroid, and stomach, as well as leukemia. He noted that these were studies in which people received radiation during various medical practices, such as therapy, diagnostic tests, iodine, stress tests, and bone tests. NAS concluded that it did not have enough sample size and the quality of dosimetry was not very good. According to Dr. Charp, if your doctor gave you some radioactive material and you asked what dose you would receive, the doctor would say something that is not a radiation dose, such as 5 milliliters. He expressed his belief that doctors will rarely know the radiation dose that is being given. Thus, unless there are really good records, the radiation dose received will not necessarily be known. Even though a physician could give a standard concentration of radioactive material, the dose absorbed differs between individuals because body types differ.

Mr. Washington asked about the tissue types. Dr. Charp indicated that this was another issue. According to Dr. Charp, most of these medical studies were in the medium- and high-dose range; very few were in the low-dose range. Thus, by definition, NAS sort of discarded the medical studies. Dr. Charp mentioned a co-worker who was part of a nuclear medicine study and received as much as 100 mrem a month, which is well above the low-dose range. Therefore, these studies were not included in the medical reviews.

NAS also looked at occupational radiation studies. These include studies that were carried out at Y-12; studies conducted in 15 countries across the globe that use nuclear materials; studies of atomic weapons employers in various countries, including England, Russia, France, and Germany; and other studies as well. According to Dr. Charp, there is very good dosimetry relative to some of the other studies because everyone wore film badges. There are over 1 million individuals in these studies, including radiologists, radiological technicians, nuclear medicine workers, specialists (dentists and hygienists), defense workers, researchers, and a number of other exposed groups.

Dr. Charp presented Table 8-7, which compared nuclear workers with atomic bomb survivors. If you looked at all cancers except leukemia, Dr. Charp said, you would see that atomic bomb survivors have an excess relative risk of 0.24, or about 24 percent above the regular risk. For leukemia (except chronic lymphocytic leukemia), atomic bomb survivors have a 2.2 excess relative risk. According to Dr. Charp, the three-country study, which came out prior to the 15-country study, found a similar relationship for leukemia, but did not find a relationship with all cancers. Dr. Charp explained that the excess relative risk is a lot lower in workers than in atomic bomb survivors when you look at the overall studies. Dr. Charp indicated that the main differences between the two are associated with the "healthy worker syndrome" or the dose rate (instantaneous versus over long periods of time; it is unknown).

In his opinion, Dr. Charp said, the healthy worker effect cannot be excluded from many of these studies. He explained the effect: a worker in a facility may have regularly scheduled medical exams, might get paid extra for doing some of this work, could be badged, might have better health insurance, could know the doses, and could be affected by other similar factors. Therefore, these people will actually have more visits to the doctor and more diagnoses than someone who only goes to the doctor on a fairly irregular basis.

Dr. Charp asked if Dr. Cember had anything to add, since he discusses this in his textbooks. Dr. Cember said he had read a paper about 20 years ago in the American Journal of Public Health that looked at what factors went into good and poor health. Age, sex, education, manner of living, and type of work were all considered. After these things were taken into account, education was the single factor that counted the most. According to Dr. Cember, measures included longevity, age-specific death rate, days absent from work, days spent in the hospital, and other things. When they looked at the groups, all measures showed the same finding–those with graduate school degrees had better health. The next groups (in order from better to poorer health) were people who graduated from college, high school, and elementary school. According to Dr. Cember, people who did not finish elementary school had the worst health. He indicated that education was the primary factor in how healthy these people were, after socio-economic levels and other factors were taken into account. His personal impression, he said, is that nuclear workers are better educated than the average person. He stated he suspected the -0.39 to 0.30 and -0.28 to 0.52 on Table 8-7 were nuclear workers. In his opinion, he said, now nuclear workers show no effect because they are better educated than the average person. He said this was a possible explanation, as was that a little bit of radiation is good for you and helps you live longer. (He said he did not follow the latter, but it is a possibility.)

Mr. Washington said this still did not give any definitive information regarding what happens when people are exposed to low doses. Dr. Charp said this will be discussed at the end.

Dr. Davidson said she took issue with associating things, such as education, with health. In her opinion, she said, it is not education. It could be lifestyle–that people who are more highly educated do not engage in as many risky behaviors (such as smoking) and might have a healthier diet. She expressed her belief that those things can be related, but it was not education per se that would keep you from getting sick. In looking at the rates of cancer and healthy workers, she said she failed to see how this is involved in the mechanism by which radiation would induce cancer. She expressed her opinion that this would be the same regardless of your education level. Mr. Washington said that this was his point as well.

Dr. Cember asked if these were incidence or death rates. Dr. Charp said he did not recall, but that they were excess relative risks. Dr. Cember explained that the conclusion of this article was that people who are better educated know what to look for so they go to the doctor earlier and can understand medical instructions, and so on. The conclusion was not that a person is inherently more resistant to illness if he or she is better educated, but that a better-educated person will know how to deal better with health problems than a person who is not educated. Mr. Box said they would also more financially able. Mr. Washington indicated that some people might have avoidance. Dr. Davidson expressed her belief that it was not education, but medical intervention. Mr. Washington stated that he had had a heart transplant primarily as a result of education: he knew it was available and he had the insurance to get it.

Dr. Charp said he had read some of the Army's history of the Manhattan Project, which indicated that one requirement of early custodial staff hired at the ORR was to be illiterate so they would not know what they were throwing away. According to Mr. Washington, this was not true. He said that there were people doing janitorial work who were college graduates. Dr. Charp said he stood corrected.

Ms. Adkins said if they needed statistics on cancer and workers and so forth, she had interviewed the foreman of 1,400 engineering construction workers at ORR. According to Ms. Adkins, they were young and healthy men from around the area. She stated that the foreman told her that 800 of the 1,400 had died of cancer between the ages of 45 and 65; he stopped his count after 800. In her opinion, there is information out there that they could be looking into beside the information that the AEC and DOE have provided. She expressed her belief that they did not have to look at other countries to see how their nuclear workers are doing because there are things they could find if they really looked.

Dr. Charp said that some of those things have already been looked at. For instance, he said, Steve Wing looked at workers at (he believed) Y-12, and the National Institute for Occupational Safety and Health had looked at ORR workers. There have been other studies done on ORR workers too, so the data are out there.

According to Mr. Washington, it was only recently that people who worked at ORR died of cancer because local doctors would not put this on their death certificates as a cause of death.

Referring to occupational studies, Dr. Charp explained that BEIR VII said that the risks were variable, ranging from no risk to a risk an order of magnitude or more higher than those seen in atomic bomb survivors. Because there are no individual doses in most of the cohorts, NAS concluded that the occupational studies have minimal information that is useful for quantification of low-dose health effects.

In evaluating environmental studies, NAS looked at four groups of people living in areas that have very high natural radioactive background. Two were conducted in China, one in Great Britain, and one in India. Different cancer outcomes were found based on incidence, mortality, and prevalence of cancer in these populations. No higher disease rates were found in the geographic areas within the high background levels of radiation exposure than in the areas with lower background levels. No association was found between radiation and increased adverse health effects.

Dr. Charp presented a table showing preferred estimates of lifetime risk attributable to exposure for all solid cancers and leukemia for males and females. The first two lines were cancer incidence, the bottom two lines were cancer mortality, and numbers in parentheses were the confidence intervals. For solid cancers in females, Dr. Charp said they had seen around 610 deaths from exposure to 10 rad out of an estimated 17,500 deaths without exposure to 10 rad, or about 3 percent.

Dr. Cember asked if these had been calculated based on the no-threshold. Dr. Charp said this was correct. Mr. Hanley stated that there were 610 excess deaths. Dr. Charp explained that for leukemia in males, there were 70 excess deaths out of 710 deaths, or 10 percent. Jeff Hill asked the level of exposure; Dr. Charp said it was exposure to 10 rad. Mr. Hill asked if this was annual or one time exposure to 10 rad. Dr. Charp replied that it was over lifetime. Mr. Hill confirmed that this was 10 rad over lifetime. Dr. Charp said that was correct.

Dr. Charp referred to a table detailing the BEIR V continuous lifetime exposure to 1 millisievert per year for cancer mortality. For the top two lines, the risk is per 100,000 in males and females for leukemia and non-leukemia cancer. The rate for non-leukemia is about 2.3 percent in males and about 3.2 percent for females. For leukemia, it is about 9 percent for both males and females. Dr. Charp pointed out that there was not much difference between males and females except with non-leukemia, which he said could be due to the prevalence of breast cancer in women compared to prostate cancer in men. He noted that the report did not clearly state what the difference was. Mr. Hanley asked if this was based on the 1990 data; Dr. Charp said that was correct.

Dr. Charp presented a table that showed rate comparisons of BEIR V and BEIR VII. According to Dr. Charp, there was about a 21 percent lower rate in males for all cancers, meaning that the BEIR V rate was about 21 percent higher than the BEIR VII rate. In his opinion, Dr. Charp said, BEIR V was way off for all cancers for females, as BEIR VII was 154 percent lower.

Dr. Charp expressed his belief that one of the problems with the BEIR VII was that there were a lot of uncertainties. One uncertainty has to do with the sampling variability in risk model parameter estimates from the atomic bomb studies. For some of the studies, depending on where the dosimetry was taken, the report extrapolated it out to a low dose, but it may have actually been looking at doses in excess of 100 rad or so. There is also uncertainty about comparing risk from an average Japanese population of the 1940s to the metabolism of a U.S. population. In addition, there is uncertainty in looking at the variability of dose and dose-rate effective factor (DDREF). According to Dr. Charp, this could range from about 1.1 to 2.3 based on the first graph with the A, B, C, and D curves, but the committee used 1.5. Thus, he said, there is 50 percent or more variability in doses just based on DDREF.

Dr. Charp said there are also qualitative uncertainties. The largest qualitative uncertainty is for cancers of the stomach and liver; its main contributor is transport, meaning how transport codes from one population to another. For example, diets of the 1940s Japanese population were very different from those of the "standard" U.S. population. Also, cancers of the bladder and ovary have large uncertainties, with the main contribution being from sample estimation (sampling variability). Female breast cancer and the combined category of solid cancer (excluding thyroid and non-melanoma skin cancer) have the least uncertainty. In both cases, he said, the main contribution is from the DDREF.

According to Dr. Charp, ATSDR finds the impacts of BEIR VII on the agency to be minimal. ATSDR public health decisions will still be based on dose and dose factors used, which already incorporate linear no-threshold: it is part of the Comprehensive Environmental Response, Compensation, and Liability Act legislation to look at observable and tolerable health effects. The risk numbers from BEIR VII are not significantly different from those in BEIR V. Though there are some variations, when the populations and uncertainties are considered and given the sufficient play, the numbers are essentially the same. The agency will, however, add an appendix to all PHAs. This will provide the old risk numbers of BEIR V, the BEIR VII risk numbers, and possibly EPA risk numbers, and also supply the method that can be used to convert dose to risk. It will provide the doses calculated, show equations to use to take the dose to risk, and provide examples of how to do this. Thus, ATSDR anticipates that providing this appendix will address concerns of ORRHES and the community by showing how to do a risk assessment.

Dr. Charp referred to another handout from Health Physics News, which contained an interview with three people who were involved with the BEIR VII study. In total, about 17 people were involved, including oncologists, physicists, epidemiologists, statisticians, biologists, and others. Dr. Charp said that handout contained two tables from the report and an example of how you could go from risk numbers and calculate the number of excess cancers that might occur. He explained that the new appendix of the PHA will have tables such as this with organ and risk per exposure, and say how to multiply this out.

Mr. Washington expressed concern that they still had not been told what happens with low levels of radiation at the other end of that curve. According to Dr. Charp, the BEIR VII report said there are insufficient data to say linear no-threshold is wrong or right, and there are insufficient data to say low doses of radiation are protective of human health. There were, however, significant data to say that low-dose radiation is not more harmful than the linear no-threshold will predict. Mr. Washington asked what this has really told them because it is not any different. Dr. Charp said the report said the same thing in 1990 as the BEIR VII–they did not know.

According to Dr. Cember, not being able to prove this one way or another was inherent in this situation because the additional number of cancers predicted at these low doses are within the statistical year-to-year variability in the number of cancer cases. Therefore, he said, you cannot distinguish additional cancers from naturally occurring cancers (those that would occur without the radiation dose), and it can never be proven or disproved which category a cancer belongs to.

Dr. Charp explained that in a population of 100,000 people, one-third of the population will get cancer normally. Thus, if you say the risk of cancer from radiation exposure is about 5 percent, this will be out of the approximate 30,000 people who will get cancer. Dr. Charp expressed his belief that the rates of cancer are not steady–they bounce around–so these excess cancers would be in the "noise." According to Dr. Charp, cancer from radiation is right now indistinguishable from cancer caused by chemicals or natural effects. However, he said, the National Council on Radiation Protection and Measurements held a meeting 3 years ago that discussed gene markers for sensitivity to ionizing radiation. He said that they are beginning to find some of these, but there are not enough data yet to show they are true findings. However, he stated, the theory is that certain genes are more susceptible to radiation than others. For instance, he said, for one particular area of exposure there could be about 200 or 700 genes that might be involved in some type of radiation repair.

Mr. Washington asked Dr. Charp for his opinion about people in Japan who are still alive and had high doses of radiation. Dr. Charp replied that about half of the people who had high doses are still alive. He asked them to think about the people from the Manhattan Project who have multiple curies of plutonium still in their bodies and are still alive. Mr. Richards said it was a matter of probability–if you smoke, there is not a 100 percent chance you will get cancer.

Dr. Cember stated that 25 out of the 26 Lost Alamos workers who inhaled enormous amounts of plutonium, more than the maximum acceptable body burden, are still alive. The other one died about 2 years ago from bone cancer, he said.

Mr. Box asked if the study covered both external and internal radiation. Dr. Charp said that it did. Mr. Box asked why the study did not consider alpha. Dr. Charp explained that the study looked at low-dose, low-LET, and alpha is a high-energy linear transfer. Thus, on a relative basis, alpha is about 10 times higher: about 1 rad alpha is equivalent to about 1/10 rad beta.

Mr. Merkle asked Dr. Charp about some wording questions. He referred to the occupational summary and read "Risk estimates from these studies are variable, ranging from no risk to risks an order of magnitude or more than those seen in atomic bomb survivors." Mr. Merkle questioned whether this should say "or more less than," stating that the table makes the medians look less. Dr. Charp said it would be less, but for all cancers. Mr. Merkle said he knew this. Dr. Charp said you could throw those out. Mr. Merkle indicated, however, that the confidence intervals do not vary over a factor of 10, but medians do. Dr. Charp agreed that this should be "less than."

Mr. Merkle asked about the word "preferred" in the table "Preferred Estimates of Lifetime Risk Attributable to Exposure." Dr. Cember indicated this depended on which model you use to make the estimate. Mr. Merkle asked if they were talking about a best estimate; Dr. Charp said this was correct.

According to Dr. Cember, in the BEIR V, there was a statistically significant difference between irradiated and non-irradiated for the total number of cancers and for breast cancer in female and leukemia, but there was no statistical significance from the frequency in the general population for other individual cancers (such as colon cancer). Thus, he said, there was only an increased number when they were concentrated together. He asked how this compared to the BEIR VII. Dr. Charp expressed his belief that it may have involved some of the same tactics. For instance, in the BEIR V, NAS decided to throw out things like gastrointestinal cancers. Dr. Cember said this was correct, noting that they were not statistically significant, though the trend was toward more cancers in irradiated than non-irradiated (though it was not statistically significantly more). According to his review, Dr. Charp said, the same method of handling was done in BEIR VII. Dr. Cember expressed his belief that the total number of excess cancers, for all kinds of cancers together, was about 500 more among Japanese survivors. Dr. Charp recalled that this was correct, noting that the cancers were mostly leukemias. Dr. Cember reiterated that they were all together; Dr. Charp indicated that this was not a lot. In his opinion, Dr. Cember said, this is what leads to the great degree of uncertainty.

According to Dr. Charp, a prevalence of non-cancerous health effects is showing up in the Japanese atomic bomb survivor studies. Most of these are related to the cardiovascular system and are associated with radiation exposure. Dr. Charp asked why, if this is true, they give people nuclear medicine tests for cardiovascular studies.

Dr. Davidson asked if any of these studies looked at cancer incidence or mortality in younger people. The theory, she pointed out, is that you will die of cancer if you live longer and eliminate all competing causes of death; therefore you are more likely to get cancer as you get older just because of aging. She suggested looking at a younger subset that is not expected to get cancer instead of picking a whole group and including these individuals with those in the much higher age range. Dr. Charp said Dr. Davidson was correct. He indicated that some recommendations were made at the end of the report to include looking at exposures to people younger than the average workers, such as people under 18. For the longest time, Dr. Charp said, lifetime radiation exposure limits were calculated by subtracting 18 from your age and then multiplying by 5. He explained that there was really not much exposure to people under 18 for a very long time so it was assumed they should not have had any exposure.

Additional Business

Dr. Davidson reminded the ORRHES members to send their comments to Dr. Malinauskas on the Evaluation of Current (1990 to 2003) and Future Chemical Exposures in the Vicinity of the Oak Ridge Reservation by October 24. She said that if they had no work group meeting, Dr. Malinauskas would collate the comments and prepare to send them to ATSDR if they had another ORRHES meeting. If there was no work group meeting, they would bring the recommendation to ORRHES directly. Dr. Cember asked what would determine if they had other meetings. Dr. Davidson said it would depend on money. Dr. Cember asked whether the money had been appropriated already for this year. Dr. Davidson explained it was for the fiscal year beginning on October 1.

Dr. Davidson noted that September 30 is the last day that the field office will be open.

Ms. Adkins said she had called Advanced Wellness in Nashville at 1-800-433-0854. According to Ms. Adkins, they were willing to work with ATSDR, and she told them that Mr. Hanley would be calling them. They could not provide individual information, but they could tell the frequency of contaminants found in residents and workers in this community.

Ms. Adkins said she had made a statement earlier that she did not back then, but wanted to do so at this time. She read some portions of her notes to the group. According to Ms. Adkins, the water intakes were far above the allowed limits at K-25, and the water was tested every 3 or 4 days at carefully selected times. She quoted a statement reportedly made by an official to an official of the plant, "We've been ordered not to test our own intake water. It's highly sensitive. It contains extremely high concentrations of cesium 137 and strontium 90. The orders come directly from DOE headquarters."

According to Ms. Adkins, materials from Y-12 (plutonium, uranium, assay materials, nickel, and every other metal) were dumped into one end of Poplar Creek and the Clinch River and four ponds at the west end of Y-12. She expressed her belief that these were dumping sites for nitric acids and all kinds of hazardous wastes. According to Ms. Adkins, Tennessee officially ordered the plant to be shut down in the 1980s, and the area was later cleaned up in 1985. She claimed that it showed excrement from the guts of people at K-25, and it was loaded with cesium 137, strontium 90, and other hazardous materials. She expressed her belief that samples of intake water showed that these wastes were from X-10 and went into the Watts Bar and the Clinch River, and toxic wastes were dumped into White Oak Creek from X-10.

According to Ms. Adkins, bacteria surrounded the toxic particles in the Y-12 and X-10 sludge that was placed in the K-25 sewage plant reaction chamber. The sludge contained nickel, cadmium, and arsenic, and radioactive K-25 sewage workers dumped this toxic sludge at the pond onto sand beds to drain the sludge. She expressed her belief that workers loaded the trucks with this radioactive fertilizer for area gardens. She noted that she wanted to be clear where this material came from and what it had contained because some people had asked her.

Dr. Charp indicated that the S-3 ponds are not a parking lot. Ms. Adkins said it was the S-1, S-2, S-3, and S-4 ponds she had mentioned. Dr. Cember asked if S-3 ponds were paved over; Dr. Charp said they were. Ms. Adkins expressed concern that the gardens are still growing dandelions, sweet potatoes, and radishes. In fact, she said, her potatoes were the largest potatoes at the Tennessee Valley Agricultural Industrial Fair for 7 years straight.

Dr. Davidson thanked everyone for coming to the meeting, particularly those who had stayed to the end.

Meeting Adjourned

Dr. Davidson said they will wait to hear from ATSDR regarding ORRHES’s continuing role in the public health assessment process. She adjourned the meeting at 6:45 p.m.

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