Oak Ridge Reservation: Public Health Assessment Work Group

Public Health Assessment Work Group

June 28, 2001 - Meeting Minutes

Agenda

1. Public Health Assessment process Flow Chart - James Lewis
   
2. Epidemiology (Mangano) study - Lucy Peipins
   
3. Iodine-131 issues - Al Brooks
   
4. "Inconclusive by Design" - Susan Kaplan (postponed)
   
5. Health status in Oak Ridge vs. State of Tennessee; Tennessee Cancer Registry - Ed Frome

Attendees

Members present: Bill Pardue, Chair; David Johnson; Al Brooks; Ed Frome; LC Manley; James Lewis; Barbara Sonnenburg; Bob Eklund (phone); Kowetha Davidson, Chair, ORRHES (phone and in person).

Members of public present: Walter Coin; Mike Knapp (Save Our Cumberland Mountains); Cristina Carbajo (Oak Ridge High School).

ATSDR staff present: Lucy Peipins, Michael Grayson, Karl Markiewicz, and Jack Hanley were on the conference line; Bill Murray was present.

Summary

The meeting was called to order by the Chair at 5:05 pm. The minutes and attachments for the May 31, 2001 meeting and the agenda for this meeting were distributed. A brief summary of each topic follows.

1. PHA Process Flow Chart - James Lewis distributed an updated version of this chart and explained the chart to the WG. The chart depicts the responsibilities of ATSDR, ORRHES, and the PHA WG in the PHA process. The process is broken down into seven phases in three stages. In each phase, the chart shows how advice and recommendations are developed by the PHA WG and ORRHES and presented to ATSDR. The WG had several suggestions to simplify the chart and James Lewis will revise the chart and bring a new draft back to the WG.


2. Epidemiology study - The Mangano study distributed to ORRHES at the June meeting was the major topic of discussion. Lucy Peipins will prepare a list of questions that are used to evaluate an epidemiology study. There was considerable discussion about evaluating this study as a model. The WG preferred to evaluate another study to avoid appearance of criticizing the Mangano study. Another community study will be used in the training session and the Mangano study will be evaluated at a later time. (Ed Frome discussed studies he had written/reviewed on radiation and cancer and his comments are in Attachment A.)


3. Iodine-131 issues - Al Brooks presented a short summary on how scrubbers operate since the scrubbers were the main source of I-131 releases at the Oak Ridge National Laboratory (X-10) in the RaLa process. He also presented comments on the operation of the scrubbers in the RaLa process based on data and reports he had reviewed. There are few data on scrubber efficiency. The values selected are conservative and not much can be done to adjust them. He suggested using a central value for I-131 releases rather than the 95% value selected by the Steering Panel.

There was extended discussion of all sources of I-131 doses including the Nevada Test Site (NTS). Also mentioned were the delay in releasing the ATSDR peer review of the I-131 dose reconstruction and lack of time for the review to be addressed by the authors of the dose reconstruction in the presentations at the June ORRHES meeting. It was emphasized that ATSDR has not reached any conclusions about the impact of releases from the ORR and that the review was not released prior to establishing the ORRHES.

4. The discussion of "Inconclusive by Design" was postponed due to the absence of Susan Kaplan.


5. Comparison of health status in Oak Ridge to the rest of Tennessee - Ed Frome talked about the Tennessee Cancer Registry and what information can be obtained from it. Other health/disease information is difficult if not impossible to obtain. The WG will continue its discussion on this topic at a future meeting.


6. Correspondence received - The Chair distributed a letter for Ms. Peggy Adkins, a concerned resident who grew up near K-25 and thinks she has health problem related to exposures. She urged the PHA WG and ORRHES to consider arsenic, cadmium, lead, nickel, mercury, cobalt and strontium in the PHA. She also wants residents tested for these elements and a cutting-edge treatment center set up for the affected residents.

The meeting was adjourned at 7:45 pm.

ATTACHMENT A

Correction to Statement at PHA work group meeting June 28, 2001

I reviewed the 1991 JAMA paper by Wing et al. and a later paper that I wrote. Both of these papers had results involving SMRs for leukemia, and my statement was based on results in the second paper as indicated below. For the record, please note the following correction to the statement that I made yesterday at the PHA work group meeting.

The Wing et al. JAMA paper DID find an increase relative to U S rates in deaths among 8318 white males ONLY employed at ORNL. The SMR for leukemia was 1.63 based on 28 deaths. The study did NOT find evidence for an association between leukemia deaths and external radiation.

Wing, S., Shy, C.M., Wood, J., Wolf, S., Cragle, D., and Frome, E.(1991), "Mortality among workers at Oak Ridge National Laboratory: Evidence of radiation effects in follow-up through 1984," Journal of the American Medical Association, vol. 256, pp.1397-1402.
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Frome, E.L., Cragle, D.L., Watkins, J., Wing, S., Shy, C., Tankersley, W., and West, C. (1997), "A mortality study of employees of the nuclear industry in Oak Ridge, Tennessee," Radiation Research, vol.148, pp. 64-80.

This second paper in Radiation Research (after the Mangano paper) was a study of the mortality of 106,020 workers employed between 1943 and 1985 at the federal nuclear plants in Oak Ridge (who also live in communities around ORR). Workers omitted from earlier studies are included in this report. The mortality rates of workers at the Oak Ridge plants are compared with each other and with U. S. rates. Dose-response analyses are presented for those individuals who were potentially exposed to external radiation.

This second paper DID NOT find an increase in leukemia deaths relative to U S white males. Table I in this paper shows the SMR for leukemia for the 68,666 white males employed at all ORR facilities was NOT elevated. The SMR was 0.98 based on 180 deaths (but see below).

A smaller group of 28,347 white males employed at X-10 or Y-12 who were at risk for exposure to external penetrating radiation was examined to determine if there was a relationship between rates of death from selected causes and level of radiation dose.

There was no evidence for an association between leukemia deaths and external radiation. Leukemia death rates for X-10 workers were higher than U. S. rates and other similar Oak Ridge workers.

For more details see the summary and/or the entire report at http://www.csm.ornl.gov/~frome/ORMS/ Sorry for the confusion on this point. Ed

P.S. The following two papers describe the statistical methods for
the analysis of event rates that were used in both of these studies:

Frome, E. L. and Checkoway, H. (1985), "The Use of Poisson Regression Models in Estimating Incidence Rates and Ratios," American Journal of Epidemiology, vol. 121, pp. 309-323.

Frome, E. L. (1983), "The Analysis of Rates Using Poisson Regression Models," Biometrics, vol.39, pp. 665-674.

These methods are also described in the texts by Breslow & Day and Checkoway et al. along with a discussion of other methods that have been used for the analysis of rates.

N. E. Breslow and N. E. Day. Statistical Methods in Cancer Research, Volume II: The Design and Analysis of Cohort Studies. Scientific Publication Number 82. International Agency for Research on Cancer, Lyon, 1987.

H. Checkoway, N. E. Pearce, and D. Crawford-Brown. Research Methods in Occupational Epidemiology. Oxford University Press, 1989.