azby three-year symposium-health v06

HEALTH

(This is an expanded version of a talk given at the Fukushima: The Next Three Years symposium in

Tokyo, March 15, 2014)

Azby Brown, SAFECAST

v06

Lots of potential health consequences = Lots of concerns

Thyroid cancer, leukemia, other cancer,birth effects, other disease, DNA mutations?

Food, water, playing outside, pregnancy?

Legitimate grievancesIs the Gov’t doing everything it can to

ensure our health and safety?

Is justice being done, in terms of compensation, accountability, etc?

How can people be compensated for such massive damage to their lives anyway?

Uncertainty

It is almost always impossible to say conclusively how many people will get sick.

Estimates are almost always based on incomplete information.

UncertaintyBut even with good data we’re usually left with no more than a “range of probability.”

--Depending on the type of data and its quality, uncertainty might be small i.e., +/- 10%. --In our current situation, it’s rarely less than a factor of 2, i.e. +/- 2x --In many cases, it’s an order of magnitude or more, i.e. +/-10x. This is actually normal.

Uncertainty

• So, expert A says “Probably 2.5% will get sick.”

• Expert B says, “Probably 5% will get sick.”

• Expert B’s estimate is double expert A’s.

• But actually they agree closely.

“Essentially, all models are wrong, but some are useful.”

“Remember that all models are wrong; the practical question is how wrong do

they have to be to not be useful.”

George E.P. Box

MODELS:

immediate (acute) effects

long-term(stochastic)

effects

begin to see ARS

50% fatal in 1 monthfatal in weeks

1 Sv=1000 mSv: increased risk of fatal cancer 5% (but good arguments for assuming 10%)

good (but not conclusive) evidence for increased leukemia

0mSv

20 100 1000 5000 10,000

increased cancer % is clearuse LNT

immediate (acute) effects

long-term(stochastic)

effects

begin to see ARS

50% fatal in 1 monthfatal in weeks

1 Sv=1000 mSv: increased risk of fatal cancer 5% (but good arguments for assuming 10%)

good (but not conclusive) evidence for increased leukemia

0mSv

20 100 1000 5000 10,000

increased cancer % is clearuse LNT

Best Fukushima dose estimates

Dumb Luck.

The wind usually blew the plume out to sea.That’s the main reason the doses are so low.

About “dose” and “risk”5% per Sv? 10% per Sv?

Public health risk:

Increased fatal cancer risk:

Individual risk:100mSv = 0.5 -1%10mSv= 0.05-0.1%1mSv= 0.005- 0.01%

100mSv = 5-10 per 1000 pers10mSv = 5-10 per 10,000 pers1mSv = 5-10 per 100,000 pers

Current assumption:Some evidence suggests:

Measurement (“in-vivo”)Based on WBC, blood tests, personal dosimetry, etc.

Estimates (reconstruction, simulation)Based on environmental dose rates, models, food intake surveys, etc.

Epidemiology (past experience, statistics)Based on historical statistics, etc.

Less uncertainty

More uncertaintyIt’s very important to have good

in-vivo measurements!

Some things we’ll never know for sure:

Initial doses, i.e March-May, 2011

Not enough in-vivo screening was done!

(But maybe enough to make acceptable estimates)

Psycho-social effects

Very real, very serious already

Stress, PTSD, depression, sleep disorders, chronic anxiety, physical symptoms, family

problems, breakdown of community support, etc.

Already 1,660 “disaster-related deaths” in Fukushima! (i.e. life shortened by stress of evacuation)

Thyroid Cancer

Fukushima Prefecture Health Survey thyroid screening program

Total screened to date (age 0-18): 269,354 (out of 333,403 planned in 1st round of screening)

Anomalies (nodules/cysts found): 46.6%

Cancers found or suspected: 74 cases (0.027%)

What does this mean?

Opinions of outside experts: Sir Dillwyn Williams, Cambridge Univ. :

(A leading endocrinologist who, with, Keith Baverstock, made a crucial effort to get thyroid cancer outbreak

acknowledged after Chernobyl)

--The observed incidence of any cancer in a population depends on the method used to look for it.--Any systematic survey will find more cases than the normal system of waiting for the patient or relatives to notice something.--The more sensitive the screening system the larger number of cases will be found.--This is particularly true for slow growing cancers like thyroid, where it takes a considerable time for the earliest cancer to grow from just a few cells to a detectable lump.

He points out that:

(personal communication)

Sir Dillwyn Williams, cont’d

- The chance that the current apparent increase in thyroid tumours is due to radiation exposure is very low. - The tumors pose little health threat.- High-resolution ultrasound screening is a new technique, and reveals many harmless anomalies.- Not enough time has passed for radiogenic tumors to appear.- The doses are uncertain, but appear too low in nearly all areas to cause detectable increase.- Milk and other contaminated food was stopped soon.- Japanese children have sufficient iodine in their diet compared to Chernobyl.- This study will show the normal baseline prevalence of thyroid tumors.- It’s too early to know for sure how many new cases will arise (incidence), we will have to wait at least 4 years.

Initial opinion in Feb., 2012:


As more data became available, similar opinions expressed by Baverstock, Demidchik, Tronko, Ivanov, Jacob, and other

leading experts:

Fukushima thyroid cancers, so far (Feb. 2014): - Still to soon to be caused by radiation.- Children under 5 would be first, but none so far. - No clear correlation with dose levels

“It’s still too early to know.”

But we can expect some increase !

At this point, strong consensus.

!""

2.2 Suspicious or malignant cases on FNAC by age and sex (including one confirmed case of benign nodules as of

31 December 2013)

2.2.1 Suspicious or malignant cases by age as of 11 March 2011

2.2.2 Suspicious or malignant cases by age as of the date of confirmatory examination

0

2

4

6

8

10

12

14

16

18

20

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Male

Number

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4

6

8

10

12

14

16

18

20

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Female

Male

Number

Age

Fukushima Health Management Survey, Reported on 7 February 2014

None under 5yrs

“Dissenting” viewpoint: Tsuda, Hamaoka, etc.:

- Rate seems to be increasing 2011-2013.- Maybe there is a correlation with dose levels.- Maybe Chernobyl tumors would have been detected. earlier if there had been widespread ultrasound screening.- Maybe Fukushima dosimetry is very wrong.- Maybe Fukushima Pref Health Survey is untrustworthy.

The evidence is not strong, but these ideas need to be considered and tested!

Good scientists never say “never” !

Results of thyroid comparison survey

Dates of study: Nov, 2012 - March 2013

4365 children in Aomori Pref., Yamanashi Pref., Nagasaki Pref. Age 3-18 years

Anomaly detection rate: 56.88%

(Detection rate in Fukushima: 43.6%)

Source: Japan Environ. Ministry: http://www.env.go.jp/press/press.php?serial=16419

More anomalies outside Fukushima

The results are similar, but the surveys are not perfectly comparable, and the size of the cohort is statistically very

small; one more cancer case would double the apparent rate.

Preliminary report March, 2013; Detailed report, Hayashida, et al, Dec., 2013

UPDATE: March 28, 2014: Results of followup examinations:--31 children had followup exams.--1 cancer case found or suspected. --The rate so far is 0.022% ; the rate in Fukushima is 0.027%

(but actually quite similar)

http://www.env.go.jp/press/press.php?serial=16419

http://www.env.go.jp/press/press.php?serial=16419

What do we know about the thyroid doses?

Unfortunately, not many timely in-vivo measurements, and it’s difficult to be confident in the results:

Hosokawa, et al: 1080 children in Iitate, Kawamata, Iwaki: avg 12mSv, max 42 mSv

Tokonami, et al: 62 pers 0-83 yrs: Children: median 4.2 mSv, max 23 mSv Adults: median 3.5 mSv, max 33 mSv

(About 400,000 people were screened a short time after the Chernobyl disaster!)

Also some data from US military, overseas embassies.

These match the most thorough independent dose reconstruction for Iitate (Imanaka):

--1yr old: min 14mSv, avg 24mSv, max 55mSv Though these reconstructions match well,

the initial doses are still uncertain.

What do we know about the thyroid doses?

WHO estimates, 2013:--Iitate: 1yr old: 73mSv--Namie: 1yr old: 122mSv

(Assumed outdoors 24 hrs/day, and atecontaminated food)

UNSCEAR, 2013:--All Fukushima: 1yr old: avg 15-83mSv--Iitate: 1yr old: avg 56mSv--Maximum estimated dose: 150 mSv

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Hosokawa, et al:

Tokonami, et al:

Rayon-average thyroid doses of children and adolescents (as of time of the Chernobyl accident)

in Belarus, Russia and Ukraine (Ivanov, Kenigsberg, Likhtarev, Balonov, 2006)

All rights reserved

>650 mGy150-650 mGy30-150 mGy10-30 mGy

Quite a few over 1 Gy!(1Gy≈1Sv)

Chernobyl thyroid doses: up to 1000mSv +

Fukushima thyroid dose estimates

(But some cancers expected at low dose range)

1000 200 300 400 500 600 700 800 900 1000

mSv

0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150mSv

WHO:

UNSCEAR:

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Hosokawa, et al:

Tokonami, et al:

How much thyroid cancer are we likely to see?

One reasonable estimate so far:

Many uncertainties, not conclusive!

Jacob, et al, 2014:--New baseline (normal prevalence) will be about 7x higher than previously believed, i.e., 2.2%.--Based on the estimated percentages, in the next 50 years, with 330,000 people being studied, about 7300 will be diagnosed with thyroid cancer.--Only about 300-1000 of these will be new cases (incidence) due to radiation.--Most of these would not cause health problems if not discovered (i.e. they would be “subclinical”).

Pros and Cons of thyroid screening according to Williams:

Pros:--Screening reassures the great majority of the population that they do not have a cancer.--Resection of screen detected tumors in children may prevent the development of ‘more difficult to treat’ cancers at a later age.

Cons:--Screening raises the level of concern in the population generally.--Some, possibly many, of the operations may have been for ‘technical cancers’ which would not have progressed.--Operations carry a risk of complications, even though these are extremely rare in skilled hands.


Will the Fukushima thyroid screening program create more health problems

than it solves?

“It was appropriate to set up the screening program for those exposed to Fukushima fallout; on balance I believe it will benefit the population as well as providing information that will be very important in the event of another accident. Open discussions with the public to consider all the results and decide on the appropriate future course of action are extremely important.”

Williams suggests that:


So far, most experts generally agree with the interpretation of thyroid screening results stated by the gov’t, but many

people do not believe them.

Legitimate grievances-- Very poor communication, gov’t did not manage expectations.

-- Misleading statements by Dr. Yamashita (“No risk below 100 mSv”).

-- Many people feel the emphasis has been on “collecting data” rather than on providing “health care.”

What can be done to improve the credibility of health screening?

--Involve independent, 3rd-party groups, individuals, in setting study parameters.--Involve independent monitors for studies themselves, and analysis of results.--Include “dissenters” in all important conferences, meetings.

Improve transparency!

The problems that have arisen concerning this thyroid screening program should cause us to re-examine

how such programs can best be implemented.

--Screening should be restricted to those under age 14 at exposure.--Should be limited to areas with estimated average infant thyroid doses of more than 10mGy. --Screening should be offered on an individual basis, with an explanation of the risks and benefits. --Resection should continue to be advised for screening-detected cancers in children as we cannot currently distinguish those that will progress from those that will not.


Williams' provisional suggestions include:

Other screening, monitoringInternal contamination screening done using

whole body counters (WBC)

--Fukushima Prefecture: Results very incompletely reported!

--Local governments (Minamisoma, Hirata, Soma, etc):Often most complete, accurate surveys

--NPOs (CRMS, others):Wide range in quality, completeness.

But basically, results are similar

WBC Screening program administered by Fukushima Prefecture

Total screened to date

Period ending Jan., 2014

Fukushima Prefecture Internal Contamination Screening (WBC)

Total screened this period

Below 1mSv/yr (99%)1mSv/yr2 mSv/yr3 mSv/yr

-- No distribution by Bq/body is given! (But data probably exists)

-- No information given about % which were below detection level (ND)

-- People were not weighed, so it will be impossible to know distributions by Bq/kg!

Over 99% less than 1mSv to date

WBC Screening programs administered by Municipal Governments

Since 2011, municipal governments such as Minamisoma and Hirata have taken the lead in

providing well-planned and well-run WBC screening programs, under the guidance of Dr. Ryugo Hayano and Dr. Masaharu Tsubokura of Tokyo University. Their results are also the most completely and

informatively published, and have withstood repeated peer-review. Gradually other local

governments, such as Soma, Iwaki, and Kawachimura, have begun to adopt similar standards.

WBC Screening programs administered by Municipal Governments

Among the important features of these surveys are:--Repeated testing of residents to assess changes over time and effectiveness of interventions.--Families measured together whenever possible.--One-to-one counseling after tests.--Development of new technologies for accurately measuring infants and small children (“BabyScan”).--Clear demographic breakdowns of results by age, gender, etc..--Examine correlations between sources of food, drinking water etc.. and internal contamination levels.--Excellent graphs and visualizations, as well as internet blogs to explain results.

In late 2011, almost 40% of children in Minamisoma had internal contamination above a detection limit of 250 Bq/body. Their initial doses shortly after the accident can only

be estimated because WBC devices were not available.

The detection rate declined throughout 2012, and effectively reached zero (though a 20kg child could still have as much as 12 Bq/kg and not be detected)

By late 2013, largely due to effective counseling about food sources, the detection rate for adults

also approached zero.

MINAMISOMA CITY, April-Sept 2013WBC results for adults (n=5810)

(Canberra FastScan)Cs137, DL= 250 Bq/body

Source: Minamisoma Municipal Hospital

pers

ons

Cs, Bq/kg

ND=98%

Over 20Bq/kg=0.04%

MINAMISOMA CITY, April-Sept 2013WBC results for children (n=3390)

(Canberra FastScan)Cs137, DL= 250 Bq/body

Source: Minamisoma City

pers

ons

Cs, Bq/kg

ND=99.9%

Over 20Bq/kg=0.0%

Late 2013, detection rates in children remained effectively zero.

Detection rates for both adults and children in Minamisoma are basically zero at present, but keeping them

low will require continual monitoring and counseling.

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AdultsChildren

Minamisoma: Monthly Cs detection rates, 2011-2013


While detection rates have declined overall, 33 people who were “ND” at the 1st screening showed internal Cs at the

second, and 22 had Cs at both screenings despite counseling. All are elderly who find it difficult to change their eating habits.

Cs137 ; 2380 pers total

Minamisoma: Changes observed in successive WBC screenings

1st screening 2nd screening

Cs137 DETECTED

Cs137 NOTDETECTED

No. of pers.


The results in Hirata City are similar. Detection rates were low overall in late 2011- early 2012.

The detection rate for children during the same period was about 1%. This trend has continued.

(Again, a 20kg child could have as much as 12 Bq/kg and not be detected.)

Results have been consistent in most municipalities with similar screening and counseling programs.

These municipalities usually provide useful breakdowns to help inform people which groups have the highest risk.

WBC Screening programs administered by citizens’ groups

Independent WBC screening report NPO CRMS Fukushima, Jan. 2014

Bq/kg

Period Oct. 2011 - Dec. 2013

Over 80% ND

Very few over 10Bq/kg

(But detection level varied and is sometimes unclear)

n= 5042 persons

How do these results compare with the experience after Chernobyl?

2929

Zvnova et al.Radiation Protection Dosimetry

2000

Minenko et.alHealth Physics 2006

2929

Zvnova et al.Radiation Protection Dosimetry

2000

Minenko et.alHealth Physics 2006

100,000 Bq/body

300,000 Bq/body

Low average levels after

several years: 10,000-20,000

Bq/body

In most areas of Chernobyl, internal contamination was many times higher than what’s been found so far in Fukushima.

Average internal contamination was between 20-40 Bq/kg 10-20 years after Chernobyl accident!

(So far in Fukushima, very few people have been found with more than 10 Bq/kg)

Avg. range

Though their reliability and transparency differ, prefectural, municipal, and

independent tests all indicate that internal contamination of Fukushima residents is

many times lower than in Chernobyl. (peak levels as much as 1 order of

magnitude lower, avg. levels 2 orders of magnitude lower)

Food screening results, both official and independent, reinforce this conclusion.

Nevertheless, “outliers” with higher contamination levels are still found.

Strongest critique of WBC testing: --Lower levels can be detected by urine tests, WBC can’t detect Sr90, etc.Counter critique: --Urine tests error-prone, difficult to collect,unsuitable for mass screening. Sr90 doses can be estimated from known ratios.

WBC alone is inadequate to give “clean bill of health.” Regular health checks of many types are needed.

WBC can reliably show whether internal doses are greater than the 0.01 - 0.1mSv/year range.

It will never be possible to have a perfect assurance of “no negative health effects” no

matter what kind of testing is done.

This is true always, even without radiation!

Legitimate grievancesPeople have a right to uncontaminated food; a right to demand 0 Bq/body from cesium.

The environment and farmland will be contaminated for decades; will it really be

possible to continue adequate food and internal contamination screening the whole time?

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only hope would have been time, the time it would takefor the natural elimination of 137Cs from the ecosystem.And time is not an ally. While the half-life of 137Cs in ag-ricultural products is 2.8–5.6 years, it is approximately 10years for berries and 20 years for mushrooms [11]. Fes-enko, et al.[12] studied twenty-seven rural settlements toassess the effectiveness of countermeasures. They ob-served an initial decrease of up to 40% of doses with agradual diminution of effect over time.

DiscussionIntroduction of countermeasures such as the provision ofnon-contaminated foodstuffs from 1988 until 1991, re-sulted in decreases of 137Cs exposures based upon bio-monitoring and WBC data in the Rokitnovsky Rayon bymore than two-fold. Similar decreases were documentedin other villages, such as in Perehodichi and Vezhitsia,where levels dropped nearly four fold. After the collapseof the Soviet Union in 1991, values of Dint in these areasrapidly increased and approximated values registered inthe immediate post-accident period.

A plausible explanation for the increase in Dint relates tothe severe economic strains brought on by the dissolutionof the Soviet Union and a cessation of government spon-sored counter-measures. The collapse of the FSU, which

was accompanied by high unemployment and economichardship, led to a reversion to traditional diets. Peoplewere forced to once again consume more locally producedfood as well as "free" natural foods from the forests(mushrooms, berries, wild game, etc.). Moreover, after arelatively short period of time, it is likely that people be-came indifferent to warnings of the possible harm fromradiation and to recommendations about the consump-tion of these foods. The influence of these factors is espe-cially strong in those villages located in the forest area,where wild foods are a traditional mainstay of the local di-et. Radiological contamination is tasteless, odorless andinvisible. It is only natural that after the "immediate" cri-sis passed more people were more concerned with the im-mediate effects of hunger rather than any possible long-term health effects.

Further evidence to support this hypothesis can begleaned from interviews conducted by one of the authors(PZ) among a sample of residents of the northern rayonsof the Rivno Oblast covering the period 1987 and 1994(retrospectively collected by PZ). Families were askedwhether they consumed the following foods: home milkand milk products, vegetables, potatoes, home meat,mushrooms and berries from the forest, local fish andwild game (Figure 4). Results indicate that for 1994, more

Figure 3Dynamics of annual effective doses of internal exposure (Dint) due to 137Cs ingestion in Rokitnovsky Rayon and selected vil-lage, Rivno Oblast, Ukraine by year from Whole Body Count (WBC) data

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After Chernobyl, internal doses decreased until 1990-91, then increased again as food screening was cut back.

This is probably the greatest future risk for Fukushima residents in terms of internal contamination.

External Exposures

Individual exposures can be assessed by giving each person a personal dosimeter (“glass badge”)

--Virtually every municipality in Fukushima has done many glass badge surveys since 2011, involving large proportions of the population.--Results consistently show actual received doses to be much lower than estimates based on environmental dose rates and models (usually half or less).

Again, inconsistent technically and in how reported;no independent oversight.

Personal dosimetry (glass badge)

ガラスバッジの結果 Glass badge results, 2011

福島市伊達市

二本松市郡山市

南相馬市相馬市

注：各市HP掲載データをもとに，1年分に変換1mSv/y 1mSv/y

Data from thousands of individuals from many towns in 2011 showed that the majority of external exposures were already under 2 mSv/yr.

(data from individual towns, graphed by R. Hayano)

Fukushima City “glass badge” results, 2011Fukushima City “glass badge” results, 2011

51% less than1mSv/yr

36,767 persons totalDistribution of yearly exposure estimates

yearly exposure (mSv/yr)Data from Fukushima City Gov’t

Doses measured for 3 months,extrapolated to 1 year.

20 mSv/yr level

no. o

f per

s

36,767 children and pregnant women living in Fukushima City were given personal dosimeters in Oct-Dec. 2011. Less than half had additional external exposures over 1mSv/yr. A few children

receiving doses far above average, and the causes, were also identified. (In most cases the highest dose records were from people who left their badges outdoors for long periods, or

allowed them to go through an airport Xray machine.)

Fukushima City “glass badge” results, 2012

16,223 children under middle-school age were again given glass badges to wear from Nov. 2012 to Jan. 2013. Results

showed that 88.7% had additional exposures below 1mSv/yr, a sharp decline in doses compared to the previous year.

Distribution of yearly external exposure estimates 16,223 persons total

Data from Fukushima City Gov’t

88.7% less than1mSv/yr

yearly exposure (mSv/yr)


no. o

f per

s

The doses showed a modest decline the following year, based on data from 10,100 children given glass badges from Sept. to Nov., 2013. Of these, 93.48% had additional exposures below 1mSv/yr, and no child received an exposure above 5mSv/yr.

Fukushima City “glass badge” results, 2013Distribution of yearly exposure estimates 10,100 persons total

Data from Fukushima City Gov’t

93.48% less than1mSv/yr

yearly exposure (mSv/yr)


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Date City Glass Badge Results52,783 pers, July 2012- June 2013

(Based on environmental dose rate)

(Actual dosimetry)

--Results show that 66% of residents’ additional external exposure is less than 1 mSv/yr--94% are less than 2 mSv/yr--76 persons are are over 5 mSv/yr--No child’s dose exceeded 4 mSv/yr

(Data from Date City Govt)

Personal dosimeters are available which can provide a good record of how exposures change from hour-to-hour. This is very

useful for identifying the locations where the highest exposures are received, so

decontamination can be effectively targeted and residents can avoid those locations.

This requires people to sit down and counsel every resident, but unfortunately there are not

enough staff for this at present!

CONCLUSIONS

In conclusion, citizens have many legitimate grievances about health testing programs, and

independent oversight is still lacking. Lack of trust causes people to doubt even reliable data and

conclusions. The health risks from the Fukushima NPP accident will never be zero.

Nevertheless the best screening and research to date suggest that an outbreak of radiation-induced

thyroid cancer is unlikely, and that additional internal and external doses can be kept below 1mSv/yr for the vast majority of the population.

This may not be “safe enough” in the eyes of many citizens, but it is realistic.

To achieve and maintain even this, however, will require a long-term commitment on the part of the government to conscientious, well

managed monitoring of the environment, food, and health.

If past experience is any guide, we can’t assume that this will happen. Citizens should

continue their efforts to gather and share information, and to press for independent

oversight where needed.

azby three-year symposium-health v06

Technology