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1.0 INTRODUCTION
1.1 Background
The Oak Ridge Reservation is a US Department of Energy (DOE) facility
that was established in Oak Ridge, Tennessee in 1942 as part of the Manhattan
Project, the federal government's World War II effort to build the atomic
bomb. There are three major installations at the Oak Ridge site: the Y-12
weapons plant; the X-10 complex, now known as the Oak Ridge National Laboratory;
and the gaseous diffusion plant, K-25, now known as the East Tennessee
Technology Park.
After World War II, the mission of the facilities broadened to include
a variety of research and production projects. In recent years, however,
the facilities developed in the interest of the national defense have
been downsized. Presently, the missions include environmental restoration,
government and industry partnerships, national security programs, research
and development, technology transfer, and waste management.
1.2 Purpose
The purpose of this compendium of public health activities is to outline
the past and present strategies used to address and evaluate public health
issues related to chemical and radioactive substances released from the
Oak Ridge Reservation. This compendium serves as a foundation document
that summarizes both ongoing and completed activities that local, state,
and federal health agencies have conducted to address public health issues.
This document was developed to enhance communication and help ensure interaction
and coordination among individual citizens, local organizations, and government
agencies.
This document also provides a framework of the systematic approaches
used to evaluate and address public health issues at the Oak Ridge Reservation.
In order to evaluate the potential health effects on people working on
the reservation or living in the area, the following questions must be
answered.
- What is the nature and extent of the contamination?
- Is there an exposure pathway and what are its characteristics?
- What are the demographics of the exposed population?
- What are the public health implications?
- How does the health effects data in the community compare with rates
in other areas?
1.3 Agencies Involved
The Agency for Toxic Substances and Disease Registry (ATSDR), the Centers
for Disease Control and Prevention's (CDC) National Center for Environmental
Health (NCEH) and National Institute for Occupational Safety and Health
(NIOSH), the Tennessee Department of Health, the Tennessee Department
of Environment and Conservation (TDEC) and DOE have responded over the
years to workers and communities concerned about potential exposures and
reported unexplained illnesses afflicting workers and residents.
1.4 Public Health Issues
This document outlines public health activities related to the following
broad public health issues at the Oak Ridge Reservation.
1.4.1 Issue 1: Worker Exposure
Employees of the Oak Ridge Reservation may have been exposed to radiological
and chemical agents in the workplace. The health risks associated with
low-level chronic exposure to ionizing radiation and chemical hazards
are of personal interest to the Oak Ridge workforce. Additionally, as
an occupationally exposed and relatively well-monitored population, this
group offers a unique research opportunity to examine and understand exposure-response
relationships.
1.4.2 Issue 2: Off-Site Exposure
Residents in communities surrounding the reservation may have been exposed
to chemical and radiological substances released from operations at the
site. Recent studies are used to characterize exposures, identify exposed
populations, assess the impact on public health, and determine follow-up
public health actions or studies needed to evaluate and mitigate or prevent
adverse health outcomes.
1.4.3 Issue 3: Reported Illnesses
Illnesses afflicting workers and residents in communities surrounding
the Oak Ridge Reservation have been reported to public health agencies.
1.4.4 Issue 4: Community Involvement
Broader representation of the community is needed in planning and implementing
current and future public health activities.
2.0 ONGOING PUBLIC HEALTH ACTIVITIES
2.1 Issue 1: Worker Exposure
2.1.1 Leukemia Case-Control Study
Purpose
This multi-site case-control study will explore the relationship between
external ionizing radiation and leukemia risk. Leukemia is the abnormal
cell development of blood-forming organs causing excessive white blood
cell development. Exactly 257 leukemia deaths have been identified at
four DOE sites and the Portsmouth Naval Shipyard now that the vital status
(vital status refers to the number of living versus deceased) has been
updated through 1994. One of the four DOE sites included in the study
is the Oak Ridge National Laboratory. Confounding exposures to internal
radiation, chemicals, and electromagnetic fields will be evaluated for
all cases and controls. This study is a followup to recent positive findings
of leukemia and radiation in cohort studies and includes an update of
vital status of Hanford and Savannah River cohorts.
Background and Agencies Involved
Exposure to ionizing radiation has been associated with excessive risk
of leukemia mortality. This excess risk has been observed in persons exposed
to high dose acute radiation, as well as in persons occupationally exposed
to protracted low dose radiation. However, inconsistency of findings across
studies continues to be a problem. Some studies of occupationally exposed
persons have demonstrated a dose-response relationship between exposure
to ionizing radiation (Kendall, et al., 1992; IARC, 1994; Cragle, et al.,
1995). Wing, et al. (1991) observed an elevated risk of leukemia, though
no apparent dose-response relationship with radiation exposure. In a combined
study of three facilities in the United States, Gilbert et al. (1993)
found no overall increase in leukemia risk nor any dose-response relationship.
Many of these studies have suffered from limited statistical power due
to the relatively small number of cases. As a result of this limited statistical
power, NIOSH investigators have designed and begun this multi-site leukemia
case control study.
Time Line
The expected date of completion of the Leukemia Case-Control Study is
September 2001.
Status
The protocol for this study was approved in 1996. The study is currently
underway, and controls have been selected from a combined roster of 94,517
eligible workers. Validation of radiation exposure records is underway,
comparing electronic summary data with the original records at the sites.
2.1.2 Cohort Mortality Study of DOE Chemical Laboratory
Workers
Purpose
In limited studies of chemical laboratory workers, increased risk has
been found for several specific cancers and for all cancers combined.
A multi-site mortality study of DOE chemical laboratory workers is feasible
through use of the available data set. The Cohort Mortality Study of DOE
Chemical Laboratory Workers addresses chemical and mixed exposure hazards
that are applicable to workers outside the DOE complex. The workforce
under study has remained quite stable and should provide valuable information
on the mortality expectation of chemical laboratory workers across the
United States.
Background and Agencies Involved
Chemical laboratory workers have been identified from previous studies
of workers at DOE Oak Ridge facilities. Identification of the laboratory
workers has been accomplished by cross matching job titles and department
titles and codes from work history records by personnel at the Oak Ridge
Associated University Center for Epidemiologic Research who are familiar
with these cohorts. Potential exposures of workers to groups of chemicals
and to ionizing radiation will be assessed, and the relationship of these
exposures to mortality patterns will be investigated.
Time Line
An all-causes mortality rate for this workforce as compared to the general
U.S. population is expected to be completed by December 2002.
Status
Vital status (determining the number of living versus deceased) is currently
being updated through 1998 for the chemical laboratory workers. In fiscal
year 2000, walk-through surveys were conducted at the Oak Ridge National
Laboratory, K-25, Y-12, and Savannah River sites. Dosimetry data and work
history records are being requested from site management for the exposure
assessment portion of the study.
2.1.3 Multiple Myeloma Case-Control Study at K-25
Plant
Purpose
Multiple myeloma is a malignant growth of bone marrow causing bone pain
and deformities that result in anemia and pulmonary and kidney complications.
This case-control study of 63 multiple myeloma cases at K-25 complements
a multiple myeloma study that focused on external radiation. This study
addresses the question of whether multiple myeloma is related to internal
or external radiation exposure, and it evaluates potential confounders
with reasonable statistical power.
Background and Agencies Involved
The K-25 workforce was exposed primarily to internal radiation. Both
radiation and chemical exposure will be included in the exposure assessment
for all cases and controls in this study conducted by NIOSH. A multi-site
case-control study, which was conducted by Dr. Steve Wing at the University
of North Carolina, evaluated possible etiologic risk factors for multiple
myeloma, focusing on external radiation (radiation dose from outside the
body) and chemical exposures. This study of K-25 multiple myeloma cases
will allow specific examination of internal radiation (radiation dose
inside the body).
Time Line
The expected date of completion for the Multiple Myeloma Case-Control
Study at K-25 Plant is December 2002.
Status
The vital status (determination of living versus deceased) of the K-25
cohort of workers has been updated through 1998. Controls will be matched
as specified by the approved scientific study protocol. Updated information
on work history and exposure is being compiled prior to analysis.
2.1.4 Construction Workers Mortality Study
Purpose
Relatively few mortality studies have been conducted among construction
workers. This Construction Workers Mortality Study is an all-cause retrospective
cohort mortality study of former DOE construction workers. The study provides
an opportunity to further define the risks associated with asbestos fibers,
silica-containing dusts, beryllium particulates, and other exposures encountered
by construction workers. The study will provide useful information applicable
to the present construction workforce across the DOE weapons complex.
Background and Agencies Involved
There have not been specific health studies of construction workers across
the DOE weapons complex, although there have been studies of workers who
were more production-oriented. This study will be an all-causes mortality
study performed by researchers of the NIOSH Health-Related Energy Research
Branch.
Time Line
The expected date of completion for the study is December 2001.
Status
A scientific study protocol is being developed, and a roster of construction
workers with work history information is being compiled. Work on the project
was suspended in Fiscal year 2000 due to scarce resources; work will resume
when resources permit.
2.1.5 Beryllium Worker Medical Surveillance Program
Purpose
The Beryllium Worker Medical Surveillance Program (BWMSP) is designed
to detect and diagnose chronic beryllium disease (CBD) among current and
former workers exposed to beryllium throughout the DOE complex, including
Oak Ridge. Early detection of CBD offers hope of reducing morbidity from
this condition. In addition to understanding the size of the CBD problem,
information from this program is used to improve and evaluate worker protection
and control measures, to monitor trends in CBD frequency, and to strengthen
work planning to minimize worker exposures. This program includes an intensive,
coordinated health-risk communication effort.
Background and Agencies Involved
The program, currently focused on Y-12, is operated by the Oak Ridge
Institute for Science and Education (ORISE) under contract to the DOE.
The program began in 1992 when plant records were used to compile a roster
of more than 3,000 living current and former beryllium workers. Between
December 1993 and December 1996, more than 1,000 current and former beryllium
workers were screened. In addition, those not identified on the initial
roster were allowed to self-identify themselves as having worked with
beryllium. Screening medical examinations provided by off-site clinics
include a physical examination, a symptoms questionnaire, a chest radiograph,
the beryllium lymphocyte proliferation test (Be-LPT), and a pulmonary
function test. The Be-LPTs are performed by ORISE and the National Jewish
Medical and Research Center. Individuals suspected of having CBD are referred
to Vanderbilt University Medical Center for further diagnostic examinations.
This is an ongoing program whose scope and duration will be determined
by its ability to find additional cases of CBD in this population of all
current and former Oak Ridge workers, including those at the East Tennessee
Technology Park (K-25) and the .
Status
To date, 25 Oak Ridge workers have been diagnosed with CBD. An additional
77 workers who do not have CBD at present have been found to be sensitized
to beryllium.
This program has also been ongoing at Rocky Flats. In 1999, the BWMSP
is being expanded to all 20 DOE sites that have or have had beryllium
operations under the direction of ORISE.
2.1.6 Former Oak Ridge Construction Workers
Purpose
DOE's Former Worker Program is a pilot program designed to provide medical
surveillance for selected former DOE workers at risk of work-related illness
as a result of exposures while working at DOE facilities. One such pilot
project is underway at Oak Ridge, focusing on former Oak Ridge construction
workers.
Background and Agencies Involved
The Defense Authorization Act 1993, in particular 42 USC Sec. 7274i,
directs the Secretary of Energy to develop a "Program to Monitor
DOE Workers Exposed to Hazardous and Radioactive Substances." The
Oak Ridge pilot project began in October 1996 with a Phase I needs assessment
designed to identify critical groups of at-risk former construction workers.
The project is led by Dr. Eula Bingham of the University of Cincinnati
in cooperation with the United Brotherhood of Carpenters Health and Safety
Fund, the Center to Protect Workers' Rights, and Duke University Medical
Center.
Time Line
The Phase I needs assessment was completed in 1997, and the Phase II
medical screening began in late 1998 and is scheduled to run through 2001.
Status
Initially, approximately 800 former construction workers were identified
as potentially at high risk. The exposures that will be focused on during
the medical screening include asbestos, beryllium, noise, silica, solvents,
and heavy metals (e.g., cadmium and lead).
2.1.7 Former Production Workers from Oak Ridge K-25,
Paducah, and Portsmouth Gaseous Diffusion Plants
Purpose
DOE's former worker program is a pilot program designed to provide medical
surveillance for selected former DOE workers at risk of work-related illness
as a result of exposures while working at DOE facilities. One such pilot
project focusing on production workers is underway at the Oak Ridge K-25,
Paducah, and Portsmouth gaseous diffusion plants.
Background and Agencies Involved
The Defense Authorization Act 1993, in particular 42 USC Sec. 7274i,
directs the Secretary of Energy to develop a "Program to Monitor
DOE Workers Exposed to Hazardous and Radioactive Substances." The
Oak Ridge project began in October 1996 with a Phase I needs assessment
designed to identify critical groups of at-risk former production workers.
The project is led by Dr. Steven Markowitz of Queens College, City University
of New York, and Mr. Robert Wages of the Oil, Chemical, and Atomic Workers
International Union, in cooperation with the University of Massachusetts
at Lowell.
Time Line
The Phase I needs assessment was completed in 1997, and the Phase II
Medical Screening began in late 1998 and is scheduled to run through 2001.
Status
Initially, approximately 1,260 former production workers were identified
as potentially at high risk. Exposures of concern that were identified
in Phase I and that will be focused on during the Phase II medical screening
include asbestos, beryllium, bladder carcinogens, chlorinated solvents,
fluorine compounds, nickel, noise, silica, uranium, welding fumes, and
heavy metals (e.g., cadmium, lead, and mercury).
2.1.8 Case-Control Study of Lung Cancer and External
Ionizing Radiation
Purpose
Several recent epidemiologic studies have shown a dose-response relationship
between lung cancer and external ionizing radiation. These studies, however,
have had potentially confounding exposures to lung carcinogens. This project
will investigate the association of mortality from lung cancer and exposure
to external ionizing radiation among DOE workers. The study population
was selected to target workers primarily exposed to external radiation
and includes those involved in reactor operations. The sites identified
include the Oak Ridge National Laboratory (X-10), Hanford (Area 100),
Savannah River (Area 100), and the Idaho National Engineering and Environmental
Laboratory.
Background and Agencies Involved
This study will be a case-control study performed by researchers of the
NIOSH Health-Related Energy Research Branch.
Time Line
The expected date of completion for the study is December 2003.
Status
The protocol has received approval from the NIOSH-Human Subject Review
Board and all site institutional review boards. Opening meetings have
been held at all sites, and preliminary records review was initiated.
Data coding for roster development has begun. Roster development and selection
of cases and controls will be completed during fiscal year 2001.
2.1.9 Work Histories Evaluating New Participatory
Methods
Purpose
Workers in the construction trades are exposed to a wide variety of chemical
and radiological agents at DOE sites, and an effective allocation of medical
surveillance resources to these workers depends upon adequate knowledge
of these exposures. However, documentation of the exposure histories for
these workers is complicated by the difficulty in worker recall of their
complex exposure patterns over time periods which typically include a
large number of short-term workplace assignments. Investigators from the
Department of Environmental Health at the University of Cincinnati, supported
by a NIOSH grant, are developing new methods for construction trade workers
to improve recall of their occupational exposure histories which can be
used to establish guidelines and formats for the maintenance of personal
work histories. These improved personal histories would then be utilized
to improve the efficiency and effectiveness of medical surveillance programs
intended to assist those former construction workers at risk due to their
occupational exposure histories.
Phase I of this project was carried out from 1995 to 1998 with the active
participation of the United Brotherhood of Carpenters. This phase focused
on former construction workers at the Oak Ridge site and included four
major elements:
- Identification and current location of former Oak Ridge construction
workers and the administration of traditional occupational history interviews
using available information
- Assembly of available documents with information regarding exposure
histories from the institutions on the site, including union pension
records and other task history documentation, for various Oak Ridge
construction work sites
- Development of new techniques for aiding occupational history recall,
including graphic displays of work site locations, detailed Oak Ridge
work site histories, and discussion groups, followed by administration
of modified occupational history interviews.
- Comparison of the results of traditional and innovative methods of
occupational exposure history recall in providing detailed exposure
histories, along with an evaluation of the improvements in identifying
workers with risk-associated need for cost-effective medical surveillance.
Phase II of the project is intended to utilize those methods found to
be the most effective in Phase I in order to validate their usefulness
at DOE sites in general. This phase, begun in 1998, is being conducted
at another DOE site, and it involves a similar group of construction workers.
The second phase effort will be used to establish the validity and applicability
of the first phase study carried out at the Oak Ridge site. The results
will be applied to the establishment of guidelines and formats for personal
work histories for construction trade workers at DOE sites generally.
Background and Agencies Involved
This work is being carried out by the Department of Environmental Health
at the University of Cincinnati, in collaboration with the United Brotherhood
of Carpenters, with Dr. Eula Bingham as the principal investigator. The
work is supported by a grant from the NIOSH Health-Related Energy Research
Branch.
Time Line
The expected date of completion for this study is November of 1999.
Status
The study is currently in its second year at the DOE Hanford site, and
the final report is expected in late 1999.
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