Public Health Assessment Work Group
Meeting Minutes
June 28, 2001
Agenda
- Public Health Assessment process Flow Chart - James Lewis
- Epidemiology (Mangano) study - Lucy Peipins
- Iodine-131 issues - Al Brooks
- "Inconclusive by Design" - Susan Kaplan (postponed)
- 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.
- 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.
- 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.)
- 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.
- The discussion of "Inconclusive by Design" was postponed
due to the absence of Susan Kaplan.
- 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.
- 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.
-----------------------------------
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.
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