Announcement of ATSDR's Decision on Medical Monitoring
for Hanford

The Agency for Toxic Substances and Disease Registry (ATSDR) is announcing its decision that a medical monitoring program is needed for people exposed to past radiation releases from the Hanford Nuclear Reservation site in eastern Washington. When it is established, approximately 14,000 eligible people with significant radiation doses to the thyroid will be offered medical evaluations to detect thyroid neoplasms and other thyroid and parathyroid conditions.

The purpose of a medical monitoring program is to identify specific diseases or conditions through periodic medical examination of an exposed, at-risk population of people. Individuals found to have abnormalities are referred for additional evaluation and, as appropriate, treatment. This proposed program does not compensate for past harms, provide comprehensive medical care, or provide treatment for the conditions identified. ATSDR's proposed program will refer individuals with identified problems to appropriate health care providers for additional assessment or treatment.

The National Center for Environmental Health at the Centers for Disease Control and Prevention (CDC) published in 1994 estimates of projected radiation doses to the thyroid glands of Hanford residents. This Hanford Environmental Dose

Reconstruction (HEDR) project identified large significant releases of iodine-131 to the air from the Hanford Nuclear Reservation during the period from 1945 to 1951. The most important pathway of human exposure was the consumption of contaminated milk produced by cows grazing on contaminated pasture located downwind of Hanford. Children were estimated to have received the highest doses. The dose a person received depended on where they lived and when and how long they lived in a location downwind of Hanford. ATSDR determined the areas of eligibility by generating several maps using data from the HEDR project. Generating these findings, applying the medical monitoring criteria to the Hanford area and working with the affected communities took two years to complete.

In evaluating the design of a medical monitoring program, ATSDR has worked closely with the Hanford Health Effects Subcommittee, a federally chartered advisory board of citizens, that provides advice and recommendations to ATSDR and the CDC on health research and public health activities related to the Hanford Nuclear Reservation. The state health agencies of Washington, Oregon, and Idaho have representatives working with the subcommittee. In addition, ATSDR has worked with the Intertribal Council on Hanford Health Projects, which is comprised of members of the nine tribes in the Hanford region. Each of the tribes also has representation on the subcommittee. ATSDR and the subcommittee have also worked with panels of experts that considered the appropriateness and type of program for Hanford.

Once funding is received, it will take approximately a year for a contractor to develop the program. Individuals eligible for medical monitoring will participate voluntarily; they will be identified by age, place and duration of residence, and time period of residence. Persons eligible for the medical monitoring are those who received an estimated median thyroid dose of 10 rad or higher from 1945 to 1951 and who resided in the affected areas. The initial program will provide medical evaluations to detect thyroid cancer and other thyroid and parathyroid conditions.

Several important benefits will result from a medical monitoring program: 1) a comprehensive health history to review general health of the participants; 2) medical evaluation for specific conditions; 3) referral to appropriate health care providers for treatment; 4) referrals for those affected without sufficient financial resources; 5) better informed clients and providers; and 6) addition of other future medical evaluations if other exposures and health effects are warranted based on ATSDR criteria.

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