Azby three-year symposium-health v06

HEALTH
(This is an expanded version of a talk given at the
Fukushima:The Next ThreeYears 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 grievances
Is 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.

Uncertainty
But 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 month
fatal 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
0
mSv
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 month
fatal 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
0
mSv
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 pers
10mSv = 5-10 per 10,000 pers
1mSv = 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 uncertainty
It’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)

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.

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
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
Number
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)

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

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0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 150
mSv
WHO:
UNSCEAR:
children
children
Iitate 1yr old
Imanaka:
Iitate 1yr old
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Namie1yr old
adults
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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 mGy
150-650 mGy
30-150 mGy
10-30 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 90 100 110 120 130 140 150
mSv
WHO:
UNSCEAR:
children
children
Iitate 1yr old
Imanaka:
Iitate 1yr old
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Namie1yr old
adults
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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.

--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. (personal communication)
Williams' provisional suggestions include:

Other screening, monitoring
Internal 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/yr
2 mSv/yr
3 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 2013
WBC results for adults (n=5810)
(Canberra FastScan)
Cs137, DL= 250 Bq/body
Source: Minamisoma Municipal Hospital
persons
Cs, Bq/kg
ND=98%
Over 20Bq/kg=0.04%

MINAMISOMA CITY, April-Sept 2013
WBC results for children (n=3390)
(Canberra FastScan)
Cs137, DL= 250 Bq/body
Source: Minamisoma City
persons
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.
%detected
Adults
Children
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 NOT
DETECTED
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?

R
2929
Zvnova et al.
Radiation Protection Dosimetry
2000
Minenko et.al
Health 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!

People 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 take
for 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 10
years for berries and 20 years for mushrooms [11]. Fes-
enko, et al.[12] studied twenty-seven rural settlements to
assess the effectiveness of countermeasures. They ob-
served an initial decrease of up to 40% of doses with a
gradual diminution of effect over time.
was accompanied by high unemployment and economic
hardship, led to a reversion to traditional diets. People
were forced to once again consume more locally produced
food as well as "free" natural foods from the forests
(mushrooms, berries, wild game, etc.). Moreover, after a
relatively short period of time, it is likely that people be-
came indifferent to warnings of the possible harm from
radiation and to recommendations about the consump-
tion of these foods. The influence of these factors is espe-
Figure 3
Dynamics 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
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
years
AnnualdoseDint,mSv
Rokitnovsky rayon
Perehodichi
Vezhytsia
St. Selo
Drozdyn
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.

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, 2011
Fukushima City“glass badge”results, 2011
51% less than
1mSv/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.ofpers
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.)

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
88.7% less than
1mSv/yr
no.ofpers

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.
Distribution of yearly exposure estimates 10,100 persons total
93.48% less than
1mSv/yr
20 mSv, the level not to
be exceeded according
to ICRP 1990
no.ofpers

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Date City Glass Badge Results
52,783 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!

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

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Azby three-year symposium-health v06