Health Effects fromHealth Effects fromChernobylChernobyl

Dr Ian FairlieDr Ian FairlieConsultant on Radiation in the EnvironmentConsultant on Radiation in the Environment

LondonLondonUnited KingdomUnited Kingdom

Chernobyl Accident (1986)Chernobyl Accident (1986)

““..the foremost nuclear catastrophe in ..the foremost nuclear catastrophe in human historyhuman history”” IAEA (1996)IAEA (1996)

““..its magnitude and scope, the size of the ..its magnitude and scope, the size of the affected populations, and its longaffected populations, and its long--term term consequences make it, by far, the worst consequences make it, by far, the worst industrial disaster on recordindustrial disaster on record”” IAEA/WHO (2005)IAEA/WHO (2005)

““..radioactivity released ~200 times that ..radioactivity released ~200 times that from Hiroshima or Nagasakifrom Hiroshima or Nagasaki”” WHO/IPHECA (1995)WHO/IPHECA (1995)

Chernobyl FalloutChernobyl Fallout

Doses from Chernobyl (2006)Doses from Chernobyl (2006)sources: *Cardis et al, 2005; ** TORCH (2006)sources: *Cardis et al, 2005; ** TORCH (2006)

SizeSize Average DoseAverage Dose(mSv)(mSv)

Collective DoseCollective Dose(Person Sv)(Person Sv)

Liquidators*Liquidators* 240,000240,000 100100 24,00024,000

High contam areas*High contam areas* 270,000270,000 5050 13,50013,500

Low contam areas*Low contam areas* 5.2 m5.2 m 1010 52,00052,000

Evacuees in 1986*Evacuees in 1986* 116,000116,000 3333 3,8003,800

Rest of Europe**Rest of Europe** 600 m600 m ~0.4~0.4 240,000240,000

Rest of World**Rest of World** 4,000 m4,000 m ~2.5 x 10~2.5 x 10--22 100,000100,000

TOTALTOTAL ~~430,000 430,000 estimated deathsestimated deaths ~43,000~43,000

Updated doses Updated doses from UNSCEAR 2008from UNSCEAR 2008

Population group Size(1000s)

Aver eff dose 1986-2005

(mSv)

Coll eff dose 1986-2005 (man

Sv)Recovery operation workers 530 117 61 200Evacuees 115 31 3 600Inhabitants of contam areas of Belarus, Russia and Ukraine

6 400 - 58 900

Inhabitants of Belarus, Russian Federation and Ukraine

98 000 1.3 125 000

Inhabitants of W Europe 500 000 0.3 130 000

Total 380 000

New BookNew Book“Chernobyl's radioactive contamination >37 kBq/m2 (1986-87) is responsible for 3.8 to 4.4% of overall mortality in areas of Russia, Ukraine, and Belarus. In other European countries with contamination levels around 19 kBq/m2 (1986-87), the mortality is about 0.3 to 0.7%. Reasonable extrapolation for additional mortality in the heavily contaminated territories of Russia, Ukraine, and Belarus brings the estimated death toll to about 900,000 for the first 15 years after Chernobyl."

Chernobyl: Chernobyl: observed health effectsobserved health effectsthyroid cancersthyroid cancersleukaemiasleukaemiasother solid cancersother solid cancersnonnon--cancer effectscancer effectsminisatellite mutationsminisatellite mutationsmental health + psychosocialmental health + psychosocial

Thyroid Cancer IncidenceThyroid Cancer Incidence((in those in those who were children and adolescents in 1986) who were children and adolescents in 1986) source:source: Jacob Jacob et alet al (2005)(2005)

Thyroid Cancer Incidence (2)Thyroid Cancer Incidence (2)source: reproduced from lecture presentation by E Cardis to IAEAsource: reproduced from lecture presentation by E Cardis to IAEA/WHO Conference Chernobyl: Looking Back to Go /WHO Conference Chernobyl: Looking Back to Go

Forward. September 2005. Original data from Dr Yuri Demidchik.Forward. September 2005. Original data from Dr Yuri Demidchik.

Incidence per 100,000 in Belarus

0.3

6.9

0

2

4

6

8

10

12

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Cas

es p

er 1

00 0

00

Children (0 -14)

Adolescents (15 - 18)Adults (19 - 34)

Adolescents

Children

Young adults

How many excess thyroid cancers How many excess thyroid cancers may occur?may occur?

So far >6,000So far >6,000Cardis et al estimate 18,000 to Cardis et al estimate 18,000 to 66,000 in Belarus alone66,000 in Belarus aloneassumes a constant relative risk assumes a constant relative risk over the whole of lifeover the whole of life

Thyroid cancer Thyroid cancer in other countriesin other countries

Czech RepublicCzech Republic-- Murbeth et al (2004)Murbeth et al (2004)--after 1990, incidence increased by 2.6% per year after 1990, incidence increased by 2.6% per year (95%(95%--CI: 1.2CI: 1.2--4.1) in all age categories4.1) in all age categories

North England North England (greatest incidence in Cumbria)(greatest incidence in Cumbria)-- Cotterill et al (2001)Cotterill et al (2001)-- incidence in children/young adults, (1987incidence in children/young adults, (1987--97 97 rate)/(1968rate)/(1968--1986 rate ) = 2.3 1986 rate ) = 2.3

Leukaemia in Clean-up Workers

source: Ivanov (1997)

Leukaemia in EuropeLeukaemia in Europe

Some reports of increased incidence of Some reports of increased incidence of infant leukaemiainfant leukaemianot correlated with dosenot correlated with doseuncertainties in dose estimatesuncertainties in dose estimatesEuropean Childhood LeukaemiaEuropean Childhood Leukaemia--Lymphoma Incidence Study (IARC)Lymphoma Incidence Study (IARC)possible possible in uteroin utero effecteffect

Solid cancersSolid cancers

Okeanov et al (2004)Okeanov et al (2004)data from Belarus National Cancer data from Belarus National Cancer RegistryRegistry40% increase in cancer incidence 40% increase in cancer incidence 19901990--2000 cf 19762000 cf 1976--8585

Cancer Incidence in controls

Incidence in liquidators

RR 95% confidence intervals

All sites 373.3 449.3 1.20* 1.14 – 1.27Bladder 10.9 17.0 1.55* 1.21 – 1.99Colon 17.0 22.3 1.31* 1.03 – 1.67Lung 52.4 67.3 1.28* 1.13 – 1.46Kidney 14.8 17.9 1.21 0.97 – 1.50Stomach 41.7 44.9 1.08 0.92 – 1.26Breast ♀ 58.6 61.3 1.05 0.81 – 1.35Rectum 19.0 18.4 0.97 0.77 – 1.23

Solid Cancers RR in cancer incidence (for ages 20-85 per 100,000 population) in Belarus liquidators

1997-2000, compared with control adults in least contaminated area (Vitebsk)

source: Okeanov et al (2004) *statistically significant differences

Breast CancerBreast Cancer

Recent ecologic study (Pukkala et al,Recent ecologic study (Pukkala et al,2006) of incidence in Belarus and Ukraine2006) of incidence in Belarus and Ukraine

in most contaminated districts, average in most contaminated districts, average dose > 40 mSvdose > 40 mSvrelative risk in Belarus 2.2relative risk in Belarus 2.2relative risk in Ukraine 1.8relative risk in Ukraine 1.8

NonNon--cancer effects in Acancer effects in A--bomb survivors bomb survivors (Preston and Pierce, 2003)(Preston and Pierce, 2003)

ConditionCondition ERR/Sv ERR/Sv 95% CI95% CI

respiratory disease respiratory disease 0.18 0.18 0.06 to 0.320.06 to 0.32

heart diseaseheart disease 0.170.17 0.08 to 0.260.08 to 0.26

digestive diseasedigestive disease 0.150.15 0.00 to 0.320.00 to 0.32

strokestroke 0.120.12 0.02 to 0.220.02 to 0.22

NonNon--cancer effectscancer effects

Many reported effects (IAEA/WHO 2005) Many reported effects (IAEA/WHO 2005) but evaluation is difficult but evaluation is difficult

different diagnostic criteriadifferent diagnostic criteriainsufficient control groupsinsufficient control groupslow statistical powerlow statistical powerconfounding factorsconfounding factors

Cardiovascular diseaseCardiovascular disease

seen in Aseen in A--Bomb survivors (Pierce Bomb survivors (Pierce et et alal, 2003) ERR/Sv = 0.17, 2003) ERR/Sv = 0.17(Ivanov (Ivanov et alet al, 2000) study of Russian , 2000) study of Russian cleanup workers, ERR/Sv = 0.54 ie cleanup workers, ERR/Sv = 0.54 ie comparable to Acomparable to A--bomb survivorsbomb survivors

Heritable EffectsHeritable Effects

germline minisatellite mutation ratesgermline minisatellite mutation ratesDubrova et al (1996, 1997, 2002)Dubrova et al (1996, 1997, 2002)

2 x increase in groups from Belarus 2 x increase in groups from Belarus and Ukraineand Ukrainemutation induction in fathers not mutation induction in fathers not mothersmothers

Collective dose and cancer deathsCollective dose and cancer deaths

best global estimate = 600,000 person sievertsbest global estimate = 600,000 person sievertsusing risk factors of 5% and 10% per sievertusing risk factors of 5% and 10% per sievert

= 30,000 = 30,000 –– 60,000 predicted excess cancer deaths60,000 predicted excess cancer deathsabout 1/3 in Belarus, Ukraine and Russia, the about 1/3 in Belarus, Ukraine and Russia, the rest in northern hemisphere, mostly in W Europerest in northern hemisphere, mostly in W Europedepends on the assumption of LNTdepends on the assumption of LNT

Displaced Persons Displaced Persons (UNDP 2002)(UNDP 2002)

Epidemiology studies: Epidemiology studies: care requiredcare required

•• differing diagnostic criteria useddiffering diagnostic criteria used•• insufficient/poorly matched control groupsinsufficient/poorly matched control groups•• small numbers small numbers –– low statistical powerlow statistical power•• confounding factors and biasesconfounding factors and biases•• nil or poor dose estimatesnil or poor dose estimates

Only use reliable studiesOnly use reliable studies

Thyroid Cancer IncidenceThyroid Cancer IncidenceJacob Jacob et alet al (2005)(2005)

Leukemias in Clean-up Workers Ivanov (1997)

CancerCancer Relative RisksRelative Risks 95% CIs95% CIs

All sitesAll sites 1.20*1.20* 1.14 1.14 –– 1.271.27

BladderBladder 1.55*1.55* 1.21 1.21 –– 1.991.99

ColonColon 1.31*1.31* 1.03 1.03 –– 1.671.67

LungLung 1.28*1.28* 1.13 1.13 –– 1.461.46

BreastBreast 2.22.2 N/AN/A

Solid CancersOkeanov et al (2004), Pukkala et al (2006)

*RRs statistically significant at 95%

Cardiovascular DiseaseCardiovascular Disease

Russian cleanup workers Russian cleanup workers ERR/Sv = 0.54 ERR/Sv = 0.54 (Ivanov (Ivanov et alet al, 2000), 2000)

(is consistent with A(is consistent with A--Bomb studies ERR/Sv = 0.17)Bomb studies ERR/Sv = 0.17)(Pierce (Pierce et alet al, 2003), 2003)

NonNon--cancer effects in Acancer effects in A--bomb survivorsbomb survivors(Preston and Pierce, 2003)(Preston and Pierce, 2003)

ERR/SvERR/Sv 95% CI95% CIss

heart diseaseheart disease 0.170.17 0.08 to 0.08 to 0.260.26

strokestroke 0.120.12 0.02 to 0.02 to 0.220.22

respiratory disease respiratory disease 0.18 0.18 0.06 to 0.06 to 0.320.32

digestive diseasedigestive disease 0.150.15 0.00 to 0.00 to 0.320.32

all statistically significant at 95% levelall statistically significant at 95% level

Transgeneration EffectsTransgeneration Effects

DNA minisatellite mutation incidence DNA minisatellite mutation incidence doubled in Belarus and Ukrainedoubled in Belarus and Ukraine

mutations in fathers not mothersmutations in fathers not mothers

passed to their childrenpassed to their children

Dubrova et al (1996, 1997, 2002)Dubrova et al (1996, 1997, 2002)

Chernobyl: conclusionsChernobyl: conclusions

•• terrible consequencesterrible consequences•• health effects still occurringhealth effects still occurring•• different health effects appearingdifferent health effects appearing•• need more research + fundingneed more research + funding•• need to question denials by many need to question denials by many

governmentsgovernments

Uncertainties in Dose CoefficientsUncertainties in Dose CoefficientsGoossens LHJ, Harper FT, Harrison JD, Hora SC, Kraan BCP, Cooke Goossens LHJ, Harper FT, Harrison JD, Hora SC, Kraan BCP, Cooke RM (1998) Probabilistic Accident Consequence Uncertainty AnalysiRM (1998) Probabilistic Accident Consequence Uncertainty Analysis: s:

Uncertainty Assessment for Internal Dosimetry: Main Report. PrepUncertainty Assessment for Internal Dosimetry: Main Report. Prepared for U.S. Nuclear Regulatory Commission, Washington, DC 2055ared for U.S. Nuclear Regulatory Commission, Washington, DC 205555--0001, 0001, USA. And for Commission of the European Communities, DG XII and USA. And for Commission of the European Communities, DG XII and XI, BXI, B--I049 Brussels Belgium. NUREG/CRI049 Brussels Belgium. NUREG/CR--6571 EUR 16773.6571 EUR 16773.

NuclideNuclide IntakeIntake OrganOrgan U Range U Range = (ratio of = (ratio of

9595thth/5/5thth percentiles)percentiles)

CsCs--137137 ingestioningestion red bone marrowred bone marrow 44II--131 131 inhalationinhalation thyroidthyroid 99SrSr--90 90 ingestioningestion red bone marrowred bone marrow 240240PuPu--239239 ingestioningestion red bone marrowred bone marrow 1,3001,300SrSr--9090 inhalationinhalation lungs lungs 5,3005,300CeCe--144 144 inhalationinhalation red bone marrowred bone marrow 8,5008,500PuPu--239239 ingestioningestion bone surfacebone surface 20,00020,000

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Reading ListReading List

BooksBooksCaufield C (1990) Multiple Exposures: Chronicles of the RadiatioCaufield C (1990) Multiple Exposures: Chronicles of the Radiation Age. n Age. Penguin Books. London UKPenguin Books. London UKGreene G (1999) The Woman Who Knew Too Much. University of MichiGreene G (1999) The Woman Who Knew Too Much. University of Michigan gan Press. Ann Arbor, MI, USPress. Ann Arbor, MI, USProctor RN (1995) Cancer Wars: How Politics Shapes What We Know Proctor RN (1995) Cancer Wars: How Politics Shapes What We Know and and DonDon’’t Know about Radiation. Basic Books. New York, NY, USt Know about Radiation. Basic Books. New York, NY, US

ArticlesArticlesGreenberg M (1991) The Evolution of Attitudes to the Human HazarGreenberg M (1991) The Evolution of Attitudes to the Human Hazards of ds of Ionising Radiation and to its Investigators. Am J of Industrial Ionising Radiation and to its Investigators. Am J of Industrial Medicine Vol Medicine Vol 20 pp 71720 pp 717--721 721 Rose G (1991) Environmental Health: Problems and Prospects. J ofRose G (1991) Environmental Health: Problems and Prospects. J of Royal Royal College of Physicians of London Vol 25 No 1, pp 48College of Physicians of London Vol 25 No 1, pp 48--5252Stewart AM (1991) Evaluation of Delayed Effects of Ionising RadiStewart AM (1991) Evaluation of Delayed Effects of Ionising Radiation: an ation: an Historical Perspective. Am J of Industrial Medicine Vol 20 pp 80Historical Perspective. Am J of Industrial Medicine Vol 20 pp 8055--810810