1. John A. Burns School of Medicine, University of Hawaii
Nuclear Weapons Testing in the Marshall Islands: Implications for Cancer Screening and Cancer Health Seeking Behaviors
UICC
Kuala Lumpur, Malaysia
October 3, 2018
Neal A. Palafox MD MPH
John A. Burns School of Medicine, University of Hawaii

3. US Thermo-nuclear Weapons Testing- Marshall Islands
Operation Crossroads
1946 – 1958
67 total thermo nuclear tests, 12 yr span
Testing done above ground & in atmosphere
Total yield = 7200 Hiroshima bombs.
An average of more than 1.6 Hiroshima bombs per day for the 12 yr nuclear test program

4. Nuclear Legacy

6. OUTCOMES Direct fallout on people of two atolls
Ongoing radiation contamination of island ancestral, home lands
Food chain contamination
Vaporization of some islands
Disrupting lineage
Community breakdown

7. Is Nuclear Testing Associated with Cancer?
24 types of cancer: leukemia, multiple myeloma, lung, intestine, stomach, kidney, liver, bone, thyroid, skin and brain cancers.
Biologic Effects of Ionizing Radiation (BEIR) VII
2004 US National CA report (Marshall Is)
530 excess cancers due to nuclear testing
250 may be latent, onset yrs after exposure
Radiation exposure to all of Marshall Islands

8. Cultural Perspective Land - focal point of social structure
- social hierarchy
- cultural value system
- land rights
- nutrition / dietary disruption

9. The impact of culture on a person’s experience of cancer
Integration of the event into the culture
Will I and my children get cancer because of the nuclear testing?
Are all cancers caused by nuclear testing?
Risk: What is cancer and what is my risk of ever getting cancer?. How long will my family and I be at risk because of the testing?
Trust: Who do I believe? What should I believe?
Cultural Healing: Can the damage, including cancer, be undone? How can / will the culture trauma be addressed?

10. Culture’s influence on CA screening, & Health Seeking Behaviours
What is cancer? What is radiation? Understanding personal risk?
Accountability: Who is responsible for my cancer? Who pays the bill? What standard of care do I deserve / receive?
Compensation: Should I be compensated if I get cancer?
Cultural Healing: Can the damage to the culture and from cancer be undone? How can the culture trauma be addressed?

11. Barriers to Cancer Prevention and Care
Structural
Political and Economic Relationships
Accountability
System and Provider
Standard of Care
Who bears cost
Patient
Cultural Trauma
Literacy re radiation and CA

12. Cultural Trauma
loss of identity / meaning, associated with a traumatic event (s) affecting a group of people
Identity formation of a group of people is grounded in collective memory of the event(s)
Not have to be present or alive at tme

13. Conclusion
Nuclear Legacy greatly affects the cultural context and perceptions of cancer, and health seeking cancer behavior
Barriers to be addressed
Structural Barriers
Personal Barriers
Cultural Healing
Healing of trauma
What does justice look like

14. Komol Tata