1. HEALTH CONSEQUENCES OF AND LESSONS LEARNED FROM MEDICAL RESPONSE TO SELECTED RADIATION ACCIDENTS Module XIXChernobyl

2. Module Medical XIX-(15) 2 Accident at Chernobyl NPP (26 April 1986) UKRAINE BELARUS RUSSIAN FEDERATION ? Moscow Kaluga Bryansk Chernobyl Gomel Kiev Map of area studied

3. Module Medical XIX-(15) 3 Chernobyl reactor accident Total contaminated surface (> 1 Ci/km 2 ): 1 000 000 km 2 Near zone (<100 km): deposition of heavy particles ( Sr, Pu... Far zone (up to 2000 km) : deposition of volatile elements (I, Cs)

4. Module Medical XIX-(15) 4 Chernobyl disaster: radionuclides released

5. Module Medical XIX-(15) 5 Main radionuclides contributing to health effects to health effects n iodine - 131 n volatile n T 1/2 : 8 day n disappears from environment in 2 months n inhalation and ingestion n concentrates in thyroid n caesium-137 n volatile n T 1/2 : 30 years n stays long in environment n body elimination in about 100 days n homogenous distribution in all organs and soft tissues

6. Module Medical XIX-(15) 6 Biological effects of exposure to ionizing radiation Deterministic effects n occur when the dose is above given threshold (characteristic for the given effect) n severity increases with the dose n many cells die or have function altered examples: erythema, fibrosis, marrow depletion, cataract examples: erythema, fibrosis, marrow depletion, cataract Stochastic (probabilistic) Stochastic (probabilistic) n have no known threshold n probability of occurrence increases with dose n may result from alteration in only one or few cells examples: carcinogenic - various neoplasms examples: carcinogenic - various neoplasms genetic - various hereditary disorders genetic - various hereditary disorders

7. Module Medical XIX-(15) 7 Erythema on a Chernobyl fireman on Day 17 (primarily from beta radiation)

8. Module Medical XIX-(15) 8 Severe multiple necrotic-ulcerative radiation burns in Chernobyl fireman on Day 40 after the accident

9. Module Medical XIX-(15) 9 Lloyd, D.C.: Chromosome analysis to assess radiation dose, Stem Cells, 15: 195-201, 1997

10. Module Medical XIX-(15) 10

11. Module Medical XIX-(15) 11 14 death in 106 confirmed ARS patients, 1987-2000 l In 1987-2000 14 confirmed ARS patients died for different reasons l Cause of death only in three cases (Myelodysplastic syndrome) may be associated with II-III degree of ARS [Ref.: UNSCEAR Report 2000, Part II, Table 55, p.542, United Nations, New York, 2000]

12. Module Medical XIX-(15) 12

13. Module Medical XIX-(15) 13 Human data on radiation cancerogenesis

14. Module Medical XIX-(15) 14 Thyroid cancer and ionizing radiation l Chernobyl accident shows that exposure to iodine isotopes may cause increase in prevalence of thyroid carcinoma l In 1990-2000 about 1800 thyroid cancers observed in 18 million children and adolescents, i.e. under 18 years old, living in the most contaminated areas of Belarus, Ukraine and Russia

15. Module Medical XIX-(15) 15 Post-Chernobyl thyroid cancer increase observed mainly in children under 15 incidence rates increased by 100 in the most affected areas (Gomel, Belarus and North of the Ukraine) in 1990-94 incidence rate multiplied by 3 in adults (Belarus)

16. Module Medical XIX-(15) 16 Childhood thyroid cancer Childhood thyroid cancer around Chernobyl in 1986-1998 (children <15 years old at diagnosis <15 years old at diagnosis) [UNSCEAR: Exposures and Effects of the Chernobyl Accident, Annex J, New York, 2000]

17. Module Medical XIX-(15) 17 Incidenceof childhood thyroid cancer Incidence of childhood thyroid cancer (<15 years old at diagnosis (<15 years old at diagnosis) around Chernobyl in 1986-1998 [UNSCEAR: Exposures and Effects of the Chernobyl Accident, Annex J, New York, 2000] Incidence, number of new cases in 100 000 children per year

18. Module Medical XIX-(15) 18 Thyroid cancer Thyroid cancer around Chernobyl in 1986-1998 (Annual number of cases 18 years old in 1986 among ~18M citizens <18 years old in 1986) [UNSCEAR: Exposures and Effects of the Chernobyl Accident, Annex J, New York, 2000] Total No. of thyroid cc. in 13 years =1791 -

19. Module Medical XIX-(15) 19 Clinical and epidemiological features of childhood thyroid carcinomas diagnosed in Belarus Chernobyl accident l less influenced by gender female/male ratio was 1.4:1.0 (spontaneous: 2.5/1) l mean age At time of first diagnosis: 9.4±2.8 years At time of first diagnosis: 9.4±2.8 years At time of the accident: 3.8 ± 2.4 years At time of the accident: 3.8 ± 2.4 years More than 90% of the patients were less than 6 years old and 3% were still in utero at time of accident.

20. Module Medical XIX-(15) 20 Morphological analysis of post-Chernobyl childhood thyroid carcinomas l Large majority are papillary carcinomas, very few follicular histotype. Among papillary type, many (33%) solid and follicular variants l Focal micropapillary hyperplasia frequently found in post-Chernobyl thyroid glands J Clin endocrinol Metab 1997;82:3563 Cancer 1994;74:748 J Clin Endocrinol metab 1996;81:9-14

21. Module Medical XIX-(15) 21 Distribution of thyroid doses in children and adolescents in Belarus and the Ukraine %

22. Module Medical XIX-(15) 22 -500 Gy -250 Gy -100 Gy -70 Gy - 0.15-5.7 Gy I-131 therapy of hyperthyroidism I-131 therapy of differentiated thyroid carcinoma radiation induced thyroid carcinoma Thyroid doses in I-131 therapy vs radiation induced I-131 therapy vs radiation induced thyroid carcinoma

23. Module Medical XIX-(15) 23 Other factors contributing to the increased rate of childhood thyroid cancer around Chernobyl n moderate to severe iodine deficiency n late iodine prophylaxis (or thyroid blocking in many villages and towns not evacuated) n active screening (ultrasound, fine needle biopsy) manifesting also the occult cases n awareness (parents request more thyroid examinations of their children than before)

24. Module Medical XIX-(15) 24 Leukemia and other cancer l No significant increase in leukemia or cancer other than thyroid; solid tumor observed in Chernobyl cleanup workers* l Tendency for elevated leukemia rates, however, among those who received significant doses while working on site in 1986 and 1987. So far statistically significant leukemia excess reported for Russian cleanup workers only**

25. Module Medical XIX-(15) 25 Psychological disorders l Significant psychological disorders caused by mental distress, among most frequent consequences of accident l Psychological effects of Chernobyl accident mainly due to lack of reliable public information l Distress caused by misperception of radiation risk extremely harmful

26. Module Medical XIX-(15) 26 Lifetime mortality in population of all ages from fatal cancer after exposure to low doses * general public (all age groups) only Summary factor of cancer risk for working population taken to be 400x10 -4 Sv -1 Reference ICRP, Publ. 60, 1991

27. Module Medical XIX-(15) 27 Attributable lifetime risk, % per sievert Age at time of exposure Attributable lifetime risk of fatal cancer depending on age at exposure

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30. Module Medical XIX-(15) 30 Chernobyl conclusions l Radiation burns frequent l Burns over 50% of body surface led to death in 19 of 28 cases l Internal contamination present in most patients but was significant in few l Sepsis was uniform cause of death l BMT –very limited indication l Some radiation burns did not re-epithelialize, required surgery