As you know, a Naval Submarine Medical Research Laboratory employee discovered a logbook containing radium treatment data in April 1996. The ledger contains data for the period October 1944 through December 1945. Col. Claud Bailey (Department of Defense, Radiation Experiments Command Center; 6801 Telegraph Road; Alexandria, VA 22310-3398; PH: 703/556-7300) and his staff are currently analyzing this logbook at the Radiation Experiments Command Center and are beginning to locate military personnel who are listed in it. I appreciate your consent in allowing me to share your information with him. He has offered to follow up with you directly.
I thought you might also be interested to learn more about this issue. These treatments were widely used between the 1940s and the 1960s on military personnel to alleviate pressure changes associated with submarine and flying duties and on civilians, mostly children, in order to alleviate earaches and adenoid problems. The procedure involved the insertion of radium-tipped rods into a patient's nasal cavity in order to burn out adenoid tissue. The Journal of the National Cancer Institute released an initial study in 1982 suggesting that treated individuals have an increased risk of developing benign and malignant head and neck tumors. However, this study was based on a relatively small population. An additional study of a larger population published in the Annals of Otology, Rhinology, and Laryngology in 1989 did not document a statistically significant increase in head and neck cancers in the exposed group. However, the dose received by the exposed population in the second study was significantly less than the dose received by individuals in the 1982 study. Further study on the health risks associated with nasal radium treatment is clearly required.
Since I learned about nasal radium treatments, I have focused on pursuing three specific avenues of response. First, I want to ensure that treated individuals receive information on possible adverse health affects from these treatments such as onset of head and neck problems and on how they can follow through with preventive mechanisms by routine checkups with their doctors. This step requires public outreach and educating both medical doctors and former patients. Second, I have urged the Department of Veterans Affairs' (VA) medical facilities and hospitals to provide care for treated veterans and veterans' dependents. Third, I have urged that a study be conducted to determine more conclusively whether this treatment does have adverse health effects.
I encouraged the Department of Defense (DOD) and the VA to notify individuals who received nasal radium treatments. DOD currently is cooperating with VA in the search for medical records of treated veterans. The discovery of a radium treatment logbook at the Naval Submarine Medical Research Laboratory in April 1996 may help in this notification effort.
I also wrote to Jesse Brown, Secretary for Veterans Affairs, and asked him what veterans and veterans' dependents must establish in order to receive treatment at a VA medical center. He responded to my query and explained that individual veterans who have developed health problems from nasal radium treatments during military service may apply for medical care in accordance with the usual Veterans Affairs procedures. He also mentioned that exposure to radium at military facilities does not qualify veterans to participate in the VA’s Ionizing Radiation Registry since this is restricted to radiation exposure associated with atmospheric nuclear testing or exposure during military service in Japan. Legislation was introduced in the last Congress by Congressman Sam Gejdenson (D-CT) to address this issue. Although the legislation did not pass in the last session, it may be reintroduced in the next Congress. I will work to support inclusion of veterans in the registry.
I succeeded in inserting a provision into the 1995 VA appropriation bill that urges the VA to undertake an epidemiologic study to determine whether the veterans who received this treatment face increased medical risks. In order to determine if such a study is feasible, the VA currently is evaluating records from the Army Air Corps and the Naval Laboratory radium treatment logbook. The VA plans to use these data to determine if a large enough population of servicemen who received this treatment can be identified to perform an epidemiological study. The VA analysis of the logbook is about 50% complete. I will continue to monitor actively VA activities in this area.
I worked with the Veterans of Foreign Wars (VFW) to conduct a survey in the Spring of 1995 to determine the number of the nasopharyngeal irradiation patients and their respective health effects. To date, the VFW is performing a more detailed survey with those individuals who responded to the first survey. For more information, you may wish to contact Mark Fox at 202/543-2239. The Veterans Administration is working in conjunction with the Centers for Disease Control and Prevention (CDC) on the development of education programs for VA and civilian physicians as to the issues involved in nasal radium treatment.
Because the experts believe cancers that result from radiation treatments may not appear until long after an individual is exposed, a possibility exists that the 1982 and 1989 studies did not capture the total number of cancers that might be attributable from nasal radium irradiation. The National Cancer Institute (NCI) and CDC started a program to update the results of the 1989 study I mentioned previously. Johns Hopkins University is performing a similar update on the population examined in the 1982 study. Patients exposed to nasal radium will be re-examined to determine if additional negative health effects are noticed in the exposed populations. The additional 10 years of data will be useful in determining if further epidemiological study is warranted. The point of contact for the NCI study is Maureen Wilson (301/496-1148). Results from the Johns Hopkins study are expected to be published in a peer-reviewed journal in the near future.
In order to improve awareness on this issue among health care practitioners and the public, the VA and the CDC recently produced a video that was taped from the CDC/VA public health training network satellite teleconference called, Nasopharyngeal Radium Irradiation: Current Medical Issues held on September 5, 1996. For more information about this video, or to order a copy, you can call 800/418-7246.
Local and state health departments have formed partnerships to coordinate an appropriate public health response. With my encouragement, the CDC set up a nationwide toll-free nasal radium hotline (888/519-2400), which is staffed by Chief Scientist Dr. Mary Lou Fleissner of the Connecticut State Department of Public Health and Diane Aye, Ph.D. of the Connecticut State Department of Public Health and of Yale's Department of Epidemiology, for anyone seeking more information about nasal radium treatments. Both of these individuals are experts in nasopharyngeal irradiation. A press release about this matter was sent out at the end of April 1996 by the Connecticut Department of Health; and an article was published about it in the March 30, 1996 edition of the Hartford Courant.
I am committed to working to ensure that these government agencies uphold their stated commitments. I intend to pursue this issue so that treated individuals will be notified and an appropriate epidemiological study that assesses the possible health effects of nasopharyngeal irradiation will be conducted.