Hanford Health Effects Subcommittee - Update on Hanford Medical Monitoring Program

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Update on Hanford Medical Monitoring Program

The Agency for Toxic Substances and Disease Registry (ATSDR) recommended the Hanford Medical Monitoring Program (HMMP) in 1997 as a response to address concerns of people living around the Hanford Nuclear Facility who have an estimated increased exposure to iodine-131. From 1944 through 1972, the Department of Energy's Hanford Nuclear facility released radioactive materials—primarily iodine-131—into the atmosphere.

Current status:

The ATSDR program has been updated to address the recent Institute of Medicine (IOM) concerns about thyroid cancer screening and incorporate important screening procedures utilized by the draft Hanford Thyroid Disease Study (HTDS); the modified program will proceed, once funded by the Department of Energy.
The revised program has been carefully reviewed by the Centers for Disease Control and Prevention and is supported by the Hanford Health Effects Subcommittee which includes representation from the Hanford Native-American Tribes.

Reasons to proceed with HMMP:

Dose estimates indicate that residents near the Hanford site may have received high radiation doses to the thyroid.
The draft of HTDS alone cannot resolve all the questions about the potential health risks from iodine-131 exposure.
There is a high level of concern in this population about radiation exposure; some of whom will seek thyroid examinations.
A public education campaign is needed to assist individuals in understanding the results and absence of risk found in draft HTDS, balanced with other studies on the potential health risks from iodine-131. Public education also will provide important information about the potential risks and benefits of medical evaluations for thyroid disease and the uncertainties in estimating exposures.
The medical monitoring program has been substantially modified on the basis of IOM concerns and the draft HTDS clinical protocol. The modified program focuses on providing the information necessary for members of the public to appropriately assess their risks from Hanford exposures and to make informed decisions about their health.
After individuals are informed of the potential risks of exposure to iodine-131 and screening fro thyroid cancer, they may wish to be medically evaluated. The HMMP will ensure high-quality testing and minimize the risk associated with thyroid screening.

Updated HMMP proposal consists of the following:

information and education for eligible individuals and clinicians to ensure understanding of associated risks and informed decision making;
high quality medical evaluation services provided to those in the eligible population who, once informed, voluntarily seek and request thyroid examination; and
various mechanisms, designed to reduce the harms of thyroid screening and to improve clinical services.

Key modifications:

Outreach efforts. A variety of approaches will be used to provide information about the program to the public. It will not be possible for such a large eligible population to use individual tracing methods from historical methods (e.g., birth records), nor will it be necessary, given how much of the population already receives information about Hanford Related activities or is included in health studies around Hanford.
Risk communication and education. One of the primary modifications incorporates a risk communication and education program as the principal component of the HMMP. HTDS findings will be included.
Medical evaluation. A high quality medical evaluation, including thyroid palpation and thyroid and parathyroid function tests, will be available to eligible individuals who seek the examination on a voluntary basis.
Thyroid ultrasound. Thyroid ultrasound will only be used when clinically appropriate rather than as a general screening tool.
Thyroid evaluation protocol. The ATSDR contractor will work closely with a clinical policy workgroup and will incorporate information about clinical procedures and outcomes from HTDS and other studies.
Program evaluation. Evaluations will be conducted annually and in the fifth year to assess the appropriateness of continuing the medical monitoring program.

For further information contact the ATSDR Information Center, toll free, 888-42-ATSDR (888-422-8737) Refer to the "Hanford Medical Monitoring Program" when requesting information.