Increased leukemias near Increased leukemias near nuclear power stationsnuclear power stations

Dr Ian FairlieDr Ian FairlieConsultant on Radiation in the Consultant on Radiation in the

EnvironmentEnvironmentLondonLondon

United KingdomUnited Kingdom

Childhood Leukemias Childhood Leukemias near Nuclear Facilitiesnear Nuclear Facilities

in 1980s -90s, increases found near UK in 1980s -90s, increases found near UK nuclear facilities (Dounreay, Windscale, nuclear facilities (Dounreay, Windscale, Burghfield)Burghfield)

Also in Germany, increased incidence at Also in Germany, increased incidence at Kruemmel Kruemmel

UK NRPB said not due to radiation as doses UK NRPB said not due to radiation as doses were too low x 300were too low x 300

But no-one had expertise to challenge thisBut no-one had expertise to challenge this Reay v BNFL – plaintiffs lost a very large caseReay v BNFL – plaintiffs lost a very large case

KiKK Report in Germany in KiKK Report in Germany in 2008 2008 KKinderkrebs inderkrebs iin der Umgebung von n der Umgebung von

KKernernKKraftwerkenraftwerkenKaatsch P, Spix C, Schulze-Rath R, Schmiedel S, Blettner M. 2008. Kaatsch P, Spix C, Schulze-Rath R, Schmiedel S, Blettner M. 2008. Leukaemias in young children living in the vicinity of Leukaemias in young children living in the vicinity of

German nuclear power plants. Int J Cancer 122:721–726.German nuclear power plants. Int J Cancer 122:721–726.Spix C, Schmiedel S, Kaatsch P, Schulze-Rath R, Blettner M. 2008. Case–control study on childhood cancer in the vicinity of Spix C, Schmiedel S, Kaatsch P, Schulze-Rath R, Blettner M. 2008. Case–control study on childhood cancer in the vicinity of

nuclear power plants in Germany 1980–2003. Eur J Cancer 44:275–284.nuclear power plants in Germany 1980–2003. Eur J Cancer 44:275–284.

• reignited the leukemia debatereignited the leukemia debate

• large controversy in Germanylarge controversy in Germany

• almost unknown in UKalmost unknown in UK

KiKK Study: 2008 KiKK Study: 2008 very large study of cancer incidence near very large study of cancer incidence near

all (16) German nuclear power stationsall (16) German nuclear power stations commissioned by German Governmentcommissioned by German Government 1.2 x increase in child leukemias1.2 x increase in child leukemias 0.6 x increase in embryonal cancers0.6 x increase in embryonal cancers strongly linked to proximity to reactorsstrongly linked to proximity to reactors validity accepted by German Governmentvalidity accepted by German Government

the closer to reactor – the the closer to reactor – the greater the risk of child greater the risk of child

leukemialeukemiaKaatsch et al., Int J Cancer, 2008

Do Other Studies Back up Do Other Studies Back up KiKK?KiKK?Yes.Yes.(1) Laurier D et al (2008) Epidemiological (1) Laurier D et al (2008) Epidemiological

studies of leukaemia in children and young studies of leukaemia in children and young adults around nuclear facilities: a critical review. adults around nuclear facilities: a critical review. Radiat Prot Dosimetry 132(2):182-90. Radiat Prot Dosimetry 132(2):182-90. REVIEWED REVIEWED

26 MULTI-SITE STUDIES26 MULTI-SITE STUDIES

(2) Laurier D, Bard D (1999) Epidemiologic (2) Laurier D, Bard D (1999) Epidemiologic studies of leukemia among persons under 25 studies of leukemia among persons under 25

years of age living near nuclear sites. Epidemiol years of age living near nuclear sites. Epidemiol Rev 21(2):188-206. Rev 21(2):188-206. LISTED 50 STUDIES (36 LISTED 50 STUDIES (36

SINGLE AND 14 MULTI-SITE)SINGLE AND 14 MULTI-SITE)

ie over 60 STUDIESie over 60 STUDIES

What do 26 latest studies What do 26 latest studies show?show?LeukLeukincrease increase observedobserved

No Leuk No Leuk increase increase observed*observed*

%%observedobserved

All 26 StudiesAll 26 Studies 1919 77 73%73%Studies statistically Studies statistically significant at 95% levelsignificant at 95% level

66 11 85%85%

from table 1 of Laurier et al (2008)from table 1 of Laurier et al (2008)

* Absence of evidence does not mean evidence of * Absence of evidence does not mean evidence of absenceabsence

Conclusion: a steady pattern of leukemia increases Conclusion: a steady pattern of leukemia increases near NPPsnear NPPs

What are possible causes? What are possible causes? ConfoundersConfounders XX CoincidenceCoincidence XX Population mixingPopulation mixing XX Exposure to chemicals Exposure to chemicals XX Exposure to viruses/fungiExposure to viruses/fungi XX Exposure to radiationExposure to radiation ??

KiKK stated radiation doses were too low, KiKK stated radiation doses were too low, but without supportive estimatesbut without supportive estimates

But there are large But there are large uncertainties in the estimated uncertainties in the estimated

doses/risks near reactorsdoses/risks near reactors

OFFICIAL ESTIMATES OF DOSES/RISKS HAVE OFFICIAL ESTIMATES OF DOSES/RISKS HAVE MANY UNCERTAINTIES see CERRIE Report MANY UNCERTAINTIES see CERRIE Report www.cerrie.orgwww.cerrie.org

Why the large uncertainties?Why the large uncertainties?Because they use many Because they use many dosedose

modelsmodels Environmental models Environmental models (behaviour of nuclides in (behaviour of nuclides in

environment)environment)

Biokinetic models Biokinetic models (uptake and retention of nuclides in humans)(uptake and retention of nuclides in humans)

Dosimetric models Dosimetric models (convert Bq to mGy: mSv)(convert Bq to mGy: mSv)

Dose weighting factors Dose weighting factors (tissue W(tissue WTT and radiation W and radiation WRR))

Why the large uncertainties?Why the large uncertainties?Because an inappropriate Because an inappropriate riskrisk

model is usedmodel is used Official ICRP risk model is based on data from 1945 Japanese Official ICRP risk model is based on data from 1945 Japanese

bomb survivorsbomb survivors

Is this appropriate for environmental exposures from NPPs?Is this appropriate for environmental exposures from NPPs?

Higher risks in infants?Higher risks in infants?

Higher risks from Higher risks from in uteroin utero exposures? exposures?

Uncertainty distributions in Uncertainty distributions in dose estimatesdose estimates

Uncertainties in Dose Uncertainties in Dose CoefficientsCoefficients

Goossens LHJ, Harper FT, Harrison JD, Hora SC, Kraan BCP, Cooke RM (1998) Probabilistic Accident Consequence Uncertainty Goossens LHJ, Harper FT, Harrison JD, Hora SC, Kraan BCP, Cooke RM (1998) Probabilistic Accident Consequence Uncertainty Analysis: Uncertainty Assessment for Internal Dosimetry: Main Report. Prepared for U.S. Nuclear Regulatory Commission, Analysis: Uncertainty Assessment for Internal Dosimetry: Main Report. Prepared for U.S. Nuclear Regulatory Commission,

Washington, DC 20555-0001, USA. And for Commission of the European Communities, DG XII and XI, B-I049 Brussels Belgium. Washington, DC 20555-0001, USA. And for Commission of the European Communities, DG XII and XI, B-I049 Brussels Belgium. NUREG/CR-6571 EUR 16773.NUREG/CR-6571 EUR 16773.

NuclidNuclidee

IntakeIntake OrganOrgan U Range U Range = (ratio = (ratio of 95of 95thth/5/5thth percentiles)percentiles)

Cs-Cs-137137

ingestioningestion red bone red bone marrowmarrow

44

I-131 I-131 inhalatioinhalationn

thyroidthyroid 99

Sr-90 Sr-90 ingestioningestion red bone red bone marrowmarrow

240240

Pu-Pu-239239

ingestioningestion red bone red bone marrowmarrow

1,3001,300

Sr-90Sr-90 inhalatioinhalationn

lungs lungs 5,3005,300

Ce-Ce-144 144

inhalatioinhalationn

red bone red bone marrowmarrow

8,5008,500

Pu-Pu-239239

ingestioningestion bone surfacebone surface 20,00020,000

So, radiation exposures to So, radiation exposures to nearby people nearby people couldcould be a be a

causecause

KiKK: cancer increases strongly KiKK: cancer increases strongly associated with proximity to associated with proximity to

nuclear reactorsnuclear reactors direct radiation from reactors?direct radiation from reactors? XX EM radiation from power lines?EM radiation from power lines? XX cooling tower emissions?cooling tower emissions? XX reactor emissions and discharges?reactor emissions and discharges?

Hypothesis Hypothesis to explain KiKK findingsto explain KiKK findings

episodic spikes in reactor releasesepisodic spikes in reactor releases high concentrations in pregnant high concentrations in pregnant womenwomen large doses to embryos/fetuseslarge doses to embryos/fetuses resulting babies are born pre-resulting babies are born pre-leukemicleukemic after 1-2 years develop full after 1-2 years develop full leukemialeukemia

Leukemogenesis in ChildrenLeukemogenesis in Children (after Professor Roessig)(after Professor Roessig)

Preleukemic cloneBone marrowStem cell Leukemic cell

2nd hit1st hit

In Utero Birth Post-Natal

11stst Stage – Environmental Stage – Environmental EmissionsEmissions

when reactors opened - large pulse of when reactors opened - large pulse of radioactive gasesradioactive gases

H-3, C-14, Kr-85H-3, C-14, Kr-85

Spikes in radioactive Spikes in radioactive releasesreleases

Tritium doses from Tritium doses from ingestioningestion(EU RODOS Model) in mSv(EU RODOS Model) in mSv

8th Meeting of the IAEA (EMRAS) Tritium & C-14 Working Group8th Meeting of the IAEA (EMRAS) Tritium & C-14 Working GroupMay 30 - June 1, 2007 - Bucharest, Romania (http://www.nipne.ro/emras/)May 30 - June 1, 2007 - Bucharest, Romania (http://www.nipne.ro/emras/)

Estimated tritium levels in cow’s Estimated tritium levels in cow’s milkmilk

(EU RODOS Model) (EU RODOS Model) OBTOBT Bq/kg Bq/kg8th Meeting of the IAEA (EMRAS) Tritium & C-14 Working Group8th Meeting of the IAEA (EMRAS) Tritium & C-14 Working Group

May 30 - June 1, 2007 - Bucharest, Romania (http://www.nipne.ro/emras/)May 30 - June 1, 2007 - Bucharest, Romania (http://www.nipne.ro/emras/)

re Embryos/fetuses: re Embryos/fetuses: we don’t knowwe don’t know

(a)(a) their radiation doses?their radiation doses?(b)(b) how radiosensitive are they ? how radiosensitive are they ? (c)(c) risks from internal nuclides?risks from internal nuclides?

Ask governments for their Ask governments for their estimates of doses/risks to estimates of doses/risks to embryos, + the uncertainties embryos, + the uncertainties involved ?involved ?

““We conclude that there is strong We conclude that there is strong evidence that low dose irradiation evidence that low dose irradiation of the fetus of the fetus in uteroin utero, particularly in , particularly in the last trimester, causes an the last trimester, causes an increased risk of cancer in increased risk of cancer in childhood.”childhood.”

Doll R and Wakeford R (1997) Risk of childhood cancer Doll R and Wakeford R (1997) Risk of childhood cancer from fetal irradiation. Br J Radiol; 70: 130-9from fetal irradiation. Br J Radiol; 70: 130-9

Main Radioactive Releases to Main Radioactive Releases to AirAir

from Nuclear Facilitiesfrom Nuclear Facilities tritium (radioactive water vapour) tritium (radioactive water vapour) noble gases (including Kr, Ar, Xe)noble gases (including Kr, Ar, Xe) plus smaller amounts of plus smaller amounts of carbon-14carbon-14 iodine-131, iodine-129 …iodine-131, iodine-129 … and very small amounts of other nuclidesand very small amounts of other nuclides

Tritium in airTritium in air

Tritium in Food MoistureTritium in Food Moisture

What is tritium?What is tritium? the radioactive isotope of the radioactive isotope of

hydrogenhydrogen

mostly in the form mostly in the form 33H-O-HH-O-H

Ie tritium is radioactive waterIe tritium is radioactive water

undetected by any of our sensesundetected by any of our senses

Unusual Tritium PropertiesUnusual Tritium Properties Extreme mobility + exchangeabilityExtreme mobility + exchangeability Sticks inside us, and builds upSticks inside us, and builds up Very short range, so damage depends on Very short range, so damage depends on

location in cell, eg close to DNA?location in cell, eg close to DNA? Tritium described as “weak”, but more Tritium described as “weak”, but more

dangerous than “strong” emittersdangerous than “strong” emitters

RESULT: Official models significantly RESULT: Official models significantly underestimate its doses and its hazardsunderestimate its doses and its hazards

List of Hazardous PropertiesList of Hazardous Properties(after Dr Gerald Kirchner) (after Dr Gerald Kirchner)

Tritium =Tritium = √ √ Carbon-14 = √Carbon-14 = √

1.1. large releases to environment large releases to environment √ √ √√2.2. rapid nuclide transport and cycling in biosphere rapid nuclide transport and cycling in biosphere √√√√3.3. high solubility high solubility √√√√4.4. many environmental pathways to humans many environmental pathways to humans √√√√5.5. rapid molecular exchange rates (ie very fast intakes) rapid molecular exchange rates (ie very fast intakes) √√6.6. high uptake to blood after intake high uptake to blood after intake √√√√7.7. organic binding in biota organic binding in biota √√√√8.8. long biological half-life in humans long biological half-life in humans √√√√9.9. long radiological half-life long radiological half-life √√√√10.10. global distribution global distribution √√√√11.11. long nuclide decay chains with radiotoxic daughterslong nuclide decay chains with radiotoxic daughters12.12. high radiotoxicity (ie high dose coefficient)high radiotoxicity (ie high dose coefficient)

Apply the Precautionary Apply the Precautionary PrinciplePrinciple

uncertainty not an excuse for inactionuncertainty not an excuse for inaction if reasonable evidence, should take if reasonable evidence, should take

precautionary stepsprecautionary steps eg health warnings near reactors?eg health warnings near reactors? whatever the explanation for KiKK, the whatever the explanation for KiKK, the

raised leukemia risk is still thereraised leukemia risk is still there

RecommendationsRecommendations

Further studies (EU wide)Further studies (EU wide) Advise local people of risksAdvise local people of risks Health warnings near reactorsHealth warnings near reactors Rethink plans to build more reactors in Rethink plans to build more reactors in

some countries (UK, France, US)some countries (UK, France, US)

Thanks for comments toThanks for comments to

Dr Alfred Dr Alfred KörbleinKörbleinDr Philip Day Dr Philip Day (who sadly passed away in (who sadly passed away in 2010)2010)Dr Keith BaverstockDr Keith Baverstock

(Of course, any errors which remain are my responsibility (Of course, any errors which remain are my responsibility alone)alone)