401542 z . : fon Pie beh is oe a Ae in a fg BROOKHAVEN NATIONAL LABORATORY ASSOCIATED UNIVERSITIES,INC. Upton, New York 11973 Medical Department (516) 345-3577 January 4, 1978 The Honorable Adrian P. Winkel High Commissioner Trust Territory of the Pacific Islands Saipan, Mariana Islands 96950 Dear Mr. Winkel, There are several subjects I would like to bring up: 1) We have been puzzled by the occurrence of three cases of cancer of the thyroid in the exposed Utirik people which is a greater incidence than expected based on dose, particularly since the non-malignant tumors were not increased in that population as they were, along with thyroid cancer, in the exposed Rongelap people. We need to know more about the general incidence of cancer of the thyroid in the unexposed Marshallese people in order to be able to assess the Utirik finding. We have therefore, in addition to examination of the thyroids in the exposed people, tet carried out thyroid examinations in nearly all unexposed Rongelap and Utirik people. We have picked up about 8-10 tumors of the thyroid in this group. We would like to have thyroid surgery done on some of this group that meet the same criteria we have used in the exposed people. We may have as many as 4-6 of these unexposed people at this time on whom thyroid Surgery is indicated. We would like to get this done at Tripler Hospital in Honolulu and have our surgeon, Dr. Dobyns, perform the surgery. (Tripler has agreed to this.) In order to avoid any association of their tumors with radiation exposure in this group, we wonder if the. Trust Territory would be willing to refer these patients to Tripler (usual procedure) and handle travel and other logistics arrangements. DOE has agreed to reimburse or pay the Trust Territory directly for the expenses involved. ‘I would appreciate your consideration of this matter (and also Masao Kumangai and Ezra Riklon who will receive copies of this letter). 2) As you know, we have had some problems in the past related primarily to misunderstandings due to poor communications with people. We feel that it is very important that we try and correct this, not only by having our Resident Physician learn to speak Marshallese, but by hiring a Marshallese assistant to help explain to the people the objectives and results of .our examinations. Such an individual would preferably be from your medical group in the Marshalles and he would work closely with our Resident Physician at Ebeye and accompany him on quarterly trips to Rongelap and Utirik as well as ai eog4s AO / v