EXECUTIVE SUMMARY Introduction Asa result of the radiation exposure of individuals on the Marshall Islandsatolls of Rongelap and Utrik shortly after test shot Castle Bravo, the United States began providing surveillance and health care associated with radiation related diseases to those individuals exposed. This responsibility was codified into law by Public Law 95-134 (1977) and Public Law 99-239 (1986). The distribution of the initially exposed group was as follows: 64 persons on Rongelap, plus 3 fetuses; 18 persons on Ailingnae, plus 1 fetus; and 159 persons on Utirik, plus 8 fetuses. In later years, the Ailingnae have been combined into the Rongelap population. The Department of Energy’s (DOE) Office of Environment, Safety and Healthis responsible for ensuring that the Marshallese who were exposed to radiation during Castle Bravo in 1954 receive medical care and treatment for any injury,illness, or condition that may be the result, directly or indirectly, from their exposure to the fallout from Castle Bravo. For the last 37 years, the Brookhaven National Laboratory (BNL), under contract to DOE, has provided the required health care and surveillance for this program. In addition to conducting surveillance of the exposed Marshallese group, BNL has been monitoring a cohort of unexposed Marshallese. The individuals in this cohort were selected to mirror the age, sex, etc., distribution of the exposed group. Currently, there are approximately 154 of the exposed population and 115 of the unexposed population being monitored. This report discusses the medicai care provided and the medical findings for the years 1988-1991. Procedure In the spring andfall of each year, the BNL medical team visits the islands of Mejatto, Utrik, Ebeye, and Majuro to provide medical surveillance to the exposed and unexposed cohorts. The medical team is composed of BNL personnel, DOE Headquarters personnel, staff of the Marshallese Government Health Services, and volunteer physicians from various universities and government andprivate institutions in the United States. The medical team travels from island to island on a DOEleased vessel. The vessel has examinationfacilities and is capable of doing basic laboratory work. Blood samples for more complex tests, such as Thyroid Stimulating Hormone tests, are frozen and taken to BNL. The following examinations are performed during the medicalvisits: A. A cancer-related examination as defined by the American Cancer Society; o A review of systems and a complete medical examination; o Pelvic examinations with Papanicolaou smears; o Stool testing for occult blood; o A mammogram for females; 0. A flexible sigmoidoscopy for females and males; and o Advice on decreasing risk factors and on self-detection of lesions B. An annual thyroid examination and thyroid function testing; C. Serum prolactin testing looking for pituitary tumors; D. Annual blood counts to include platelets; and E. Evaluation for paraneoplastic evidence of neoplasms.