125-14-6535 4. Comprehensive Progress Report a. Period: March 9, 1954 to present. b. Summary: Post-exposure surveys in the Marshall Islands have been conducted for 25. years In addition to the 244 people originally exposed, a group of 209 unexposed Marshalles are examined as a comparison population to assess late effects of radietion fron Fall out. The continuing development of thyroid neoplasms and biochemical hypofunction, and the appearance of one case of acute leukemia, indicate the need for frequent examinations. In addition to physical, hematological, andother laboratory examination the surveys involve special studies related to aging, malignancy reproduction and measurement of body burdens of radionuclides resulting Erom the slight contamination remaining on the islands. .Thyroid patients are returned to the United States for hospitalization and surgical treatment. In view.o£ the diverse medical problems and their management, a physician, nurse practitioner,.and Laboratory assistant are in residence at Kwajalein and make regular trips to Rongelap, Majuro and Utirik to supervise care and perform interim examinations of the exposed Marshallese. Medical surveys of these people are conducted at frequent intervals. The surveys are carried out jointly by Brookhaven National Laboratory under the auspices of the Department of Energy and the Trust Territory of the Pacific Islands~ c. Detailed Report: : . - -— . The progress relative to. the research objectives for this twenty-five-year follow-up is best presented in the 20 Year Report , There have now been 39 thyroid abnormalities (35 with surgery) among the 244 exposed Marshallese. The occurrence of three thyroid cancers in the exposed Utirik popu- lation (compared with four in the Rongelap group) appears to implicate radiation exposure in the etiology, but the high incidence is puzzling since it is greater thar would be predicted based on Rongelap and Japanese data;. there does not appear to be any increase in benign thyroid tumors in the group compared to the much greater incidence in the Rongelap group. Because of the uncertainty of the incidence of thyroid tumors in unexposed Marshall Islanders and in order to obtain better statis—. tics, during the past two years thyroid examinations were included on all unexposed Rongelap and Utirik people on any of the Marshall Islends visited. This study has been extended to include thyroid surgery when indicated. Also, in order to help solve the Utirik dilemma, re-evaluation of radiation doses from fallout to the Utirik people, including the thyroid, has begun. In 1977, a bill authorizing compensation to certain of the Utirik and Rongelap people for radiation injuries was signed by the Presidemt and in FY 1979 payments were completed. A study of the high incidence of maturity onset diabetes in the study group was initiated several years ago and continues. During the past year an intestinal parasite survey was completed on Rongelap Atoll with studies of stool szecimens and serological testing. Anthelmintic therapy (Vermox) was completed on nearly the entire population. A large percentage of the people had positive stools for para— sites. The parasites have been virtually eliminated in this island group by the treatment regimen. A similar study is under way in Utirik, using a different agent evy Ct (Varautyl Pamoate) (Personal Correspondence, UW. A. Krotoski). torogs wok 7 wet 29 ,