subscapular area (unless he had been customarily
shirtless). However, two persons developing skin
cancer out of a radiation-exposed population of 82
(2.5%) is greater than expected if Black
population studies are used for comparison
(Fleming, I.D. et al.). Furthermore, there is a
suggestion of a temporal association, for the
cancers occurred 32 and 37 years after exposure.
Therefore, the possibility remains that radiation
exposure did contribute in a direct or indirect way
to the development of basal cell carcinomas in
these two patients.

Table 2 summarizes the thyroid nodule
in the exposed Marshallese through 1
includes the nodule described in the
"Occult Papillary Carcinoma.” The n
types of nodules in the Comparison group
listed in Table 2, although the U.S. De
Energy-sponsored program forsurgical e
of palpated nodules in this group was con
1985.

THYROID SURGERY FINDINBS,
1964 THROUGH 1991

Thyroid nodules

Only one thyroid nodule was diagnosed in the
exposed population from January 1988 through

December 1991. That nodule occurredin a Utirik

man who had been in utero at the time of
exposure in 1954. The mother was in her third
trimester at the time of exposure, her whole-body
and thyroid-absorbed doses being estimated at 11
and 160 cGy, respectively. The patient’s estimated
dose was, therefore, 11 cGy whole-body and 99
cGy internally to the thyroid, for a total thyroid
dose of 110 cGy. This patientis the first of eight
Utirik persons exposed in utero to develop a
thyroid nodule. (Two of four Rongelap persons
who were in utero at the time of exposure have
also had benign noduies removed). <A thyroid
lobectomy was performed at the Clinical Center,
The National Institutes of Health. Histological
review of the surgical material was performed by
the four pathology consultants to the Marshall
Islands Medical Program (see p. 16). Selected
comments from their diagnoses are:
Consultant #1
"Thyroid nodule of
histologically normal tissue which contains a tiny
focus of occult papillary carcinoma."

Introduction:

Thyroid nodules and hypofunction ambng the
exposed populations of Rongelap and, to lesser
extent, Utirik are well documented consequgnces of
the BRAVO exposure. A recent reevaluftion of
external and internal radiation exposures
those
populationsin all likelihood represents the dEfinitive
quantitative analysis of organ and whdle-body
radiation dose stemming from this catastrophe
(Lessard et al., 1985). The thyroid dose
particularly close scrutiny because of early
of extensive thyroid injury and because an impportant

osed

following radiation exposure. The incidqnce of
thyroid cancer has been reported to be qlevated

Consultant #2 - "Adenomatous goiter in the
colloid stage."
Consultant #3 - "Nodule with fibrosis.... No
evidence of cancer.”

"Tiny occult sclerosing
Consultant #4
papillary carcinoma." ©
A summary of this patient’s hospital case is
included in Appendix C.
The patient was
returned home on thyroxine suppression.

surgeries for recurrent benign nodules
Rongelap group, but these are not include
statistics that follow). Although occasional
increases naturally with aging, it is possible tRat the
recent dearth of cases represents a pause tht is

14

Select target paragraph3