EXECUTIVE SUMMARY Introduction Asa result of the radiation exposure of individuals on the Marshall Islands atolls of Rongelap agd 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 lav by Public Law 95-134 (1977) and Public Law 99-239 (1986). The distribution ofthe initially exposed group wall as follows: 64 persons on Rongelap, plus 3 fetuses; 18 persons on Ailingnae, plus 1 fetus; and 159 persons oft Utirik, plus 8 fetuses. In later years, the Ailingnae have been combinedinto the Rongelap population. ThefDepartment of Energy’s (DOE)Office of Environment, Safety and Health is responsible for ensuring that the Mfarshallese who . were exposed to radiation during Castle Bravo in 1954 receive medical care and treatmentfor 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, hfs provided the required health care and surveillance for this program. In addition to conducting surveillancefof the exposed Marshallese group, BNL has been monitoring a cohort of unexposed Marshallese. The individuags in this cohort were selected to mirror the age, sex, etc., distribution of the exposed group. Currently, there ard approximately 154 of the exposed population and 115 of the unexposed population being monitored. This rep i medical 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, Ebqye, 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 Serviceq and volunteer physicians from various universities and governmentandprivate institutions in the United State§. The medical team travels from island to island on a DOE leased vessel. The vessel has examination facilitie@ and is capable of doing basic laboratory work. Blood samples for more complex tests, such as Thyroid Stimulfting Hormone tests, are frozen and taken to BNL. The following examinations are performed during the mefiicalvisits: A. A cancer-related examination as defined by the American Cancer, Society; oA 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; o flexible sigmoidoscopy for females and males; and o Advice on decreasing risk factors and on self-detection oflesions. 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.