Do Ae RNA SS : so * deedte ea ae. ol em Te so . * 4 , : oe pe caate tet eg Soe nO eat eb Dae he cde € wet” so ‘ speue og thee * ta Ota Mi “ul x . . W.H. ADAMS: LATE MEDICAL CONSEQUENCES OF EXPOSURE TO RADIOACTIVE and will be discussed ap, with vomiting and people that had beenresiding temporarily on Ailingnae, were notable to reinhabit their homeisland for three years. During this period a program for long-term medical follow-up of the Marshallese was instituted. . About one-fourth of These symptoms were emitters. Most of the itis. Skin effects were ‘ossae. The severity of sbserved on their atoll. whitened the hair and lly affected half of this 1 effects there were less the people. On Utirik, ‘more heavily exposed values for unexposed age groups fell 20-30% lly returning to normal It control values by the depressions were even xhibited more profound one-third control levels i two years to return to less severe hematologic 3 on Ailingnae, whereas of any blood elements the entire population at 1 the heavily irradiated ere not observed. Even ) an outbreak of upper of one miscarriage in a safe for habitation, and ‘stock. Rongelap atoll, ation, including the 18 FEATURES OF THE MEDICAL PROGRAM ’ The chronicling of the medical events involving the exposed Marshallese after 1954 has been one of the tasks of the Marshall Island's medical program. Humanitarian concern for the Marshallese and for other human populations that might suffer from some future exposure continues to be manifested by the interest of many individuals and institutions worldwide that request the program'spublished reports, a selection of which is includedin the reference section (3-8). The general health of the exposed population, morbidity directly or indirectly related to the exposure, and present and future risks continue to be monitored and reported by the Marshall Island's medical program. Aspart of its health care delivery, the program pursues tworelated objectives. One is the provision of a cancer-oriented annual examination that follows as nearly as is practicable, the recommendations of the American Cancer Society. The other is to place in perspective the risks of radiation exposure as they relate to the overall health of the individual and the community. Diabetes mellitus, for example, is a major health problem in the republic of the Marshall Islands, affecting some 20% of the adults examined by the medical program and causing renal failure, blindness, infection, peripheral neuropathy, impotence and accelerated atherosclerotic disease. The importance of diabetes, diseases of poorsanitation, and other serious health hazards should not be trivialized by excessive attention to radiation injury incurred almost two generations earlier. Nevertheless, the late morbidity from that irradiation can in no way be consideredtrivial. Indeed,it is the purpose of this presentation to show whythat is so. But first it is appropriate to review the policies and procedures of the medical program in recentyears. Under congressional mandate, the U.S. Department of Energy has a contract with the Medical Department of Brookhaven National Laboratory to provide for the diagnosis and treatment of radiation-related disease among the exposed populations of Rongelap and Utirik. Although considerable effort is spent on the care of acute and chronicillnesses of any etiology, a program is in place which is oriented toward the problems posed by their 1954 radiation exposure. These people must be considered at increased risk for malignant disease, and chief among the responsibilities of an on-going program is a cancer-related evaluation which includes a review of systems and a complete medical examination, advice on decreasing risk factors for cancer and on self-detection of lesions, pelvic examinations with Papanicolaou smears, stool testing for occult blood, annual mammography(introduced when low dose techniques becameavailable), and flexible 271