Pet ale beet tee ee ta tt W. H. ADAMS: LATE MEDICAL CONSEQUENCES OF EXPOSURE TO RADIOACTIVE sigmoidoscopy every three years for those 50 years of age or older. In addition, since the radiation exposure of the Marshallese was of a unique type involving both external and internal exposures,a tabulation ofrisks derived from thestatistics of other irradiated populations may not cover the.range of late consequencesthat could befall them. Data collected by the Brookhaven Medical Program suggested other late effects of radiation exposure in man, effects which include an increase in incidenceof pituitary neoplasms, hypothyroidism, thyroid nodularity, and a trend to lower blood cell counts. Therefore, the medical program has, for many years, included annual thyroid examinations by an endocrinologist or surgeon, thyroid function testing for all exposed persons, thyroid suppression with thyroid hormonefor all the Rongelap-exposed population (the intent being to decrease the likelihood of thyroid nodules and cancer), annual blood counts, and evaluation for paraneoplastic and other evidence suggestive of neoplasia, such as hypogammaglobulinemia, monoclonal spikes on serum protein electrophoresis, hypercalcemia, and elevated alpha-fetoprotein levels in persons knownto be seropositive for hepatitis B surface antigen. There is also ongoing evaluation for clinical evidence of depression in immunocompetence, for the exposed population may be at increased risk for unusual manifestations of infectious diseases. Medical examinations and services are performed primarily aboard a vessel chartered by the U.S. Department of energy. The physicians for the medical team are volunteers selected from around the U.S., most being faculty members of well-known academic medicalinstitutions. The participation of many excellent medical specialists has undoubtedly been a majorfactorin the acceptance of the Marshall Island's medical program by the populationit serves, for the enrollment of the Marshallese is, of course, voluntary. The percent of persons in the exposed and unexposed groups who appearfor the voluntary examination remains high. In 1987, of those available for examination, the acceptance rate was 95% for Rongelap, 90% for Utirik, and 72% for the unexposed population. Over a three-year period it was 97% for Rongelap, 100% for Utirik, and 94% for the unexposed. In addition, the acceptance rate for mammography among eligible women has been 100%. For sigmoidoscopy, about 50% of age-eligible persons elect to undergo this procedure. It is important to understand that the Marshall Island’s medical program is distinct from the Marshallese Government Health Services which is a national program of health care which encompasses two hospitals and a network of clinics scattered over some 20 atolls. This network funded medical program is directed at those persons, now numbering 160, who were exposed to - fallout radiation in 1954. However, the program also provides equivalent health care for all persons tesiding on Rongelap and Utirik atolls at the time of medical team visits, regardless of their radiationhistory. roe setves the entire population of the Marshall Islands, which numbers about 40,000, whereas the U.S.- tr 272