The percent ofthe eligible population examined on at least one occasion during the three vear period was: Rongelap Utirik Comparison IT". 100", 94", These figures do not include several persons residing outside the Marshall Islands. Most exposed persons in this category have medical examinations arranged through a local physician by the Department of Energy or the Marshall Islands Medical Program. The acceptance rate for mammography among eligible women was 100‘. For sigmoidoscopy, about 50% of ageeligible persons elect to undergo this procedure on a regular basis. MEDICAL FINDINGS Overall Survival: After thirty-three vears there continues to be no significant difference in the survival curves of the high-exposure Rongelap group, the lowexposure Utirik group, and the unexposed Rongelap population followed for the purpose of comparison (Fig. 1). Estimates of the survival distribution by the actuarial life table method — were analyzed by Mantei-Cox and Bresiow statistics for testing the equality of the survival curves. The “p” values were 0.68 by both techniques. In the Brookhaven National Laboratory report covering January 1983 through December 1984. it was noted that Okajima etal. (1985) suggested that medical programs providing health screening might lead to an underestimauion of the effect of radiation on mortality. In particular, it was postulated that this could explain the lower age-specific death rates from ail causes among Nagasaki A-bomb survivors, compared to acontrol population. The effect of medical examinations on the survival of the exposed Marshallese is unknown. On the one hand about 15 percent of the Comparison group selected in 1957 is no longer seen because those individuals have voluntarily foregone examination. In addition, BNL referrals for the Comparison group are channeled into the Marshallese Health Services system. whereas selected medical problems in the exposed groups can be referred directly to tertiary care facilities in the United States. On the other hand. the exposed populations of Rongelap and Utirik have received SO0k10S equivalent medical attention trom the BNLpro- gram since 1972. and vet. despite the far higher radiation dose received by the Rongelap group. the survival curves are similar. Another factor that contributes to thedifficulty in interpreting differences in the group survivals in Fig. ] is that the population used to construct the “Rongelap unexposed” curve was selected in 1957. and it is in that vear that their survival is graphed as one-hundredpercent:i.e.. data from three vears of observation. during which some deaths occurred. had already been acquired from the two exposed populations. Causes of Recent Mortality: The number of deaths occurring in the last three vearsare as follows: Rongelap exposed - 2: Utirik exposed - 9: Comparison group - 10. The specific clinical situations are described below. Rongelap Subject No. 1. The causes of death listed on the deathcertificate of this 81-vear-old woman in June 1985 were “Inanition” and “Senility.” When seen in March 1985. she had a normal blood pressure and cardiac examination revealed “premature beats.” In 1984 she was noted to have cataracts. atrial fibrillation, and complaints of urinary incontinence, some cough, constipation, and joint pains. Her hemoglobin was 12.7 g/dl. the mean corpuscular volume was 92 fl, and the white blood cell count was 6,600 perul with a normaidifferential. Subject No. 11. This 81-vear-old man died in 1987 of unknown cause. Diagnoses made during the preceding four years included severe osteoarthritis, chronic obstructive pulmonary disease with bullous emphysema. macrocytic anemia that was being treated with vitamin B12 injections, cataracts, and “organic brain syndrome.” He had declined a medical examination when visited at his home in September 1986, but did not appear acutelyill at that time. Udrik Subject No. 2123. This 47-year-old man died in December 1986 from biopsy-proven hepatocellular carcinoma. His alpha fetoprotein level was elevated and the serum contained hepatitis B surface antigen but no delta antibody. No evi- dence of tumor was found at his March 1986 examination. Symptoms related to the tumor developed in June of that year.