RECOMMENDATIONS FOR FUTURE FOLLOW-UP In this section, general and specific recommendations are madefor the follow-up from the present through the year 2000, of the inhabitants of the Marshallese Islands who were involved in the nuclear test accident in 1954. The basis for the recommendationalso is provided. 71 General Recommendations Follow-up by medical surveillance should continue and build on the past efforts, focusing on describing the health status of the exposed population, early diagnosis of disease, and assuring proper treatmentandreferral. Clinically appropriate new tests suitabie for use on site should be introduced as they becomeavailable. Quality assurance procedures should be strengthened and future observations carefully documented. 7.2 The Basis for the Recommendations The basis for the recommendations include: e The humanitarian and ethical need to monitor the health of this population to assure early detection of disease and appropriate treatment. e The Marshall Island population has been extensively studied (clinically well-studied) since the exposure in 1954. e A dose-related increase in the risk of neoplastic disease has been established as the major late health effect of exposure to ionizing radiation (see Section 3). e Apparent increases have been reported in other populations exposed to radiation in the risk of some non-neoplastic diseases e.g., cardiovascular disease, and of non-specific life- shortening (see Section 3). eo. . Deterministic effects, such as cataracts, and vascular sclerosis and associated tissue atrophy, can becomeclinically detectable only months or years following exposure to | relatively high levels of radiation (see Section 3). 42 SG1 2049