or factors. No symptom or marker has been found that can identify a specific cancer as having been caused by radiation. That creates a problem when one is trying to establish eligibility for compensation for radiogenic cancer.
A method using probability of causation/assigned share (PC/AS) has been developed to address this issue. PC/AS was introduced and discussed in general terms in Chapter 5. We consider here how PC/AS could be used in determining eligibility under RECA to avoid some of the problems described in Chapter 5.
In Chapter 5, we noted several possible schemes for dealing with compensation that differ from the classical PC/AS or use a PC/AS with various adjustments with reference to the threshold for compensation and credibility interval. These include compensation based on years of life lost (YLL), compensation proportioned according to the posterior probability that PC/AS exceeds 0.5 or some other cutoff value, and compensation based on the values of the payment schedule weighted by the probability of having each value of PC/AS as determined with respect to the credibility distribution.
The committee recognizes the merit of those alternatives and how they address shortcomings in the classical PC/AS approach. After considerable discussion, however, the committee crafted its recommendations in terms of solely PC/AS (including credibility interval). Two positive factors affecting the committee’s decision to adopt PC/AS are its widespread use in current compensation programs and the availability of user-friendly tools designed to implement the PC/AS approach. In addition, a compensation scheme based on YLL would neglect most individuals suffering from radiation-induced papillary thyroid cancer, the primary disease shown to be related to 131I dose, because of thyroid cancer’s small effect on longevity. A modified YLL method based on incidence rather than mortality, such as quality-adjusted years of life lost, was also considered and may be more reasonable. A compensation scheme based on YLL would be difficult to implement because the calculation of an individual’s YLL would be a very uncertain projection. Compensation proportional to the area of the upper tail of the PC/AS distribution and compensation weighted by the PC/AS distribution are also attractive alternatives. Such approaches fall within the bounds of the committee’s suggestion about PC/AS-based eligibility and merely adjust the amount that an individual would be awarded in compensation, which is not, in itself, a scientific decision.
The committee notes that compensation schemes based on other approaches may ultimately be preferable if the infrastructure is developed to support them. The committee would endorse such approaches if they provided for a more equitable distribution of compensation than would be possible with a PC/AS system.
In Chapter 1, we noted that the values of the threshold for compensation and the associated credibility interval result from societal decisions rather than scientific decisions. Later in this chapter, we recommend that Congress establish criteria for awarding compensation on the basis of computed distributions of PC/AS for any persons making such a claim. This chapter presents several examples