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Committee on the Analysis of Cancer Risks in
Populations near Nuclear Facilities—Phase 1
Nuclear and Radiation Studies Board
Division of Earth and Life Studies
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Govern-
ing Board of the National Research Council, whose members are drawn from the
councils of the National Academy of Sciences, the National Academy of Engineer-
ing, and the Institute of Medicine. The members of the committee responsible for
the report were chosen for their special competences and with regard for appropri-
ate balance.
This study was supported by Contract/Grant No. NRC-04-10-152 between the
National Academy of Sciences and the U.S. Nuclear Regulatory Commission. Any
opinions, findings, conclusions, or recommendations expressed in this publication
are those of the author(s) and do not necessarily reflect the views of the organiza-
tions or agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-25571-4
International Standard Book Number-10: 0-309-25571-6
Cover images: Regional maps of northeastern (front cover) and northwestern (back
cover) states and populations living in census tracts within 30 miles of nuclear
power plants. See Figures 4.4a-d for more information. Maps were created by com-
mittee member Lance Waller (Emory University, Atlanta, Georgia).
Additional copies of this report are available for sale from the National Academies
Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or
(202) 334-3313; http://www.nap.edu/.
Copyright 2012 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society
of distinguished scholars engaged in scientific and engineering research, dedicated to
the furtherance of science and technology and to their use for the general welfare.
Upon the authority of the charter granted to it by the Congress in 1863, the Acad-
emy has a mandate that requires it to advise the federal government on scientific
and technical matters. Dr. Ralph J. Cicerone is president of the National Academy
of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences, as a parallel organization of outstanding en-
gineers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi-
dent of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in
the examination of policy matters pertaining to the health of the public. The Insti-
tute acts under the responsibility given to the National Academy of Sciences by its
congressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sci-
ences in 1916 to associate the broad community of science and technology with the
Academy’s purposes of furthering knowledge and advising the federal government.
Functioning in accordance with general policies determined by the Academy, the
Council has become the principal operating agency of both the National Academy
of Sciences and the National Academy of Engineering in providing services to the
government, the public, and the scientific and engineering communities. The Coun-
cil is administered jointly by both Academies and the Institute of Medicine. Dr.
Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of
the National Research Council.
www.national-academies.org
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COMMITTEE ON THE ANALYSIS OF CANCER RISKS IN
POPULATIONS NEAR NUCLEAR FACILITIES—PHASE 1
JOHN E. BURRIS, Chair, Burroughs Wellcome Fund, Research Triangle
Park, North Carolina
JOHN C. BAILAR, III, University of Chicago (retired), Washington, DC
HAROLD L. BECK, Environmental Measurements Laboratory (retired),
New York, New York
ANDRE BOUVILLE, National Cancer Institute (retired), Bethesda,
Maryland
PHAEDRA S. CORSO, University of Georgia, Athens
PATRICIA J. CULLIGAN, Columbia University, New York, New York
PAUL M. DELUCA, JR., University of Wisconsin, Madison
RAYMOND A. GUILMETTE, Lovelace Respiratory Research Institute,
Albuquerque, New Mexico
GEORGE M. HORNBERGER, Vanderbilt Institute for Energy and
Environment, Nashville, Tennessee
MARGARET KARAGAS, Dartmouth College, Hanover, New Hampshire
ROGER KASPERSON, Clark University (retired), Worcester,
Massachusetts
JAMES E. KLAUNIG, Indiana University, Bloomington
TIMOTHY MOUSSEAU, University of South Carolina, Columbia
SHARON B. MURPHY, University of Texas Health Science Center
(retired), Washington, DC
ROY E. SHORE, Radiation Effects Research Foundation, Hiroshima,
Japan
DANIEL O. STRAM, University of Southern California, Los Angeles
MARGOT TIRMARCHE, Institute of Radiological Protection and
Nuclear Safety, Fontenay-aux-Roses, France
LANCE WALLER, Emory University, Atlanta, Georgia
GAYLE E. WOLOSCHAK, Northwestern University, Chicago, Illinois
JEFFREY J. WONG, California Environmental Protection Agency,
Sacramento
Staff
KEVIN D. CROWLEY, Study Director
OURANIA KOSTI, Program Officer
TIMOTHY A. BOULEY, Research Associate
TONI GREENLEAF, Administrative and Financial Associate
SHAUNTEÉ WHETSTONE, Senior Program Assistant
ERIN WINGO, Communications Liaison
JAMES YATES, JR., Office Assistant
v
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NUCLEAR AND RADIATION STUDIES BOARD
JAY DAVIS (Chair), Hertz Foundation, Livermore, California
BARBARA J. MCNEIL (Vice Chair), Harvard Medical School, Boston,
Massachusetts
JOONHONG AHN, University of California, Berkeley
JOHN S. APPLEGATE, Indiana University, Bloomington
MICHAEL L. CORRADINI, University of Wisconsin, Madison
PATRICIA J. CULLIGAN, Columbia University, New York
ROBERT C. DYNES, University of California, San Diego
JOE GRAY, Lawrence Berkeley National Lab, Berkeley, California
DAVID G. HOEL, Medical University of South Carolina, Charleston
HEDVIG HRICAK, Memorial Sloan-Kettering Cancer Center, New York
THOMAS H. ISAACS, Stanford University, Palo Alto, California
ANNIE B. KERSTING, Glenn T. Seaborg Institute, Lawrence Livermore
National Laboratory, Livermore, California
MARTHA S. LINET, National Institutes of Health, Bethesda, Maryland
FRED A. METTLER, JR., New Mexico VA Health Care System,
Albuquerque
BORIS F. MYASOEDOV, Russian Academy of Sciences, Moscow
RICHARD J. VETTER, Mayo Clinic, Rochester, Minnesota
RAYMOND G. WYMER, Oak Ridge National Laboratory, Oak Ridge,
Tennessee (retired)
Staff
KEVIN D. CROWLEY, Senior Board Director
JENNIFER A. HEIMBERG, Senior Program Officer
OURANIA KOSTI, Program Officer
TONI GREENLEAF, Administrative and Financial Associate
LAURA D. LLANOS, Administrative and Financial Associate
SHAUNTEÉ WHETSTONE, Senior Program Assistant
ERIN WINGO, Senior Program Assistant
JAMES YATES, JR., Office Assistant
vi
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Acknowledgments
The committee wishes to acknowledge and thank a number of individu-
als and organizations for their valuable contributions to this study:
• The U.S. Nuclear Regulatory Commission (USNRC) for its spon-
sorship of this study, and especially USNRC staff members Brian
Sheron, Terry Brock, Vered Shaffer, Marilyn Diaz, John Tomon,
Scott Burnell, Dave McIntyre, Richard Conatser, John Cassidy,
and Don Stearns. Dr. Brock, the USNRC’s designated liaison to the
committee, served as a guide to the USNRC’s regulatory programs
and the agency’s vast collection of technical documents.
• The presenters at the committee’s information-gathering meetings,
who are listed in Appendix C.
• Members of the public and nongovernmental organizations who
shared their perspectives and concerns about cancer risks associ-
ated with living near nuclear facilities. Some submitted extensive
written information, notably: Beyond Nuclear, the Erwin Citizens
Awareness Network, Inc., the C-10 Foundation, and Anthony and
Ipatia Apostolides. Their comments helped to shape the epidemio-
logic study designs that are recommended in this report.
• The Electric Power Research Institute (especially Phung Tran), Raid
Amin, University of West Florida, and Steve Wing, University of
North Carolina at Chapel Hill, for providing written advice on
epidemiologic study designs.
• Willie Harris and Robert Osgood, Dresden Nuclear Power Station,
Kathy Yhip and Mike Russell, San Onofre Nuclear Generating Sta-
vii
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viii ACKNOWLEDGMENTS
tion, and Marie Moore and Mark Elliott, Nuclear Fuel Services,
Inc (NFS), for supporting facility visits by subgroups of committee
members. Ms. Moore also provided information about NFS’ efflu-
ent release records.
• Rosanne Aaberg (Pacific Northwest National Laboratory [PNNL])
and David Baker (PNNL, retired) for assistance in obtaining
PNNL’s archived data on nuclear plant effluent releases.
• Ralph Andersen and Andrew Mauer, Nuclear Energy Institute,
for providing information about operating practices and effluent
release records at nuclear power plants.
• Robert Anderson, National Center of Health Statistics, Centers for
Disease Control and Prevention (CDC), Christie Eheman, National
Center for Chronic Disease Prevention and Health Promotion,
CDC, Kevin Ward, Georgia Center for Cancer Statistics, and Scott
Boggess, U.S. Census Bureau, for guidance on sources of health and
population data.
• Directors and staff of state departments of public health, can-
cer registries, and vital statistics offices for providing information
about the availability and release of health data (see Appendixes
K-M).
The committee extends special thanks to the staff of the National
Research Council for supporting this study. Study director Kevin Crowley
and program officer Ourania Kosti organized the committee meetings and
assisted the committee with report writing and review. They also provided
valuable insights and perspectives on many aspects of the study. Shaunteé
Whetstone managed the logistics of the meetings, report review, and pub-
lication. Erin Wingo led the public communication efforts with help from
Catherine Allen-West. Jennifer Walsh led the media communication efforts.
Timothy Bouley assisted with information gathering and analysis. Roger
Herdman, Institute of Medicine, provided guidance on identifying surveil-
lance systems that collect information on population characteristics over
time.
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with proce-
dures approved by the Report Review Committee of the National Research
Council. The purpose of this independent review is to provide candid and
critical comments that will assist the National Research Council in making
its published report as sound as possible and will ensure that this report
meets institutional standards for objectivity, evidence, and responsiveness
to the study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the deliberative process. We thank
the following individuals for their participation in the review of this report:
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ix
ACKNOWLEDGMENTS
• John Applegate, Indiana University
• John Boice, International Epidemiology Institute
• Christie Eheman, Centers for Disease Control and Prevention
• David Hoel, Medical University of South Carolina
• David Kocher, SENES Oak Ridge, Inc.
• Martha Linet, National Cancer Institute
• Paul Locke, Johns Hopkins Bloomberg School of Public Health
• Fred Mettler, New Mexico VA Healthcare System
• Beth Mueller, Fred Hutchinson Cancer Research Center
• Donald Pierce, Oregon Health and Science University
• Daniel Strom, Pacific Northwest National Laboratory
• John Till, Risk Assessment Corporation
• Richard Vetter, Mayo Clinic (retired)
Although the reviewers listed above provided many constructive com-
ments and suggestions, they were not asked to endorse the contents of this
report, nor did they see the final draft of the report before its release. The
review of this report was overseen by Lynn Goldman, George Washington
University, and Jon Samet, University of Southern California. Appointed by
the National Research Council, Drs. Goldman and Samet were responsible
for making certain that an independent examination of this report was
carried out in accordance with institutional procedures and that all review
comments were considered carefully. Responsibility for the final content of
this report rests entirely with the authorizing committee and the institution.
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Contents
SUMMARY 1
1 INTRODUCTION 11
Background on the Study Request, 13
Previous Studies of Cancer Risks, 25
Strategy to Address the Study Charge, 27
Information Gathering and Report Organization, 32
2 EFFLUENT RELEASES FROM NUCLEAR POWER PLANTS
AND FUEL-CYCLE FACILITIES 35
Effluent Releases from Nuclear Plants, 36
Effluent Releases from Fuel-Cycle Facilities, 67
Environmental Monitoring, 73
Availability of Meteorological Data, 90
Findings and Recommendations, 91
3 RADIATION DOSE ASSESSMENT 97
Background on Dose Assessment and Dose Reconstruction, 97
Reported Radiation Doses around Nuclear Plants, 104
Reported Dose Estimates around Nuclear Fuel-Cycle Facilities,
114
Approaches for Estimating Doses for an Epidemiologic Study,
118
Other Risk Factors, 129
xi
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xii CONTENTS
Characterizing and Communicating Uncertainties, 135
Findings and Recommendations, 137
4 EPIDEMIOLOGIC STUDIES 143
Background on Epidemiologic Studies, 143
Study Designs Considered, 147
Data Sources and Methods, 206
Findings and Recommendations, 246
5 RISK COMMUNICATION AND PUBLIC ENGAGEMENT 253
Public Perceptions about Nuclear Power, 254
Risk and Communication, 254
Public Engagement in Phase 1 Study, 258
Public Engagement in Phase 2 Study, 264
Recommendation, 267
APPENDIXES
A Radiation as a Carcinogen 271
B Biographical Sketches of Committee and Staff 331
C Presentations and Visits 343
D Origin of Radioactivity in Nuclear Plants 347
E Origin of Radioactivity in Fuel-Cycle Facilities 351
F Regulation of Effluent Releases 355
G Radiological Effluent Technical Specifications (RETS) 359
H Radiological Environmental Monitoring Program (REMP) 367
I Radiation Dose Assessment 371
J Modeling Incidence and Mortality Data in an Ecologic Study 389
K Letter Template to State Cancer Registry 395
L Letter Template to State Vital Statistics Offices 397
M Letter Template to Departments of Public Health 399
N Glossary 401
O Acronyms 409