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1
Introduction
T
he U.S. Nuclear Regulatory Commission (USNRC) requested that
the National Academy of Sciences (NAS) provide an assessment of
cancer risks in populations near USNRC-licensed nuclear facilities.
This assessment is being carried out in two consecutive phases. The focus of
the Phase 1 scoping study, which is the subject of this report, is to identify
scientifically sound approaches for carrying out an assessment of cancer
risks. The results of this Phase 1 study will be used to inform the design of
the assessment, which will be carried out in Phase 2. The complete study
task is shown in Sidebar 1.1.
The USNRC-licensed nuclear facilities referred to in the statement of
task are nuclear power reactors and nuclear fuel-cycle facilities that utilize
uranium for the production of electricity.1 These facilities are described in
Sidebar 1.2. A large number of nuclear facilities have been constructed in
the United States during the past six decades. Presently licensed USNRC
facilities include:
• 104 operating nuclear reactors (35 boiling water reactors and 69
pressurized water reactors) at 65 sites in 31 states (Table 1.1).
• 13 fuel-cycle facilities in operation in 10 states. The operating
facilities include four in situ uranium recovery facilities, one con-
ventional uranium mill,2 one conversion facility, two uranium en-
richment facilities, and five fuel fabrication facilities. There are
1 These are referred to as nuclear plants and fuel-cycle facilities in this report; the more ge-
neric term nuclear facilities is used to refer to nuclear plants and fuel-cycle facilities collectively.
2 Currently on standby (i.e., available for operations but not currently operating).
11
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12 ANALYSIS OF CANCER RISKS
SIDEBAR 1.1
Statement of Task
The National Academies will provide an assessment of cancer risks in popula-
tions living near U.S. Nuclear Regulatory Commission-licensed nuclear facilities.
This assessment will be carried out in two consecutive phases:
A Phase 1 scoping study will identify scientifically sound approaches for car-
rying out the cancer epidemiology study that has been requested by the U.S.
Nuclear Regulatory Commission. It will address the following tasks:
1. Methodological approaches for assessing off-site radiation dose, including
consideration of:
• athways, receptors, and source terms
P
• vailability, completeness, and quality of information on gaseous and liquid
A
radioactive releases and direct radiation exposure from nuclear facilities
• pproaches for overcoming potential methodological limitations arising
A
from the variability in radioactive releases over time and other confounding
factors
• pproaches for characterizing and communicating uncertainties.
A
2. Methodological approaches for assessing cancer epidemiology, including con-
sideration of:
• haracteristics of the study populations (e.g., socioeconomic factors, all age
C
groups, children only, and nuclear facility workers)
• eographic areas to use in the study (e.g., county, zip codes, census tracts,
G
or annular rings around the facility at some nominal distances)
• ancer types and health outcomes of morbidity and mortality
C
• vailability, completeness, and quality of cancer incidence and mortality
A
data
• ifferent epidemiological study designs and statistical assessment methods
D
(e.g., ecologic or case-control study designs)
• pproaches for overcoming potential methodological limitations arising from
A
low statistical power, random clustering, changes in population characteris-
tics over time, and other confounding factors
• pproaches for characterizing and communicating uncertainties.
A
The results of this Phase 1 scoping study will be used to inform the design of
the cancer risk assessment, which will be carried out in Phase 2.
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13
INTRODUCTION
additional state-licensed3 conventional uranium milling facilities
and in situ leaching facilities that are not shown on Table 1.2.4
Figures 1.1a and 1.1b show the locations of currently operating nuclear
plants and USNRC-licensed fuel-cycle facilities in the United States. Appli-
cations for 24 additional nuclear reactors were under active review by the
USNRC while the present study was in progress.5
1.1 BACKGROUND ON THE STUDY REQUEST
In the late 1980s, the National Cancer Institute (NCI) initiated an
investigation of cancer risks in populations near 52 commercial nuclear
power plants and 10 Department of Energy nuclear facilities (including
research and nuclear weapons production facilities and one reprocessing
plant) in the United States (Jablon et al., 1990). The investigation compared
cancer mortality rates in “study” counties (i.e., counties that contained
nuclear facilities) with rates in “control” counties (i.e., counties that were
similar to the study counties in terms of population size, income, education,
and other socioeconomic factors but did not contain nuclear facilities). The
NCI investigation also compared cancer registration (i.e., cancer incidence)
rates in study and control counties in two states: Connecticut and Iowa. No
differences in cancer mortality or incidence rates were observed between
study and control counties. The authors of the study concluded that “if
nuclear facilities posed a risk to neighboring populations, the risk was too
small to be detected by a survey such as this one” (Jablon et al., 1991).
The USNRC has been using the results of this NCI investigation as a
primary resource for communicating with the public about cancer risks
near the nuclear facilities that it regulates. However, this study is now over
20 years old. There have been substantial demographic shifts in populations
around some of these facilities, and the facility inventory itself has changed;
some facilities have shut down and new facilities have started up. Addition-
ally, at least one facility that was not included in the NCI investigation
(Nuclear Fuel Services in Tennessee) has become a focus of public interest.
The NCI investigation had several limitations: The investigation uti-
lized county-level mortality and, when available, incidence data. The use
3 Section 274 of the Atomic Energy Act of 1954 authorizes the USNRC to enter into agree-
ments with state governors to discontinue the Commission’s regulatory authority for byprod-
uct materials (radioisotopes), source materials (uranium and thorium), and certain quantities
of special nuclear materials. States that have assumed regulatory authority for these materials
are referred to as agreement states.
4 A listing of these facilities as of 2010 can be found at http://www.eia.gov/uranium/
production/annual/.
5 See http://www.nrc.gov/reactors/new-reactors/col/new-reactor-map.html.
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14 ANALYSIS OF CANCER RISKS
SIDEBAR 1.2
Nuclear Fuel Cycle
The nuclear fuel cycle comprises a set of industrial processes for producing elec-
tricity from uranium. These processes are carried out in nuclear fuel-cycle facilities, as
illustrated in Figure S.1. Facilities comprising the front end of the nuclear fuel cycle are
involved in the extraction of uranium from the environment and its fabrication into fuel
for nuclear reactors. The uranium fuel is utilized in nuclear power reactors to produce
electricity. Modern reactors typically generate on the order of 3000 megawatts of ther-
mal power and produce about 1000 megawatts of electrical power. Facilities comprising
the back end of the nuclear fuel cycle are involved in managing this fuel after it has
been utilized in reactors; fuel management activities can involve recycling, storage,
and/or disposal. The only civilian back-end facilities currently in operation in the United
States are interim storage facilities for managing used fuel, most of which are located at
commercial nuclear power plants. In the United States, almost all of these fuel storage
facilities are co-located with nuclear plants.
The USNRC regulates five types of front-end fuel-cycle facilities:
Mining facilities: Facilities that are used to extract uranium from the environment.
Currently, uranium is extracted using either conventional mining or leaching methods.
The former method involves the physical removal of uranium-bearing ores from the
subsurface in underground and open-pit mines. The latter method includes in situ
leaching, in which solutions are pumped into the subsurface to extract uranium, and
heap leaching, in which solutions are sprayed onto piles of mined rock to extract ura-
nium. This study is concerned only with in situ leaching facilities. (The USNRC did not
ask the NAS to examine conventional mining facilities because these facilities are not
regulated by that agency.)
Milling facilities: Facilities that are used to process uranium ore or leach solutions to
produce uranium oxide (U3O8) powder, or yellowcake. Mills can be standalone facilities,
or they can be integrated into a uranium extraction operation. The former type of facil-
ity is used for conventional mining operations, where a single mill can service several
mines, whereas the latter type of facility is used for in situ leaching operations.
Conversion facilities: Facilities that are used to convert yellowcake into a solid
hexafluoride form (uranium hexafluoride, UF6). This compound sublimes to form a gas
at about 56°C at standard atmospheric pressures. The gaseous form of this material
is used in subsequent processing steps.
Enrichment facilities: Facilities that are used to increase the concentration of
of countywide data made it difficult to discern local effects around nuclear
facilities, especially in geographically extensive counties. The investigation
also focused primarily on cancer mortality, because good-quality cancer in-
cidence data were largely unavailable at the time the study was conducted.
(Incidence may be a better indicator of risk than mortality because advances
in cancer treatments have lowered mortality rates for many types of cancer,
including leukemia.)
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15
INTRODUCTION
uranium-235 in uranium hexafluoride. Almost all natural uranium contains about 99.3
percent uranium-238 and about 0.7 percent uranium-235 by mass. Enrichment in-
creases the mass percentage of uranium-235, the fissile (i.e., the component of the
nuclear fuel that can be induced to fission with thermal [low-energy] neutrons) compo-
nent of nuclear fuel, to between about 4 and 5 percent. In the United States, uranium
enrichment is currently being carried out in gaseous diffusion and centrifuge plants.
New plants that use laser enrichment technologies are under construction.
Fuel fabrication facilities: Facilities that are used to convert enriched uranium hexa-
fluoride into a uranium dioxide (UO2) solid and fabricate it into nuclear fuel for civilian
reactors.
Some of the fuel facilities being considered in this study have had or currently have
dual civilian and defense missions. Prior to the USNRC assuming regulatory control,
some of these facilities were previously regulated by the U.S. Department of Energy
and its predecessor agencies.
FIGURE S.1 Schematic depiction of the nuclear fuel cycle. SOURCE: USNRC.
Figure S.1.eps
bitmap
The NCI investigation also did not attempt to estimate radiation expo-
sures resulting from the operation of nuclear facilities. However, NCI inves-
tigators noted that such exposures are likely to be “too small to result in
detectable harm” (Jablon et al., 1991, p. 1407). Absent reliable information
about radiation exposures, it is difficult to provide scientifically supportable
explanations for any observed associations between a nuclear facility and
cancer incidence or mortality.
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16 ANALYSIS OF CANCER RISKS
TABLE 1.1 Civilian Nuclear Power Plants in the United States
Number
of Active Name of Nuclear Power Operating
Reactors Plant (USNRC-abbreviated Reactor License Shutdown
State in State plant names) Unit Issue Date Date
Alabama 5 Browns Ferry Nuclear Plant 1 1973
(Browns Ferry) 2 1974
3 1976
Joseph M. Farley Nuclear 1 1977
Plant (Farley) 2 1981
Arizona 3 Palo Verde Nuclear 1 1985
Generating Station (Palo 2 1986
Verde) 3 1987
Arkansas 2 Arkansas Nuclear One 1 1974
(Arkansas Nuclear) 2 1978
California 4 Diablo Canyon Power Plant 1 1984
(Diablo Canyon) 2 1985
San Onofre Nuclear 1 1967 1992
Generating Station (San 2 1982
Onofre) 3 1982
Humboldt Bay Nuclear 3 1963 1976
Power Plant (Humboldt Bay)
Rancho Seco Nuclear 1974 1989
Generating Station (Rancho
Seco)
Colorado 1 Fort Saint Vrain Generating 1973 1989
Station (Fort Saint Vrain)
Connecticut 2 Millstone Power Station 1 1970 1998
(Millstone) 2 1975
3 1986
Haddam Neck (Connecticut 1968 1996
Yankee)
Florida 5 Crystal River Nuclear 3 1976
Generating Plant (Crystal
River)
St. Lucie Plant (St. Lucie) 1 1976
2 1986
Turkey Point Nuclear Plant 3 1972
(Turkey Point) 4 1973
Georgia 4 Edwin I. Hatch Nuclear Plant 1 1974
(Edwin I. Hatch) 2 1978
Vogtle Electric Generating 1 1987
Plant (Vogtle) 2 1989
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17
INTRODUCTION
TABLE 1.1 Continued
Number
of Active Name of Nuclear Power Operating
Reactors Plant (USNRC-abbreviated Reactor License Shutdown
State in State plant names) Unit Issue Date Date
Illinois 11 Braidwood Station 1 1987
(Braidwood) 2 1988
Byron Station (Byron) 1 1985
2 1987
Clinton Power Station 1 1987
(Clinton)
Dresden Nuclear Power 1 1959 1978
Station (Dresden) 2 1969
3 1971
LaSalle County Station 1 1982
(LaSalle) 2 1983
Quad Cities Nuclear Power 1 1972
Station (Quad Cities) 2 1972
Zion Nuclear Power Station 1 1973 1997
(Zion) 2 1973 1996
Iowa 1 Duane Arnold Energy Center 1974
(Duane Arnold)
Kansas 1 Wolf Creek Generating 1 1985
Station (Wolf Creek)
Louisiana 2 River Bend Station (River 1 1985
Bend)
Waterford Steam Electric 3 1985
Station (Waterford)
Maine 0 Maine Yankee Nuclear 1972 1996
Power Plant (Maine Yankee)
Maryland 2 Calvert Cliffs Nuclear Power 1 1974
Plant (Calvert Cliffs) 2 1976
Massachusetts 1 Pilgrim Nuclear Power 1972
Station (Pilgrim)
Yankee Rowe Nuclear Power 1961 1991
Station (Yankee-Rowe)
continued
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18 ANALYSIS OF CANCER RISKS
TABLE 1.1 Continued
Number
of Active Name of Nuclear Power Operating
Reactors Plant (USNRC-abbreviated Reactor License Shutdown
State in State plant names) Unit Issue Date Date
Michigan 4 Donald C. Cook Nuclear 1 1974
Plant (Cook) 2 1977
Palisades Nuclear Plant 1971
(Palisades)
Fermi 1 1966 1992
2 1985
Big Rock Point Nuclear Plant 1962 1997
(Big Rock Point)
Minnesota 3 Monticello Nuclear 1 1970
Generating Plant
(Monticello)
Prairie Island Nuclear 1 1974
Generating Plant (Prairie 2 1974
Island)
Mississippi 1 Grand Gulf Nuclear Station 1 1984
(Grand Gulf)
Missouri 1 Callaway Plant (Callaway) 1 1984
Nebraska 2 Cooper Nuclear Station 1974
(Cooper)
Fort Calhoun Station (Fort 1 1973
Calhoun)
New 1 Seabrook Station (Seabrook) 1 1990
Hampshire
New Jersey 4 Hope Creek Generating 1 1986
Station (Hope Creek)
Oyster Creek Nuclear 1969
Generating Station (Oyster
Creek)
Salem Nuclear Generating 1 1976
Station (Salem) 2 1981
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19
INTRODUCTION
TABLE 1.1 Continued
Number
of Active Name of Nuclear Power Operating
Reactors Plant (USNRC-abbreviated Reactor License Shutdown
State in State plant names) Unit Issue Date Date
New York 6 James A. FitzPatrick Nuclear 1974
Power Plant (FitzPatrick)
R. E. Ginna Nuclear Power 1969
Plant (Ginna)
Indian Point Nuclear 1 1962 1974
Generating (Indian Point) 2 1973
3 1975
Nine Mile Point Nuclear 1 1969
Station (Nine Mile Point) 2 1987
Shoreham Nuclear Power 1989 1992
Station (Shoreham)
North 5 Brunswick Steam Electric 1 1976
Carolina Plant (Brunswick) 2 1974
McGuire Nuclear Station 1 1981
(McGuire) 2 1983
Shearon Harris Nuclear 1 1986
Power Plant (Harris)
Ohio 2 Davis-Besse Nuclear Power 1 1977
Station (Davis-Besse)
Perry Nuclear Power Plant 1 1986
(Perry)
Oregon 0 Trojan Nuclear Power Plant 1 1976 1992
(Trojan)
Pennsylvania 9 Beaver Valley Power Station 1 1976
(Beaver Valley) 2 1987
Limerick Generating Station 1 1985
(Limerick) 2 1989
Peach Bottom Atomic Power 1 1967 1974
Station (Peach Bottom) 2 1973
3 1974
Susquehanna Steam Electric 1 1982
Station (Susquehanna) 2 1984
Three Mile Island Nuclear 1 1974
Station (Three Mile Island) 2 1978 1979
Shippingport Atomic Power 1957 1982
Station
Saxton 1962 1972
continued
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20 ANALYSIS OF CANCER RISKS
TABLE 1.1 Continued
Number
of Active Name of Nuclear Power Operating
Reactors Plant (USNRC-abbreviated Reactor License Shutdown
State in State plant names) Unit Issue Date Date
South 7 Carolinas-Virginia Tube 1963 1967
Carolina Reactor
Oconee Nuclear Station 1 1973
(Oconee) 2 1973
3 1974
H.B. Robinson Steam Electric 2 1970
Plant (Robinson)
Virgil C. Summer Nuclear 1 1982
Station (Summer)
Catawba Nuclear Station 1 1985
(Catawba) 2 1986
South Dakota 0 Pathfinder Atomic Plant 1964 1967
(Pathfinder)
Tennessee 3 Sequoyah Nuclear Plant 1 1980
(Sequoyah) 2 1981
Watts Bar Nuclear Plant 1 1996
(Watts Bar)
Texas 4 Comanche Peak Nuclear 1 1990
Power Plant (Comanche 2 1993
Peak)
South Texas Project 1 1988
2 1989
Vermont 1 Vermont Yankee Nuclear 1972
Power Station (Vermont
Yankee)
Virginia 4 North Anna Power Station 1 1978
(North Anna) 2 1980
Surry Power Station (Surry) 1 1972
2 1973
Washington 1 Columbia Generating Station 1984
(Columbia)
Wisconsin 3 Kewaunee Power Station 1973
(Kewaunee)
Point Beach Nuclear Plant 1 1970
(Point Beach) 2 1973
La Crosse Nuclear 1969 1987
Generating Station (La
Crosse)
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21
INTRODUCTION
TABLE 1.2 USNRC-Licensed Facilities that Are Part of the Nuclear Fuel
Cycle
Site Name, Location Licensee Operational Status
In situ Recovery Facilitiesa
Crow Butte, NE Crow Butte Resources, Inc. Active
Crownpoint, NM Hydro Resources, Inc. Not yet constructed
Moore Ranch, WY Uranium One Active
Smith Ranch and Highlands, Power Resources, Inc. Active
WY
Willow Creek, WY Uranium One Active
Facilitiesa
Conventional Uranium Mill Recovery
Ambrosia Lake, NM Rio Algom Mining, LLC Decommissioning
Church Rock, NM United Nuclear Corp. Decommissioning
Homestake, NM Homestake Mining Co. Decommissioning
Bear Creek, WY Bear Creek Uranium Co. Decommissioning
Gas Hills, WY American Nuclear Corp. Decommissioning
Gas Hills, WY Umetco Minerals Corp. Decommissioning
Highlands, WY Exxon Mobil Corp. Decommissioning
Lucky Mc, WY Pathfinder Mines Corp. Decommissioning
Shirley Basin, WY Pathfinder Mines Corp. Decommissioning
Split Rock, WY Western Nuclear, Inc. Decommissioning
Sweetwater, WY Kennecott Uranium Corp. Stand-by
Uranium Hexafluoride Conversion Facility
Metropolis, IL Honeywell International, Inc. Active
Uranium Fuel Fabrication Facilities
Wilmington, NC Global Nuclear Fuels-Americas, Active
LLC
Columbia, SC Westinghouse Electric Company, Active
LLC Columbia Fuel
Fabrication Fac.
Erwin, TN Nuclear Fuel Services, Inc. Active
Lynchburg, VA AREVA NP, Inc. Mt. Athos Inactive
Road
Lynchburg, VA B&W Nuclear Operations Active
Group
Richland, WA AREVA NP , Inc. Active
Mixed Oxide Fuel Fabrication Facility
Aiken, SC Shaw AREVA MOX Services, Under construction
LLC
Gaseous Diffusion Uranium Enrichment Facilities
Paducah, KY USEC Inc. Active
Piketon, OH USEC Inc. In cold shutdown
Gas Centrifuge Uranium Enrichment Facilities
Piketon, OH USEC Inc. In construction
Eunice, NM Louisiana Energy Services Active
Idaho Falls, ID AREVA Enrichment Services Under review
continued
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24 ANALYSIS OF CANCER RISKS
Index Licensee, State
1 Crow Butte Resources, Inc., Nebraska
Figure 1.1b.eps
2 Uranium One, Wyoming
3 Power Resources, Inc, Wyoming
bitmap
4 Uranium One, Wyoming
Kennecott Uranium Corp.,a Wyoming
5
6 Honeywell International, Inc, Illinois
7 Global Nuclear Fuels-Americas, LLC, North Carolina
8 Westinghouse Electric Company, LLC Columbia Fuel Fabrication Fac., South Carolina
9 Nuclear Fuel Services, Inc., Tennessee
10 B&W Nuclear Operations Group, Virginia
11 AREVA NP, Inc., Washington
12 USEC Inc., Kentucky
13 Louisiana Energy Services, New Mexico
aStandby
FIGURE 1.1b Currently operating USNRC-licensed nuclear fuel-cycle facilities in
the United States.
comparisons are made (e.g., for multiple cancer types) as well as “false
negative” associations (i.e., associations not established because statistical
power is low) because effect size is small. There is little way of knowing
whether any such associations (or lack of associations) are anything more
than statistical effects.
On the other hand, epidemiologic studies provide the most direct evi-
dence for associations between suspected risk factors (e.g., radiation) and
disease (e.g., cancer). Perhaps for this reason, epidemiologic studies con-
tinue to be used to assess cancer risks in populations near nuclear facilities
in other countries (see Section 1.2 in this chapter and Appendix A). A well-
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25
INTRODUCTION
designed epidemiologic study can be used to formulate or test hypotheses
about cancer risks in populations around nuclear facilities.
The committee received two somewhat conflicting messages from pre-
senters at its information-gathering meetings (see Section 1.4 in this chap-
ter) and peer reviewers for this report: (1) A Phase 2 epidemiologic study
should be carried out; (2) the study will be a “political” rather than a
“scientific” exercise. The committee has endeavored to recommend a tech-
nically sound approach for carrying out an epidemiologic study while at
the same time clearly identifying the challenges for assessing cancer risks at
low doses. The committee hopes that the USNRC will be able to use this
information to help make an informed decision about whether to undertake
a new epidemiologic study and what type of study to conduct.
1.2 PREVIOUS STUDIES OF CANCER RISKS
Concerns about the potential health impacts from living near nuclear
facilities are not new or unique to the United States. A British television
program in 1983 reported a cluster of childhood leukemia in Seascale, a
village located on the coast of the Irish Sea about 3 kilometers from the
nuclear fuel reprocessing facility at Sellafield. The television program re-
ported on seven childhood leukemia cases in the village over the previous
30 years, whereas fewer than one case was expected (Urquhart et al., 1984).
Given the proximity of the village to Sellafield, and the absence of other
obvious causative agents, radioactive discharges from the reprocessing plant
were hypothesized to be responsible for the excess leukemia.
The British government appointed an independent advisory group to
investigate these claims. The group (Black, 1984) confirmed the leukemia
cluster but could not link it to radioactive discharges. A governmental Com-
mittee on Medical Aspects of Radiation in the Environment (COMARE)
was subsequently established in 1985 to undertake further investigations.
To date, this committee has published 14 reports using data from the na-
tional registry of children’s tumors (see Appendix A for literature review).
Since 1985, epidemiologic studies of cancer risks in populations near
nuclear facilities have been carried out in at least 11 countries.6 The major-
ity of these studies investigated rates of cancer deaths or cancer occurrence
in populations living in various-size geographic areas including counties
and municipalities, zones of increasing distance, or zones based on models
of dispersion of releases from the nuclear facilities (see Table 4.2, Chap-
ter 4). These studies have come to different conclusions, with some suggest-
ing a positive association between living in proximity to a nuclear facility
6 Canada, Finland, France, Germany, Great Britain, Israel, Japan, Spain, Sweden, Switzer-
land, and the United States.
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26 ANALYSIS OF CANCER RISKS
and cancer risk. However, studies have been unable to attribute positive
associations to radioactive releases from the facilities.
A widely publicized study with a positive finding is the German Kinder-
krebs in der Umgebung von Kernkraftwerken (KiKK) study, which was
carried out by researchers from the German Childhood Cancer Registry in
Mainz on behalf of the Federal Office of Radiation Protection. Study re-
sults were published in 2008 (Kaatsch et al., 2008; Spix et al., 2008). They
indicated that for a child of age 0-5 years, the risk of developing leukemia
doubles if that child lives in close vicinity of a nuclear plant. However, the
methodology, presentation, and interpretation of results from the study
have been strongly criticized by others (COMARE, 2011; Kinlen, 2011).
Additional information about these studies is provided in Appendix A.
Results from two other epidemiologic studies were published during
this Phase 1 study: the 14th report of COMARE, which provided further
consideration of the incidence of childhood leukemia around nuclear plants
in Great Britain (COMARE, 2011), and a study on the risk of childhood
leukemia and all childhood cancers in the vicinity of Swiss nuclear plants
(Spycher et al., 2011). Neither provided significant evidence of a positive
association between distance from nuclear plants and cancer risk.
A third report from France showed that children living within 5 kilo-
meters of nuclear plants are twice as likely to develop leukemia compared
to those living 20 kilometers or farther away from the plants. However,
analysis of the same population of children using a dose-based geographic
zoning approach, instead of distance, did not support the findings. The
authors suggest that the absence of any association with the dose-based
geographic zoning approach may indicate that the observed association of
distance and cancer risk may be due to some unidentified factors other than
the releases from the nuclear power plants (Sermage-Faure et al., 2012).
Current joint efforts from France and Germany are focusing on develop-
ing studies that would improve understanding of the positive associations
between childhood leukemia and distance from nuclear power plants by
improving current knowledge on the etiology of the disease.
Epidemiologic studies of cancer risks in populations near nuclear facili-
ties have used a number of approaches to assess exposures of study popu-
lations to radiation from facility releases (see Section 4.2.1 in Chapter 4).
In most cases, exposures are based on surrogate measures (e.g., distance
from a facility) that are not related to quantifiable radiation doses. How-
ever, some recent studies have attempted to obtain dose estimates based on
facility effluent releases. Evrard et al. (2006) grouped communes within 40
kilometers of nuclear plants in France into five categories based on esti-
mated doses based on airborne radioactive effluent discharges (see Chapter
2) and local climate data. The Nuclear Safety Council and the Carlos III
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27
INTRODUCTION
Institute of Health (2009) estimated effective doses in populations living in
municipalities at various distances from nuclear facilities in Spain.
More detailed dose reconstructions have been carried out for other ap-
plications. These include reconstruction of doses for World War II atomic
bombing survivors in Japan; U.S. military personnel exposed to radiation
from atmospheric nuclear-weapons testing; U.S. Department of Energy
workers who were exposed to occupational radiation at nuclear weapons
production and testing facilities and residents in nearby states who were
exposed to radiation that was released from these facilities; and individuals
who responded to the 1986 Chernobyl accident. These dose reconstruction
efforts are described in a number of reports; see, for example, NCRP (2009)
and NAS (1995).
1.3 STRATEGY TO ADDRESS THE STUDY CHARGE
This study was carried out by a committee of experts appointed by the
NAS. The committee consists of 20 members with expertise that spans the
disciplines relevant to the study task: biostatistics, contaminant fate and
transport, environmental exposure monitoring, epidemiology, medicine,
public health, radiation dosimetry, radiobiology, social science and risk
communication, and toxicology. In selecting the committee, the NAS sought
to obtain a balance between experts in the design and execution of risk as-
sessment studies for low-dose radiation exposures and experts with relevant
disciplinary expertise but no direct experience with low-dose radiation risk
assessment. Biographical sketches of the committee members are provided
in Appendix B.
The committee was tasked to recommend appropriate study design(s)
to assess cancer risks associated with living near nuclear facilities. The selec-
tion of suitable study designs primarily involved judgments about scientific
soundness, data availability and accessibility, and level of effort versus
likely scientific return. The committee’s judgments were also informed by
information that it received from technical experts (see Appendix C) and
comments from the public (see Chapter 5). The committee attempted to
identify study approaches that were scientifically sound and that addressed
public concerns.
The focus for this study is on cancer risks arising from exposures to
radiation from nuclear plants and fuel-cycle facilities past and present in
the course of their ordinary day-to-day operations. The study is not focused
on risks arising from nuclear accidents (e.g., Chernobyl or, more recently,
Fukushima). Nevertheless, the committee recognizes that public percep-
tions about the risks related to nuclear plants and fuel-cycle facilities may
be shaped by these events.
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28 ANALYSIS OF CANCER RISKS
One of the scientific challenges for carrying out assessments of cancer
risks in populations near nuclear facilities is the lack of sufficient statistical
power7 to detect relatively small associations between cancer incidence or
mortality and exposures to radiation from facility releases. This is primarily
the result of the small radiation doses that are typically received by indi-
viduals living near nuclear facilities as a result of normal operations at those
facilities (see Chapter 3). As a consequence, epidemiologic assessments of
cancer risk require the study of very large populations to have any hope of
having adequate statistical power to detect positive associations between
cancer and radiation exposure. Modest improvements in the statistical
power can be achieved by examining dose-response gradients, especially
when the population under study is exposed to a range of doses.
Tables 1.3 and 1.4 show the populations living within 5 and 30 miles
of currently operating nuclear facilities in the United States as determined
in the 2010 census.8 As can be seen in this table, there was a wide variation
in the numbers of persons living near nuclear facilities in 2010:
• Approximately 1 million people lived within 5 miles of operating
nuclear plants in 2010; over 45 million people lived within 30
miles.
• Approximately 116,000 people lived within 5 miles of USNRC-
licensed operating fuel-cycle facilities in 2010; over 2 million peo-
ple lived within 30 miles.
• Approximately 210 people lived within 5 miles of a USNRC-
licensed operating in situ recovery or conventional uranium mill
recovery facility in 2010; about 11,000 lived within 30 miles.9
The committee decided to focus most of its efforts in this Phase 1 study
on nuclear plants because of their large associated populations. The com-
mittee decided not to consider mining and milling facilities in this Phase 1
study because of their low associated populations. The committee recog-
nizes that people who live near these mining and milling facilities may be
just as concerned about cancer risks as people who live near nuclear plants.
However, epidemiologic studies of cancer risk would have no statistical
7 That is, the ability of a statistical test to detect a predetermined difference in risk (e.g., a
doubling in cancer mortality associated with radiation exposure) if it exists. In this context,
statistical power depends on the risk in the control population, the smallest increase in risk
the investigator wants to be reasonably sure of finding (if it is present), and the acceptable
probabilities of a false positive result (if there is no increase) and a false negative result (if
there is an increase of at least the size to be sought).
8 The 2010 census data are used here simply to illustrate population differences for various
facilities. The 2010 data do not reflect the population distribution around sites in prior years.
9 Note: These are median estimates for individual in situ recovery or conventional uranium
mill recovery facilities, not total populations for all facilities.
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29
INTRODUCTION
TABLE 1.3 Populations in the 5- and 30-Mile (Approximately 8- and
50-Kilometer) Zones around Currently Operating Nuclear Power Plants
Based on the 2010 U.S. Census Data
Index State Name 5 Mile 30 Mile
1 Alabama Browns Ferry Nuclear Plant 6,098 530,011
2 Joseph M Farley Nuclear Plant 2,534 186,768
3 Arizona Palo Verde Nuclear Generating Station 1,117 273,806
4 Arkansas Arkansas Nuclear One 14,177 137,107
5 California Diablo Canyon Power Plant 1,648 338,602
6 San Onofre Nuclear Generating Station 23,525 2,410,113
7 Connecticut Millstone Power Station 53,321 667,492
8 Florida Crystal River Nuclear Generating Plant 6,142 271,625
9 St. Lucie Plant 34,017 584,465
10 Turkey Point 7,963 1,838,689
11 Georgia Edwin I. Hatch Nuclear Plant 2,063 135,568
12 Vogtle Electric Generating Plant 1,941 398,181
13 Illinois Braidwood Station 16,834 971,587
14 Byron Station 12,339 600,581
15 Clinton Power Station 1,643 419,698
16 Dresden Nuclear Power Station 22,872 1,815,892
17 LaSalle County Station 3,211 345,966
18 Quad Cities Nuclear Power Station 6,252 451,281
19 Iowa Duane Arnold Arnold Energy Center 12,180 351,236
20 Kansas Wolf Creek Generating Station 1,690 75,810
21 Louisiana River Bend Station 5,647 536,645
22 Waterford Steam Electric Station 13,774 1,119,079
23 Maryland Calvert Cliffs Nuclear Power Plant 18,438 443,962
24 Massachusetts Pilgrim Nuclear Power Station 23,108 1,245,016
25 Michigan Donald C. Cook Nuclear Plant 16,977 563,815
26 Palisades Nuclear Plant 7,693 288,716
27 Fermi 18,035 2,230,762
28 Minnesota Monticello Nuclear Generating Plant 21,107 964,863
29 Prairie Island Nuclear Generating Plant 6,650 789,039
30 Mississippi Grand Gulf Nuclear Station 1,657 87,677
31 Missouri Callaway Plant 1,620 225,301
32 Nebraska Cooper Nuclear Station 892 54,338
33 Fort Calhoun Station 9,305 829,567
34 New Seabrook Station 47,004 1,667,009
Hampshire
continued
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30 ANALYSIS OF CANCER RISKS
TABLE 1.3 Continued
35 New Jersey Hope Creek Generating Station 5,681 1,512,768
36 Oyster Creek Nuclear Generating Station 44,156 1,010,661
37 Salem Nuclear Generating Station 5,434 1,490,771
38 New York James A. Fitzpatrick Nuclear Power 10,838 615,046
Plant
39 R.E. Ginna Nuclear Power Plant 14,788 894,227
40 Indian Point Nuclear Generating 88,189 5,695,758
41 Nine Mile Point 6,729 307,622
42 North Carolina Brunswick Steam Electric Plant 13,398 315,360
43 McGuire Nuclear Station 51,561 2,014,369
44 Shearon Harris Nuclear Power Plant 29,445 1,567,691
45 Ohio Davis-Besse Nuclear Power Plant 3,390 733,031
46 Perry Nuclear Power Plant 24,164 810,777
47 Pennsylvania Beaver Valley Power Station 16,181 1,656,510
48 Limerick Generating Station 97,649 4,453,399
49 Peach Bottom Atomic Power Station 11,326 1,787,122
50 Susquehanna Steam Electric Station 15,462 664,767
51 Three Mile Island Nuclear Station 48,714 1,520,777
52 South Carolina Oconee Nuclear Station 15,616 634,339
53 H.B. Robinson Steam Electric Plant 11,927 292,920
54 Virgil C. Summer Nuclear Station 2,940 663,629
55 Catawba Nuclear Station 50,337 1,768,246
56 Tennessee Sequoyah Nuclear Plant 29,485 714,473
57 Watts Bar Nuclear Plant 5,152 362,142
58 Texas Comanche Peak Nuclear Power Plant 6,842 285,159
59 South Texas Project 1,691 66,066
60 Vermont Vermont Yankee Nuclear Power Station 12,737 345,863
61 Virginia North Anna Power Station 6,903 507,945
62 Surry Power Station 13,081 984,927
63 Washington Columbia Generating Station 407 282,505
64 Kewaunee Power Station 2,974 324,911
65 Wisconsin Point Beach Nuclear Plant 3,297 304,151
Total: 934,488 45,020,247
NOTE: Plants in close geographic proximity may have overlapping populations, so persons
living near those plants could be included (i.e., counted) in more than one plant population.
The population total shown at the bottom of the table corrects for multiple counting (i.e., each
person living near a plant is only counted once). As a consequence, the sum of the popula-
tions for the individual plants does not equal the population total at the bottom of the table.
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31
INTRODUCTION
TABLE 1.4 Populations in the 5- and 30-Mile (Approximately 8- and
50-Kilometer) Zones around Currently Operating USNRC-Licensed
Facilities that Are Part of the Nuclear Fuel Cycle Based on the 2010 U.S.
Census Data
Index State Licensee Type 5 mile 30 mile
1 Nebraska Crow Butte Resources, Inc Mining 196 10,796
2 Wyoming Uranium One Mining 237 5,986
3 Power Resources, Inc Mining 72 14,378
4 Uranium One Mining 123 5,340
Kennecott Uranium Corp.a
5 Wyoming Milling 21 1,438
6 Illinois Honeywell International, Conversion 11,334 184,442
Inc
7 North Carolina Global Nuclear Fuels- Fuel 35,854 349,780
Americas, LLC Fabrication
8 South Carolina Westinghouse Electric Fuel 14,512 796,391
Company, LLC Fabrication
Columbia Fuel
Fabrication Fac.
9 Tennessee Nuclear Fuel Services, Inc. Fuel 12,765 432,825
Fabrication
10 Virginia B&W Nuclear Operations Fuel 21,810 280,396
Group Fabrication
11 Washington AREVA NP , Inc. Fuel 33,253 276,038
Fabrication
12 Kentucky USEC Inc. Enrichment 7,370 190,772
13 New Mexico Louisiana Energy Services Enrichment 934 48,631
Total: 116,282 2,308,747
NOTE: Facilities in close geographic proximity may have overlapping populations, so persons
living near those facilities could be included (i.e., counted) in more than one facility popula-
tion. The population total shown at the bottom of the table corrects for multiple counting
(i.e., each person living near a facility is only counted once). As a consequence, the sum of
the populations for the individual facilities does not equal the population total at the bottom
of the table.
aStandby
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32 ANALYSIS OF CANCER RISKS
power to detect associations between radiation and cancer because of these
small populations.
With respect to the other types of fuel-cycle facilities, the committee
focused most of its efforts on one facility, Nuclear Fuel Services in Erwin,
Tennessee, primarily because of the public interest in cancer risks resulting
from radioactive releases from that facility. The methodology proposed by
the committee for assessing cancer risk at this facility is applicable to other
fuel-cycle facilities as well.
1.4 INFORMATION GATHERING AND REPORT ORGANIZATION
The committee held five information-gathering meetings to receive
briefings from subject-matter experts, including experts in the fields of
epidemiology, dosimetry, and social science; representatives of the USNRC
and the nuclear industry; representatives of cancer registries; and interested
members of the public. Small groups of committee members visited the
Dresden Nuclear Power Station (Illinois) in April 2011, the San Onofre
Nuclear Generating Station (California) in July 2011, and the Nuclear Fuel
Services facility (Tennessee) in October 2011 to learn about the design and
operation of these facilities’ radioactive effluent release and environmental
monitoring programs. A list of committee meeting briefings is provided in
Appendix C.
The committee’s information-gathering sessions were webcast in an
effort to enhance public awareness and participation in the study. Cop-
ies of these webcasts are available at http://www.nationalacademies.org/
cancerriskstudy.
The committee received a large number of oral and written comments
from nongovernmental organizations and other members of the public.
These were helpful for informing the committee about public concerns
related to the study and for uncovering data sources and documents that
were useful to the committee.
This report is organized into five chapters that address the statement of
task (Sidebar 1.1) in its entirety:
• Chapter 1 (this chapter) provides background on the study.
• Chapter 2 describes the effluent releases from nuclear facilities.
• Chapter 3 describes methods to estimate radiation exposure and
dose from radioactive effluent releases and other sources.
• Chapter 4 describes epidemiologic study designs that could be used
to investigate whether populations near nuclear facilities are at an
increased risk of developing cancer.
• Chapter 5 describes the public engagement process used in this
Phase 1 study and suggests how it can be extended for Phase 2.
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33
INTRODUCTION
Definitions of terms and acronyms are provided in Appendixes N and O,
respectively.
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