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## Exposure of the American People to Iodine-131 from Nevada Nuclear-Bomb Tests: Review of the National Cancer Institute Report and Public Health Implications (1999) Commission on Life Sciences (CLS)

### Citation Manager

. "4 Implications for Clinical Practice and Public Health Policy." Exposure of the American People to Iodine-131 from Nevada Nuclear-Bomb Tests: Review of the National Cancer Institute Report and Public Health Implications. Washington, DC: The National Academies Press, 1999.

 Page 124

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Exposure of the American People to Iodine-131 from Nevada Nuclear-Bomb Tests: Review of the National Cancer Institute Report and Public Health Implications
 Positive (including indeterminate results) Diagnosis Prior Conditional Product Revised Cancer 3% 89% 267 10.7% No cancer 97% 23% 2,231 89.3% Σ = 2,498
The revised probability after a positive or indeterminate result

would be only 10.7 percent, but 24.98 percent of patients would proceed to surgery (compared to 5.46 percent, as calculated above for positive FNA results) whereas 75.02 percent would avoid surgery.

In contrast, if an indeterminate result were treated as negative (i.e., the work-up stops), then the revised probability of cancer would be 0.4 percent because of false negatives. In this case, 82.78 percent of patients would avoid surgery (compared to 75.02 percent above).

 Negative (including indeterminate results) Diagnosis Prior Conditional Product Revised Cancer 3% 11% 33 0.4% No cancer 97% 85% 8,245 99.6% Σ = 8,278

In a similar vein, consider the effect of an unsatisfactory FNA. Because cancers are more likely to provide satisfactory samples, an unsatisfactory result lowers the probability of cancer, as shown above, from 3 percent to 1 percent. Recall that a negative FNA only lowers the probability of cancer to 0.3 percent (because of the possibility of false-negative results).

 Page 124
 Front Matter (R1-R16) Executive Summary (1-9) 1 Introduction (10-16) 2 Review of the NCI Radiation Dose Reconstruction (17-44) 3 Health Risks of I-131 Exposure (45-85) 4 Implications for Clinical Practice and Public Health Policy (86-124) 5 Communicating with the Public about Exposure to I-131 (125-151) 6 Research Needs (152-156) References (157-172) Glossary (173-176) Appendix A. Study Activities (177-185) Appendix B. Copy of the Memorandum from Dr. Charles Land to Dr. Richard Klausner (186-193) Appendix C. Calculation of Collective Thyroid Dose to the U.S. Population from the Release of I-131 from the Nuclear Weapons Tests in Nevada (194-197) Appendix D. Thyroid Cancer in Idaho, 1970-1996 (198-213) Appendix E. Applicable Radiation Exposure Standards and Guides: Past and Present (214-220) Appendix F. Screening for Thyroid Cancer: Background Paper (221-263) Committee Biographies (264-272)