risks to develop information strategies that are sensitive to the concerns and perceptions of these groups. For example, if DHHS wishes to communicate effectively with people living in the regions where the tests were conducted, it will need to bring representatives from these areas into the information planning process at the very beginning.

The building blocks for the information and communication program should include several kinds of materials. Brochures or the equivalent should be developed for clinicians, public health departments, and others to give to concerned patients. In addition, although many people lack access to computers, an updated Internet site for both the lay public and clinicians can be a convenient, in-depth source of information for many others. Electronic and written sources of information should explain basic facts about the Nevada tests, I-131, and thyroid cancer and should provide basic education about screening tests, including explanations of possible benefits and harms.

The committee recognized the particular challenge of communicating its conclusions about screening in ways that respond to understandable public concerns about the likely (albeit small) risk of thyroid cancer linked to exposure to iodine-131 from the Nevada atomic weapons tests. Screening programs—whether or not they are supported by scientific evidence—can be a popular response to risk. Notwithstanding this appeal, the committee recommends that DHHS concentrate on developing a program of information and education for the concerned public and clinicians that builds on the analyses, conclusions, and information approaches described in the committee report and on the experience the Department and others have gained in developing similar informational materials.

FURTHER RESEARCH

The committee suggests that DHHS consider additional research in several areas. These areas include (a) the relative effectiveness of external radiation versus internal radiation in producing thyroid cancer; (b) the relative malignancy of radiation-related versus spontaneous thyroid neoplasms; (c) the role of genetic events in the development of thyroid cancer, in particular, the role of ret/PTC oncogene as it may affect the nature of the dose-response relationship for thyroid cancer; (d) people's perceptions of the benefits and risks of screening for thyroid and other cancers and the factors affecting such perceptions including the way quantitative information is presented; and (e) the effectiveness of existing programs to communicate radiation risks. The committee considered public comments calling for further research on the total radiation exposure resulting from all radionuclides deposited in radioactive fallout from nuclear tests in both the United States and other countries. It concluded that such research was unlikely to benefit public health and would divert resources from other uses of greater probable benefit and this as well as the cost of such research should be clearly understood before a decision is made to undertake it due to public concern.



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