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The exposure of troops to agents and situations that may have long-term health effects raises the issue of whether there is any appropriate medical monitoring (screening) that will detect such effects before they are evident clinically and that may positively affect disease progression or outcome. The primary effect in the cumulative radiation dose range that the committee considers in this report is an excess risk of certain types of cancer and leukemia. Unfortunately, at this time only a few screening tests are clearly effective; these tests are used to detect breast, cervical, and colon cancers. Physician-directed individual diagnostic testing may be useful in selected situations, particularly when radiation absorbed doses are extremely high. It should be noted that cancer occurs in about 40 percent of the U.S. population (NCI, 1994). For doses in the highest dose range addressed in this report (500-700 mSv), the increased risk of cancer attributable to the radiation dose is about 1/10 the normal baseline incidence rate for unexposed individuals. Although this is a low percentage, a large number of troops exposed at these doses could result in a large number of excess cancers.
Recommendation 5: Given the tests that are currently available, and their limitations, testing and monitoring programs for cancer (whether spontaneous or radiogenic) should be limited to those testing and monitoring programs included in guidelines for the general population.
Specific periodic screening or medical monitoring of radiation exposed populations is not warranted solely on the basis of radiation exposure in the dose range considered in this report.
If effective tests for other cancer types do become available, screening may be useful on the basis of the normal cancer incidence in the general population.
For persons who have received cumulative effective doses in excess of 50 mSv, the establishment of well-designed and dynamic registries may be helpful in addressing future health-related issues on an individual or population basis.