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This report was prepared under contract No. PH-43-64-44 between the Department of Health, Education, and Welfare (on behalf of the Federal Radiation Council) and the National Academy of Sciences. Publication is made jointly by the Department of Health, Education, and Welfare and the Environmental Protection Agency, which succeeded to the authorities of the Federal Radiation Council under Reorganization Plan No. 3 of 1970. The report is solely the product of the contractor. The data and analysis contained in the report represent a major review of the effects of low levels of ionizing radiation and the role of such information in measures to protect the public. They will be reviewed extensively and with the utmost deliberation and care by the Department of Health, Education, and Wel- fare and the Environmental Protection Agency, with particular regard to their usefulness and applicability in the regulatory and other program activities of the Department and the Agency. Publication of the report does not constitute acceptance or approval of its contents; neither does it indicate their rejection or disagreement. Publi- cation is made at this time so that the report will be available as a resource to the scientific community and the public generally.
The Effects on Populations of Exposure to Low Levels of Ionizing Radiation REPORT OF THE ADVISORY COMMITTEE ON THE BIOLOGICAL EFFECTS OF IONIZING RADIATIONS DIVISION OF MEDICAL SCIENCES NATIONAL ACADEMY OF SCIENCES â¢ NATIONAL RESEARCH COUNCIL WASHINGTON, D.C. 20006 NOVEMBER 1972 DEC 2 91972 LIBRARY
NOTICE The study reported herein was undertaken under the aegis of the National Research Council with the express approval of the Governing Board of the NRC. Such approval indicated that the Board considered that the problem is of national significance, that elucidation or solution of the problem re- quired scientific or technical competence, and that the resources of the NRC were particularly suitable to the conduct of the project. The institu- tional responsibilities of the NRC were then discharged in the following manner: The members of the study committee were selected for their individual scholarly competence and judgment with due consideration for the balance and breadth of disciplines. Responsibility for all aspects of this report rests with the study committee, to whom we express our sincere apprecia- tion. Although the reports of our study committees are not submitted for ap- proval to the Academy membership nor to the Council, each report is re- viewed by a second group of appropriately qualified persons according to procedures established and monitored by the Academy,s Report Review Committee. Such reviews are intended to determine, inter alia, whether the major questions and relevant points of view have been addressed and whether the reported findings, conclusions, and recommendations arose from the available data and information. Distribution of the report is ap- proved, by the President, only after satisfactory completion of this review process. Order from National Technical Information Service, Springfield, Va. 22161 Order No.
oooo FOREWORD In the summer of 1970, the Federal Radiation Council (whose activities have since been transferred to the Radiation Office of the EPA) asked the National Academy of Sciences for information relevant to an evaluation of present radiation protection guides. This report is in response to that re- quest. It presents a summary and analysis, by members of the Advisory Com- mittee on the Biological Effects of Ionizing Radiations and its subcommit- tees, of current knowledge relating to risks from exposure to ionizing ra- diation. In many respects, the report is a sequel to the reports of the Com- mittee on the Biological Effects of Atomic Radiation, published by the NAS-NRC from 1956 to 1961. We extend our gratitude to the members of the committees and their con- sultants who contributed to the development of this report, many of whom have given unstintingly of their time and thought to this effort. We hope that the information contained herein will serve not only as a summary of present knowledge on the effects of ionizing radiation on human popula- tions but also as a scientific basis for the development of suitable radia- tion protection standards. We also wish to thank Dr. Cavalli-Svorza, Dr. William Cole, Dr. Maurice Fox, Mr. Joseph Gitlin, Dr. Ralph Lapp, Dr. Joshua Lederberg, Dr. Peter Morris, Mr. Lester Rogers, Dr. Francisco Sella, Dr. Charlotte Silverman, Dr. Alice Stewart, Dr. Lauriston Taylor, Dr. John C. Thompson, and Mrs. Edythalena Tompkins, all of whom gave of their time to meet with various subcommittees.
Preface This report of the National Academy of Sci- ences - National Research Council Advisory Committee on the Biological Effects of Ionizing Radiations (BEIR Committee) deals with the sci- entific basis for the establishment of radiation protection standards and encompasses a re- view and re-evaluation of existing scientific knowledge concerning radiation exposure of human populations. The present basis of radia- tion protection is essentially the establishment of single upper limits for individual and popu- lation average exposures with the understand- ing that any biological risks should be offset by commensurate benefits and that these risks should be kept as low as practicable. It has become apparent that these current concepts of radiation protection may not be adequate in a future age of large-scale use of nuclear ener- gy. Inadequacy arises because there is the po- tential for radiation exposure of entire popula- tions and such exposure may be an alternative to other types of hazards as, for example, the substitution of radioactive contaminants from nuclear power plants for the combustion prod- ucts from fossil fuel plants. Thus there is a need somehow to make comparisons of biologi- cal risks and benefits not only for radiation but for the alternative options. In this report it has not been possible for us to deal with critical interacting factors such as socio-economics, energy needs, and comparative effects of other toxicological agents; nor have we attempted to explore in detail technological matters such as sustained engineering performance of power reactors, large-scale waste disposal, or the problem of catastrophic accidents. Neverthe- less, we have felt it urgent to call attention to these issues because ultimately, decisions will have to be made involving them, and public acceptance gained on the basis of providing society with the services that it needs at a mini- mum risk to health and the environment. The BEIR Committee has endeavored to en- sure that no sources of relevant knowledge or expertise were overlooked in its study and to- ward this end has established and maintained liaison with appropriate national and interna- tional organizations, and has solicited the opinions and counsel of individual scientists. The Committee wishes to express appreciation to those who served on the Subcommittees, and to the many organizations and individuals who have cooperated by providing viewpoints and information. The members of the Committee and Subcommittees acted as individuals, not as representatives of their organizations. Chapters IV through VII represent the re- ports of the respective Subcommittees but may have been modified by the Committee. All mem- bers of the Committee approve the substance of the report if not necessarily each specific detail. iii
Members of the Advisory Committee on the Biological Effects of Ionizing Radiations Cyril L. Comar, Chairman, Department of Physical Biology, New York State Veteri- nary College, Cornell University, Ithaca, New York Seymour Abrahamson, Zoology Research Building, University of Wisconsin, 1117 West Johnson Street, Madison, Wisconsin Victor P. Bond, Brookhaven National Labora- tory, Upton, Long Island, New York J. Martin Brown, Department of Radiology, Stanford Medical Center, Stanford, Califor- nia George W. Casarett, Department of Radiation Biology and Biophysics, University of Roch- ester Medical Center, 260 Crittenden Boule- vard, Rochester, New York James F. Crow, Department of Medical Genet- ics, Genetics Building, University of Wiscon- sin, Madison, Wisconsin John H. Dingle, Department of Community Health, Wearn Research Building, Universi- ty Hospitals, Cleveland, Ohio Robert A. Good, University of Minnesota Hos- pitals, Mayo Box 494, Minneapolis, Minneso- ta Samuel P. Hicks, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan George G. Hutchison, Department of Epide- miology, Ha-rvard School of Public Health, 665 Huntington Avenue, Boston, Massachu- setts Cyrus Levinthal, Department of Biology, Room #754 Schermerhorn Extension, Columbia University, 119th Street & Amsterdam Ave- nue, New York, New York Edward B. Lewis, Biology Division, California Institute of Technology, Pasadena, Califor- nia Robert W. Miller, Epidemiology Branch, Na- tional Cancer Institute, National Institutes of Health, Bethesda, Maryland iCarl V. Moore, Department of Internal Medi- cine, Washington University School of Medi- cine, 660 So. Euclid Avenue, St. Louis, Mis- souri Edward P. Radford, Department of Environ- mental Medicine, Johns Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, Maryland Joseph E. Rall, National Institutes of Health, Bldg. 10, Rm. 9N222, Bethesda, Maryland William L. Russell, Biology Division, Oak Ridge National Laboratory, P. O. Box Y Oak Ridge, Tennessee Eugene L. Saenger, University of Cincinnati, College of Medicine, Cincinnati, Ohio Edward L. Tatum, The Rockefeller University, New York, New York Arthur C. Upton, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, New York Consultants Wilfrid J. Dixon, Department of Biomathemat- ics, School of Medicine, University of Califor- nia, Los Angeles, California Brian MacMahon, Department of Epidemiolo- gy, Harvard School of Public Health, 665 Huntington Avenue, Boston, Massachusetts Shields Warren, Cancer Research Institute, New England Deaconess Hospital, 194 Pil- grim Road, Boston, Massachusetts * Deceased
Members of the Subcommittee on Environmental Effects Cyril L. Comar, Chairman, Department of Physical Biology, New York State Veteri- nary College, Cornell University, Ithaca, New York Delbert S. Barth, Bureau of Criteria and Standards, National Air Pollution Control Administration, 411 W. Chapel Hill Street, Durham, North Carolina James H. Carpenter, Macauley Hall, The Johns Hopkins University, Charles and 34th Streets, Baltimore, Maryland John C. Evans, Box 3275, Duke University Med- ical Center, Durham, North Carolina R. John Garner, Office of Radiation Programs, Environmental Protection Agency, Washing- ton, D. C. Ronald G. Menzel, Water Quality Management Laboratory, U. S. Department of Agricul- ture, Durant, Oklahoma Dade W. Moeller, Harvard University School of Public Health, 665 Huntington Avenue, Bos- ton, Massachusetts Roy E. Nakatani, Fisheries Research Institute, University of Washington, 260 Fisheries Center, Seattle, Washington Robert B. Platt, Department of Biology, Emory University, Atlanta, Georgia Edward P. Radford, Department of Environ- mental Medicine, Johns Hopkins University, School of Hygiene and Public Health, 615 North Wolfe Street, Baltimore, Maryland H. B. Tukey, Jr., Department of Floriculture and Ornamental Horticulture, Plant Sciences Building, Cornell University, Ithaca, New York Members of the Subcommittee on Genetic Effects James F. Crow, Chairman, Department of Medi- cal Genetics, Genetics Building, University of Wisconsin, Madison, Wisconsin Seymour Abrahamson, Zoology Research Building, University of Wisconsin, 1117 West Johnson Street, Madison, Wisconsin H. John Evans, MRC Clinical and Population Cytogenetics Unit, Western General Hospi- tal, Crewe Road, Edinburgh, EH4, 2XU, Scot- land James V. Neel, Department of Human Genetics, University of Michigan, Ann Arbor, Michi- gan Howard B. Newcombe, Biology and Health Physics Division, Atomic Energy of Canada Limited, Chalk River, Ontario, Canada Dean R. Parker, Department of Biology, Uni- versity of California, Riverside, California Klaus Patau, Department of Medical Genetics, University of Wisconsin, Madison, Wisconsin William L. Russell, Biology Division, Oak Ridge National Laboratory, P. O. Box Y, Oak Ridge, Tennessee H. Eldon Sutton, Department of Zoology, Uni- versity of Texas at Austin, Austin, Texas Sheldon Wolff, Laboratory of Radiobiology School of Medicine, University of California, San Francisco, California Members of the Subcommittee on Effects on Growth and Development Samuel P. Hicks, Chairman, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan Jacob I. Fabrikant, Liaison Representative, The University of Connecticut Health Cen- ter, Hartford, Connecticut. Ernest Furchtgott, Department of Psychology, University of South Carolina, Columbia, South Carolina Robert W. Miller, Epidemiology Branch, Na- tional Cancer Institute, National Institutes of Health, Bethesda, Maryland John J. Mulvihill, Epidemiology Branch, 410 WISCON Bldg., National Cancer Institute, Bethesda, Maryland Melvin R. Sikov, Battelle-Northwest, Battelle Memorial Institute, P. O. Box 999, Richland, Washington V1
Members of the Subcommittee on Somatic Effects Arthur C. Upton, Chairman, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, New York Gilbert W. Beebe, National Academy of Sciences, Medical Follow-up Agency, 2101 Constitution Avenue, N. W., Washington, D.C. Victor P. Bond, Brookhaven National Labora- tory, Upton, Long Island, New York J. Martin Brown, Department of Radiology, Stanford Medical Center, Stanford Califor- nia George W. Casarett, Department of Radiation Biology and Biophysics, University of Roch- ester Medical Center, 260 Crittenden Boule- vard, Rochester, New York Louis H. Hempelmann, Strong Memorial Hospi- tal, Rochester, New York Edward B. Lewis, Division of Biology, Califor- nia Institute of Technology, Pasadena, Cali- fornia Robert W. Miller, Epidemiology Branch, Na- tional Cancer Institute, National Institutes of Health, Bethesda, Maryland Carl V. Moore, Department of Internal Medi- cine, Washington University School of Medi- cine, 660 So. Euclid Avenue, St. Louis, Mis- souri Edward P. Radford, Department of Environ- mental Medicine, Johns Hopkins University, School of Hygiene and Public Health, Balti- more, Maryland Joseph E. Rall, National Institute of Arthritis and Metabolic Diseases, National Institutes of Health, Bethesda, Maryland Eugene L. Saenger, University of Cincinnati, College of Medicine, Cincinnati, Ohio William B. Seaman, Department of Radiology, Columbia University, 622 West 168th St., New York, New York John B. Storer, Biology Division, Bldg. 9207, Oak Ridge National Laboratory, Oak Ridge, Tennessee Shields Warren, Cancer Research Institute, New England Deaconess Hospital, 194 Pilgrim Road, Boston, Massachusetts Consultants Wilfrid J. Dixon, Department of Biomathemat- ics, School of Medicine, University of Califor- nia, Los Angeles, California Jacob I. Fabrikant, The University of Connect- icut Health Center, Hartford, Connecticut George B. Hutchison, Department of Epide- miology, Harvard School of Public Health, 663 Huntington Avenue, Boston, Massachu- setts Seymour Jablon, Medical Follow-up Agency, National Academy of Sciences, 2101 Consti- tution Avenue, Washington, D. C. Brian MacMahon, Department of Epidemiolo- gy, Harvard School of Public Health, 665 Huntington Avenue, Boston, Massachusetts Members of the Advisory Committee on the Biological Effects of Ionizing Radiations Ad Hoc Committee Cyrus Levinthal, Chairman, Department of Biology, Room #754 Schermerhorn Exten- sion, Columbia University, 119th Street & Amsterdam Avenue, New York, New York J. Martin Brown, Department of Radiology, Stanford Medical Center, Stanford, Califor- nia Cyril L. Comar, Department of Physical Biolo- gy, New York State Veterinary College, Cor- nell University, Ithaca, New York James F. Crow, Department of Medical Genet- ics, Genetics Building, University of Wiscon- sin, Madison, Wisconsin Samuel P. Hicks, Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan Joseph E. Rall, National Institutes of Health, Bldg. 10, Rm. 9N222, Bethesda, Maryland Arthur C. Upton, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, New York Division of Medical Sciences - National Acade- my of Sciences - National Research Council STAFF OFFICERS: Albert W. Hilberg David A. McConnaughey vii
CONTENTS Page Foreword i Preface iii Members of the Advisory Committee on the Biological Ef- fects of Ionizing Radiation v Summary and Recommendations 1 Chapter I Introduction 5 Chapter II Needs of the Times 7 Chapter III Sources of Ionizing Radiation and Popula- tion Exposures 11 Chapter IV Environmental Transport and Effects of Radionuclides 21 Chapter V Genetic Effects of Ionizing Radiation 41 Chapter VI Effects of Ionizing Radiation on Growth and Development 73 Chapter VII Somatic Effects of Ionizing Radiation 83 Appendices A. General Bibliography 201 B. Glossary 213 C. Record of Meetings 217
TABLES AND FIGURES P&ge Chapters I and II None Chapter III Estimated Total Annual Average Doses from Natural Radiation in the United States (Whole- body) Table 1 12 Summary of Estimates of Annual Whole-body Dose Rates in the United States (1970) Table 2 19 Chapter IV None Chapter V Sources of Genetically Significant Radiation Table 1 50 Estimated Effects of Radiation for Specific Genet- ic Damage Table 2 54 Estimates of Cytogenetic Effects from 5 Rem per Generation Table 3 55 Estimated Effect of 5 Rem per Generation on a Population of One Million Table 4 57 Chapter VI Children with Small Head Circumference Follow- ing In Utero Exposure to the Hiroshima Bomb â¢â¢ Table 1 75 Chapter VII Appendix IâBases of Evaluation of Risks of Low-level Radiation Hypothetical Dose-effect Curves Fig. 1 98 Appendix HaâLeukemia Incidence of Leukemia in A-Bomb Survivors, by T-65 Dose and by City, 1950-1966 Table a-1 102 Incidence of Leukemia in A-bomb Survivors by T-65 Dose, City, and Type of Leukemia, 1950- 1966 Table a-2 105 Approximate Factors for Estimating Excess Cases of Leukemia, Based on the Experience of the A-bomb Survivors, 1950-1966 Table a-3 107 Mortality from Leukemia in A-bomb Survivors, by T-65 Dose and by City, 1950-1970 Table a-4 108 Calculation of Excess Deaths from Leukemia, 1950-1970, by Age ATB and City Table a-5 109 Observed and Expected Deaths from Leukemia, 1935-1960, Among 14,554 Patients with An- kylosing Spondylitis Treated by X-ray, 1935- 1955 Table a-6 110 Risk Estimates for Leukemia Table a-7 117 Annual Incidence Rate of Definite and Probable Leukemia per 100,000 Population of A-bomb Survivors Fig. a-1 104 Definite and Probable Leukemia in the ABCC Master Sample by T-65 RBE Dose, 1950-1966 Fig. a-2 104 Myeloid Leukemia in Male Mice Fig. a-3 115
Page Appendix lIbâThyroid Basis of Risk Estimates for Thyroid Cancer, Childhood Exposure Table b-1 124 Incidence of Thyroid Neoplasms versus Thy- roid Dose (rads) Fig. b-1 121 Incidence of Thyroid Nodularity in Relation to Estimated Cumulative Dose to the Thyroid Gland Fig. b-2 121 Appendix HeâBone Summary of Risk Estimates for Bone Cancer .. Summary 123 Basis of Risk Estimates for Bone Cancer Table c-1 129 Risk of Bone Cancer, Radium -226 Exposed Group "Dial Painters"; Followup through 1971 Fig. c-1 130 Risk of Bone Cancer, Radium -224 Exposed German Patients, Followup through 1969 Fig. c-2 131 Appendix lIdâSkin Relative Risks for Skin Cancer at Various Exposure Levels after Therapeutic Radiation Table d-1 134 Appendix lIeâBreast Basis of Risk Estimates for Breast Cancer Table e-1 139 Follow-up Details of the 306 Non-fluoroscoped and the 243 Fluoroscoped Patients who Sur- vived at. Least 10 Years Table e-2 142 Incidence of Breast Cancers from Fluorosco- pies Fig. e-1 138 Mortality Ratio for Breast Cancer vs. Age ATB Fig. e-2 140 Appendix IlfâLung Summary of Risk Estimates for Bronchial Cancer Summary 150 Basis of Risk Estimates for Lung Cancer Table f-1,2 151 Risk of Lung Cancer, Hiroshima-Nagasaki Survivors, 1955-1971 Fig.f-1 153 Risk of Lung Cancer, U. S. Uranium Miners 1951-1971 Fig.f-2 154 Risk of Lung Cancer, Newfoundland Fluorspar Miners, 1952-1968 Fig.f-3 155 Appendix IlgâOther Neoplasms Basis of Risk Estimates for Stomach Cancer .. Table g-1 158 Basis of Risk Estimates for all G. I. Cancer except Stomach Table g-2 159 Appendix IlhâAll Cancers Other than Leukemia Basis of Risk Estimates for All Cancer except Leukemia Table h-1 161 Appendix II A 2âCancer following Irradiation Table h-2 162 before Conception or during Intrauterine Life Basis of Risk Estimates for Leukemia, and for All Cancers except Leukemia, after Fetal Radiation Table2-1 163 xn
Appendix IIA 3âTotal Cancer Risk Calculation of the Excess Annual Number of Cancer Deaths for Individuals Exposed from 20 to 65 years of Age Estimated Numbers of Deaths per Year in the U.S. Population Attributable to Continual Exposure at a Rate of 0.1 rem per Year, Based on Mortality from Leukemia and From all Other Malignancies Combined Assumed Values Used in Calculating Estimates of Risk Shown in Table 3-1 Calculation of the Annual Number of Excess Cancer Deaths in the U. S. Population from Continuous Exposure to 0.1 rem/year, Using Relative Risk Model Calculations of Annual Number of Excess Can- cer Deaths in the U. S. Population from Con- tinuous Exposure to 0.1 rem/year, Using the Absolute Risk Model Appendix II BâMortality from Causes of Death Other than Cancer None Appendix II CâMorbidity from Causes Other Than Cancer None Appendix IIIâAnalysis of Viewpoints on Record Variation in Cancer Induction per rad A Comparison of Relative and Absolute Risk Estimates of the Major Types of Malignan- cies Induced Among the A-bomb Survivors (all Ages) The Relative Risk of Induction of all Malignan- cies (except Leukemia) in the A-bomb Survi- vors, Versus Age ATB The Absolute Risk of Induction of all Malig- nancies (except leukemia) in the A-bomb Sur- vivors Versus Age ATB Appendix IVâCalculation of Confidence Limits None Appendix VâRadiation Dosimetry of Heavily Irradiated Sites in Patients Treated for Anky- losing Spondylitis Stomach Types Transverse Section of Cadaver, at Thoracic-12 Lung Diagram Appendix VIâDefinitions and Notes None Summary Table 3-1 Table 3-2 Table 3-3 Table 3-4 Page 170 Table III-I Table III-2 Fig. III-1 Fig. III-2 169 171 172 173 183 185 184 187 Fig.V-1 191 Fig. V-2 193 Fig. V-3 194 xin