The evidence of radiation effects in embryos and fetuses exposed to Chernobyl fallout and the question of dose response

CDC Division of Reproductive Health's Emergency Preparedness Resources and Activities for Radiation Emergencies: Public Health Considerations for Women's Reproductive Health

Pregnant, postpartum, and lactating people, and infants have unique needs during public health emergencies, including nuclear and radiological incidents. This report provides information on the CDC Division of Reproductive Health's emergency preparedness and response activities to address the needs of women of reproductive age (aged 15-49 years), people who are pregnant, postpartum, or lactating, and infants during a radiation emergency. Highlighted preparedness activities include: (1) development of a quick reference guide to inform key questions about pregnant, postpartum, and lactating people, and infants during radiation emergencies; and (2) exercising the role of reproductive health experts during nuclear and radiological incident preparedness activities.

Population monitoring of trisomy 21: problems and approaches

Trisomy 21 (Down syndrome) is the most common autosomal aneuploidy among newborns. About 90% result from meiotic nondisjunction during oogenesis, which occurs around conception, when also the most profound epigenetic modifications take place. Thus, maternal meiosis is an error prone process with an extreme sensitivity to endogenous factors, as exemplified by maternal age. This contrasts with the missing acceptance of causal exogenous factors. The proof of an environmental agent is a great challenge, both with respect to ascertainment bias, determination of time and dosage of exposure, as well as registration of the relevant individual health data affecting the birth prevalence. Based on a few exemplary epidemiological studies the feasibility of trisomy 21 monitoring is illustrated. In the nearer future the methodical premises will be clearly improved, both due to the establishment of electronic health registers and to the introduction of non-invasive prenatal tests. Down syndrome is a sentinel phenotype, presumably also with regard to other congenital anomalies. Thus, monitoring of trisomy 21 offers new chances for risk avoidance and preventive measures, but also for basic research concerning identification of relevant genomic variants involved in chromosomal nondisjunction.

Ionizing radiation and cancer: The failure of the risk model

This review presents evidence that the methodology that supports the current radiation risk model for cancer is insecure. As a consequence, the legal limits on internal exposures to certain common radionuclides are incorrect by several orders of magnitude. Because of this, hundreds of millions of people will have developed cancer due to internal exposures from atmospheric testing fallout, nuclear accidents, Depleted Uranium and releases from nuclear sites. There are fatal errors in both the mechanistic and epidemiological bases of the Linear No Threshold (LNT) Absorbed Dose model. The review discusses the history of the model and refers to published studies that clearly demonstrate these errors. It argues that the ways in which the models were constructed were arbitrary, capricious and unscientific.

De novo congenital malformation frequencies in children from the Bryansk region following the Chernobyl disaster (2000-2017)

BACKGROUND

Ionizing radiation and chemical pollution can disrupt normal embryonic development and lead to congenital malformations and fetal death. We used official government statistical data for 2000-2017 to test the hypothesis that radioactive and chemical pollutants influenced the frequency of de novo congenital malformations in newborns of the Bryansk region of southwest Russia.

METHODS

A variety of statistical approaches were used to assess congenital malformation frequencies including the Shapiro-Wilk test, White's homoscedasticity test, Wilcoxon T-test, Spearman's rank correlation test, and the inversely proportional regression.

RESULTS

We found that the frequency of polydactyly, multiple congenital malformations, and the frequency of de novo congenital malformations in newborns were significantly higher (p = 0.001-0.054) in regions with elevated radioactive, chemical and combined contamination. Polydactyly, multiple congenital malformations, and the sum of all congenital malformations were 4.7-7.4 times, 2.5-6.8 times, and 3.5-4.6 times higher in contaminated regions in comparison with the control group. The combination of both radioactive and chemical pollutants led to significantly higher frequencies of multiple congenital malformations when compared to regions with only one pollutant (radiation alone: 2.2 times, p = 0.034; chemical pollutants alone: 1.9 times, p = 0.008) implying that the effects of these stressors were at minimum additive. Although there was a trend for decreasing frequencies of multiple congenital malformations during the 2000-2017 period in areas of combined pollution, the opposite was true for regions with radioactive or chemical pollutants alone. However, overall, our models suggest that the frequency of multiple congenital malformations in areas of combined pollution will significantly (p = 0.027) exceed the frequencies observed for regions containing radioactive or chemical pollutants alone by 39.6% and 45.7% respectively, by 2018-2023.

CONCLUSION

These findings suggest additive and potentially synergistic effects of radioactive and chemical pollutants on the frequencies of multiple congenital malformations in the Bryansk region of southwestern Russia.

Low dose or low dose rate ionizing radiation-induced health effect in the human

The extensive literature review on human epidemiological studies suggests that low dose ionizing radiation (LDIR) (≤100 mSv) or low dose rate ionizing radiation (LDRIR) (<6mSv/H) exposure could induce either negative or positive health effects. These changes may depend on genetic background, age (prenatal day for embryo), sex, nature of radiation exposure, i.e., acute or chronic irradiation, radiation sources (such as atomic bomb attack, fallout from nuclear weapon test, nuclear power plant accidents, ⁶⁰Co-contaminated building, space radiation, high background radiation, medical examinations or procedures) and radionuclide components and human epidemiological experimental designs. Epidemiological and clinical studies show that LDIR or LDRIR exposure may induce cancer, congenital abnormalities, cardiovascular and cerebrovascular diseases, cognitive and other neuropsychiatric disorders, cataracts and other eye and somatic pathology (endocrine, bronchopulmonary, digestive, etc). LDIR or LDRIR exposure may also reduce mutation and cancer mortality rates. So far, the mechanisms of LDIR- or LDRIR -induced health effect are poorly understood. Further extensive studies are still needed to clarify under what circumstances, LDIR or LDRIR exposure may induce positive or negative effects, which may facilitate development of new therapeutic approaches to prevent or treat the radiation-induced human diseases or enhance radiation-induced positive health effect.

Current Evidence for Developmental, Structural, and Functional Brain Defects following Prenatal Radiation Exposure

Ionizing radiation is omnipresent. We are continuously exposed to natural (e.g., radon and cosmic) and man-made radiation sources, including those from industry but especially from the medical sector. The increasing use of medical radiation modalities, in particular those employing low-dose radiation such as CT scans, raises concerns regarding the effects of cumulative exposure doses and the inappropriate utilization of these imaging techniques. One of the major goals in the radioprotection field is to better understand the potential health risk posed to the unborn child after radiation exposure to the pregnant mother, of which the first convincing evidence came from epidemiological studies on in utero exposed atomic bomb survivors. In the following years, animal models have proven to be an essential tool to further characterize brain developmental defects and consequent functional deficits. However, the identification of a possible dose threshold is far from complete and a sound link between early defects and persistent anomalies has not yet been established. This review provides an overview of the current knowledge on brain developmental and persistent defects resulting from in utero radiation exposure and addresses the many questions that still remain to be answered.

Genetic radiation risks: a neglected topic in the low dose debate

OBJECTIVES

To investigate the accuracy and scientific validity of the current very low risk factor for hereditary diseases in humans following exposures to ionizing radiation adopted by the United Nations Scientific Committee on the Effects of Atomic Radiation and the International Commission on Radiological Protection. The value is based on experiments on mice due to reportedly absent effects in the Japanese atomic bomb (Abomb) survivors.

METHODS

To review the published evidence for heritable effects after ionising radiation exposures particularly, but not restricted to, populations exposed to contamination from the Chernobyl accident and from atmospheric nuclear test fallout. To make a compilation of findings about early deaths, congenital malformations, Down's syndrome, cancer and other genetic effects observed in humans after the exposure of the parents. To also examine more closely the evidence from the Japanese A-bomb epidemiology and discuss its scientific validity.

RESULTS

Nearly all types of hereditary defects were found at doses as low as one to 10 mSv. We discuss the clash between the current risk model and these observations on the basis of biological mechanism and assumptions about linear relationships between dose and effect in neonatal and foetal epidemiology. The evidence supports a dose response relationship which is non-linear and is either biphasic or supralinear (hogs-back) and largely either saturates or falls above 10 mSv.

CONCLUSIONS

We conclude that the current risk model for heritable effects of radiation is unsafe. The dose response relationship is non-linear with the greatest effects at the lowest doses. Using Chernobyl data we derive an excess relative risk for all malformations of 1.0 per 10 mSv cumulative dose. The safety of the Japanese A-bomb epidemiology is argued to be both scientifically and philosophically questionable owing to errors in the choice of control groups, omission of internal exposure effects and assumptions about linear dose response.

Determining and Managing Fetal Radiation Dose from Diagnostic Radiology Procedures in Turkey

OBJECTIVE

We intended to calculate approximate fetal doses in pregnant women who underwent diagnostic radiology procedures and to evaluate the safety of their pregnancies.

MATERIALS AND METHODS

We contacted hospitals in different cities in Turkey where requests for fetal dose calculation are usually sent. Fetal radiation exposure was calculated for 304 cases in 218 pregnant women with gestational ages ranging from 5 days to 19 weeks, 2 days. FetDose software (ver. 4.0) was used in fetal dose calculations for radiographic and computed tomography (CT) procedures. The body was divided into three zones according to distance from the fetus. The first zone consisted of the head area, the lower extremities below the knee, and the upper extremities; the second consisted of the cervicothoracic region and upper thighs; and the third consisted of the abdominopelvic area. Fetal doses from radiologic procedures between zones were compared using the Kruskal-Wallis test and a Bonferroni-corrected Mann-Whitney U-test.

RESULTS

The average fetal doses from radiography and CT in the first zone were 0.05 ± 0.01 mGy and 0.81 ± 0.04 mGy, respectively; 0.21 ± 0.05 mGy and 1.77 ± 0.22 mGy, respectively, in the second zone; and 6.42 ± 0.82 mGy and 22.94 ± 1.28 mGy, respectively, in the third zone (p < 0.001). Our results showed that fetal radiation exposures in our group of pregnant women did not reach the level (50 mGy) that is known to increase risk for congenital anomalies.

CONCLUSION

Fetal radiation exposure in the diagnostic radiology procedures in our study did not reach risk levels that might have indicated abortion.

Pilot study of congenital anomaly rates at birth in fallujah, iraq, 2010

Objectives

To examine numbers of congenital anomaly (CA) at birth overall and by class in one clinic in Fallujah General Hospital, Fallujah, Iraq.

Study Design:

All congenital anomaly birth referrals to one pediatric clinician at Fallujah General Hospital for an eleven month period beginning November 1, 2009 were recorded. This clinic was one of three clinics to which cases would be referred.

Results:

There were 291 CA cases registered at birth in the period at the study’s clinic. The total number of births recorded in the hospital over the period was 6049. The CAs included 113 heart and circulatory system cases, 72 nervous system cases, 40 digestive system cases, 9 genitourinary cases, 6 ear, face and neck cases, 7 respiratory cases and 30 Down syndrome cases.

Conclusion:

Owing to difficulties establishing the exact number of births from which these cases were drawn, the exact rates cannot be precisely determined. Nevertheless, on the basis of reasonable assumptions relating to the activity of the clinic involved, these results support earlier epidemiological findings. On the basis of work reported elsewhere, the higher rates of congenital anomalies are believed to be caused by exposure to some genotoxic agent, possibly uranium.

Fear of the unknown: ionizing radiation exposure during pregnancy

Ionizing radiation during pregnancy can negatively impact a fetus. In light of the Fukushima nuclear plant disaster in Japan, we discuss existing knowledge on the health effects of radiation and preventive measures for pregnant women. Overall, the risk of exposure to radiation is limited but severe defects can result from fetal radiation exposure >100 mGy equivalent to 10 rad (>1000 chest x-rays). While such high-level exposure rarely occurs during single medical diagnostic procedures, caution should be exercised for pregnant women. As a protective public health measure in light of a disaster, evacuation, shielding, and elimination of ingested radioactive isotopes should all be considered. Detailed radiation reports with health effects and precautionary measures should be available for a population exposed to more than background radiation.

Cancer in children residing near nuclear power plants: an open question

BACKGROUND

Global warming and the established responsibility of the anthropogenic emissions of greenhouse gases represent a strong push towards the construction of new nuclear power plants (NPPs) to cope with the growing energy needs. The toxicity of nuclear waste associated with the extreme difficulty of their disposal and increase in cancer mortality and incidence following occupational radiation exposure are considered the only health problems.

METHODS

A search of scientific articles and government documents published since January 1, 1980 to July 1, 2010 was performed to evaluate cancer rate and mortality in residents, particularly children, in the vicinity of NPPs.

RESULTS

A recent well conducted state-of-the-art case-control study of childhood cancers in the areas around German NPPs (KiKK study) showed a statistically significant cancers (2.2-fold increase in leukemia and a 1.6-fold increase in solid tumor) among children under five years of age living in the inner 5 km circle around NPPs when compared to residence outside this area. These findings have been confirmed by two meta-analyses. Nevertheless, other UK, France, Spain and Finland studies did not find cancer incidence and/or death increase near NPPs.

CONCLUSIONS

Increased cancer risk near NPPs remains in fact an open question. The stronger evidence from the KiKK study suggests there may well be such increases at least in children regardless of the country in which nuclear reactors are located. In fact, few months ago the U.S. Nuclear Regulatory Commission has asked the National Academy of Sciences (NAS) to perform a state-of-the-art study on cancer risk for populations surrounding NPPs.

Very low dose fetal exposure to Chernobyl contamination resulted in increases in infant leukemia in Europe and raises questions about current radiation risk models

Following contamination from the Chernobyl accident in April 1986 excess infant leukemia (0–1 y) was reported from five different countries, Scotland, Greece, Germany, Belarus and Wales and Scotland combined. The cumulative absorbed doses to the fetus, as conventionally assessed, varied from 0.02 mSv in the UK through 0.06 mSv in Germany, 0.2 mSv in Greece and 2 mSv in Belarus, where it was highest. Nevertheless, the effect was real and given the specificity of the cohort raised questions about the safety of applying the current radiation risk model of the International Commission on Radiological Protection (ICRP) to these internal exposures, a matter which was discussed in 2000 by Busby and Cato [7,8] and also in the reports of the UK Committee examining Radiation Risk from Internal Emitters. Data on infant leukemia in the United Kingdom, chosen on the basis of the cohorts defined by the study of Greece were supplied by the UK Childhood Cancer Research Group. This has enabled a study of leukemia in the combined infant population of 15,466,845 born in the UK, Greece, and Germany between 1980 and 1990. Results show a statistically significant excess risk RR = 1.43 (95% CI 1.13 < RR < 1.80 (2-tailed); p = 0.0025) in those born during the defined peak exposure period of 01/07/86 to 31/12/87 compared with those born between 01/01/80 and 31/12/85 and 01/01/88 and 31/12/90. The excess risks in individual countries do not increase monotonically with the conventionally calculated doses, the relation being biphasic, increasing sharply at low doses and falling at high doses. This result is discussed in relation to fetal/cell death at higher doses and also to induction of DNA repair. Since the cohort is chosen specifically on the basis of exposure to internal radionuclides, the result can be expressed as evidence for a significant error in the conventional modeling for such internal fetal exposures.

Childhood leukemia and cancers near German nuclear reactors: significance, context, and ramifications of recent studies

A government-sponsored study of childhood cancer in the proximity of German nuclear power plants (German acronym KiKK) found that children < 5 years living < 5 km from plant exhaust stacks had twice the risk for contracting leukemia as those residing > 5 km. The researchers concluded that since "this result was not to be expected under current radiation-epidemiological knowledge" and confounders could not be identified, the observed association of leukemia incidence with residential proximity to nuclear plants "remains unexplained." This unjustified conclusion illustrates the dissonance between evidence and assumptions. There exist serious flaws and gaps in the knowledge on which accepted models for population exposure and radiation risk are based. Studies with results contradictory to those of KiKK lack statistical power to invalidate its findings. The KiKK study's ramifications add to the urgency for a public policy debate regarding the health impact of nuclear power generation.