> **Agenda for HHS Public Health Activities**

(For Fiscal Years 2005--2010) at

U.S. Department of Energy Sites

**January 2005**

**U.S. Department of Energy**

Office of Health Studies

and

**U.S. Department of Health and Human Services**

Agency for Toxic Substances and Disease Registry

Centers for Disease Control and Prevention

National Center for Environmental Health

National Institute for Occupational Safety and Health

**Table of Contents**

Introduction....................................................................................................
3

Background....................................................................................................
4

Agenda
Organization.........................................................................................
6

Brookhaven National
Laboratory.....................................................................\...\....
7

Energy Technology Engineering
Center..................................................................
11

Fernald Environmental Management
Project............................................................. 14

Hanford Nuclear
Reservation........................................................................\...\.....
18

Idaho National
Laboratory......................................................................\...\...\...
27

Laboratory for Energy-Related Health
Research........................................................ 34

Lawrence Livermore National
Laboratory...............................................................
35

Los Alamos National
Laboratory..........................................................................
38

Mallinckrodt
Plant..........................................................................................
44

Middlesex Sampling
Plant.................................................................................
46

Monticello Mill Tailings
Site..............................................................................
49

Mound
Plant..................................................................................................
52

Nevada Test Site
(NTS)....................................................................................
55

Oak Ridge
Reservation.....................................................................................
60

Paducah Gaseous Diffusion
Plant.........................................................................
76

Pantex
Plant...................................................................................................
88

Portsmouth Gaseous Diffusion
Plant......................................................................
80

Rocky Flats
Plant............................................................................................
84

Salmon Test
Site............................................................................................
.92

Savannah River
Site........................................................................................
.95

Shipyards in the Naval Nuclear Propulsion
Program.................................................. 101

Agency for Toxic Substances and Disease Registry Multi-Site
Activities......................... 104

National Center for Environmental Health (NCEH) Multi-Site
Activities......................... 110

National Institute for Occupational Safety and Health (NIOSH) Multi-Site
Studies..............111

Department of Energy (DOE) Health-Related
Activities.............................................115

Appendix A

Abbreviations, Acronyms, and
Symbols...................................................\.....123

Appendix B

Glossary of
Terms..................................................................................129

**Introduction**

The U.S. Department of Health and Human Services (HHS) and the U.S.
Department of Energy (DOE), Office of Health Studies, developed the
present *Agenda for HHS Public Health Activities (for Fiscal Years
2005--2010) at Department of Energy Sites*. HHS committees chartered
under the Federal Advisory Committee Act provided suggestions on
conducting HHS health studies and DOE public health activities at these
sites: the Fernald Environmental Management Project, the Hanford Nuclear
Reservation, the Idaho National Laboratory, and the Savannah River Site.
Open public meetings were specifically convened in 1997 and 1998 to
gather suggestions and feedback on health studies and public health
activities at the following DOE sites: the Los Alamos National
Laboratory, the Oak Ridge Reservation, and the Rocky Flats Plant.

At public meetings at these and other DOE sites, individuals also
provided input. A draft agenda was prepared and public comment sought.
In April 1999, notice of the agenda was published in the *Federal
Register* and 54 individuals or groups sent in comments. The present
agenda reflects input from all the above noted sources, as well as
comments received that are pertinent to the development of a
consolidated and coordinated health studies and public health activities
strategy for DOE workers and surrounding communities. DOE and HHS are
examining ways to increase future public participation into the agenda
process. One approach being used is to request comments when this agenda
is distributed each year to the respective agencies' stakeholders and
the public. Comments and suggestions received by the agencies are
considered for incorporation into subsequent revisions of the agenda.

This agenda is not a complete review of the literature, but instead it
provides some background for the proposed activities. It focuses
primarily on current and future activities. Implementing the activities
on the agenda is contingent on funding by Congress.

**Background**

Energy-related health studies and public health activities conducted by
the National Center for Environmental Health (NCEH), the National
Institute for Occupational Safety and Health (NIOSH), and the Agency for
Toxic Substances and Disease Registry (ATSDR) are accomplished under a
Memorandum of Understanding (MOU) with HHS. DOE's Office of Environment,
Safety and Health (EH) manages the MOU. A moratorium is currently in
place on the destruction of any DOE records that might be useful in
conducting health studies or public health activities.

Health-related research and public health activities are occurring at
numerous sites. However, not all sites have ongoing or planned research
or public health activities. Workers, managers, and other stakeholders
have identified knowledge gaps that are both general to DOE and
site-specific (including some sites not in this agenda). This agenda
attempts to address the identified gaps.

**General Information and Overall Gaps in Knowledge**

Scientific opinions regarding the magnitude of risk associated with
chronic low-level radiation exposure are polarized and the subject of
ongoing debates. The contribution of risks to workers and community
members around DOE sites stemming from exposures to chemical hazards and
combinations of chemicals and radioactive materials have not been
adequately described. For the reasons listed below, the next decade is
the best time to study low-level radiation exposure, and any association
of chemical and complex chemical/radiological exposures among workers
and community members around DOE sites.

-   Findings may be relevant to former workers, to 300,000 current DOE
    nuclear-facility workers, to the 1.5 million current U.S. radiation
    workers in other industries (including nuclear energy and the
    medical field), and to community members around DOE sites;

-   Findings may help resolve the controversy surrounding low-level
    chronic exposure and linear no-threshold risk models;

-   Findings would address and answer concerns and interests of
    stakeholders about the risks from chemicals and the combination of
    chemical/radioactive hazard exposures;

-   An important window of opportunity of limited duration for DOE
    records and institutional memory of past and present employees
    currently exists; and

-   Latency periods for the development of health effects in workers and
    communities are long enough (in most cases) to conduct meaningful
    health studies.

Nevertheless, no single study will remove all uncertainty from the
current risk estimates. The exact relationship between adverse health
effects and exposures to chemicals or radioactive materials can only be
discovered and appropriately characterized through the collective
evaluation of multiple epidemiological and mechanistic studies. For
example, recent occupational studies found a dose-response relationship
between external radiation dose and the risk of mortality from lung
cancer (Fernald) and leukemia (Savannah River and Portsmouth Naval
Shipyard). Also, the three-nation study by the International Agency for
Research on Cancer (IARC) showed a dose-response relationship for
external radiation and leukemia.

The following general activities have knowledge gaps that need to be
addressed (this list is neither final nor comprehensive).

-   Further epidemiologic research is needed to evaluate current
    occupational radiation exposure limits. Many of these exposure
    limits were developed from bomb survivor and radiation therapy
    exposure data that differ in intensity, duration, route of exposure,
    and frequency from that found in the workplace.

-   The relationship between internal radiation dose and health effects
    needs to be evaluated.

-   Results from ongoing mortality studies need to be evaluated to
    improve our understanding of the causes of cancer and chronic
    diseases. Additional studies can be proposed to focus on a single
    disease in worker groups, such as previously reported excesses of
    multiple myeloma and Hodgkin disease.

-   Complete records, including industrial hygiene and work history data
    for the various levels of subcontractors at each site, must be made
    available.

-   Primary care providers should be given lists of sentinel health
    events for radiation communities and training programs.

-   As significant exposures are identified, community members and
    healthcare professionals need educational information concerning
    risks and potential health effects.

-   Subcontractors and cleanup workers, as well as their respective
    exposures, need better characterization and documentation in order
    to support potential prospective studies.

-   Health effects among workers with simultaneous exposures to low
    levels of chemicals and/or radiation and other risk factors should
    be addressed.

Emerging findings from DOE-funded former worker medical monitoring
projects suggest that nonradiological hazards may contribute to
work-related disease among DOE workers to a greater extent than
previously recognized.

**Agenda Organization**

The agenda is organized first according to general information and
overall gaps in knowledge about the health effects of hazards at DOE
sites and then alphabetically by the DOE site for which specific public
health activities and/or research are planned. The NIOSH Multi-Site
Section describes single and/or multi-site worker studies proposed by
NIOSH, but for which sites cannot be selected until additional
evaluation is carried out to determine the best locations for conducting
the studies. Other sections describe multi-site studies performed by
ATSDR, NCEH, and DOE. The following information is provided for each
site plan:

-   Background information on the site

-   Summary of past studies and assessments of the site

-   Summary of current health research and public health activities at
    the site

-   Issues that might need to be addressed in the future about the site

-   Ongoing and proposed new activities at the site for fiscal years
    (FY) 2005-2010.

**Brookhaven National Laboratory (BNL)**

Upton, New York

**Background**

The Brookhaven National Laboratory (BNL) consists of slightly more than
8 square miles (5,265 acres) near the center of Long Island, in Suffolk
County, about 60 miles east of New York City. The surrounding area is
heavily populated, with more than 1.5 million people living in Suffolk
County.

BNL is an active site, which carries out basic and applied research in
high-energy nuclear and solid state physics; fundamental material and
structure properties and the interactions of matter; nuclear medicine;
biological effects of ionizing radiation; medical uses of radionuclides
and ionizing radiation; biomedical and environmental sciences; and
selected energy technologies. The Army used the site (named Camp Upton)
during World Wars I and II. From 1947 to 1998, Associated Universities,
Inc., operated BNL under contract first to the Atomic Energy Commission
(AEC) and then to DOE. Brookhaven Science Associates now operates BNL
under contract to DOE.

Past practices at BNL have resulted in on and off-site groundwater
contamination with radionuclides, such as tritium and strontium-90. A
1992 Interagency Agreement signed by the Environmental Protection Agency
(EPA), the New York State Department of Environmental Conservation, and
DOE governs the environmental restoration program. Suffolk County and
the public are active in the decision-making process. The site is
removing or immobilizing sources of groundwater contamination, and
treating groundwater to remove contaminants.

The community is concerned about groundwater contamination, the
existence of radionuclides in on-site soils, off-site contamination in
the Peconic River, and the effects of radioactive air emissions
resulting from past and present facility operations. The community and
special interest groups are highly aware of activities at the site since
a tritium leak from the spent fuel pool of one of the two research
reactors was discovered. The community is especially concerned about the
association between an increased incidence of cancer, especially breast
cancer on Long Island, and air releases of radionuclides from the site's
reactors.

**Past Activities at BNL**

*Off-Site Contamination*

-   A health consultation by ATSDR, which focused on groundwater,
    concluded that sampling results of residential wells do not indicate
    that individuals are being exposed to contaminant levels that would
    cause adverse health effects. In 1995, plumes of groundwater
    contaminated with volatile organic compounds (VOCs), including
    carbon tetrachloride, were found off-site. Further characterization
    found that the contamination had migrated approximately 7,500 feet
    south of the site boundary. The plumes become deeper as the distance
    from the source areas increases. Contaminants are generally deeper
    than residential wells in the area. A plume of lower concentration
    VOCs, predominantly trichloroethylene, extends approximately 4,000
    feet east of the site boundary. The source of the contaminants is
    historical releases from the BNL sewage treatment plant. While low
    levels of tritium have been detected off-site, no monitoring well or
    residential well samples are above the drinking water standard for
    any radionuclide.

-   As a precaution, DOE offered to test the water in existing private
    wells that might be affected and, at the homeowner's option, connect
    residences to the public water supply. When the hookup program ended
    in 1998, DOE, in conjunction with the Suffolk County Department of
    Health Services, had connected approximately 1,500 residences to the
    public water supply.

*Community Health Studies and Activities*

-   A 1994 study by the New York State Department of Health found
    elevated risks for postmenopausal breast cancer among women living
    close to chemical facilities in Nassau County. Although BNL is not
    located in this county, community and activist groups are concerned
    about BNL's possible contribution to increased incidences of breast
    cancer.

-   A limited study commissioned by the Suffolk County legislature
    assessed the geographic patterns of cancers and congenital
    malformations in relation to BNL. Cancer rates for all types of
    cancers studied, including childhood cancers, were not elevated near
    BNL, and there was no evidence that rates differed by sector or were
    correlated with underground plume or wind direction. Malformation
    rates were similar in Suffolk County and other areas, except for
    congenital hip dislocation, which was higher in Suffolk County but
    similar to the rate of upstate New York. The rate of female breast
    cancer was elevated on the east end of Long Island; however, it was
    not attributed to BNL.

*Studies of the Health of BNL Workers*

> The New York Department of Health recently released a study comparing
> the cancer incidence of workers at BNL to the cancer incidence in New
> York state less New York City and Suffolk County.

**Current Activities at BNL**

*Community Involvement*

> **ATSDR meetings to determine priorities for public health assessment
> and consultation.** As part of the public health assessment process,
> ATSDR, DOE, and local community members and organizations (e.g.,
> homeowners' associations from the Yaphank, Manorsville, Longwood,
> Brookhaven, and Middle Island communities; and two activist groups:
> the Citizens Campaign for the Environment and Environmental Advocates
> of Long Island) are determining priorities. The community has
> requested health consultations on groundwater contamination and air
> quality. ATSDR has completed the groundwater health consultation and
> presented its findings to the Brookhaven Executive Roundtable.

*Off-Site Contamination*

> **ATSDR public health assessment.** ATSDR is preparing a public health
> assessment of the public health impact from releases of hazardous
> materials from the site. Potential exposure pathways include on- and
> off-site groundwater contaminated with VOCs, and on-site groundwater
> contaminated with radionuclides. Air releases are also being
> considered. In addition, community health concerns, such as incidence
> of rhabdomyosarcoma and health outcome data for the area, are being
> evaluated. ATSDR submitted the public health assessment for data
> validation in FY2004; public comment release is targeted for FY2005.

*Community Health Studies and Activities*

-   **ATSDR health education and promotion.** As a follow-up to the
    public health activities conducted at the site, ATSDR will provide
    health education and health promotion activities for the communities
    around the site. This could include healthcare provider education
    and community education regarding the information from the state
    health department and other agencies' work.

-   **Long Island Breast Cancer Study Project.** This multi-study effort
    investigates whether environmental factors are responsible for
    breast cancer in Tolland County, Connecticut, and in the New York
    counties of Nassau, Schoharie, and Suffolk. The study began in 1993
    and is funded and coordinated by the National Cancer Institute and
    the National Institute for Environmental Health Sciences.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE work force at 14 DOE sites, including BNL. The goal
> is to identify groups of workers who are not always union workers that
> may be at increased risk for occupation-related injury and illness.

**Issues Needing Attention at BNL**

-   Community groups have requested an in depth epidemiologic study of
    workers.

-   The community is concerned about rhabdomyosarcoma in relationship to
    BNL.

**Proposed Activities at BNL**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway and to initiate new ones. However, such activities
> will be implemented only if feasible and appropriate and beneficial to
> the community. The agencies will establish a coordinated plan,
> schedule, and lead organization for each new public health activity.
> The plan and schedule will be presented to all potential partners for
> their comment.

*New Activities for FY 2005--2010*

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers. A new project will be initiated within
> the next several months.

-   A new regional former worker medical screening project, administered
    by Queens College will offer former workers from BNL medical
    screening.

**Energy Technology Engineering Center**

**(Santa Susana Field Laboratory, SSFL)**

Simi Valley, California

**Background**

The 2,700-acre Santa Susana Field Laboratory (SSFL) is located in Simi
Valley, Ventura County, California. SSFL was established in 1946 to test
rocket engines. The then named Atomics International facility was
operated by North American Aviation. Later name and ownership changes
resulted in current operations of the site by Rocketdyne, until recently
a division of Rockwell International. Rocketdyne is now a division of
Boeing North American.

The DOE lease-options a small part of Area IV, known as the Energy
Technology Engineering Center (ETEC), which consists of government-owned
buildings on 90 acres of land owned by Rocketdyne. The ETEC site
includes buildings used for auxiliary support facilities mechanical and
chemical test facilities; offices; and the testing of apparatus for
large-scale heat transfer and fluid mechanics experiments. ETEC opened
in the late 1950s and developed security-sensitive projects involving
hazardous materials. These projects supported nuclear research and
energy development projects for DOE and its predecessor agency. There
are no longer any DOE-funded research and development activities at the
site.

**Past Activities at SSFL**

*Off-Site Contamination*

> · The site has a number of buildings and areas contaminated with
> chemical and radioactive substances. This contamination may exist in
> the air, groundwater, soil, structures, and surface water. Some
> testing procedures and the sodium disposal facility are the source of
> some off-site contamination, including contamination with tritium and
> other radionuclides. Off-site radionuclides that exceed background
> concentrations include cesium-137, plutonium-238, strontium-90, and
> tritium.

· **ATSDR preliminary site evaluation.** In December 1999, ATSDR
completed a Draft Preliminary Site Evaluation for SSFL, which concluded
that a more in depth evaluation of exposure pathways that addresses
past, current, and future exposure to chemicals and radionuclides from
SSFL is needed.

*Community Health Studies and Activities*

· The California Department of Health Services conducted a cancer
incidence study in the Los Angeles County census tracts near SSFL for
1978--1989. The study found that, for 1983--1988, males residing near
SSFL were at increased risk of developing cancers, in particular bladder
cancer, possibly due to radiation.

· In 1997, the Tri-Counties Regional Cancer Registry performed a
preliminary analysis on 1988--1995 cancer incidences among Ventura
County residents living within a 5-mile radius of SSFL. An increase in
lung cancer was reported for the combination of men and women. However,
this increase was small, and lung cancer was not significantly increased
in men or women separately. This preliminary analysis also reported a
significant decrease in the leukemia incidence in women.

· As part of DOE funding, which ended in FY 1999, the State of
California established an oversight panel of citizens and scientists to
study Rocketdyne workers. The panel has recommended that a community
health study be conducted.

*Studies of the Health of SSFL/ETEC Workers*

> The University of California at Los Angeles (UCLA) conducted two
> epidemiologic studies of workers employed at Rocketdyne/Atomics
> International in Ventura County. Many of these workers were assigned
> to SSFL. The first study was of mortality among workers monitored for
> exposure to ionizing radiation. The second study was an in depth
> analysis of mortality among workers exposed to asbestos and the rocket
> fuel monomethyl hydrazine.

· The first study concluded that workers exposed to higher lifetime
doses of external ionizing radiation had an increased risk of dying from
cancers of the blood and lymphatic system, and from lung cancer. Among
workers who were monitored for internal radiation, those who received
higher lifetime doses had a significantly higher risk of dying from
cancers of the blood and lymphatic system and cancers of the esophagus,
oral cavity, pharynx, and stomach.

· In the second study, asbestos and hydrazine exposures were evaluated
for radiation-monitored workers. The study concluded that the higher
risk of lung cancer seen for these workers was not due to asbestos
exposure. Workers exposed to the highest levels of hydrazine in the
1960s had a higher risk of lung cancer relative to those with the lowest
exposures.

**Current Activities at SSFL**

*Community Health Studies and Activities*

> In response to petition requests from Senators Diane Feinstein and
> Barbara Boxer, and Representative Elton Gallegly, ATSDR released a
> draft preliminary site evaluation in December 1999. The document
> addressed the concerns of the community and presented a preliminary
> assessment of the potential for adverse human health effects from
> past, present, and future activities at the site based on currently
> available information. The preliminary site evaluation recommended
> specific followup activities.

-   **ATSDR exposure assessment and ATSDR health education and
    promotion.** In December 1999, ATSDR completed a Draft Preliminary
    Site Evaluation for SSFL. To implement the recommendations of that
    report, ATSDR contracted with Eastern Research Group, Inc. (ERG) to
    conduct the Santa Susanna Public Health Initiative. This initiative
    will address the following issues:

> · The development of a regional hydrogeological flow model and
> additional
>
> monitoring at down-gradient springs or seeps in Simi Valley and Santa
> Susana
>
> Knolls to evaluate the potential for deep fracture flow and future
> exposure;
>
> · The additional radiological characterization of Area IV with more
> sensitive
>
> instrumentation and appropriate grid spacing to ensure a lower
> detection limit;
>
> · A more in depth evaluation of airborne chemical releases from SSFL
> operations, including air dispersion modeling of past accidents and
> disposal activities, and the compilation and use of a consistent,
> site-specific meteorological data set to improve the assessment of
> past exposures to these substances; and
>
> · A re-analysis of the cancer registry data, which includes additional
> years of newly available cancer data and updated demographic
> information, to determine if the apparent increases in the incidence
> rates of bladder and lung cancers persist.

*Occupational Health Studies*

No DOE sponsored occupational health studies are currently underway.

**Issues Needing Attention at SSFL**

> Issues identified in the preliminary site assessment are being
> addressed through ATSDR's Santa Susana Public Health Initiative.

**Proposed Activities at SSFL**

*New Activities for FY 2005*

No new activities planned.

**Fernald Environmental Management Project (FEMP)**

Fernald, Ohio

**Background**

The Feed Materials Production Center (FMPC) was a DOE facility located
near Fernald, Ohio, about 18 miles northwest of Cincinnati. FMPC was
operational from 1951 to 1988, and was involved in a number of
activities related to uranium production and processing. Specifically,
the facility produced highly purified uranium metal products that were
used as feed materials in DOE production reactors. After production
stopped, the site was renamed the Fernald Environmental Management
Project (FEMP). DOE and its contractor are now decommissioning and
cleaning up the site.

During its more than 40 years of operation, the facility released
radioactive and hazardous materials into the environment, primarily
uranium, radon, and radon decay products. Releases occurred during
routine plant operations and waste management and storage activities.
Four large concrete silos, built in 1952, store radioactive residues
from former uranium processing activities. Two of these, the K-65 silos,
contain high radium-bearing residues. The silo residues are being
removed, processed, and shipped off-site for permanent disposal sometime
after 2007.

Emissions from the K-65 silos have been a significant source of radon
exposure to workers and residents. In 1991, bentonite clay was injected
into the silos to cap the residues and reduce radon emissions.
Communities and workers have health concerns about the radioactive
wastes stored at the site and the historical releases to the
environment.

**Past Activities at FEMP**

*Off-Site Contamination*

· **NCEH Fernald Dosimetry Reconstruction Project.** Studies by CDC's
NCEH have shown that past inhalation of radon and radon progeny from the
silos (prior to capping with bentonite) was a major contributor to
radiation dose. Other contributors included uranium, thorium, and other
radionuclides. The project estimated releases of radiation materials
from past operations at the Fernald site and the potential effects of
those releases on off-site residents.

· **NCEH Fernald Risk Assessment Project.** This project aims to
characterize the human health risk that may have been associated with
past exposures to radioactive materials that were released from FMPC
while it was operating. The project sought to address community health
concerns and to help evaluate the feasibility of an epidemiologic study
within the community. The first phase of this project provided estimates
on the impact of the site on lung cancer mortality. The study reported
that the estimated number of lung cancer deaths occurring between 1951
and 2088 may increase between 1% and 12% as a result of FMPC radiation
exposure. Exposure to radon and radon progeny accounted for most of the
estimated total lung dose. Estimates were projected through the year
2088 to allow residents who were exposed the last year the plant
operated, 1988, to reach 100 years of age.

> The second phase of this project provided screening level estimates of
> the lifetime risk for developing kidney cancer, female breast cancer,
> bone cancer, and leukemia as a result of the maximum estimated
> exposure to radioactive materials released from the site.
>
> The project estimated an upper bound (or worst case number) of 23 or
> less additional cases of leukemia, 4 or less additional cases of
> kidney cancer, 3 or less additional cases of female breast cancer, and
> 4 or less additional cases of bone cancer among the approximately
> 46,000 people who resided within the assessment domain sometime from
> 1951 through 1988 as a result of exposure to radiation released from
> the site.

· **ATSDR public health assessment.** In May 2000, ATSDR released a
public health assessment for public comment. ATSDR concluded that past
exposure to uranium in groundwater was a public health hazard. (NCEH had
previously determined that past airborne exposure to radon had been a
public health hazard.) Although potential effects from current exposure
to groundwater could not be determined because of incomplete
information, ATSDR concluded that there are no known exposure pathways
that now pose a public health hazard under current conditions at the
site. The public health assessment was finalized on August 17, 2004.

· **ATSDR residential radon monitoring.** Public concern about whether
bentonite caps on the K-65 silos effectively controlled radon emissions
led ATSDR and EPA's National Air and Radiation Environmental Laboratory
(NAREL) to monitor radon levels in residences near the site. Two sets of
indoor radon measurements were made from 1993 to 1994. The radon levels
measured in most homes were below the EPA's recommended action level of
4 picocuries per liter (pCi/L). Therefore, they were considered typical
of naturally occurring radon and not indicative of increased radon
emissions from the site. ATSDR notified residents of homes with radon
levels greater than 4 pCi/L and provided information about radon sources
and abatement.

· **ATSDR ambient radon monitoring.** In response to public concern
about radon releases from the K-65 silos and other sources on the site,
ATSDR and NAREL have been monitoring radon levels in ambient air
off-site since 1993. ATSDR concluded that, despite increases in on-site
radon emissions over time, radon measured in off-site air has been
relatively constant and at levels considered typical of naturally
occurring radon. An ATSDR health consultation summarizes the findings of
radon monitoring from December 1993 to June 1994. ATSDR is continuing
the ambient radon monitoring during the remediation process.

· **ATSDR health consultation on local milk.** ATSDR concluded that
levels of radionuclides in locally produced milk are not a public health
hazard.

· **ATSDR health consultation on local produce.** ATSDR concluded that
levels of radionuclides associated with locally grown produce are not a
public health hazard.

· **ATSDR health consultation on groundwater.** ATSDR concluded that
using groundwater for nondrinking water uses is not a health hazard from
radionuclides.

*Community Health Studies and Activities*

· In November 1998 and February 2000, ATSDR provided health education
for Fernald area healthcare professionals. The program provided
information and education about industrial processes at Fernald,
historical and current radiological and chemical exposures to workers
and residents, the results of NCEH's lung cancer risk assessment, and
resources for healthcare providers. Representatives from the University
of Cincinnati, Mercy Health Partners, the Fernald Health Effects
Subcommittee, NIOSH, and ATSDR participated in the program.

· **Fernald Health Effects Subcommittee (HES).** The Fernald Health
Effects Subcommittee (FHES) was chartered in 1996 to advise CDC and
ATSDR on their health research and propose actions based on each
agency's findings. The FHES held its final meeting on August 22, 2001,
in Harrison, Ohio. CDC/NIOSH will continue its approach of meeting
independently with workers to obtain input and may convene public
meetings as the need arises, rather than through the Federal Advisory
Committee Act process.

· **ATSDR examination of medical monitoring data**. ATSDR sponsored the
University of Cincinnati Medical Center to conduct a study on the
prevalence of noncancer adverse health outcomes in persons living near
the site. The university used previously collected (since 1990) physical
examination and questionnaire data from participants of the Fernald
Medical Monitoring Program (FMMP). Researchers analyzed medical and
residential history, demographic variables, and selected diagnostic
tests (hematology, serum chemistry, and urinalysis). The final report
was published in FY 2001.

*Studies of the Health of Fernald Workers*

> · The mortality of 4,014 white male workers hired at Fernald from 1951
> to 1981 was studied. Hourly workers had higher death rates than the
> general population for combined cancers, lung cancer, and motor
> vehicle accidents. Salaried workers had a higher rate of death from
> stomach cancer. Lung cancer death rates increased as radiation dose
> increased, and noncancerous respiratory disease mortality increased
> with internal radiation dose.

· A multi-site study of lung cancer mortality and uranium dust exposure
at four uranium processing operations included 51 Fernald workers.
However, specific results for Fernald were not reported. Overall, a
higher risk of lung cancer was reported for workers first hired at age
45 years and older.

· **Mortality among female nuclear workers (MAFN).** A study of female
workers from 12 DOE plants, including Fernald, was combined in a cohort
mortality study, and risk estimates were developed for exposure to
ionizing radiation or to chemical hazards. For the entire pooled cohort,
mortality from mental disorders, diseases of the genitourinary system,
and from ill-defined conditions was higher than expected. External
ionizing radiation exposure in these workers appeared to be associated
with increased relative risk for leukemia and, to a lesser degree, with
increased relative risks for all cancers combined and for breast cancer.

· **Decontamination and decommissioning workers registry (DDWR).** A
NIOSH study assessed whether the information and records at seven DOE
sites, including Fernald, accurately identify remediation workers and
their complete exposure, work history, and medical information. Because
this information is not available, individual workers cannot
consistently be linked to their exposure and medical data, and
comprehensive epidemiologic, exposure assessment, or hazard surveillance
studies of remediation workers cannot be conducted. This study has been
deferred due to budgetary constraints.

· **Exposure assessment of hazardous waste, decontamination and
decommissioning, cleanup workers (HAWW).** Feasibility studies at seven
DOE sites, including Fernald, determined that the availability of
records to identify workers and their primary activities, exposures,
work histories, and medical information varied significantly from site
to site. The necessary information to conduct exposure assessment,
hazard surveillance, or epidemiology studies of remediation workers is
currently not readily available. Within sites, data systems are
fragmented and data management is inconsistent in the current
environment of decentralized management and increased subcontracting.

**Current Activities at FEMP**

*Off-Site Contamination*

**No activities are planned at this time.**

*Community Health Studies and Activities*

-   **ATSDR health education and promotion**. ATSDR, in coordination
    with the University of Cincinnati, developed a Grand Rounds
    presentation in FY 2002. The program addresses chemical toxicity of
    uranium to the kidney and is confirmed for the Nephrology Grand
    Rounds at University Hospital in Cincinnati, Ohio on January
    8, 2003. The program will be videotaped and be shared with other
    interested parties.

*NIOSH Occupational Health Studies*

· **Mortality/exposure assessment study of Fernald (FNUP).** NIOSH is
updating and expanding the mortality study of Fernald workers to expand
on the studies of white males hired at Fernald from 1951 to 1981. All
workers, including females and nonwhite workers employed from 1951 to
1989, will be examined. The mortality update has been expanded to
include both the genders and all races for a total of 7,300 workers.
Special attention will be paid to worker exposures to acid mists,
asbestos, radon, and uranium dust. The protocol has been finalized and
the data collection is planned for FY05.

· **Radon and cigarette smoking exposure assessment in Fernald workers
(PFRS).** University of Cincinnati researchers developed yearly and
cumulative individual radon exposure estimates for Fernald workers using
data from existing occupational histories and other site information.
Smoking history information from an ongoing medical surveillance program
was extended to living workers not enrolled. Surrogate data was
collected from family members of the deceased. The data analysis has
been completed and reports will be drafted in FY05.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE work force at 14 DOE sites, including FEMP. The goal
> is to identify groups of workers that may be at increased risk for
> occupation-related injury and illness.
>
> *DOE Former Workers Program*

-   The Former Fernald Production Workers project, administered by
    Queens College, will offer former production workers and other
    nonconstruction workers from Fernald medical screening.

-   These activities will complement an ongoing effort, conducted under
    the Fernald Settlement Fund, to screen former workers who were
    employed at the plant between the years 1952-1985 for at least one
    year.

**Issues Needing Attention** **at FEMP**

> To address community concerns about the storage of radon in the K-65
> silos, potential exposures to radionuclides must be evaluated if a
> catastrophic event (for example, an earthquake or tornado) occurs and
> disrupts the integrity of the silos.

**Proposed Activities** **at FEMP**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway. New activities will be initiated only if feasible
> and deemed appropriate and beneficial to the community. The agencies
> will establish a coordinated plan, schedule, and lead organization for
> each new public health activity. The plan and schedule will be
> presented to all potential partners for their comment.
>
> *New Activities for FY 2005-2010*

*DOE Former Workers Program*

> The DOE-funded Former Workers Program will soon offer medical
> screening services to former DOE workers. There will be two projects
> at Fernald:

-   The Fernald Building Trades Medical Screening Program, led by the
    Center to Protect Workers' Rights, will offer medical screening to
    former building trades (construction) workers who may be at risk due
    to work-related exposures.

-   The Former Fernald Production Workers project, administered by
    Queens College, will offer former production workers and other
    nonconstruction workers from Fernald medical screening.

-   These activities will complement an ongoing effort, conducted under
    the Fernald Settlement Fund, to screen former workers who were
    employed at the plant between the years 1952-1985 for at least one
    year.

**Hanford Nuclear Reservation**

Richland, Washington

**Background**

The 570-square mile Hanford Nuclear Reservation is located in
southeastern Washington State near the cities of Richland, Pasco, and
Kennewick. Starting in 1944, Hanford produced plutonium. During the
early years of operation, large amounts of radioactive materials were
released into the atmosphere and the Columbia River, including an
estimated 740,000 curies of iodine-131 into the atmosphere and 22
million curies of mixtures of radionuclides into the Columbia River.

Radioactive materials, such as plutonium, have been inhaled or ingested
by workers, but the extent of this form of radiation exposures is
uncertain. In addition, approximately 30 million cubic feet of
high-level, transuranic, low-level, and tank wastes are stored on-site.
Communities, tribal nations, and workers are concerned about the health
hazards posed by the hazardous wastes stored on-site and the historical
releases to the air and water.

**Past Activities at the Hanford Nuclear Reservation**

*Off-Site Contamination*

· **Hanford Environmental Dose Reconstruction (HEDR).** This project
evaluated historical off-site radioactive releases from Hanford to the
surrounding communities. The study indicated that the largest doses of
radiation to residents surrounding the site were from iodine-131
released to air and deposited on soil and into the Columbia River
between December 1944 and December 1957. The most important radiation
exposure pathway for iodine-131 was the consumption of contaminated milk
produced by cows and goats that the residents kept on their properties.
Children received the highest estimated thyroid doses. Radiation doses
from releases to the Columbia River were highest from 1956 through 1965,
peaking in 1960. The most important exposure pathway was the consumption
of nonmigratory fish from the Columbia River during the years of
releases, a particular concern to Native Americans.

· **ATSDR public health assessment for the Hanford 1100 Area (the
vehicle maintenance area).** ATSDR concluded that the area did not pose
a public health hazard from site-specific contaminants and that
follow-up health actions are not indicated at this time.

· **ATSDR health consultation for the North Slope Area.** ATSDR
concluded that data were inadequate to determine if there was a threat
to human health if the area were used as a wildlife refuge or if use
were unrestricted, which would include agricultural and residential
development.

· **SENES Oak Ridge, Inc., analysis.** This ATSDR-sponsored analysis
concerned dose estimates from eating contaminated fish and waterfowl
along the Columbia River during the period of peak releases. The
analysis found that additional work was needed before doses could be
calculated for Native American dietary lifestyles. Specifically, the
report recommended that three other radionuclides be considered: (1)
iodine-131 because children are more sensitive, (2) cobalt-60 because it
accumulates in soil and sediment, and (3) strontium-90 (Sr-90) because
it accumulates in fish bones. Assuming people only ate filleted fish did
not account for all of the Sr-90 exposure if they ate the whole fish.

*Community Health Studies and Activities*

· **The ATSDR Infant Mortality and Fetal Death Analysis.** This study,
finalized in November 2000, investigated the association between
estimated I-131 exposure and infant mortality, fetal death, and preterm
birth. The study focused on the years 1940--1952, and included the eight
Washington counties in the HEDR project (Adams, Benton, Franklin, Grant,
Kittitas, Klickitat, Walla Walla, and Yakima). The study used the HEDR
project's 1945 exposure estimates for I-131, and found a 70% higher rate
of preterm birth and a 30% higher rate of infant mortality in the areas
with the highest estimates of I-131 exposures compared to areas with the
lowest estimates of exposure. No association was found for fetal death.

> · **NCEH Hanford Individual Dose Assessment (IDA) project.** This
> project provided individual thyroid dose estimates to people who lived
> or spent time in the HEDR study area and helped them understand what
> it means to their health. Approximately 8,000 dose estimates were
> provided to people who lived in the study area between December 26,
> 1944 and December 31, 1957, and who were therefore potentially exposed
> to air releases of I-131. This project was a service, not a study, and
> was provided through a joint effort of the state health agencies in
> Idaho, Oregon, and Washington. There is no work going on currently,
> but CDC/NCEH has the software and could calculate doses if required.

· **Hanford Health Information Network (HHIN).** The HHIN was a
partnership among the state health agencies of Idaho, Oregon,
Washington, and nine Pacific Northwest Indian Nations. HHIN prepared and
distributed information about the releases of radioactive materials from
the site and what was known about the potential health effects of
radiation exposure. HHIN built a credible communication program,
focusing on a two-way, interactive exchange of information with
individuals and groups about health effects and concerns they may have.
HHIN provided information to citizens and education to healthcare
providers about Hanford releases, health risks, and related topics.
Information was provided from a variety of perspectives allowing
individuals to draw their own conclusions. HHIN was established by
Congress in 1991 and funded by the U.S. Department of Energy until June
2000.

*Studies of the Health of Hanford Workers*

> Workers at Hanford have been included in previous epidemiologic
> studies. Findings include the following.

· Positive trends in the death rate with occupational exposure to
external ionizing radiation have been reported for liver cancer, cancer
of the pancreas, female genital cancer, multiple myeloma, and Hodgkin
disease.

· Lung cancer has been associated with internal radiation exposure in
populations, such as uranium miners but there is less certainty about
any relationship with external exposure.

· In a recent multi-site study sponsored by NIOSH, an age at exposure
effect was found. External doses received at older ages, particularly
over 45 years, were associated with an increased risk of multiple
myeloma.

· A study of the potential association between paternal exposure to
ionizing radiation at Hanford and risk of childhood cancer found no
evidence of a link between leukemia and paternal employment at Hanford
and weak evidence for a link with central nervous system cancer.

· Beryllium metal was machined at Hanford and some of the workers
exposed to the metal have chronic beryllium disease.

· **Mortality among female nuclear workers (MAFN).** A study of female
workers from 12 DOE plants, including Hanford, was combined in a cohort
mortality study, and risk estimates were developed for exposure to
ionizing radiation or to chemical hazards. For the entire pooled cohort,
mortality from mental disorders, diseases of the genitourinary system,
and from ill-defined conditions was higher than expected. External
ionizing radiation exposure in these workers appeared to be associated
with increased relative risk for leukemia and, to a lesser degree,
associated with increased relative risks for all cancers combined and
for breast cancer.

-   **Exposure assessment of hazardous waste, decontamination and
    decommissioning, cleanup workers (HAWW).** Feasibility studies at
    seven DOE sites, including Hanford, determined that the availability
    of records to identify workers and their primary activities,
    exposures, work histories, and medical information varied
    significantly from site to site. The necessary information to
    conduct exposure assessment, hazard surveillance, or epidemiology
    studies of remediation workers is currently not readily available.
    Within sites, data systems are fragmented and data management is
    inconsistent in the current environment of decentralized management
    and increased subcontracting.

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-   **Multi-site study of heat stress among carpenters (HTST).** The
    United Brotherhood of Carpenters Health and Safety Fund, sponsored
    by a NIOSH grant, studied heat stress among carpenters at several
    sites, including Hanford. The study measured physiologic and
    neurobehavioral changes in workers wearing protective clothing
    during actual working conditions. Findings in the final report
    include: (1) positive correlations between ambient temperature and
    urine pH and urine specific gravity; (2) inverse correlations
    between average skin temperature and diastolic blood pressure,
    and: (3) a lack of correlation between ambient temperature and
    average pulse, systolic blood pressure, or diastolic blood pressure.
    The final report was released by NIOSH on September 24, 2002.

-   **Exposure history for the construction trades (WHEP).** The
    University of Cincinnati, under a NIOSH grant, created a
    comprehensive institutional history of buildings at the Oak Ridge
    site, including information on potential exposures for the
    construction trades from the Oak Ridge and Hanford sites. The
    investigators used this database to investigate mechanisms to
    improve worker recall of complex occupational exposures across a
    large number of short-term workplace assignments. A variety of
    recall prompts (including photos, maps, and focus groups) were
    tried, demonstrating significant improvement in worker recall when
    maps were used. Study results were used to establish guidelines and
    formats for assembling personal work histories. The study findings
    were released by NIOSH on September 24, 2002.

-   **Comprehensive Occupational Safety and Health Surveillance system
    (COHS).** The University of Washington, under a NIOSH grant,
    designed, implemented, and evaluated a model occupational safety and
    health surveillance system at Hanford for use in those situations
    where comprehensive exposure data is absent. This study gathered
    appropriate occupational medicine and industrial hygiene data to
    identify hazardous exposures and adverse health outcomes in an
    Employee Job Task Analysis (EJTA). The investigators reported that a
    quality assessment of the EJTA process indicated assignment of
    workers to medical surveillance programs was generally appropriate,
    and that the EJTA process appears to gather the correct type of data
    needed for medical surveillance decisions. It was noted that correct
    assignments of workers to medical surveillance programs was most
    controversial when professional judgment, criteria interpretation,
    or administrative factors were involved. The study findings were
    released by NIOSH on September 24, 2002.

> · **Surveillance Methods for Solvent-Related Hepatotoxicity, a
> Cross-sectional Study at Hanford (SMSH).** The purpose of this
> cross-sectional study at the Hanford Nuclear Reservation was to
> establish a scientific basis for surveillance of hepatic effects in
> solvent-exposed workers. One hundred industrial painters exposed
> subacutely and chronically to a variety of solvent mixtures over their
> working careers were compared to a referent group of 100 nonexposed
> carpenters matched by age, gender, and race. The study examined the
> hypothesis that solvent-related hepatic injury is characterized by
> pharenchymal changes of steatosis and fibrosis without associated
> necrotic changes, which are detected by elevated transaminases in
> blood. The study findings were released by NIOSH on September 24,
> 2002.
>
> **Current Activities at the Hanford** **Nuclear Reservation**
>
> *Community Involvement*

-   **Hanford Health Effects Subcommittee (HHES).** ATSDR and the
    Centers for Disease Control and Prevention implemented a community
    involvement activity with the formation of the HHES in January 1995.
    The subcommittee, which includes technical experts, clinicians,
    citizens, public interest groups, tribal representatives, labor
    representatives, and governmental liaisons (tribes and health
    departments), provides advice. ATSDR's work with Hanford Health
    Effects Sub-committee was completed in January 2004 and the FACA has
    been dissolved.

· **ATSDR tribal grants.** The nine tribes use tribal cooperative
agreements funded by ATSDR (in FY 1999 and 2000) to address human health
issues related to exposures from Hanford releases and to build tribal
capacity in collaboration with ATSDR on site-specific public health
activities, community involvement, and preventive health education.
Seven of the nine tribes received funding in FY2002 and five of the nine
tribes received funding in FY2004.

Through funding from ATSDR, the Inter-tribal Council on Hanford Health
Projects (ICHHP) provides advice and guidance to the agencies from the
perspective of the nine Native American tribes within the Hanford
region.

*Off-Site Contamination*

· **ATSDR public health assessment.** ATSDR is conducting a combined
public health assessment of the site (the 100, 200, and 300 Areas) and
worked with HHES to revise the public health assessment document. The
agency also performs health consultations on site-specific issues.

· **NCEH Columbia River dose reconstruction followup.** NCEH funded a
contract to complete additional work on the Columbia River dose
reconstruction model. Once completed, Native Americans and others whose
diets included fish from the Columbia River between 1956 and 1965 will
benefit from new parameters to estimate radiation doses. The model
included the 11 radionuclides for which HEDR had source term estimates,
plus cobalt and strontium for which HEDR did not have source term
estimates. This project has been completed.

*Community Health Studies and Activities*

· **NCEH followup to hot particles report.** NCEH developed computer
programs to calculate the evaluation of radioactive particles and
short-lived radionuclides doses to persons, such as members of the armed
services and construction workers, whose duty locations and/or living
quarters were within the bounds of the reservation. Estimates of doses
for persons in off-site locations can also be performed using the code.
This project has been completed.

· **NCEH Web-based IDA project.** NCEH developed a Hanford Individual
Dose Assessment tool to allow individuals to estimate their personal
thyroid dose as a result of exposure to historic iodine-131 releases
from the site. Only a minimum amount of user-supplied information will
be required to perform this calculation. This tool is

accessible on the Internet. This project has been completed.

-   **NCEH** completed its response to peer review of the Draft Final
    Report of the Hanford

> Thyroid Disease Study (HTDS) and will be disseminating the final
> report. (Note:
>
> Funding for HTDS was not from DOE). This project has been completed.

· **ATSDR Columbia River assessment for possible medical monitoring.**
ATSDR plans to implement a Columbia River Assessment to be conducted in
parallel with the NCEH dose reconstruction activity for the river. This
would provide dose estimates for people who ate fish from the Columbia
River which were contaminated from releases from the Hanford reactors. A
series of workshops will be conducted with experts and community and
tribal representatives to evaluate the exposures and potential human
health risks.

-   **ATSDR Hanford Community Health Project (HCHP)**. In the fall of
    1999, ATSDR initiated the HCHP to inform and educate individuals
    exposed to off-site releases of I-131 about associated health
    effects and healthcare options. By engaging the exposed population
    and their healthcare providers in an information sharing dialogue,
    the HCHP will help them make informed risk benefit decisions about
    their healthcare choices.

> As an initial step, ATSDR has contracted with National Opinion
> Research Center (NORC) to conduct a review of healthcare use patterns,
> issues related to access to healthcare and information needs related
> to thyroid disease among the Hanford population exposed to radioactive
> iodine releases. The data collected by NORC showed a lack of
> effectiveness of prior health education efforts in this population,
> poor understanding of health risks and a desire for health education
> activities for exposed individuals and their healthcare providers.
> More than 80% of the respondents indicated that they would use a free
> thyroid disease screen if it were available through the HCHP.
>
> The HCHP has launched a "clearinghouse" of health education materials
> related to radioactive iodine exposure and thyroid disease at the
> Hanford site. The clearinghouse contains 29 separate educational
> materials available at no charge to individuals and healthcare
> providers who request them. Additional materials will be added as they
> become available. Over 800 requests for materials have been received
> to date.
>
> The HCHP has developed a "project Web page." The Web page contains
> background information about the Hanford site clearinghouse for
> educational materials, links to related Web pages, and the ability to
> join the HCHP mailing list.
>
> A thyroid disease treatment guideline for Hanford downwinders has been
> developed. This product provides advice to physicians on how to manage
> thyroid disease concerns in patients within their practice who
> consider themselves at risk from Hanford's I-131 releases and request
> thyroid evaluation. The guidelines have been endorsed by major medical
> associations and will be distributed to over 26,000 physicians across
> the Pacific Northwest and California.
>
> Two streaming video products are under development for the HCHP
> webpage. The first streaming video for physicians will address the
> psychological implications of historical exposure to Hanford's I-131
> releases. The second video will cover the results of the Hanford
> Thyroid Disease Study with the general public as the target audience.
>
> The HCHP is launching an outreach initiative across Washington State,
> Oregon and Idaho in January 2005 to increase awareness regarding the
> project. Newspapers, television stations, and other groups and
> associations will be contacted to run stories about the project in
> hopes of alerting many other Hanford downwinders about the education
> materials and resources available from the HCHP.

-   **ATSDR Birth Cohort Study.** A study of adverse autoimmune function
    and cardiovascular disease.

> The purpose of this study is to (1) explore the potential relationship
> of radioactive releases, mainly iodine-131, into the environment and
> the prevalence of autoimmune diseases within the affected area; (2)
> explore the potential relationship of radioactive releases, mainly
> iodine-131, into the environment and the prevalence of cardiovascular
> diseases within the affected area; and (3) conduct comparative
> analyses with selected controls from same area.
>
> Eligibility criteria for the high exposed population (cases): (1) born
> in Adams, Benton, or Franklin counties in the sate of Washington
> between January 1, 1945 and December 31, 1951; and (2) resided in the
> county for at least 30 consecutive days. Eligibility criteria for the
> low exposed population (controls): (1) born in San Juan, Whatcom, or
> Mason counties in the state of Washington between January 1, 1945 and
> December 31, 1951; (2) resided in the county for at least 30
> consecutive days; and (3) did not live in any of the high exposure
> counties during the same time period. ATSDR randomly (using computer
> programs) chose 2,000 persons from the six counties to participate in
> the study. The interviews were conducted using Computer-Assisted
> Telephone Interviewing (CATI) technology.
>
> Phase I: Data Collection ended March 2003. Phase II: Medical
> Verification was completed in August 2004. Phase III: Data Analysis to
> ongoing. A report of the study results will be released early in
> Calendar Year 2005.
>
> · **ATSDR Iodine-131 Registry.** ATSDR has proposed an I-131 Registry
> to gain new scientific knowledge about health effects potentially
> associated with low-level, long-term, residential exposure to I-131,
> primarily from releases by Hanford. The I-131 Registry would collect
> information through personal and telephone interviews on 40 health
> outcomes, including thyroid diseases. The eligible population of
> approximately 17,000 persons are those who were (l) born in Adams,
> Benton or Franklin Counties between 1940 and 1951 or (2) 5 years old
> or younger and lived for more than 30 days in Adams, Benton, or
> Franklin Counties between 1945 and 1951. To date, 6,630 persons have
> been located, including 730 deceased. No further work will be
> undertaken unless funded by DOE.
>
> · **ATSDR Case Studies in Environmental Medicine: Iodine-131
> Toxicity.** ATSDR released case studies in environmental medicine that
> focus on I-131 in early 2004. The case studies are a series of
> educational programs, in a self-training format that allow continuing
> medical education credits to be earned.
>
> · **ATSDR health education and promotion.** The findings from the
> Hanford Health Information Network Needs Assessment of Healthcare
> Physicians indicated that physicians wanted education about
> environmental exposures. (They were interested in radiation health
> effects and preferred self-instructional education methods.) The
> agency has conducted training for healthcare providers in the area and
> has continued to work with the providers to ensure they understand how
> information about exposures will improve patient care. This work will
> continue to be accomplished through ATSDR's partnering with existing
> local/state public health agencies and medical association programs.
>
> The agency's new *Case Studies in Environmental Medicine: Iodine-131
> Toxicity* serves as an additional resource for the training of
> healthcare professionals. Implementation of training for healthcare
> professionals in the Hanford area has been coordinated through the
> HHES and HCHP.
>
> *NIOSH Occupational Health Studies*
>
> · **Ionizing radiation and mortality among Hanford workers (HANF).**
> The University of North Carolina, under a NIOSH grant, is updating a
> mortality study of Hanford workers. The study will reanalyze cancer
> and noncancer mortality from chronic, low-level external radiation
> exposure. New methods will be used to estimate doses previously
> assumed to be zero and to account for the effects of internal dose.
> The mortality analysis manuscript has been submitted for publication.

-   **Multi-site case-control study of lung cancer and external ionizing
    radiation LUNG).** This ongoing NIOSH case-control study combines
    worker information from multiple sites, including Hanford, to
    clarify the relationship between lung cancer and external radiation
    exposure. Project was cancelled during fiscal year 2004 due to the
    difficulty of estimating exposures to other potential lung
    carcinogens (e.g. asbestos) for workers in the first few decades of
    reactor operations at the sites chosen for the study.

-   **Multi-site leukemia case-control study (LCCS).** This ongoing
    NIOSH case-control study combines worker information from multiple
    sites, including Hanford, to explore the relationship between
    external radiation and leukemia risk among 250 workers with leukemia
    compared to similar workers who do not have leukemia.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE work force at 14 DOE sites, including Hanford. The
> goal is to identify groups of workers that may be at increased risk
> for occupation-related injury and illness.

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers. There are two projects at Hanford:

-   The Hanford Building Trades Medical Screening Program, led by the
    Center to Protect Workers' Rights, offers medical screening to
    former building trades (construction) workers who may be at risk due
    to work-related exposures.

-   The Medical Surveillance for Former Hanford Production Workers
    project, administered by the University of Washington, offers former
    production workers and other nonconstruction workers from Hanford
    medical screening.

**Issues Needing Attention** **at the Hanford** **Nuclear Reservation**

The following issues need to be addressed in order to obtain more
information:

> The impact of the Columbia River pathway on the health of Native
> Americans and others who may have extensively used the River needs to
> be evaluated.

**Proposed Activities** **at the Hanford** **Nuclear Reservation**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway. Ongoing projects include the following:

ATSDR Public Health Assessment

ATSDR tribal grants

ATSDR Birth Cohort Study

ATSDR Hanford Community Health Project

ATSDR *Case Studies in Environmental Medicine: Iodine-131 Toxicity*

ATSDR health education and promotion

NCEH followup to hot particle report

NCEH web-based IDA project

NIOSH Leukemia Case Control Study

> Ionizing radiation mortality among Hanford workers (Extramural grant,
> University of North Carolina

*New Activities for FY 2005--2010*

-   **Thyroid Stimulating Hormone (TSH) Study.** ATSDR is proposing the
    evaluation of thyroid function in people exposed as children to past
    releases of iodine-131 from the Hanford Nuclear Reservation. In
    1999, while reviewing the draft findings from the Hanford Thyroid
    Disease Study, an expert panel of the Institute of Medicine (IOM)
    noted that the medical literature supports the relationship between
    iodine-131 exposure and occurrence of thyroid cancer, hypothyroidism
    and other thyroid conditions. In 1998, the American College of
    Physicians and American Society of Internal Medicine recommended
    that screening be provided to all women older than 50 years of age
    for unsuspected but overt hyper-and hypothyroidism using the
    sensitive TSH test. In 2000, the American Thyroid Association
    recommended that screening with sensitive TSH be provided to all
    individuals 35 years of age or older and that these individuals be
    retested every 5 years.

> ATSDR estimates that approximately 14,000 individuals received
> sufficient exposure to iodine-131 releases from Hanford between 1945
> and 1951 to put them at increased risk of developing thyroid disease
> later in life. We, therefore, plan to offer TSH testing to as many of
> these individuals as possible. TSH testing is a simple and safe blood
> test that can be performed in any doctor's office, laboratory or
> hospital. Those found to have an abnormal TSH level will be referred
> to appropriate medical specialists for diagnosis and treatment. The
> ATSDR program will offer TSH testing and referral services only.
>
> **Idaho National Laboratory (INL)**
>
> Idaho Falls, Idaho
>
> **Background**
>
> The Idaho National Laboratory (INL) is on the upper Snake River Plain
> in the Arco Desert in southeastern Idaho, 4,900 feet above sea level.
> The 890-square mile site spans Butte, Bingham, Bonneville, Clark, and
> Jefferson Counties.
>
> The Federal Government used the site in the 1940s as a gunnery test
> range. In 1949, the Atomic Energy Commission designated the site as
> the National Reactor Testing Station. Its mission was to develop and
> test nuclear reactors and related facilities. The first nuclear fuel
> was brought to the site in 1951, and radioactive waste disposal and
> storage began in 1954. There are eight major facilities at the site in
> Scoville, with offices in Idaho Falls.
>
> Current programs include providing test irradiation services and
> radioisotope production for medical and commercial uses at the
> Advanced Test Reactor; processing radioactive wastes into solid form
> and storing them at the Idaho Nuclear Technology and Engineering
> Center; conducting light water-reactor safety testing and research;
> storing, processing, and monitoring radioactive wastes; and conducting
> environmental restoration. The Naval Reactors Program is also located
> at the site.
>
> The community and INL workers are concerned about the potential health
> effects caused by releases of nitric oxides or radioactive fission
> products to the air from various facilities. They are also concerned
> about the potential for groundwater contamination, increased cancer
> incidence, and potential beryllium exposure.
>
> **Past Activities at INL**
>
> *Off-Site Contamination*

-   In 1991, INL completed a 3-year effort to evaluate historical
    releases of radioactive materials and potential doses to a
    hypothetical individual who may have resided at an off-site location
    with the highest concentration of airborne radionuclides (less
    significant pathways to off-site radiation doses were not fully
    evaluated). Airborne releases were highest from 1955 through 1965.
    The most important radionuclides were iodine-129 and -131,
    cesium-137, strontium-90, and noble gases including krypton-88. The
    body organs receiving the highest doses were the thyroid and skin.
    However, the evaluation found that "radiation doses from airborne
    releases over the operating history of the INL were small compared
    to doses from natural background radiation" and "the largest
    radiation doses were calculated for an infant in 1956 when the
    effective dose equivalent from operational and episodic releases was
    estimated to be 61 mrem." In that year doses to infants, the most
    sensitive population, were twice as high as doses to adults.

-   The Idaho Department of Health and Welfare formed the Dose
    Evaluation Review and Assessment Advisory Panel to review the 1991
    Historical Dose Evaluation and to make recommendations for future
    work. The advisory panel published its findings in 1993 and
    concluded that the following recommendations for future activities
    to reconstruct doses from toxic exposures to workers and members of
    the public potentially affected by INL should be implemented:

-   Independent collection and verification of data;

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-   Comparisons between modeled and monitored data;

-   Rigorous uncertainty analyses;

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-   Quality assurance program for all data collection and analysis;

-   Dose reconstruction for all exposure pathways;

-   Dose reconstruction for both radiation and chemical exposure; and

-   Future studies to include full public participation.

> NCEH and its contractors located and catalogued several thousand
> documents, which may potentially be used to calculate the extent of
> releases and exposures to the public. This document review started the
> INL dose reconstruction project.
>
> ATSDR Public Health Assessment. ATSDR finalized the document on March
> 29, 2004. ATSDR concluded that the site posed no off-site health
> hazard to the public.

*Community Health Studies and Activities*

-   The Idaho Division of Environmental Quality INL Oversight Committee
    maintains monitoring stations around INL and frequently analyzes
    air, soil, and water samples around the laboratory.

-   In response to community concerns about a brain cancer cluster, the
    Idaho Division of Health (IDH) conducted a Public Health Brain
    Cancer Study. The study evaluated people in six southeastern Idaho
    counties (including Moreland) who were diagnosed with brain cancer
    between 1978 and 1994. IDH found a high rate of brain cancer in the
    most recent data. However, the cancer cases could not be traced to a
    common event and therefore could not be associated with a singular
    cause. IDH presented the results of the study to the Idaho Health
    Effects Subcommittee in December 1997.

-   The Idaho Department of Health and Welfare reviewed cancer morbidity
    and mortality data in Clark and Minidoka, two counties near INL.
    Clark County lies northeast of INL, and Minidoka County is southwest
    of INL. Cancer death rates were examined for 1950--1989, and cancer
    incidence rates were examined for 1978--1987 to determine if any
    significant trends in cancer morbidity and mortality could be
    observed in these counties compared with the state. No statistically
    significant differences in age- and sex-adjusted death rates were
    observed in either county. However, when cancer incidence data were
    considered, the overall cancer incidence rate in Clark County was
    higher than expected based on the state rate for female breast
    cancer and lip cancer.

-   Jablon et al. (*JAMA*, 1991:1403--1408) examined cancer mortality in
    populations living near nuclear facilities in the United States,
    including INL. Cancer mortality rates in 107 counties near 62
    nuclear facilities were compared with cancer mortality rates in
    control counties that were not near nuclear facilities. Rates were
    compared for 1950--1984. Cancer mortality for Bingham, Butte, and
    Jefferson Counties, where INL is located, was compared with nine
    control counties with similar demographic characteristics in the
    same region. No general association was detected between residence
    in a county with a nuclear facility and death attributable to
    leukemia or any other form of cancer. Interpretation of the study
    results was limited by the study\'s ecological approach in which the
    exposures of individuals are not known.

*Studies of the Health of INL Workers*

-   A study of the potential association between paternal exposure to
    ionizing radiation and risk of childhood cancer found no link
    between brain cancer or leukemia and paternal employment at INL.
    Children whose fathers worked at Hanford were more likely to get
    central nervous system cancer than children whose fathers worked at
    other sites, including INL, but this finding was based on small
    numbers and was not statistically significant.

-   **Prevention of stress and health consequences of downsizing
    (STDN).** The effects of downsizing on organizational climate,
    worker health, and performance were studied at several DOE sites,
    including INL. Data gathering included interviews, workplace
    observations, employee discussion groups, an employee survey
    distributed to more than 10,500 employees, and a historical record
    review. Researchers identified opportunities to reduce job stress
    that could lead to improved employee health and organizational
    well-being. Suggested intervention strategies were proposed for
    further research.

· **Exposure assessment of hazardous waste, decontamination and
decommissioning, cleanup workers (HAWW).** Feasibility studies at seven
DOE sites, including INL, determined that the availability of records to
identify workers and their primary activities, exposures, work
histories, and medical information varied significantly from site to
site. The necessary information to conduct exposure assessment, hazard
surveillance, or epidemiology studies of remediation workers is
currently not readily available. Within sites, data systems are
fragmented and data management is inconsistent in the current
environment of decentralized management and increased subcontracting.

-   **Cohort mortality study of Idaho National Engineering and
    Environmental Laboratory (INEEL).** This intramural NIOSH study was
    completed in early fiscal year 2005 and communicated to the site and
    DOE headquarters in October 2005. The study evaluated mortality
    patterns among 63,561 civilian employees ever employed at the INEEL
    with vital status follow-up through 1999. Statistical models
    evaluated relations between specific causes of mortality and
    exposures to ionizing radiation. Mortality patterns among various
    occupational groups were also compared. The largest group was
    construction and maintenance service workers which comprised
    approximately 47% of the cohort. Overall, about 17% of the cohort
    was deceased and the total number of deaths was slightly less than
    expected based on comparison with the residents of Idaho, Montana
    and Wyoming (SMR: 0.96, 95% confidence interval 0.94, 0.97, 10,788
    deaths). Cancer rates were slightly elevated (all-cancer SMR: 1.07,
    95% confidence interval 1.03, 1.11, 2873 deaths). Non-Hodgkin
    lymphoma was elevated in the full cohort (SMR: 1.26, 95% confidence
    interval 1.05, 1.50). Brain tumor mortality rates were elevated
    among male chemical workers (SRR: 2.12, 95% confidence interval
    0.82, 5.49) as were asbestosis mortality rates among construction
    and maintenance workers (SRR: 4.92, 95% confidence interval 2.35,
    9.26). Cancers likely to mesotheliomas were also elevated in this
    same group (SRR: 4.54, 95% confidence interval 1.01, 20.4). Positive
    but non-significant associations were detected with external
    radiation exposures with brain tumors, with leukemia, and with
    lymphatic cancers.

**Current Activities at INL**

*Community Involvement*

-   **INL Health Effects Subcommittee (HES).** ATSDR and NCEH will
    continue to work with the INL HES, which serves as a vehicle for the
    public and tribal nations to express concerns and provide advice and
    recommendations on the agencies' public health activities and
    research at INL. As soon as NCEH receives and distributes the NIOSH
    worker study to the Subcommittee members, the Subcommittee will be
    terminated.

*Off-Site Contamination*

-   **NCEH dose reconstruction.** NCEH has completed a screening
    analysis of releases identified by the INL Environmental Dose
    Reconstruction document search to determine which contaminants and
    exposure pathways have the highest potential for affecting the
    public. The Risk Assessment Corporation (RAC) completed
    prioritization of radionuclide releases from INL and presented final
    results at the November 2002 meeting of the INL HES meeting. Sanford
    Cohen and Associates is the contractor conducting the current work,
    PHASE II, at INL. They are doing a dose reconstruction on two
    sources, the Aircraft Nuclear Propulsion Program (ANP) Initial
    Engine Test (IET) series and the Idaho Chemical Processing Plant
    (ICPP). CDC has approved their research protocol, and findings have
    been presented to the INL HES. This project has been completed.

-   **ATSDR health education and promotion.** ATSDR will continue to
    address community concerns through health education programs for
    healthcare providers and the potentially affected community. As
    additional needs are identified, ATSDR will collaborate with other
    federal and state public health agencies, and community partners to
    carry out health education activities.

-   **ATSDR health studies.** The Idaho Department of Health is studying
    the prevalence of brain cancer. HHS reviewed the questionnaire that
    was being used by Idaho before the study began. ATSDR might be asked
    to review the complete study.

*NIOSH Occupational Health Studies*

-   **International collaborative study of nuclear industry workers
    (IARC).** NIOSH contributed data from the INL study cohort to an
    international collaborative study of nuclear workers in 15
    countries. This study, sponsored by the International Agency for
    Research on Cancer, is the largest cancer mortality study of nuclear
    workers. The cohort data has been analyzed and will soon be
    published in a peer-reviewed scientific journal.

-   **Multi-site case-control study of lung cancer and external ionizing
    radiation (LUNG).** This ongoing NIOSH case-control study combines
    worker information from multiple sites, including INL, to clarify
    the relationship between lung cancer and external radiation
    exposure. Project was cancelled during fiscal year 2004 due to the
    difficulty of estimating exposures to the potential lung carcinogens
    (e.g. asbestos) for workers in the first few decades of reactor
    operations at the sites chosen for the study.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE work force at 14 DOE sites, including INL. The goal
> is to identify groups of workers that may be at increased risk for
> occupation-related injury and illness.

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers. There is one ongoing project and one
> project that will be initiated within the next several months.

-   The Worker Health Protection Program, INL, administered by PACE and
    Queens College, offers former production workers and other
    nonconstruction workers from INL medical screening.

-   The Idaho Building Trades Medical Screening Program, led by the
    Center to Protect Workers' Rights, will offer medical screening to
    former building trades (construction) workers who may be at risk due
    to work-related exposures.

**Issues Needing Attention** **at INL**

> Depending on the results of the environmental dose reconstruction, a
> determination may need to be made on the potential health effects that
> might result from past exposures to chemicals and radionuclides
> released from the site to the surrounding communities.

**Proposed Activities** **at INL**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.

*New Activities* *for FY 2005--2010*

No new activities are planned.

**Laboratory for Energy-Related Health Research (LEHR)**

Davis, California

**Background**

The Laboratory for Energy-Related Health Research (LEHR) was a DOE
research facility, located on property owned by the University of
California at Davis (UCD), in Solano County, in the city limits of
Davis, California. DOE and its predecessor, the Atomic Energy Commission
(AEC), funded the laboratory primarily to investigate the long-term
effects of low levels of radium-226 (Ra-226) and strontium-90 in
beagles.

The 15-acre site is near existing UCD landfills, and a portion of the
dog pen area was built over a part of the landfills. The main UCD campus
lies north of the site, and the property west, south, and east of the
site is used for farming. The south fork of Putah Creek flows east
approximately 250 feet from the southern boundary of the site. Today,
UCD operates the Institute of Toxicology and Environmental Health at the
site.

Animal wastes generated during LEHR activities were placed in holding
tanks, trenches, boreholes, and the UCD landfills near the LEHR animal
pens and laboratories. Restoration of the site, including the removal of
some buildings, cages, and the contents of waste tanks, began in 1990.
Generally, DOE is responsible for cleanup of site soils and UCD is
responsible for cleanup of groundwater.

**Past Activities at LEHR**

*Off-Site Contamination*

-   In a site summary document, ATSDR identified the following public
    health concerns: nitrate and organic chemicals in groundwater, and
    potentially contaminated fish in Putah Creek.

-   Putah Creek fish were collected and tested for potential mercury and
    lead contamination. ATSDR concluded that elevated levels of mercury
    in large-mouth bass are a public health hazard to fetuses and
    nursing infants whose mothers eat large-mouth bass from the creek.

-   Yolo County sponsored a Putah and Cache Creek Ecotoxicity Project
    which was conducted by the Central Valley Regional Water Quality
    Control Board. The *Cache Creek and Putah Creek Watersheds Toxicity
    Monitoring Results: 1998--1999 Final Report* was released on
    November 30, 2000.

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-   ATSDR public health assessment. After being released for public
    comment on

July 11, 2003, the public health assessment was finalized on June 17,
2004. ATSDR concluded that past exposure to nitrate and metals in
off-site groundwater posed a health hazard to infants six-months of age
or younger who could ingest private well water directly or mixed in
formula. The contaminants may not be related to the LEHR site. Exposure
to mercury is possible for people who consume fish from Putah Creek.
Mercury has been detected in some species of fish, primarily
large-mouthed bass at concentrations that could be harmful to the fetus
or nursing infant.

*Community Health Studies and Activities*

-   No studies on the health of residents living near the laboratory
    exist.

*Studies of the Health of LEHR Workers*

-   No studies on the health of LEHR workers exist.

**Current Activities at LEHR**

No current involvement at the present time.

*Off-Site Contamination*

*Community Health Studies and Activities*

-   The California Department of Health Services (CDHS), Environmental
    Health Investigations Branch, through a cooperative agreement with
    ATSDR, prepared a health consultation and a fact sheet on nitrate in
    drinking water, which were distributed to the community surrounding
    the site and to other areas of the state.

-   **ATSDR health education and promotion.** ATSDR will determine its
    community involvement and health education activities based on the
    findings and recommendations from the final public health assessment
    and comments received from community residents. These activities
    could include holding a public availability session for residents
    impacted by the LEHR and developing community health educational
    materials which may include fact sheets, educational brochures, and
    document summaries.

*Occupational Health Studies*

-   No occupational health studies are currently underway.

**Issues Needing Attention** **at LEHR**

> No issues at this time.

**Proposed Activities** **at LEHR**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.
>
> *New Activities for FY 2005-2010*

No new activities are proposed at this time.

**Lawrence Livermore National Laboratory (LLNL)**

Livermore, California

**Background**

The Lawrence Livermore National Laboratory (LLNL) site consists of two
separate parcels: the main site and site 300. The 826-acre main site is
located in the flat land of the Livermore-Amador Valley in Alameda
County, on the eastern edge of the city of Livermore, approximately 40
miles east of San Francisco, California. Site 300 is approximately 15
miles east of the main site and occupies approximately 7,000 acres in
Alameda and San Joaquin Counties. The terrain consists of rolling hills
and canyons at elevations ranging from 525 to 1,750 feet above sea
level.

In 1942, the land was converted from agricultural use to a naval flight
training base and aircraft assembly and repair facility. Since 1951, the
site has been an active, multi-program research facility operated by the
University of California for DOE. The laboratory's mission is research
and education in defense, biomedicine, energy, magnetic fusion, lasers,
and the environment.

A number of operations at LLNL handle or generate hazardous materials,
radioactive wastes, and mixed wastes. Activities from naval operations
prior to 1951 and activities from LLNL since that time have resulted in
on- and off-site contamination and potential exposure to both workers
and local residents.

Local residents are particularly concerned about radiological
contamination in parks and other public areas in and around Livermore.
Additional community concerns include (1) the contamination of municipal
and residential water supplies; (2) air releases of tritium, depleted
uranium, and beryllium during non-nuclear testing of weapons systems at
site 300; (3) air releases of radioactive and hazardous materials from
the main site, especially tritium; (4) water contamination by tritium at
site 300; (5) plutonium-239 in municipal sewage sludge that was
distributed to municipal and private users as a soil amendment; (6)
radiological measurements in sewage effluent and sludge from
Pleasanton's Sunol Avenue sewage treatment plant; and (7) the health
impacts, including cancer, noncancer diseases, and developmental
disabilities.

**Past Activities at LLNL**

*Off-Site Contamination*

-   In September 1984, CDHS issued an Order for Compliance to LLNL to
    provide alternative water supplies to residents west of the facility
    whose wells had been contaminated by hazardous substances from the
    site. The order also directed LLNL to conduct a groundwater
    investigation.

-   In November 1985, the California Regional Water Quality Control
    Board issued an order directing LLNL to investigate and clean up the
    on- and off-site groundwater contamination. LLNL began investigating
    the source and the vertical and lateral extent of the contamination
    of soil and groundwater.

-   In 1986, a plume of groundwater contaminated with volatile organic
    compounds, including tetrachloroethylene, was found to have migrated
    3,600 feet west of the main site. Sampling of water from monitoring
    wells at the main site found contamination by tetrachloroethylene,
    trans-1, 2-dichloroethylene, and trichloroethylene. Soil on the site
    was also contaminated.

-   CDHS, under a cooperative agreement with ATSDR, prepared a health
    consultation which concluded that public water supplies near the
    main site have not been impacted by groundwater contamination from
    the site. CDHS also identified private water wells that may be
    impacted by groundwater contamination from the main site and
    recommended that ATSDR evaluate them further. Subsequent
    investigation conducted by CDHS determined that all potentially
    impacted private off-site water wells have been sealed and abandoned
    by LLNL following State of California rules and regulations.
    Therefore, there is no threat to human health from these wells.

-   **CDHS consultation.** In 1998, CDHS, under a cooperative agreement
    with ATSDR, prepared a health consultation addressing plutonium in
    Big Trees Park in Livermore. Plutonium-239 in surface soils in the
    park was at levels that do not pose a public health hazard. The
    consultation identified possible pathways for contamination of the
    park, including aerial dispersion, sediment distribution from an
    adjacent creek channel, and use of contaminated sewage sludge as
    fill material. DOE conducted additional soil sampling for plutonium
    in the park. ATSDR evaluated these data to determine the (1) health
    impacts to park users, (2) distribution of plutonium within the
    park, and (3) pathways by which contamination may have reached the
    park. ATSDR has incorporated the findings into an addendum to the
    1998 health consultation.

-   **ATSDR expert panel and health consultation on tritium releases.**
    In response to community concerns about the effect of organically
    bound tritium on total tritium doses, ATSDR convened a panel of
    tritium experts and site and community representatives to evaluate
    cumulative tritium doses. In July 2001, ATSDR released the panel
    report and ATSDR's summary of the report as a public health
    consultation.

-   **ATSDR public health assessments.** On July 11, 2003, ATSDR
    completed an assessment of community exposures to the 1965 and 1970
    accidental tritium releases; public comment release May 24, 2002.
    ATSDR concluded that although there was exposure, there was no
    apparent health impact. On August 26, 2003, ATSDR completed an
    assessment of plutonium-239 in sewage sludge used as a soil
    amendment in the Livermore community; public comment release was
    February 10, 2003. ATSDR concluded that although there was exposure
    to plutonium-239, there was no apparent health impact. On June 29,
    2004, ATSDR completed a site-wide public health assessment; public
    comment release February 12, 2004. ATSDR concluded that past and
    on-going off-site releases from the LLNL facility do not present a
    public health hazard.

*Community Health Studies and Activities*

-   In a 1995 health study, CDHS, with assistance from CDC, investigated
    the 1960--1991 cancer incidence for children and young adults who
    lived in Livermore. CDHS reported an elevated rate of melanoma when
    compared to rates in Alameda County.

-   In 1996, in response to community concerns about elevated cancer
    rates in the Livermore area, CDHS, with assistance from CDC,
    assessed the 1988--1993 incidence of invasive cancers in residents
    of eight census tracts that include Livermore and the surrounding
    area. The incidence of cancers was not found to be elevated among
    these residents compared to the rates of Bay Area residents. The
    incidence of melanoma was elevated in one tract located west of the
    main site, although the elevation was not statistically significant.

-   In March 1999, the California Birth Defects Monitoring Program
    (CBDMP) examined birth defects in zip codes 94550 and 94551 around
    Livermore for 1983--1989 (the only years that CBDMP operated in
    Alameda County). CBDMP found no evidence of increased rates of birth
    defects among people living around Livermore.

*Studies of the Health of LLNL Workers*

· In 1980 and 1982, CDHS determined that the incidence of malignant
melanoma was higher for LLNL employees than for the population of the
region. For the 19 cases diagnosed from 1972 to 1977, work involving
exposure to ionizing radiation was not associated with a diagnosis of
melanoma; however, working as a chemist was. In 1984, based on a review
of records for persons with and without melanoma, occupational factors
were reaffirmed as being associated with melanoma risk. Later, when the
incidence rates for LLNL workers were calculated for 1969--1980, higher
rates were found for cancers, in addition to malignant melanoma. The
incidence rates for salivary gland cancer and rectal cancer among female
laboratory workers were above the rates for the region. For male
laboratory workers, other nervous system tumors, excluding brain tumors,
were higher than expected.

· Thirty-one laboratory workers with malignant melanoma and a control
group were interviewed about personal and occupational factors that
might be associated with the disease. The following factors were more
common than expected among persons with malignant melanoma: (1) exposure
to radioactive materials; (2) work at Site 300;

> \(3\) exposure to volatile photographic chemicals; (4) participation
> at the Pacific Test Site; and (5) chemist duties. The most recent
> interview study of 69 cases and an equal number of controls found that
> differences in personal factors, genetics, and recreational use of the
> outdoors were consistent with what is known about malignant melanoma
> of the skin. Only occupational exposure to alcohols, out of 39
> industrial exposures examined, was more common among persons with
> melanoma.
>
> · Studies of the microscopic features of the melanoma tumors indicated
> that the tumor thickness for laboratory workers was significantly less
> than for individuals who did not work at LLNL, up to the time when the
> concern became public in 1977. These data were taken as evidence of
> earlier detection of tumors at LLNL. A greater proportion of workers
> hired before 1962, who were engineers, particularly electrical
> engineers, had dark moles or pigmented nevi that are associated with a
> high risk of malignant melanoma.

**Current Activities at LLNL**

**ATSDR has no current involvement at this site at the present time.**

*Community Involvement*

-   **ATSDR public health assessment.** On June 22, 2004, ATSDR released
    the Site 300 public health assessment for public comment. ATSDR
    found no evidence of exposure to off-site releases and therefore
    concluded that the site presented no public health hazard. The
    document should be finalized in FY2005.

> *Community Health Studies and Activities*

-   **ATSDR health education and promotion.** Upon completion of the
    public health assessment, ATSDR will conduct a health education
    needs assessment in consultation with community organizations and
    appropriate state agencies to assess health education needs for the
    community and healthcare professionals. On the basis of this needs
    assessment, ATSDR will develop a program to regularly provide
    information and training that will enable healthcare providers to
    take an exposure history and promote behavioral changes that will be
    health-protective.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE workforce at 14 DOE sites, including LLNL. The goal
> is to identify groups of workers that may be at increased risk for
> occupation-related injury and illness.

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers. A new project will be initiated within
> the next several months.

-   A new regional former worker medical screening project, administered
    by Boston University and the University of California San Francisco,
    will offer former workers from LLNL, LBL, and Sandia California
    medical screening.

**Issues Needing Attention** **at LLNL**

> As the public health assessment and the illness and injury
> surveillance program for the LLNL sites continue, specific data gaps
> will be identified. The agencies will develop proposed activities to
> address these data gaps.

**Proposed Activities** **at LLNL**

There are no proposed activities scheduled at LLNL at the present time.

*Ongoing Activities*

> The agencies propose to continue the previously listed projects.
>
> *New Activities for FY 2005-2010*
>
> No new activities are proposed at this time.

**Los Alamos National Laboratory (LANL)**

Los Alamos, New Mexico

**Background**

The Los Alamos National Laboratory (LANL) comprises about 43 square
miles (27,500 acres) in Los Alamos and Santa Fe Counties, New Mexico. It
is situated on a volcanic plateau composed of a number of mesas
separated by steeply sloped and deeply eroded drainage canyons oriented
from west to east. The town of Los Alamos had a population of
approximately 19,000 people in 1990. Albuquerque (60 miles south) and
Santa Fe (25 miles southeast) are the closest metropolitan areas.
Several Native American pueblos reside near the site.

Public health issues of concern include the potential health effects in
the neighboring populations from current and past releases of
radioactive and hazardous materials. The major source of current
radiological atmospheric releases is the Los Alamos Neutron Science
Center, formerly known as the Los Alamos Meson Physics Facility, which
accounts for 95% of current air releases, primarily radioactive gases.
Other air releases come from incinerators which had been used from 1951
to the early 1990s to recover plutonium, the Omega West Reactor which
was defueled in 1993, the Chemical and Metallurgical Research Building,
located in Technical Area 3 (TA), the HP Site (TA-33), and the former DP
site (TA-21).

Possible sources of groundwater contamination are the active waste
disposal area (TA-54, Area G); firing sites in Bayo Canyon (used during
1944--1962 and beyond), which included underground testing and
radioactive lanthanum (RaLa) implosion tests releasing lanthanum-140
(La-140), strontium-90, and depleted uranium; atmospheric tracking tests
conducted in 1950 which released La-140; and outfall pipes discharging
laboratory wastes and other liquid wastes directly to Acid and Pueblo
canyons. Mortandad Canyon received direct discharges of both hazardous
and radioactive liquid wastes.

On May 4, 2000, the National Park Service initiated a planned burn of
accumulated deadwood and undergrowth in a 3000-acre area near Cerro
Grande Peak in the Bandelier National Monument. This peak is almost
immediately due west of LANL. As a result of low humidity and high
winds, the fire spun out of control and burned a larger area than
originally planned. The fire was officially declared out of control on
May 5, 2000, and declared fully contained on

June 6, 2000. The fire burned parts of the Bandelier National Monument,
the Santa Fe National Forest, LANL, the Santa Clara Pueblo, private
lands, and homes in the town of Los Alamos. The fire eventually burned
between 43,000 and 48,000 acres and destroyed or damaged 235 residential
structures in the town of Los Alamos and 112 LANL buildings.

Many of the people in the Los Alamos area are concerned about the
possibility of radioactive and non-radioactive hazardous material
releases from the fire burning through LANL. The fire burned many
buildings on-site, including several involved in the creation of the
first atomic bombs. It also burned areas where radioactive material or
other hazardous material had been disposed of during the operation of
LANL. In February 2001, the New Mexico Environment Department contracted
with Risk Assessment Corporation to independently evaluate the immediate
consequences and long-term impacts of the fire. The evaluation will be
completed in 2002. Draft reports are available on the internet site of
the New Mexico Environmental Department.

**Past Activities at LANL**

*Off-Site Contamination*

-   **ATSDR exposure investigation.** The investigation which sampled
    San Ildefonso lands adjacent to the laboratory, found elevated
    levels of plutonium in surface water and elevated concentrations of
    plutonium-239 and cesium-137 in sediment. Although these levels were
    higher than background levels, they are not at levels known to
    adversely affect public health.

-   **ATSDR health consultation on Acid Canyon.** ATSDR determined that
    levels of plutonium in Acid Canyon were not a public health hazard
    for recreational users.

-   **ATSDR health consultation on tritium in groundwater.** Although
    tritium was detected in groundwater wells, including monitoring
    wells, residential wells, and Los Alamos water supply wells, ATSDR
    determined that the water in the wells was safe for drinking.

-   **ATSDR health consultation on nitrates in groundwater.** ATSDR
    recommended eliminating potential exposure to nitrates for infants
    less than 4 months of age, as they are the most sensitive
    population.

*Community Health Studies and Activities*

-   In response to community concerns over a perceived excess of brain
    tumors and their relationship to radiologic contaminants from LANL,
    the New Mexico Department of Health, with funding from DOE, reviewed
    cancer rates in Los Alamos County. The 1993 health study determined
    that incidence of brain cancer was not elevated, but that the
    incidence of thyroid cancer was elevated beginning about 1980, with
    an excess incidence from 1988--1993, and a decline thereafter. No
    single factor could explain the higher rates.

Further analyses of incidence and mortality data, and tumor
characteristics were conducted for eight specific cancer sites or types.
Rates generated for Los Alamos County and its census districts were
based on a very small number of cases. Therefore, it could not be
determined if these unstable rates reflected random variation or true
trends in underlying cancer risk.

-   In FY 1997, ATSDR conducted a needs assessment for a number of
    communities in the Los Alamos area. Based on the findings of the
    needs assessment, ATSDR, NCEH and NIOSH have developed plans for
    conducting community involvement and health education activities.

In September 1995, ATSDR sponsored a workshop for pueblo and rural
communities, attended by about 60 people who received environmental
health information on chemical and radiation exposure.

**NCEH community education through Rio Arriba partnership, University of
New Mexico.** NCEH awarded a 3-year grant to the Rio Arriba
Environmental Health Partnership at the University of New Mexico to
conduct community education and training related to environmental health
research near LANL. This grant has ended.

*Studies of the Health of LANL Workers*

· The cause-specific mortality rates for all 15,727 LANL white male
employees were similar to the rates for the U.S. population through
1990. Positive trends in the mortality rate with increasing external
radiation dose were reported for cancers of the brain and central
nervous system, esophagus, and Hodgkin disease. There was an association
between increasing doses of external radiation and kidney cancer, as
well as lymphocytic leukemia among workers who were not exposed to
plutonium. However, the mortality rates were not elevated according to
statistical tests.

· There were 5,424 Zia Company employees monitored for exposure to
either plutonium or external ionizing radiation. Mortality was studied
up to the end of 1984. Hispanic males had high mortality rates for
stomach cancer, all injuries, all accidents, and motor vehicle
accidents. Non-Hispanic males had high mortality rates from all causes,
all cancers, lung cancer, all circulatory diseases, and all respiratory
diseases.

-   A cohort of 224 employees at LANL and Zia Company with a 10
    nanocurie or greater internal deposition of plutonium was studied up
    to the end of 1980. Their mortality experience was compared to the
    U.S. population and to a group of workers not exposed to radiation.
    No cause of death was reported as higher than the comparison groups.

· The mortality of 6,970 female workers at LANL was studied up to the
end of 1981. The death rate from suicide was higher among women
monitored for radiation exposure than the comparable U.S. population
rate. This finding was not related to duration of employment or
plutonium exposure.

-   A reported excess number of cases of skin cancer (malignant
    melanoma) among LLNL employees motivated scientists to conduct a
    similar investigation among LANL employees. No excess skin cancer
    was detected among the 11,000 workers studied between 1969 and 1978.
    An in-depth study of 15 LANL employees with skin cancer found no
    link between the cancer and exposure to external radiation.

· A multi-site study of multiple myeloma (a blood cell cancer) reported
that the myeloma death rate at LANL was not different from the U.S.
population rate. However, external radiation exposures received at age
45 years or older were associated with a higher risk of dying from
myeloma.

-   **Prevention of stress and health consequences of downsizing
    (STDN).** The effects of downsizing on organizational climate,
    worker health, and performance were studied at several DOE sites,
    including Los Alamos. Data gathering included interviews, workplace
    observations, employee discussion groups, an employee survey
    distributed to more than 10,500 employees, and a historical record
    review. Researchers identified opportunities to reduce job stress
    that could lead to improved employee health and organizational
    well-being. Suggested intervention strategies were proposed for
    further research.

· **Study of mortality among female nuclear workers (MAFN).** A study of
female workers from 12 DOE plants, including LANL, was combined in a
cohort mortality study, and risk estimates were developed for exposure
to ionizing radiation or to chemical hazards. For the entire pooled
cohort, mortality from mental disorders, diseases of the genitourinary
system, and from ill-defined conditions was higher than expected.
External ionizing radiation exposure in these workers appeared to be
associated with increased relative risk for leukemia and, to a lesser
degree, with increased relative risks for all cancers combined and for
breast cancer.

-   **Hazard surveillance in the defense nuclear industry (HSDN).** The
    University of California developed an integrated approach to
    statistical exposure assessment models of complex mixed exposures to
    chemical and biochemical agents. As reported by the investigators,
    the study identified appropriate statistical tools for
    characterizing multiple chemical agents, modeled pollutant
    concentration between source and worker, investigated the
    application of biologic monitoring and biomarkers for hazard
    assessment, and examined the assessment of risks from multiple
    exposures. The study findings were released by NIOSH on September
    24, 2002.

> **Current Activities at LANL**
>
> Community Involvement

-   ATSDR and NIOSH will continue to work with community-based
    organizations, such as the Northern Pueblos Institute, the New
    Mexico Educational Opportunity Center, the Tribal Environmental
    Watch Alliance, the Rio Arriba Environmental Health Partnership, the
    Eight Northern Indian Pueblos Council, and the Los Alamos Citizens'
    Advisory Board, to address current progress and future plans.

*Off-Site Contamination*

-   **NCEH historical document retrieval for dose reconstruction.** NCEH
    has initiated this project at LANL, which began in FY 1999, to
    locate, copy, and evaluate documents that contain information about
    historical chemical or radionuclide releases from LANL to the
    environment. ENSR International, CDC\'s contractor, continues to
    identify documents in LANL repositories which would be relevant to
    dose reconstruction. Copies of declassified documents are publicly
    available in the Zimmerman Library in Albuquerque, NM. The public
    can examine titles and brief descriptions of these documents on the
    internet at
    [[http://www2.cdc.gov/nceh/radiation/LANL/default.htm]{.underline}](http://www2.cdc.gov/nceh/radiation/LANL/default.htm)
    NCEH will work with Los Alamos stakeholders to determine if the
    information warrants an off-site exposure assessment. NECH awarded a
    new contract to ChemRisk. Work will start the first week of
    February 2005. Under a task order contract, Advanced Technologies
    Laboratory, Inc., (ATL) is processing the last documents identified
    by ENSR International or CDC in the last contract.

-   **ATSDR public health assessment.** On December 23, 2003, ATSDR
    released a public health assessment for data validation. After
    revising the document to include additional data, the public health
    assessment will be released for public comment in FY2005.

*Community Health Studies and Activities*

-   **ATSDR health education and promotion.** ATSDR provided support for
    health education activities through a cooperative agreement with the
    Association of Occupational and Environmental Clinics (AOEC).
    Activities that were conducted through the agreement included
    healthcare provider education and community health education. ATSDR
    will develop follow-up health education activities as needed.

*NIOSH Occupational Health Studies*

-   **Leukemia case-control study (LCCS).** An ongoing NIOSH leukemia
    case-control study will combine worker information from several DOE
    sites, including LANL. This study, the largest of its kind, will
    examine the relation between external radiation and leukemia risk
    among 250 workers with leukemia compared with workers who do not
    have leukemia. All exposure assessments for radiation and potential
    leukemogens for the 5 sites included in this study have been
    completed and final analysis should be completed in fiscal year
    2005.

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers. There is one ongoing project at LANL.

-   The DOE-funded Former Workers Program project at LANL is
    administered by Johns Hopkins University. This project offers
    medical screening to former LANL workers who may be at risk from
    occupational exposures.

*DOE ILLNESS AND INJURY SURVEILLANCE OF CURRENT WORKERS*

> DOE's illness and injury surveillance assesses the overall health of
> the current DOE workforce at 14 DOE sites, including LANL. The goal is
> to identify groups of workers that may be at increased risk for
> occupation-related injury and illness.

**Issues Needing Attention at LANL**

The following issues need to be addressed:

-   The increased rates of cases of thyroid and other cancers seen
    during the 1980s and the subsequent decrease in those rates need to
    be explained.

-   Concerns about benign thyroid condition in communities at large, and
    specifically among residents of the pueblos, need to be addressed.

-   Soil exposure pathways need to be reviewed.

-   An apparent cluster (four confirmed cases) of leiomyosarcoma in Los
    Alamos needs to be investigated.

-   Concerns about air pathways associated with the incinerator,
    including historical concentrations of dioxin need to be addressed.

**Proposed Activities** **at LANL**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.

*New Activities for FY 2005-2010*

No new activities at this time.

**Mallinckrodt Plant**

St. Louis, Missouri

**Background**

The 45-acre Mallinckrodt Plant is located in an industrial area on the
eastern border of St. Louis, approximately 300 feet west of the
Mississippi River. The property is owned and operated by Mallinckrodt,
Inc. (formerly Mallinckrodt Chemical Works).

From 1942 to 1957, under contracts with the Manhattan Engineer District
(MED) and the AEC, the site processed various forms of uranium compounds
for machining and for recovery of uranium metal. In 1946, the
manufacture of uranium dioxide from pitchblende ore began at a newly
constructed plant. The pitchblende ore was acquired from the African
Metals Company. Because this company retained ownership of the radium
content of the ore, radium-226 and its daughter products had to be
extracted along with the lead content. The radium and lead were
precipitated, and the precipitate was stored at the Lake Ontario
Ordnance Works in Lewiston, New York, and the Feed Material Production
Center in Fernald, Ohio.

Mallinckrodt now owns the buildings formerly used under the AEC
contract. At the time of the MED/AEC operations, the plants were owned
by Mallinckrodt and/or leased by AEC. Certain buildings in those plants
were also constructed for and owned by AEC. From 1942 through 1945,
uranium processing was conducted at Plants 1, 2, and 4. In 1945,
operations at Plant 2 were terminated. Some uranium metallurgical
research continued at Plant 4 through 1956. From 1945 to 1957, uranium
concentrate or ore was processed in buildings at Destrehan Street
(Plants 6, 6E, and 7). All uranium extraction operations at the
Destrehan Street location ceased in 1957.

**Past Activities at Mallinckrodt**

*Studies of the Health of Mallinckrodt Workers*

· A study conducted by Oak Ridge Associated Universities (Dupree et al.,
1995), under contract to DOE Office of Energy Research, examined the
relationship between uranium dust exposure and lung cancer mortality
among workers employed in four uranium processing or fabrication
operations located in Missouri, Ohio, and Tennessee. This study included
the Mallinckrodt facility. A total of 787 cases were identified. Odds
ratios for lung cancer mortality for seven cumulative internal dose
groups did not demonstrate increasing risk with increasing dose.
However, there was a suggestion of an exposure effect for workers hired
at age 45 years or older. Further analyses for cumulative external dose
and exposures to thorium, radium, and radon did not reveal any
statistically significant association between exposure and increased
risk, nor did categorizing workers by facility.

The study results were published in the journal *Epidemiology* (Dupree
EA, Watkins JP, Ingle JN, Wallace PW, West CM, Tankersly WG (1995).
Uranium dust exposure and lung cancer risk in four uranium processing
operations. *Epidemiology* 6(4): 370--375).

· A study conducted by Oak Ridge Associated Universities (Dupree-Ellis
et al., 2000), under contract to NIOSH, investigated the mortality in a
cohort of 2,514 white males employed at Mallinckrodt between 1942 and
1966 to evaluate: (1) mortality compared to the U.S. population, and (2)
the relationship between external ionizing radiation and cancer and
other diseases of the respiratory, digestive, genitourinary, and
lymphatic systems. A total of 1,013 deaths occurred among this cohort
through 1993. For all causes of death, fewer white male workers died
than would be expected based on the U.S. white male population (SMR =
0.90, 95% CI = 0.85-0.96). The SMR for all cancer deaths was elevated
but not statistically significant (SMR = 1.05, 95% CI = 0 .93-1.17) as
was chronic nephritis (SMR = 1.88, 95% CI = 0.75-3.81).

The study results were published as follows: (1) Dupree-Ellis E, Watkins
JP, Ingle JN, Phillips JA (1998). *External radiation exposure and
mortality among a cohort of uranium processing workers*. Oak Ridge, TN:
Oak Ridge Associated Universities; (HHS Contract #200-93-2695, Final
Report.) Available from the National Institute for Occupational Safety
and Health/Health-related Energy Research Branch, Cincinnati, OH, (26
pg.) and (2) Dupree-Ellis E, Watkins JP, Ingle JN, Phillips JA (2000).
External radiation exposure and mortality in a cohort of uranium
processing workers. *Am Epidemiol* 152:91--95.

**Current Activities at Mallinckrodt**

No studies are currently being conducted in populations near the site.

**Issues Needing Attention at Mallinckrodt**

No additional issues have emerged.

**Proposed Activities at Mallinckrodt**

*New Activities* *for FY 2005--2010*

-   **NIOSH Occupational Health Studies (2005--2006) Mallinckrodt
    Exposure Assessment Study (CUWS).** Further investigation of this
    important uranium exposure cohort is anticipated to more fully
    characterize internal exposures, such as radium, radon, and uranium
    that were encountered by the workers at this facility. The study is
    now a feasibility study of the combined exposures of uranium workers
    at the K25 and Mallinckrodt sites.

**Middlesex Sampling Plant (MSP)**

Middlesex, New Jersey

**Background**

The Middlesex Sampling Plant (MSP) is located in the Borough of
Middlesex, New Jersey. The plant is in the Raritan River drainage basin,
and runoff from the site flows south into the Raritan River through a
series of ditches, streams, and brooks.

From 1943 to 1967, MSP was the entry point for African uranium, thorium,
and beryllium ores. These ores, imported for use in the nation's early
atomic energy program, were tested at MSP and then shipped to other
sites for processing. Traces of radioactive material were carried over
the years by wind and rain to neighboring properties. From 1967 to 1979,
the site was used as a U.S. Marine Corps Reserve training center.

In 1980, the site became part of the DOE Formerly Utilized Sites
Remedial Action Program (FUSRAP). In February 1999, MSP was listed on
the Environmental Protection Agency's National Priorities List, after
uranium was detected in the stream along the site boundary. On-site
groundwater is contaminated with arsenic, chromium, lead, manganese, and
uranium.

Over the years, the buildings and soil of the MSP property and the soil
of other nearby properties were contaminated with elevated levels of
radioactive hazardous substances. A significant portion of the plant
property is covered by contaminated soil that extends to depths of
nearly 5 feet. During a 1948 regrading of the site, some of this
contaminated soil was sent to the Middlesex Municipal Landfill and to
two other properties nearby.

Excavation of radioactive material from the Middlesex Municipal Landfill
was completed in 1986. The material was stored at MSP until 1998, when
it was shipped to an off-site hazardous waste landfill.

**Past Activities at MSP**

*Off-Site Contamination*

-   During 1980 and 1981, DOE cleaned up the site and 33 nearby
    properties. Approximately 58,800 cubic yards of radioactively
    contaminated soil was excavated and placed in two covered interim
    storage piles at MSP. In 1998 and 1999, the Army Corps of Engineers
    removed both storage piles and transported them to permitted
    hazardous materials landfills.

*Community Health Studies and Activities*

· In December 1999, ATSDR sent letters to the 5,000 homes and businesses
within a 1-mile radius of the site informing residents of ATSDR's
activity at the site and requesting community members to inform ATSDR of
any concerns they may have about possible adverse health effects
relating to MSP. ATSDR heard from more than 175 residents. A major
concern was potential groundwater contamination.

-   In February--April 2000, ATSDR conducted an exposure investigation
    to determine if off-site groundwater used as drinking water was
    contaminated. ATSDR sampled water from 17 residences near MSP for
    the contaminants found in on-site groundwater (arsenic, chromium,
    lead, manganese, and uranium). The water in some of the residential
    wells was contaminated, but ATSDR concluded that the current
    contamination levels would not cause adverse health effects.

-   **ATSDR public health assessment.** On April 15, 2002, ATSDR
    completed a public health assessment to evaluate the potential for
    contaminants at the Middlesex Sampling Plant (MSP), Middlesex, New
    Jersey, to harm people living near or accessing the site. On the
    basis of its evaluation, ATSDR reached the following conclusions:

Former workers and former marines in training likely came in contact
with contaminated media during their routine responsibilities at the MSP
site in the past. Adequate information is not available to fully
evaluate past exposure of the workers or marines to site radionuclides
or other contaminants.

ATSDR has determined that *no public health hazard* is associated with:

-   Current and future uses of the site. Today, no exposure is occurring
    because the site is inactive; most of the contaminated soil has been
    removed; little exposed soil remains at the site; and only low
    levels of radon have been detected. No harmful future exposures are
    expected as long as the site is secured and workers are adequately
    protected during any future remediation activities.

-   Surface-water/sediment pathway. Surface water in the immediate area
    of the site is not used in ways (i.e., recreational uses) that would
    encourage long-term or frequent contact with surface water or
    sediment. Contaminant concentrations detected in the surface water
    and sediment are too low to pose a health hazard from any potential
    sporadic and infrequent exposures.

-   Groundwater/drinking water pathway. Although groundwater beneath the
    site is contaminated, it has never been used for drinking and there
    are no plans to use the groundwater in the future. Recent monitoring
    indicates that elevated concentrations of uranium and arsenic have
    migrated to a downgradient off-site monitoring well. In light of
    this finding, water from selected, nearby private wells has been
    tested and found to not have elevated levels of contaminants, and
    all were below EPA's current drinking water standards.

*Studies of the Health of Middlesex Workers*

> No studies of former Middlesex workers exist.

**Current Activities at MSP**

· **ATSDR health education and promotion.** ATSDR will determine its
health education and promotion activities based on the findings and
recommendations from the draft public health assessment and from the
comments received from community residents during the public comment
release period. These activities could include holding a public
availability session for residents potentially impacted by MSP and
developing community health education materials, which may include fact
sheets, educational brochures, and document summaries.

For 1979--1991, the total cancer incidence and the incidence for most
site-specific cancer groups were lower than expected. The 1979--1991
incidence rate in Middlesex Borough for leukemia in males was elevated.

During a later time period (1992--1998), total cancer incidence was
higher than in the earlier period. However, leukemia incidence in males
was not elevated.

**Issues Needing Attention at MSP**

No issues at this time.

**Proposed Activities at MSP**

*New Activities* *for FY 2005-2010*

No new activities are proposed at this time.

**Monticello Mill Tailings Site**

Monticello, Utah

**Background**

The Monticello Mill Tailings Site, is located in the city of Monticello,
in San Juan County, Utah. Initially, the site was an ore-buying station.
Ore production increased sufficiently to justify mill construction in
1941. The mill produced vanadium (1942--1943), uranium-vanadium sludge
(1943--1946), and uranium (1949--1960).

The now abandoned uranium processing mill contaminated soils and
buildings throughout Monticello because these soils were taken from the
mill site and used as fill for open lands; backfill around water, sewer,
and electrical lines; and sand mix in concrete, plaster, and mortar. The
total tonnage of uranium mill tailings removed from the mill site for
construction purposes was never documented. However, contaminated
material is estimated at 156,000 cubic yards. As a result, residents
have been exposed to low levels of uranium, radium-226, radon-222, and
associated radiation. A total of 449 properties are being remediated.

**Past Activities at Monticello**

*Off-Site Contamination*

· Hazardous substances include yellow cake (uranium oxides), black cake
(vanadium oxides), and uranium. The tailings that remain on the mill
site would be considered a public health hazard today if the public had
access to the site. However, because access is strictly controlled, the
mill site does not pose a direct threat to area residents.

*Community Health Studies and Activities*

-   The Utah Cancer Registry is part of the National Cancer Institute's
    Surveillance, Epidemiology, and End Results (SEER) program. Utah has
    the lowest cancer incidence in the SEER system and the lowest
    overall cancer mortality rate of any state. The main reason seems to
    be the low smoking rates and the associated low rates of
    smoking-related cancers. Since becoming part of the SEER system,
    Utah has had an incidence rate approximately 16% below national
    rates, while mortality rates are approximately 28% below the
    national average.

-   As part of the public health assessment published in 1997, ATSDR
    reviewed available health outcome data and identified the following
    increased causes of death for San Juan County compared to other Utah
    counties: (1) renal failure in women only, (2) breast cancer in
    women, and (3) cancer associated with the respiratory tract.

-   **ATSDR health studies.** As a followup to the 1997 public health
    assessment, ATSDR undertook a health consultation to (1) update data
    on leukemia, lymphoma, breast, kidney, and respiratory cancer
    incidence from 1943 through 1996 and analyze the 1967--1996
    data, (2) update data on death due to renal failure from 1993
    through 1995 and analyze the 1979--1995 data, and (3) collect and
    analyze incidence data on end-stage renal disease (ESRD) from 1977
    through 1995. The report was released in 2002.

*Studies of the Health of Monticello Workers*

-   Industrial hygiene surveys performed when the mill was operating
    reported that conditions were dusty and that workers were exposed to
    levels of radioactive dusts above allowable concentrations (Holaday
    et al., 1952; Archer et al., 1973). Because of the known exposure to
    workers, a urine sampling and assaying program was begun at the mill
    in 1956, which would have detected uranium exposure. Workers in
    areas with higher air dust levels, all males, were sampled weekly.

-   In occupational cohort studies of uranium mill workers, excess
    deaths due to nonmalignant respiratory disease and cancer of the
    blood-forming organs other than leukemia have been reported (Archer
    et al., 1973; Waxweiler RJ et al., 1983).

-   According to a more recent survey of health conditions among
    American Indian and non-Indian former uranium mill and mine workers,
    a majority of these workers reported respiratory diseases or
    symptoms which included chronic obstructive pulmonary disease,
    emphysema, fibrosis, persistent cough, pneumoconiosis, and
    silicosis.

**Current Activities at Monticello**

*Off-Site Contamination*

> DOE is continuing remediation of the properties near Monticello.

*Community Health Studies and Activities*

-   No health study activities are planned for this site.

-   **ATSDR health education and promotion.** These activities have been
    completed.

*NIOSH Occupational Health Studies*

-   NIOSH is conducting a followup study of former uranium mill workers;
    however, Monticello is not included because employment records could
    not be located. Instead, the study will focus on the Four Corners
    area (the point of intersection for Arizona, Colorado, New Mexico,
    and Utah) and will attempt to identify 500 exposed workers and 100
    controls in order to conduct a cross-sectional medical survey. The
    outcomes of interest are pulmonary and renal effects. The University
    of New Mexico Medical Center will send a mobile van out to
    communities in this area to carry out the medical component of this
    study.

**Issues Needing Attention at Monticello**

The gaps specific to Monticello are being addressed in the ongoing
studies.

**Proposed Activities** **at Monticello**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.

*New Activities for FY 2005--2010*

No new activities are proposed at this time.

**Mound Plant**

Miamisburg, Ohio

**Background**

The Mound Plant is a DOE production facility located in the city of
Miamisburg, in Montgomery County, Ohio, 10 miles southwest of Dayton.
While the research and production areas of the site once occupied 306
acres, most of Mound's DOE activities have been terminated or relocated
to other DOE facilities, and parcels of the original property are being
turned over to private ownership as they become available.

Mound was built in the late 1940s under the auspices of the war
department. Until recently, the Mound Plant did research and development
(for example, from the mid 1950s until 1985, scientists studied
radioactive isotopes, such as those of uranium and thorium). The plant
also manufactured components for nuclear weapons.

DOE either ended these programs or transferred them to other facilities.
The one active production program still at the site is the manufacture
of electric power sources, which use plutonium-238. However, much of
DOE's work at the site relates to environmental cleanup.

Public health issues at the site include past exposures to both workers
and residents in the community to a wide range of radioactive and
chemical contaminants including polonium-210, plutonium-238, and
tritium. Current exposures are to workers involved in the cleanup of the
site.

**Past Activities at Mound**

*Off-Site Contamination*

-   ATSDR conducted a public health assessment of possible off-site
    exposures to hazardous materials released from the site and
    determined that the plant currently poses no apparent public health
    hazard. Insufficient information, however, made it impossible for
    ATSDR to determine whether releases of polonium or non-radioactive
    materials from the site during the 1950s ever posed a public health
    hazard.

-   After being notified by ATSDR that levels of plutonium-238 were
    elevated in the Miami-Erie Canal and the Miamisburg Community Park,
    Miamisburg closed the fishing pond.

*Community Health Studies and Activities*

-   An environmental health workshop was developed through a cooperative
    agreement with the Boston University School of Public Health to
    educate and help communities and healthcare providers near DOE sites
    evaluate the usefulness and practicality of collecting and assessing
    health outcome data. On May 19, 1995, a workshop for the community
    near the site was presented in Miamisburg.

*Studies of the Health of Mound Workers*

-   A preliminary study examined the mortality of 4,697 white male Mound
    Plant workers through 1979. Overall, no death rate was higher than
    expected based on U.S. general population rates. Among men first
    hired between 1943 and 1945, the rates for all causes of death
    combined, all cancers combined, cancers of the rectum and lung, all
    respiratory diseases, and all injuries were higher than expected.
    The higher rates for all causes of death combined and lung cancer
    were localized among men who worked at the plant less than 2 years.
    Among men hired through 1959, cancer of the prostate was high among
    those who worked there more than 5 years.

-   A second mortality study looked at the same group. No increase in
    overall mortality or site-specific cancers was noted. In a subgroup
    of 3,229 workers monitored for external radiation, a dose-response
    relationship based on small numbers of deaths was observed for
    lymphopoietic/hematopoietic cancers and for all leukemias.

-   Subsequently, the mortality of 4,402 white male workers at the site
    was studied through 1983. Among the men initially hired during World
    War II, increased mortality rates, relative to the U.S. population,
    were reported for all causes of death combined, all cancers
    combined, cancer of the rectum, lung cancer, chronic rheumatic heart
    disease, all respiratory diseases combined, and all injuries. These
    results are fairly similar to the earlier study. Among the 2,181
    workers monitored for polonium-210 intake during 1944--1972, no
    death rates were higher than expected and no positive dose-response
    trends were detected.

-   **Exposure assessment of hazardous waste, decontamination and
    decommissioning, cleanup workers (HAWW).** Feasibility studies at
    seven DOE sites, including the Mound site, determined that the
    availability of records to identify workers and their primary
    activities, exposures, work histories, and medical information
    varied significantly from site to site. The necessary information to
    conduct exposure assessment, hazard surveillance, or epidemiology
    studies of remediation workers is currently not readily available.
    Within sites, data systems are fragmented and data management is
    inconsistent in the current environment of decentralized management
    and increased subcontracting.

-   **Study of mortality among female nuclear workers (MAFN).** A study
    of female workers from 12 DOE plants, including Mound, was combined
    in a cohort mortality study, and risk estimates were developed for
    exposure to ionizing radiation or to chemical hazards. For the
    entire pooled cohort, mortality from mental disorders, diseases of
    the genitourinary system, and from ill-defined conditions was higher
    than expected. External ionizing radiation exposure in these workers
    appeared to be associated with increased relative risk for leukemia
    and, to a lesser degree, with increased relative risks for all
    cancers combined and for breast cancer.

**Current Activities at Mound**

*Community Involvement*

No ongoing studies with community involvement exist.

*Off-Site Contamination*

No ongoing studies assessing off-site contamination exist.

*Community Health Studies and Activities*

> A local citizens group, Miamisburg Environmental Safety and Health, is
> conducting a neighborhood health survey.

*NIOSH Occupational Health Studies*

No ongoing studies exist.

**Issues Needing Attention** **at Mound**

No additional issues have emerged.

**Proposed Activities** **at Mound**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.

*New Activities for FY 2005--2010*

-   **NIOSH occupational health studies (2009-2012), Mound cohort
    mortality study (MCMS).**

> This will be a followup study of the Mound worker cohort that has
> experienced exposures to tritium, polonium, and plutonium in addition
> to external radiation. A mortality study through 1979 showed elevated
> lung cancer mortality in workers employed from 1943--1959 and a
> significant dose-response relationship between plutonium-238 exposure
> and lymphopoietic/hematopoietic cancers and leukemia. An update would
> allow for additional decades of followup and the use of validated
> bioassay information. This project is being postponed and is currently
> scheduled to begin in 2009.
>
> *The Former Workers Program*
>
> The DOE-funded Former Workers Program will soon offer medical
> screening services to former DOE workers. There will be two projects
> at Mound:

-   The Mound Building Trades Medical Screening Program, led by the
    Center to Protect Workers' Rights, will offer medical screening to
    former building trades (construction) workers who may be at risk due
    to work-related exposures.

-   The Former Mound Production Workers project, administered by the
    Paper, Allied-Industrial, Chemical and Energy Workers International
    Union (PACE) and Queens College, will offer former production
    workers and other nonconstruction workers from Mound medical
    screening.

**Nevada Test Site (NTS)**

Nye County, Nevada

**Background**

The 1,350-square mile Nevada Test Site (NTS) is in Nye County, in
southern Nevada. NTS is federally owned land and its access is
restricted. In 1951, the first nuclear weapons tests on the site were
conducted. It was made a permanent testing location by withdrawing the
land from public access beginning in 1952. The site was created from a
portion of land that the Air Force used as a bombing and gunnery range
(the gunnery range is now called the Nellis Air Force Range). The
combined area of NTS, the Nellis Air Force Range, and the contiguous
Tonopah Test Range is approximately 5,470 square miles.

NTS was created to accelerate the development of nuclear weapons, and
has an extensive history of nuclear weapons tests, with 119 atmospheric
tests conducted in 1951--1958 and 809 underground tests conducted in
1961--1992. The atmospheric tests deposited radioactive fallout downwind
and across the world. The underground tests left large quantities of
radionuclides in the soil and groundwater.

Low-level radioactive waste has been shipped from other DOE facilities
to two NTS waste site disposal locations. One disposal site opened in
the late 1960s and the other in 1978. The proposed Yucca Mountain
high-level radioactive waste repository is also partially located on
NTS. If plans for designating NTS as a regional waste disposal center
are approved, shipments of low-level radioactive wastes (more than
200,000 by some estimates) could increase significantly.

**Past Activities at NTS**

*Off-Site Contamination*

-   In 1997, the National Cancer Institute (NCI) published estimated
    thyroid doses for populations of each U.S. county due to releases of
    iodine-131 (I-131) during atmospheric nuclear weapons testing at NTS
    in the 1950s and 1960s. For the entire U.S. population, the average
    cumulative thyroid dose was about 2 rads. The average thyroid dose
    in the 24 counties with the highest exposures (located in Nevada,
    Utah, Idaho, and Montana) ranged from 9 to 12 rads.

The National Academy of Sciences Institute of Medicine reviewed the dose
reconstruction for I-131 from NTS and concluded that resources should be
focused on designing an education and information program about the
health consequences of exposure to fallout from the site. The Institute
of Medicine did not recommend conducting widespread thyroid screening
programs.

*Community Health Studies and Activities*

-   During the 1980s, scientists at several national laboratories
    collected all records and data pertaining to U.S. atmospheric
    nuclear weapons testing. This information is now available to the
    public at the DOE Coordination and Information Center in Las Vegas.

> A dosimetric evaluation of areas in the region was developed from this
> data. The study was characterized by community/locale and
> age/occupation. The study found that residents in southwest Utah,
> closest to NTS, received the highest exposures (whole body doses of
> less than 10 rems), but that residents of urban northern areas
> received a higher mean dose. Subsequent epidemiologic studies used
> this methodology and the models and data to estimate doses for certain
> cohorts and populations. The off-site Radiation Exposure Review
> Project established exposures from NTS fallout.

-   A number of studies have examined the possibility of adverse health
    effects from radioactive fallout to people living near NTS; these
    studies have usually focused on thyroid disease and leukemia in
    children downwind from the site. Early studies of thyroid diseases
    found no association between occurrence of disease and living near
    the site. However, a 1993 study that included calculated thyroid
    doses reported a statistically significant dose-response trend of
    increased thyroid neoplasms with increased radiation dose. The
    relative risks of thyroid cancer for higher dose levels were
    elevated, but were not statistically significant.

Studies of cancer and leukemia have generally found an excess of
leukemias considered radiogenic. A 1990 case-control study of leukemia
deaths in Utah, found a positive dose-response relationship for acute
leukemias (acute lymphocytic leukemia in particular) in persons less
than 20 years old. The study found a weak overall relationship. However,
the excess was confined primarily to a single, sparsely populated
county.

*NIOSH Occupational Health Studies*

No ongoing studies exist.

*Studies of the Health of Workers*

-   **Prevention of stress and health consequences of downsizing
    (STDN).** The effects of downsizing on organizational climate,
    worker health, and performance were studied at several DOE sites,
    including NTS. Data gathering included interviews, workplace
    observations, employee discussion groups, an employee survey
    distributed to more than 10,500 employees, and a historical record
    review. Researchers identified opportunities to reduce job stress
    that could lead to improved employee health and organizational
    well-being. Suggested intervention strategies were proposed for
    further research.

**Current Activities at NTS**

*Community Involvement*

> In 1981, the Community Radiation Monitoring Program began. The program
> now has a Citizens Advisory Board which meets regularly.

*Off-Site Contamination*

-   A milk surveillance network and sampling of wells supplying drinking
    water have been implemented.

-   **ATSDR health consultation.** No consultations are planned at this
    time.

-   **ATSDR health education and promotion.** ATSDR, has
    completed work to develop educational materials. ATSDR will continue
    to work other HHS agencies to provide  programs for the public,
    healthcare providers, media, public health agencies, and
    professional organizations related to health risks from past
    exposures to environmental releases of hazardous materials from NTS.

Under an ATSDR cooperative agreement with the American College of
Preventative Medicine, training and education programs based on the
I-131 CSEM have been provided for healthcare providers and community
members living near DOE sites. These activities have included grand
rounds presentations, presentations at national meetings and conferences
and the development of an I-131 website for both healthcare providers
and community members.

*Community Health Studies and Activities*

> Nye County, working with representatives from 10 county governments,
> and the University of Nevada at Las Vegas, has completed a first draft
> of the Nevada Baseline Rural Health Assessment Research Proposal, a
> Baseline Radiation Health Study Bibliography, and initiated organizing
> an independent Nevada Health Study Advisory Group.

*NIOSH Occupational Health Studies*

No ongoing studies exist.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE workforce at 14 DOE sites, including NTS. The goal
> is to identify groups of workers that may be at increased risk for
> occupation-related injury and illness.

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers.

-   The Former Workers Program project at the NTS offers medical
    screening to former workers from this site.

**Issues Needing Attention at NTS**

> Gaps in understanding of health effects to workers and community
> members, including special populations such as Native Americans, need
> to be addressed.

**Proposed Activities** **at NTS**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway and to initiate new ones, if feasible and beneficial
> to the community. The agencies will establish a coordinated plan,
> schedule, and lead organization for each new public health activity.
> The plan and schedule will be presented to all potential partners for
> their comment, including local communities and their governments,
> appropriate agencies of the State of Nevada, and the NTS Citizens
> Advisory Board.

*New Activities for FY 2005--2010*

> **NIOSH occupational health studies (2006-2010), Nevada Test Site
> Mortality Study (NCMS).** An occupational analytical epidemiology
> study has not been completed at this site. A preliminary record review
> by NIOSH determined that a study was feasible. The study will require
> the assembly of the study cohort members, along with their work
> histories and the subsequent linkage to exposure records. The study is
> expected to take at least 5 years to complete due to the data
> collection and assembly that will be required.
>
> **Activities for Which the Funding Source is External to DOE and HHS
> Memorandum of Understanding**
>
> A focused program of public information and education about the
> consequences of the NTS fallout will be developed in coordination with
> the State of Nevada and Health Study Advisory Groups. The following
> activities address fallout from NTS:

-   The cohort of former Utah schoolchildren who were previously
    evaluated for thyroid disease in relation to fallout exposures from
    the Nevada test site will be followed up for the second time.

-   NCEH is assessing the feasibility of conducting a nationwide
    comprehensive assessment of the health consequences of nuclear
    weapons tests. General and specific high-risk populations will be
    considered.

-   NCEH will make available CDC communication and information
    dissemination networks, as needed, to help the National Cancer
    Institute implement the public health outreach recommendations
    contained in the report prepared by the National Academy of Sciences
    and Institute of Medicine on the effects of NTS-related radioactive
    iodine exposures to people across the United States.

-   In 2002, the Department of Health and Human Services transmitted to
    the Senate Appropriations Committee a progress report and an
    extensive two-volume *Draft Report on the Feasibility Study of the
    Health Consequences to the American Population from Nuclear Weapons
    Tests Conducted by the United States and Other Nations.* The report
    provided details on the scientific methods and conclusions of this
    feasibility study. The Draft Feasibility Study was posted on CDC's
    website for public comment and was also sent to the National Academy
    of Sciences' (NAS) Committee to Review CDC-NCI Feasibility Study of
    the Health Consequences from Nuclear Weapons Tests. The NAS
    Committee issued a report in February 2003.

CDC and NCI have been working together to carefully review and respond
to the NAS comments from the public, and have prepared a final
Feasibility Study reflecting these recommendations. Many of the
recommendations were editorial in nature and related to reworking the
numerous maps and graphs to clarify their content and clarifying
assumptions, methods, and uncertainties related to dose estimation.
Because of the length and complexity of the report, making and reviewing
these changes were quite time-consuming. However, the basic technical
content and findings have NOT changed since the draft report was
published. The final report will present little information that was not
already available to the public in the draft report.

The approximately 700-page technical report is currently under final
review and clearance

by NCI and CDC. Once this is complete, it will be submitted to the
Secretary of Health and Human Services for review and transmittal to
Congress.

**Oak Ridge Reservation** **(ORR)**

Oak Ridge, Tennessee

**Background**

The Oak Ridge Reservation (ORR) occupies approximately 37,000 acres of
land in Anderson and Roane Counties, in east central Tennessee. Most of
the reservation is within the limits of the city of Oak Ridge. The
Federal Government established ORR in 1942 as part of the Manhattan
Project, the World War II effort to build the atomic bomb.

The three major installations on ORR are the Y-12 weapons plant, the
East Tennessee Technology Park (formerly known as the K-25 site), and
the Oak Ridge National Laboratory (formerly known as the X-10 site).
These installations occupy about 30% of the property, the remainder,
which was never used for nuclear weapons production, research processes,
or waste management, being a National Environmental Research Park.

In the early years, ORR produced plutonium and enriched uranium. After
the war, the installation's role broadened widely to include a variety
of nuclear research and production projects vital to national security.
In recent years, the facilities and expertise focused on the interest of
the national defense have been downsized. Currently, missions include
environmental restoration; decontamination and decommissioning; waste
management, research and development related to energy; technology
transfer; government and industry partnerships; and national security
programs.

Operations at ORR have left a legacy of radioactive and chemical waste
which have contaminated soil, groundwater, and surface water both on and
off the reservation. Old waste sites occupy 5% to 10% of the reservation
and most of them lack engineered containment structures.

**Past Activities at ORR**

*Off-Site Contamination*

-   In 1983 the Tennessee Department of Health and Environment and CDC's
    NCEH conducted a pilot survey in Oak Ridge in response to community
    concerns about mercury contamination in the East Fork Poplar Creek
    flood plain and the sewer line beltway. The pilot survey concluded
    that residents and workers in Oak Ridge are not likely to be at
    increased risk for having significantly high mercury levels. Mercury
    concentrations in hair and urine samples were below levels
    associated with known health effects.

-   In 1992, an Oak Ridge physician requested the ATSDR to review
    clinical data and medical histories of 45 patients in the Oak Ridge
    area. ATSDR and the Tennessee Department of Health reviewed the data
    and concluded that the case series referred by the physician did not
    provide sufficient evidence to associate low levels of metals with
    the diseases presented in the physician's patients. In addition,
    Howard Frumkin, of the Emory University School of Public Health,
    conducted individual clinical evaluations of these 45 patients and
    did not report any hazardous substance exposure to public health
    agencies.

-   Additional studies were conducted on hazardous substances in East
    Fork Poplar Creek. Following are some of the conclusions of a 1993
    ATSDR health consultation.

-   Soil and sediments in certain locations along the East Fork Poplar
    Creek flood plain are contaminated with levels of mercury that pose
    a public health concern.

-   Fish in the creek contain levels of mercury and polychlorinated
    biphenyls (PCBs) that pose a moderately increased risk of adverse
    health effects to people who eat fish frequently over long periods
    of time. However, the state of Tennessee has posted "no fishing"
    signs and the creek is not normally used as a source for fish.

-   Although shallow groundwater along the East Fork Poplar Creek flood
    plain contains metals at levels of public health concern, this water
    is not used for drinking or other domestic purposes.

-   In 1995, the ATSDR Science Panel Meeting on the bioavailability of
    mercury in soil was held to identify methods and strategies that
    allow health assessors to develop data-supported, site-specific
    estimates of the bioavailability of inorganic mercury and other
    metals (arsenic and lead) from soils. The panel consisted of private
    consultants and academicians internationally known for their metal
    bioavailability research and experts from ATSDR, CDC's National
    Center for Environmental Health Science, and the Environmental
    Protection Agency. ATSDR used information obtained from the panel
    meetings to evaluate the East Fork Popular Creek cleanup level. The
    findings of the science panel also were used in characterization and
    evaluation of other waste sites with mercury in the soil.

-   A 1995 ATSDR health consultation concluded that the East Fork Poplar
    Creek flood plain soil cleanup level of 400 milligrams per kilogram
    (mg/kg) for mercury is protective of public health and will pose no
    health threat to children or adults. In 1996, DOE cleaned up all
    areas along the East Fork Poplar Creek flood plain where the soil
    was contaminated with mercury at levels above 400 mg/kg.

-   A 1996 ATSDR health consultation on the Watts Bar Reservoir reported
    the following conclusions:

-   Fish in the reservoir contain PCBs, and frequent and long-term
    ingestion of these fish poses a possible moderately increased risk
    of cancer. Frequent and long-term ingestion may also increase the
    possibility of developmental effects in infants whose mothers
    consume fish regularly during gestation and while nursing.

-   Current levels of contaminants in the surface water and sediment of
    the reservoir were not at levels of public health concern, and the
    reservoir was determined to be safe for swimming, skiing, boating,
    and other recreational purposes. Water from the municipal water
    systems was determined safe to drink.

-   Public health would be protected by DOE's remedial actions, which
    included maintaining the fish consumption advisories; continuing
    environmental monitoring; implementing institutional controls to
    prevent disturbance, resuspension, removal, or disposal of
    contaminated sediment; and providing community and health
    professional education on PCB contamination.

-   A 1997 ATSDR exposure investigation on the Watts Bar Reservoir
    reached the following conclusions:

-   The serum PCB levels and blood mercury levels in participants in the
    investigation (people who consumed moderate to large amounts of fish
    or turtles from the reservoir) are very similar to levels found in
    the general population. Only 5 of the 116 people tested (4%) had PCB
    levels higher than 20 micrograms per liter (\_g/L), or 20 parts per
    billion, which is elevated.

-   The test results indicate serum PCBs levels and blood mercury levels
    in the exposed investigation participants are very similar to levels
    found in the general population. The PCB and mercury levels were
    less than ATSDR health officials expected for people who consumed
    moderate to large amounts of certain fish or turtles from the Watts
    Bar Reservoir. ATSDR health officials believe that health effects
    are not likely for the PCBs or mercury levels seen in the expose
    investigation participants.

-   Of the five participants who exceeded 20 \_g/L, four had levels of
    20--30 \_g/L. Only one participant had a serum PCB level of 103.8
    \_g/L, which is higher than the general population distribution.
    Only one participant had a total blood mercury level higher than 10
    \_g/L, which is elevated. The remaining participants had mercury
    blood levels that ranged up to 10 \_g/L, as might be expected to be
    found in the general population.

-   Additional studies were conducted for the East Tennessee Technology
    Park. A 1997 Governor of Tennessee's Independent Panel Report on the
    DOE Toxic Substances Control Act (TSCA) Incinerator at the East
    Tennessee Technology Park concluded that the TSCA incinerator
    facility and operating conditions were in harmony with its permit
    and that the facility had experienced few operating violations. The
    amount of waste actually burned is a small fraction of the volume
    that the incinerator was designed for and permitted to process. The
    highest concentrations measured by the site monitors were but a
    small fraction of the permissible levels, and most pollutants that
    were measured were not primarily from the TSCA incinerator.

*Community Health Studies and Activities*

-   In 1991, the Tennessee Department of Health entered into an
    agreement with DOE for an Oak Ridge health study project. The
    project consisted of two phases. Phase I was a dose reconstruction
    feasibility study. Phase II reconstructed releases of, and potential
    exposures to, the most significant contaminants as identified in
    Phase I.

> Phase I evaluated all past releases of hazardous substances and
> operations at the ORR. The object of the study was to determine the
> quantity, quality and potential usefulness of the available
> information and data on these past releases and subsequent exposure
> pathways. With this information, preliminary screening analyses were
> performed to identify priority hazardous substances of public health
> concern and determine the feasibility of conducting dose
> reconstruction studies that would reconstruct these releases and
> estimate exposure doses. The result of Phase I of the study was the
> determination that a full dose reconstruction should be performed for
> the release of radioactive iodine, mercury, polychlorinated biphenyls
> (PCBs), and radionuclides to the White Oak Creek.
>
> Phase II of the study reconstructed past releases of radioactive
> iodine, mercury, PCBs, and radionuclides to White Oak Creek. Phase II
> also estimated the past exposure of these hazardous substances to
> off-site populations and the resulting human risks. For releases of
> uranium, more information was sought to quantify releases to specified
> exposure pathways, and the findings were screened to determine the
> need for a dose reconstruction.
>
> In the final report of the Oak Ridge Health Agreement Steering Panel
> (ORHASP), entitled "Release of Contaminants from Oak Ridge Facilities
> and Risk to Public Health," the ORHASP reported that the results from
> Phase II dose reconstruction studies include:

-   Radioactive iodine releases were associated with radioactive
    lanthanum processing at X-10 from 1944 through 1956. The ORHASP
    reported the "population of most concern were people born between
    1944 and 1954 who lived in nearby communities and drank milk
    exclusively from a backyard dairy animal." Females born in 1952
    living near Gallaher Bend who drank milk primarily from background
    goats had the highest excess lifetime risk of thyroid cancer. The
    ORHASP also reported that a large number of children that consumed
    contaminated commercial milk would have experienced a small
    increased risk of contacting thyroid cancer. The ORHASP stated that
    the dose reconstruction team estimated that between 6 to 80 excess
    thyroid cancer cases were induced by the radioiodine releases in
    children who lived within 24 miles of the X-10 site and that most of
    these radiation-induced cancers may already have occurred.

-   The study evaluated mercury releases associated with lithium isotope
    separation operations at the Y-12 plant from 1955 through 1963. The
    ORHASP reported that the population of most concern was fetuses of
    pregnant women who ate significant quantities of fish taken from the
    Clinch Ridge or Poplar Creek during the periods (mid 1950s to early
    1960s) of highest releases to East Fork Poplar Creek. A fetus was
    considered placed at risk for severe brain damage if the mother
    ingested methyl mercury in contaminated fish at a dose above the
    level at which no adverse effects have been observed.

-   Additional studies were conducted on PCBs in fish from the East Fork
    Poplar Creek, Clinch River, and the Watts Bar Reservoir. Preliminary
    results indicated that individuals who ate a large amount of fish
    from these waters may have received doses that exceeded the
    reference dose for PCBs.

-   Radionuclides associated with various chemical separation activities
    at X-10 from 1943 through the 1960s were released via White Oak
    Creek. Eight radionuclides shown more likely to carry significant
    risks were studied in detail. The results indicate that the White
    Oak Creek releases caused increases in radiation dose to consumers
    of fish from the Clinch River near the mouth of White Oak Creek and
    to persons who used the downstream banks of the Clinch River during
    periods of low water level. However, less than 1 excess cancer case
    is expected from 50 years of these exposures.

-   Uranium was released from various large-scale uranium operations,
    primarily uranium processing and machining operations at the Y-12
    plant from 1944--1988 and uranium enrichment operations at the K-25
    and S-50 plants. Because uranium was not initially given high
    priority as a contaminant of concern, screening assessment for all
    uranium releases was performed. The ORHASP reported that the refined
    Level I screening indices for uranium, based on the cancer and
    non-cancer risk, for both Y-12 and K-25 were less than the decision
    guide of 1 chance in 10,000; 8 in 100,000 and 4 in 100,000,
    respectively.

> Because uranium, neptunium-237, and technetium-99 were contaminants of
> recycled uranium in the feed material, the risks from these
> contaminants were grouped together. The ORHASP reported that the
> refined level I screening indices for these Y-12 releases was 12 in
> 100,000, just over the Panel's decision guide of 1 chance in 10,000
> for radiological risk. Because of the lack of soil concentration data
> and uncertainties in atmospheric dispersion of Y-12 releases, the
> ORHASP recommended further evaluation.
>
> *Studies of the Health of Oak Ridge Workers*
>
> Researchers at CDC's NIOSH and various collaborators, including the
> Oak Ridge Associated Universities, the University of North Carolina,
> and the University of Michigan, have conducted numerous studies on
> exposures received at ORR and the relationship to health effects among
> workers at ORR. Study findings to date include the following:

-   The Oak Ridge National Laboratory (X-10) has been the subject of
    long-term epidemiologic study. A mortality analysis of 8,375 white
    males through 1977 found no cause of death that was higher than
    expected based on the U.S. general population. However, leukemia
    mortality was related to length of employment in engineering and
    maintenance jobs. A followup study reported that the death rate from
    leukemia through 1984 was greater than the U.S. rate, particularly
    among workers monitored for internal radiation contamination.

> For all cancers combined, except for leukemia, a positive trend was
> reported by level of cumulative external dose. In the most recent
> study of deaths through 1990, none of the rates for the four causes of
> death reported, all causes of death combined, all cancers combined,
> lung cancer, and leukemia, were higher than the corresponding U.S.
> rates.
>
> A recent study of deaths through 1990 reported that radiation doses
> received after age 45 strongly predict the combined mortality rate for
> all cancers.
>
> · The first study of Y-12 workers included 18,869 white males who ever
> worked at the plant, and mortality through 1974 was identified. The
> second study was restricted to 6,781 men who worked at least 30 days
> with mortality through 1979. A third study was expanded to include
> 10,597 nonwhite workers and females with deaths through 1990. The
> death rate from lung cancer was higher than the U.S. rate in the most
> recent two studies. Analysis of deaths through 1979 did not confirm
> positive trends for any cause of death with either external or
> internal exposure to ionizing radiation although a weak trend was
> observed for lung cancer.
>
> · Between 1953 and 1963 the Y-12 Plant used metallic mercury to
> produce large quantities of enriched lithium. There were 5,663 workers
> categorized by exposure based on results of urinalysis data. Analysis
> of deaths through 1978 revealed no differences in the mortality
> patterns for mercury-exposed workers as a whole, workers with the
> highest mercury exposures, and workers employed more than a year in a
> mercury process. A total of 502 mercury workers were also involved in
> a clinical neurology study. Clinical measurements revealed some
> deficiencies in neurological function, particularly among those
> workers with the highest exposures, but these were not associated with
> the duration of exposure. A followup study of 219 of the original
> subjects in the 1990s revealed that some neurologic effects were still
> detectable.
>
> · During the early operation of the Y-12 plant from 1942--1947, a
> group of 694 male workers was exposed to phosgene gas on a chronic
> basis and 106 males and 91 females received acute exposures. A control
> group of 9,280 workers who also worked at Y-12 during the same era,
> but who did not have phosgene exposure, was also described. All groups
> were followed through the end of 1978 with particular interest in
> respiratory diseases and lung cancer. There was no evidence for
> increased mortality from respiratory diseases in this group.

· Studies of workers at K-25 found that white males had high rates
relative to the U.S. population for all causes of death; cancer of the
respiratory system, particularly lung cancer; bone cancer; mental
disorders; all respiratory diseases, particularly pneumonia symptoms;
senility and ill-defined conditions; all external causes of death,
particularly accidents and specifically motor vehicle accidents. White
females had a high rate for symptoms of senility and ill-defined
conditions.

> · Powdered nickel was used at K-25 to produce the barrier material
> that separates and enriches uranium. Death rates for 814 nickel
> workers who made the barriers were compared to 1,600 controls. No
> differences in the death rates for the exposed and non-exposed workers
> by cause of death through 1972 were detected. A later study compared
> the mortality of the 814 nickel workers through 1977 and 7,552
> non-exposed workers. There were no causes of death with a rate higher
> than the U.S. rate and no differences between exposed and non-exposed
> workers.
>
> · Epoxy resins and solvents were common exposures among K-25 gas
> centrifuge workers. In Phase I of a study of centrifuge workers, 263
> workers with the most exposure were compared with 271 workers with no
> exposure at the plant during the same period. The centrifuge process
> workers reported five bladder cancers versus none reported by the
> non-centrifuge group. The standardized incidence rate ratio was 7.8
> for process workers versus comparison workers. In Phase II of the
> study, a larger group, who had lower levels of exposure to the
> centrifuge process, was studied. One additional case was found in a
> centrifuge worker and two additional cases were found in maintenance
> workers who were assigned to work in centrifuge areas. An equal number
> of cases of bladder cancer were found in the comparison group in Phase
> II. A specific cause for the increase in bladder cancer was not
> identified.
>
> · Several studies have considered all ORR workers; the most recent one
> updated mortality through 1984. Mortality from all causes of death
> combined and all cancers combined were similar to overall U.S. rates.
> There were substantial differences in death rates among workers at the
> various ORR plants, particularly the rates for lung cancer, leukemia
> and other lymphatic cancer. Within the second study, data for 28,374
> workers at X-10 and Y-12 were analyzed and positive trends were
> reported with increasing external radiation dose for all causes of
> death combined and all cancers combined.
>
> · Three studies of brain cancer across the four ORR facilities have
> been published. The exposure analysis of 26 chemicals found that none
> were positively associated with brain cancer. No positive trends for
> brain cancer were found with increasing external radiation dose and
> internal dose as measured by the lung dose. Although workers with
> brain cancer were more likely than other workers to have worked at ORR
> more than 20 years, there was no trend of increasing cancer with the
> number of years worked.
>
> · Mortality data through 1974 and through 1989 were analyzed for about
> 1,059 white male welders at ORR. No death rates were higher than the
> U.S. rate through 1974. When deaths through 1989 were considered,
> welders had higher rates of lung cancer, cancer of the prostate, and
> gastric ulcers. The risk of each cause was different among the
> facilities. The risk of lung cancer among welders exposed to nickel
> oxides did not differ from non-exposed welders.

· A multi-site study of multiple myeloma deaths included workers from
X-10. Although the death rate was not higher than expected, higher risks
were encountered by workers whose radiation exposures occurred after age
45.

-   A study of the potential association between paternal exposure to
    ionizing radiation and risk of childhood cancer found no link
    between leukemia and paternal employment at ORR. Children whose
    fathers worked at the Hanford Nuclear Reservation were more likely
    to get CNS (central nervous system) cancer than children whose
    fathers worked at other sites, including ORR, but this finding was
    based on small numbers and was not statistically significant.

-   A NIOSH health hazard evaluation, requested by K-25 site employees,
    investigated possible worker exposure to cyanides. The evaluation
    indicated that employees are not occupationally exposed to hydrogen
    cyanide, cyanide salts, or a wide variety of other compounds that
    contain the cyanide ion.

-   The Oak Ridge National Laboratory, sponsored by a NIOSH grant,
    investigated statistical estimation of dose from daily and weekly
    dosimetry data for ORR radiation workers included in previous
    epidemiologic studies. The study found that differences between the
    two methods were substantial, and recommended methods of reducing
    uncertainty for some estimates.

-   **Exposure assessment of hazardous waste, decontamination and
    decommissioning, cleanup workers (HAWW).** Feasibility studies at
    seven DOE sites, including ORR, determined that the availability of
    records to identify workers and their primary activities, exposures,
    work histories, and medical information varied significantly from
    site to site. The necessary information to conduct exposure
    assessment, hazard surveillance, or epidemiology studies of
    remediation workers is currently not readily available. Within
    sites, data systems are fragmented and data management is
    inconsistent in the current environment of decentralized management
    and increased subcontracting.

-   **Prevention of stress and health consequences of downsizing
    (STDN).** The effects of downsizing on organizational climate,
    worker health, and performance were studied at several DOE sites,
    including ORR. Data gathering included interviews, workplace
    observations, employee discussion groups, an employee survey
    distributed to more than 10,500 employees, and a historical record
    review. Researchers identified opportunities to reduce job stress
    that could lead to improved employee health and organizational
    well-being. Suggested intervention strategies were proposed for
    further research.

-   **Study of mortality among female nuclear workers (MAFN).** A study
    of female workers from 12 DOE plants, including ORR, was combined in
    a cohort mortality study, and risk estimates were developed for
    exposure to ionizing radiation or to chemical hazards. For the
    entire pooled cohort, mortality from mental disorders, diseases of
    the genitourinary system, and from ill-defined conditions was higher
    than expected. External ionizing radiation exposure in these workers
    appeared to be associated with increased relative risk for leukemia
    and, to a lesser degree, with increased relative risks for all
    cancers combined and for breast cancer.

-   **Improved systems for worker exposure surveillance (ISWE)**. The
    Oak Ridge Associated Universities, under a NIOSH grant, completed a
    project at ORR to develop a system for prioritizing industrial
    hygiene and medical surveillance efforts. The Worker Exposure
    Surveillance System (WESS) was designed for easy data merger with
    traditional occupational health systems using environmental level
    analyses, occupational titles, and area descriptors. The study
    findings were released by NIOSH on September 24, 2002.

-   **Exposure history for the construction trades (WHEP)**. The
    University of Cincinnati, under a NIOSH grant, created a
    comprehensive institutional history of buildings at the Oak Ridge
    site, including information on potential exposures for the
    construction trades. The investigators used this database to
    investigate mechanisms to improve worker recall of complex
    occupational exposures across a large number of short-term workplace
    assignments. A variety of prompts (including photos, maps, and focus
    groups) were tried, demonstrating significant improvement in worker
    recall when maps were used. Study results were used to establish
    guidelines and formats for assembling personal work histories. The
    study findings were released by NIOSH on September 24, 2002.

**Current Activities at ORR**

*Off-Site Contamination*

-   **ATSDR public health assessment.** ATSDR is preparing a series of
    issue-specific public health assessments. On January 30, 2004, ATSDR
    completed the public health assessment addressing Y-12 uranium
    releases. The remaining topics to be addressed include:

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-   TSCA Incinerator

-   White Oak Creek Radionuclides

-   K-25 Releases

-   Current chemical exposures

-   Iodine 131

-   Mercury

-   PCB's

-   Off-site groundwater

> ATSDR expects to release the documents for public comment in FY2005
> and finalize the documents in FY2006.

*Community Studies and Activities*

-   **Oak Ridge Health Effects Subcommittee.** The subcommittee is a
    vehicle for community members, local interest groups, and State and
    Federal Agencies to work collectively and make informed
    recommendations regarding the public health agenda for ORR. This
    forum will enable State and Federal Agencies to interact with local
    interest groups. The Agencies will have the opportunity to present
    to community members the results of previous studies, analyses of
    exposure pathways, results of the health statistics review, and the
    criteria used to select and conduct appropriate public health
    activities.

> Community members will help prioritize public health issues and
> community concerns and provide input into the choices to be made
> between current and historical exposures and different public health
> activities. Discussion between the groups will provide an opportunity
> for education and collaboration. Local interest groups and State and
> Federal Agencies can work together to develop the health agenda for
> ORR. The Agencies will address the public health concerns of the
> community and discuss their findings and any recommendations for
> further studies or additional public health actions.
>
> The following topics have been suggested for discussion in conjunction
> with the public forum: (1) the procedures for establishing medical
> cause and effect, (2) the limitations of epidemiology, and (3) the
> difficulties of dealing with residential or other ill-defined
> clusters, including small sample sizes.

-   ATSDR needs assessment for health education and promotion. In FY
    2000, the Association of Occupational and Environmental Clinics
    (AOEC) conducted a community needs assessment at ORR through a
    cooperative agreement with ATSDR. The needs assessment was the first
    step in the process to develop a site-specific health education
    program for the communities near ORR. Since completion of the
    community needs assessment, ATSDR has continued to support health
    education and promotion activities at ORR and will address future
    health education needs as resources and priorities permit.

-   A continuing need to address environmental justice issues exists.
    DOE's Oak Ridge Operations Office maintains a formal and active
    Environmental Justice Plan, consistent with Executive Order 12898,
    to address environmental justice in minority populations and
    low-income populations, at and around ORR. (The Executive Order
    requires Federal Agencies to make achieving environmental justice a
    part of their mission.) The University of Tennessee is also
    partnering with numerous East Tennessee urban and rural grassroots
    community groups, including those with special interest in ORR
    activities, to understand and address the core problems facing low-
    and moderate-income communities.

*NIOSH Occupational Health Studies*

-   **Multiple myeloma case control (K25K).** A NIOSH multiple myeloma
    case-control study at ORR's K-25 facility will help understand the
    relationship between multiple myeloma and different types of
    radiation exposure. A previous study at the University of North
    Carolina examined the relationship between multiple myeloma and
    exposures to external radiation and chemicals. The current NIOSH
    study will look at the relationship between multiple myeloma and
    exposures to internal radiation and chemicals.

-   **Cohort mortality study of DOE chemical laboratory workers
    (CLWS).** Limited previous studies outside the DOE complex suggest
    an increased risk of cancer in chemical laboratory workers. In this
    study, workers potentially exposed to groups of chemicals and
    ionizing radiation will be assessed and their relationship to
    mortality patterns will be investigated. This study is scheduled for
    completion in fiscal year 2005.

-   **Multi-site case-control study of lung cancer and external ionizing
    radiation (LUNG).** This ongoing NIOSH case-control study combines
    worker information from multiple sites, including ORR, to clarify
    the relationship between lung cancer and external radiation
    exposure. Project was cancelled during fiscal year 2004 due to the
    difficulty of estimating exposures to other potential lung
    carcinogens (e.g. asbestos) for workers in the first few decades of
    reactor operations at the sites chosen for the study.

-   **Multi-site leukemia case-control study (LCCS).** This ongoing
    NIOSH case-control study combines worker information from multiple
    sites, including ORR, to explore the relationship between external
    radiation and leukemia risk among 250 workers with leukemia compared
    to similar workers without leukemia. All exposure assessments for
    radiation and potential leukemogens for the 5 sites included in this
    study have been completed and final analysis should be completed in
    fiscal year 2005.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE work force at 14 DOE sites, including ORR Y-12
> weapons plant, Oak Ridge National Laboratory (X-10), and the East
> Tennessee Technology Park (K-25). The goal is to identify groups of
> workers that may be at increased risk for occupation-related injury
> and illness.

*DOE Occupational Health Studies*

-   An independent panel of nationally recognized occupational health
    physicians is conducting individual medical evaluations to assess
    occupational health complaints and symptoms of 53 current and former
    Lockheed Martin Energy Systems workers at the East Tennessee
    Technology Park (formerly called the K-25 site). These medical
    evaluations include reviews of prior health studies; visits to
    workers' workplaces and surroundings; work history interviews with
    individual workers; reviews of worker medical records; physical
    examinations; and specialized followup inquiries and testing.

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former workers. There are three ongoing medical screening
> projects at Oak Ridge.

-   The Oak Ridge Building Trades Medical Screening Program, led by the
    University of Cincinnati, offers medical screening services to
    former construction workers from the three Oak Ridge facilities.

-   PACE's Worker Health Protection Program offers medical screening
    services to former workers from the East Tennessee Technology Park
    (ETTP), formerly the K-25 Gaseous Diffusion Plant.

-   Queens College has joined with the Atomic Labor Trades Council to
    expand medical screening services to former Y-12 and Oak Ridge
    National Laboratory workers.

> **Issues Needing Attention at ORR**
>
> · The process for evaluating the necessity for and criteria for
> possible clinical intervention in the community needs attention.
>
> · The knowledge of possible soil contamination levels in residential
> areas closest to the ORR plants needs attention.
>
> · Current monitoring systems and atmospheric dispersion models should
> be analyzed to determine if they are appropriate for the materials in
> use and the pathways.
>
> **Proposed Activities** **at ORR**
>
> *Ongoing Activities*
>
> The agencies propose to continue the previously mentioned projects
> already underway and to initiate new ones to address the health
> conditions of the Oak Ridge area community members. New activities
> will be implemented only if feasible and deemed appropriate and
> beneficial to the community.
>
> *New Activities for FY 2005--2010*

-   **ATSDR Oak Ridge Health Statistics Review.** Citizens living in the
    communities surrounding the Department of Energy Oak Ridge
    Reservation in Oak Ridge, Tennessee, are concerned about a perceived
    increase in cancer in their area. In order to address these
    concerns, the Oak Ridge Reservation Health Effects Subcommittee
    (ORRHES) requested that the Agency for Toxic Substances and Disease
    Registry (ATSDR) and the Tennessee Department of Health Cancer
    Registry (TCR) conduct an assessment of cancer incidence in this
    area. The geographic area for the health statistics review includes
    eight counties which surround the Oak Ridge Reservation: Anderson,
    Blount, Knox, Loudon, Meigs, Morgan, Rhea and Roane. Cancer
    incidence data for the years 1991-2000 supplied by the TCR was used
    for this analysis. A "case" was defined as an individual residing in
    one of the selected counties who was diagnosed with a new primary
    malignant cancer during that time period. Analysis was conducted for
    42 cancer types.

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-   **NIOSH Occupational Health Studies (2005-2006), K-25 Cohort
    Mortality Study Update (CUWS).** The study will update an all cause
    cohort mortality study at the K25 gaseous diffusion plant. The more
    than 40,000 workers employed at the site between 1942 and 1987 will
    be followed to ascertain cause of death in workers who died though
    December 31, 2001. Occupational exposures that will be evaluated
    include external and internal radiation, as well as chemicals used
    in the K25 facility processes. The study is now considered a
    feasibility study of the combined exposures of uranium workers at
    the K25 and Mallinckrodt sites.

**Paducah Gaseous Diffusion Plant (PGDP)**

Paducah, Kentucky

**Background**

The Paducah Gaseous Diffusion Plant (PGDP) is an uranium enrichment
facility covering approximately 1,350 acres in western McCracken County,
Kentucky. It is approximately 10 miles west of Paducah, and about 3
miles south of the Ohio River. PGDP began operating in 1952. Previously,
the site and surrounding areas were used as a World War II-era ordnance
facility known as the Kentucky Ordnance Works. Currently, the plant is
leased and operated by the United States Enrichment Corporation (USEC)
to produce low-enriched commercial power reactor fuel. DOE owns the site
and retains responsibility for environmental remediation activities and
waste generated prior to July 1, 1993, when USEC assumed responsibility.

The entire reservation covers 3,424 acres, with approximately 750 acres
in a fenced security area and an uninhabited buffer zone surrounding the
fenced area. Beyond the DOE-owned buffer zone is an extensive wildlife
management area of 2,100 acres deeded or leased to the Commonwealth of
Kentucky.

PGDP has extensive support facilities, including a steam plant, four
major electrical switch yards, four sets of cooling towers, a building
for chemical cleaning and decontamination, a water treatment plant,
maintenance facilities, and laboratory facilities. The site also
includes a raw-water treatment plant, a residential landfill, an inert
landfill, a former sanitary landfill, and two industrial treatment
lagoons.

**Past Activities at PGDP**

*Off-Site Contamination*

· In August 1988, DOE found technetium-99 (Tc-99) in an off-site
drinking water well north of PGDP. Trichloroethylene (TCE) has also been
detected in nearby private wells and on- and off-site monitoring wells.
The contaminated residential wells are no longer used. Approximately
1,400 people obtain drinking water from public and private wells within
4 miles of the plant.

· Plant operations have generated hazardous, nonhazardous, and
radioactive wastes, including chromium, heavy metals, polychlorinated
biphenyls (PCBs), Tc-99, TCE, and uranium (multiple isotopes). DOE has
detected PCBs in on-site surface water and downstream of the plant in
Big Bayou Creek and in Little Bayou Creek. These creeks pass through the
West Kentucky Wildlife Management Area, which is adjacent to the plant
and to private property. Access to Little Bayou Creek is partially
restricted, but access to Big Bayou Creek is not and Big Bayou Creek is
occasionally used for fishing. In 1989, the commonwealth of Kentucky\'s
Division of Water warned against eating fish caught in Little Bayou
Creek and in several of the ponds in the wildlife management area.
Contamination in the ponds result from the former Kentucky Ordnance
Works, which operated on the property during World War II.

-   **ATSDR public health assessment.** On March 30, 2001, ATSDR release
    the public health assessment for public comment. A public meeting
    was held in Paducah on May 1, 2001, to present and discuss the
    public health assessment with the community. ATSDR concluded that
    the plant currently poses no apparent public health hazard for the
    surrounding community, under normal operating conditions. ATSDR also
    concluded that historical groundwater exposure to TCE and lead was a
    public health hazard for children routinely drinking water from four
    residential wells and that future groundwater exposure could occur
    if new residential wells are drilled into the northwest or northeast
    plume areas. Groundwater exposures to vinyl chloride and acute air
    exposures to uranium and hydrogen fluoride from a large past release
    are indeterminate public health hazards because the information
    available is incomplete. Past chronic exposures to operational
    releases were not at a level of public health concern. Other hazards
    were also addressed based on public concern. The assessment was
    finalized on May 21, 2002.

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-   ATSDR public health consultation entitled "Exposure Assessment of
    Airborne Nickel and other Metal Particulates from Historic Smelter
    Operations at the Paducah Gaseous Diffusion Plant" was released for
    public comment on December 31, 2001. The consultation was finalized
    on February 7, 2002.

    -   **ATSDR health study activities.** Based upon the review of data
        used in developing the public health assessment, drinking water
        exposure to TCE via residential wells has been documented at
        levels of concern. Fish consumption advisories are in effect due
        to PCB and mercury contamination. Other contaminants of concern
        are chromium, lead, uranium, volatile organic compounds, and
        technetium-99. ATSDR reviewed the exposure pathways and
        evaluated the potential health impact to consider appropriate
        followup health activities. The population closest to the site
        and potentially affected by these contaminants is estimated to
        be less than 100. Because the incidence of any specific disease
        is rare in small groups, it would be difficult to attribute a
        specific health outcome to PGDP-related exposures; therefore, no
        health studies activities are planned for this site at this
        time.

*HHS Community Health Studies and Activities*

No HHS community health studies or activities exist at the site.

*Studies of the Health of PGDP Workers*

> No completed health studies of workers at PGDP exist. One new study
> was initiated in FY 2002.

**Current Activities at PGDP**

> No ATSDR Community Involvement or Off-Site Contamination activities
> exist at this site at the present time.

*Community Involvement*

*Off-Site Contamination*

*Community Health Studies and Activities*

-   **ATSDR health education and promotion.** The University of Kentucky
    School of Nursing has continued to work with ATSDR to identify and
    conduct health education activities. ATSDR will continue to partner
    with the university and others to address health education needs as
    they are identified.

*NIOSH Occupational Health Studies*

-   **Health effects of occupational exposures in Paducah gaseous
    diffusion plant workers**

**(PAD1).** The University of Kentucky and the University of Louisville,
under a NIOSH

grant, are conducting research on potential health effects using an
epidemiological study.

This investigation will evaluate the impact of historical exposures on
worker mortality

and characterize the effects of more recent exposures on disease
incidence among current

and former workers at the PGDP. The feasibility phase for this study has
been completed

and the full implementation of work on the mortality study is
anticipated following final

approval of the protocol and funding by the NIOSH Office of Extramural
Programs.

*DOE Former Workers Program*

> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers. There are two Former Worker Program
> projects at this site.

-   PACE's Worker Health Protection Program offers medical screening
    services and health education to former and current DOE workers from
    the Paducah Gaseous Diffusion Plant.

-   The University of Cincinnati offers medical screening to former and
    current construction workers from the Paducah Plant.

**Issues Needing Attention** **at PGDP**

-   There is concern about past worker exposure to plutonium and other
    transuranics.

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-   For many of the off-site samples, there is no information to
    identify whether the samples were collected on or near residential
    properties.

-   Health outcome data for the immediate area around PGDP is
    unavailable. The populations of concern for the potential pathways
    of exposure in the area around the PGDP are extremely small, and the
    data available cover an area that is too large to demonstrate an
    impact from the site.

**Proposed Activities** **at PGDP**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway and to initiate new ones. Such activities will be
> implemented only if feasible and deemed appropriate and beneficial to
> the community. The agencies will establish a coordinated plan,
> schedule, and lead organization for each new public health activity.
> The plan and schedule will be presented to all potential partners for
> their comment.

*New Activities for FY 2005--2010*

No new activities are planned.

**Pantex Plant**

Carson County, Texas

**Background**

The Pantex Plant is in Carson County, Texas, approximately 17 miles
northeast of Amarillo. The area is primarily agricultural. The plant is
owned by DOE and operated under contract by Mason and Hangar-Silas Mason
Company. The plant itself covers 9,100 acres. In addition, there is a
buffer zone consisting of a 1,077-acre portion of Pantex Lake owned by
DOE and 3,170 acres of land, which DOE leases from Texas Tech
University.

The plant began in 1942 as an Army Ordnance Corps facility. Nuclear
operations began in 1950. The plant assembles nuclear weapons for the
nation's stockpile; disassembles nuclear weapons being retired from the
stockpile; evaluates, repairs, and retrofits nuclear weapons in the
stockpile; demilitarizes and sanitizes components from dismantled
nuclear weapons; provides interim storage for plutonium pits from
dismantled nuclear weapons; develops, produces, and tests chemical
explosives and explosive components for nuclear weapons; and supports
DOE initiatives. (Up to 2,000 weapons must be dismantled each year until
the stockpile has decreased to a predetermined number. Dismantlement is
estimated to be completed by 2004.)

Past and present waste practices include burning chemical wastes in
unlined pits, burying construction and/or demolition debris, including
asbestos, in unlined landfills, and discharging plant waste waters into
surface water on-site.

**Past Activities at Pantex**

*Off-Site Contamination*

-   The ATSDR public health assessment categorized the site as "no
    apparent public health hazard" to the off-site community. This
    category is used for sites where human exposure to contaminated
    media is occurring or has occurred in the past, but where the
    exposure is below levels expected to cause adverse health effects.

-   **ATSDR health consultation.** In April 2000, the community near
    Pantex became concerned when groundwater monitoring detected
    trichloroethylene (TCE) contamination at 8 parts per billion (ppb).
    Although this concentration is above the EPA's maximum concentration
    limit of 5 ppb, ATSDR determined that the water was safe to drink.

*Community Health Studies and Activities*

· The Bureau of Epidemiology of the Texas Department of Health (TDH)
helped ATSDR evaluate citizens' public health concerns. Community
members questioned excessive birth defect rates; excessive cancer rates
in Armstrong, Carson, Potter, and Randall counties; and other adverse
health effects that they believed to be associated with environmental
releases from the site. Specifically, TDH looked at records for bone,
brain, breast, leukemia, lung, prostate, and thyroid cancer and all
types of cancers combined. They found a higher than expected number of:
(1) females who have cancer (all types combined) in the combined
Potter/Randall counties area; (2) males who have chronic lymphocytic
leukemia in the combined Potter and Randall counties area; (3) males who
died from prostrate cancer in Potter and Randall counties; and (4) males
who died from cancer (all types combined) in Potter County.

> Although the number of cases or deaths reported for some types of
> cancers in those counties may be higher than expected compared with
> numbers for other populations, an ATSDR review of available
> environmental data indicated that it is unlikely that area residents
> come into contact with significant enough amounts of chemicals or
> radioactive substances from the plant to cause adverse health effects.
> Thus, exposure to off-site releases from the Pantex Plant is probably
> not the cause of the higher than expected incidence of cancers in this
> area.

· The number of children born in this area with certain categories of
birth defects appears to be higher than expected based on similar birth
defect information obtained for the entire state. To determine an
underlying cause for the apparent increase, TDH evaluated parental
occupation and place of employment and distribution of birth defects by
zip code. No parental occupations or workplaces were notable. Few
parents of children born with birth defects worked at the Pantex
facility. Additionally, although one zip code near the plant (79107,
which extends from the western edge of the Pantex Plant along the Potter
County/Carson County border toward Amarillo) showed significant
elevations for several birth defect categories, there was no consistent
pattern among zip codes showing that closer proximity to the plant
increased the risk for birth defects.

· An investigation of the incidence of low birth weight in newborns
concluded that, although the incidence was increased in Armstrong
County, no data indicated that proximity to the plant increased the risk
for low birth weight.

· An evaluation of the number of people with muscular dystrophy,
multiple sclerosis, amyotrophic lateral sclerosis, and lupus
erythematosus in the area indicated a higher than expected number of
deaths from all but lupus erythematosus. No consistent pattern of deaths
from these diseases in the four-county area was found. In some
instances, the number of deaths attributed to these diseases was
elevated for males and not females; in other instances, the reverse was
true. The causes of many of these diseases are not clearly understood.
See the Public Health Implications and Community Health Concerns
Evaluation sections of the public health assessment for details about
patterns of disease occurrence.

*Studies of the Health of Pantex Workers*

· An epidemiologic study of Pantex Plant workers was published in 1985.
This study compared total and cause-specific mortality for Pantex Plant
workers employed between 1951 and December 31, 1978, with expected
cause-specific mortalities based on U.S. death rates. Significantly
fewer deaths were observed in the workforce than would be expected based
on U.S. death rates for the following causes of death: all cancers,
arteriosclerotic heart disease, and digestive diseases. No specific
causes of death occurred significantly more frequently than expected.
Slightly elevated mortality ratios were observed for brain cancer and
leukemia; however, neither excess was statistically significant. The
four deaths from brain cancer occurred among those who had worked at the
plant less than 5 years. The four deaths from leukemia occurred with
equal frequency among those who had worked at the plant a short time and
those who had worked more than 15 years.

· **Prevention of stress and health consequences of downsizing (STDN).**
The effects of downsizing on organizational climate, worker health, and
performance were studied at several DOE sites, including the Pantex
Plant. Data gathering included interviews, workplace observations,
employee discussion groups, an employee survey distributed to more than
10,500 employees, and a historical record review. Researchers identified
opportunities to reduce job stress that could lead to improved employee
health and organizational well-being. Suggested intervention strategies
were proposed for further research.

· **Study of mortality among female nuclear workers (MAFN).** A study of
female workers from 12 DOE plants, including the Pantex Plant, was
combined in a cohort mortality study, and risk estimates were developed
for exposure to ionizing radiation or to chemical hazards. For the
entire pooled cohort, mortality from mental disorders, diseases of the
genitourinary system, and from ill-defined conditions was higher than
expected. External ionizing radiation exposure in these workers appeared
to be associated with increased relative risk for leukemia and, to a
lesser degree, associated with increased relative risks for all cancers
combined and for breast cancer.

**Current Activities at Pantex**

*Community Involvement*

> NIOSH will continue to work with labor organizations.

*Off-Site Contamination*

> The Texas Natural Resource Conservation Commission and TDH, Bureau of
> Radiation Control, continue to monitor off-site areas for compliance
> with regulations and discharge permit limits.

*Community Health Studies and Activities*

· On the basis of ATSDR's determination that the number of children born
in the Pantex area with certain categories of birth defects appears to
be higher than what would be expected, the Texas Birth Defects
Monitoring Division expanded active surveillance of birth defects to the
Panhandle Region beginning with 1998 deliveries.

· **ATSDR health education and promotion.** ATSDR will provide
educational material to support future health consultations. Topics
could include outreach to the community to inform them about potential
health effects associated with using contaminated groundwater from the
perched aquifer.

*NIOSH Occupational Health Studies*

-   **Pantex cohort mortality study (PTXP).** A NIOSH update of the
    cohort mortality study of the Pantex Plant expanded this cohort to
    include females and nonwhite males. Vital status was updated through
    1995, and a standardized mortality ratio analysis was conducted. The
    cohort was also evaluated by statistical modeling to look for any
    dose-response effects. The final report has been peer-reviewed and
    will be published as a NIOSH technical report in FY2005. Although
    the plant's mission has changed, similar exposures may be
    encountered by current and future workers.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE work force at 14 DOE sites, including the Pantex
> Plant. The goal is to identify groups of workers that may be at
> increased risk for occupation-related injury and illness.

*DOE Former Workers Program*

The DOE-funded Former Workers Program offers medical screening services
to former DOE workers.

-   A Former Workers Program, conducted by Drexel University and the
    University of Texas, offers medical screening services to former
    Pantex Plant workers.

**Issues Needing Attention** **at Pantex**

Ongoing activities are addressing the known gaps.

**Proposed Activities** **at Pantex**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway and to initiate new ones. Such activities will be
> implemented only if feasible and deemed appropriate and beneficial to
> the community. The agencies will establish a coordinated plan,
> schedule, and lead organization for each new public health activity.
> The plan and schedule will be presented to all potential partners for
> their comment.

*New Activities for FY 2005--2010*

> **NIOSH Occupational Health Studies (2009), Pantex cohort mortality
> study (PAMU).** The study will involve an updating of causes of death
> among the previously studied Pantex cohort. An exposure assessment is
> also proposed to enable evaluating any suspected exposure-response
> relationships. It will increase the length of followup for the
> previously studied Pantex study population.

**Portsmouth Gaseous Diffusion Plant**

Piketon, Ohio

**Background**

The Portsmouth Gaseous Diffusion Plant is near Piketon in rural Ohio, in
Pike County, approximately 55 miles south of Columbus. Since 1955, the
Portsmouth Plant has been enriching uranium in the chemical form of
uranium hexafluoride for use as nuclear fuel in commercial power plants.
(If released to the atmosphere, uranium hexafluoride will convert to
uranium oxide and hydrogen fluoride in moist air.)

On July 1, 1993, the U.S. Enrichment Corporation (USEC), a
government-owned corporation formed under the Energy Policy Act of 1992,
assumed control of the plant\'s production activities. USEC enriched
uranium at the Portsmouth plant for use in commercial nuclear power
reactors until May 11, 2001, when production was ceased based on a USEC
business decision.

DOE maintains responsibility for addressing the environmental legacy
left by historic plant operations.

**Past Activities at Portsmouth**

*Off-Site Contamination*

> ATSDR's public health assessment concluded that site-related
> contamination and hydrogen fluoride releases pose no apparent public
> health hazard.

*Community Health Studies and Activities*

· As part of the public health assessment process, ATSDR identified a
family with neurofibromatosis type 1 (NF1), and notified the state
health department. This disorder is not related to the Portsmouth Plant.
NF1 is an inherited dominant genetic disease and is the most common
cause of childhood cancers. It can cause café-au-lait spots, axillary
freckling, neurofibromas, Lisch nodules, and learning disabilities.

· As part of the public health assessment, ATSDR reviewed data for
causes of death for Pike, Ross, and Scioto Counties in Ohio. The
incidence of cardiovascular disease was significantly higher in Pike
County than other Ohio counties. Scioto County appeared to have a
slightly higher mortality rate from cancer. However, after age-adjusting
the data for the population, the cancer rate falls in line with the rest
of the state. (Age-adjusting health outcome data is necessary to compare
one county to another, because older subpopulations have higher rates of
cancer and cardiovascular mortality. Age-adjusting modifies the crude
mortality rate to what it would be if the population were of standard
age distribution.)

> ATSDR found that the age-adjusted rate for childhood cancer mortality
> in Pike County was roughly twice the national and state rates, but the
> number was too small to give a statistically reliable result. This
> rate was based on only five cancer deaths for the 13-year period from
> 1979 to 1991. None of the childhood cancers were of the same type and
> therefore could not be related to a common cause.
>
> Because the community expressed concerns about releases of uranium
> hexafluoride, ATSDR reviewed health outcome data related to renal
> diseases. No increase in the renal failure rate was identified in
> surrounding communities.

*Studies of the Health of Portsmouth Workers*

-   NIOSH conducted a cohort study of the Portsmouth workforce to
    determine whether mortality was associated with occupational
    exposures at the Portsmouth Gaseous Diffusion Plant (PORTS). The
    study report issued in 1987 revealed statistically non-significant
    elevated standardized mortality ratios (SMRs) for stomach cancer and
    for cancers of the lymphatic and hematopoietic system. Deaths from
    all cancers in this study population were below what was expected
    based on the U.S. population.

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-   **Mortality patterns among uranium enrichment workers at the
    Portsmouth gaseous diffusion plant (PK1P).** NIOSH investigators
    conducted a follow-up mortality study and a nested case-control
    study of Portsmouth workers. The study examined the causes of death
    among all site workers employed by the facility between September 1,
    1954, and December 31, 1991. Possible relationships were evaluated
    for deaths from several types of cancers and exposures to ionizing
    radiation and certain chemicals (fluoride, uranium metal, and
    nickel). Because of undocumented neutron exposure and many
    confounders present at the facility, NIOSH performed case-control
    analyses for hematopoietic, lung, and stomach cancers to investigate
    possible dose-response relationships.

-   Overall cohort mortality was significantly less than expected (88%
    alive as of December 31, 1991) when compared to the U.S. population,
    as was mortality from all cancers. No statistically significant
    excesses in mortality from any specific cause were identified.
    Analyses of possible relationships between causes of death and the
    identified exposures failed to reveal any clear dose-response
    trends. For leukemia, no effect of cumulative exposure to either
    external or internal radiation was identified. Additionally, no
    dose-response relationships were observed for cancers of the
    stomach, lung, Hodgkin disease, lymphoreticulosarcoma, and all other
    cancers combined. Worker deaths from cancers of the
    lympho-hematopoietic tissue, including leukemia, equaled U.S. rates.
    Stomach cancer deaths were greater than expected but this difference
    was not statistically significant. Deaths from these cancers had
    been found to be slightly elevated in a previous NIOSH study of this
    plant.

-   **Health Hazard Evaluation of potential arsenic exposures in the
    uranium enrichment process at the Portsmouth gaseous diffusion
    plant.** NIOSH investigators conducted an evaluation of potential
    arsenic exposures of chemical operators, mechanics, and welders
    working on cascade equipment. The potential for exposures in excess
    of the NIOSH recommended exposure limit of 2 micrograms per cubic
    meter of air was demonstrated. All workers encountering elevated
    levels of arsenic were using protective clothing and supplied-air
    respiratory protection. Recommendations pertaining to exposure
    evaluation and protective equipment were provided.

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-   **Health Hazard Evaluation of worker exposures to neutron radiation
    at the Portsmouth gaseous diffusion plant.** The NIOSH investigation
    addressed the following objectives: determination of potential for
    neutron exposures at the facility; identification of neutron
    sources; identification of work areas or job titles with the
    greatest potential for neutron exposure; quantification of neutron
    doses by work area or job title; assess past reporting and recording
    practices regarding neutron doses; and assessment of the feasibility
    for reconstructing past neutron doses. The investigator determined
    that under certain conditions an acute exposure to neutron radiation
    could occur and that a potential health hazard to neutron radiation
    exists at the site. A number of recommendations were provided
    addressing findings associated with the objectives previously
    listed.

-   **Health Hazard Evaluation to assess worker exposure to inorganic
    arsenic fume during torch cutting operations on process equipment
    scrap.** NIOSH investigators evaluated worker exposures to arsenic
    containing fumes from torch cutting processes during the
    dismantlement and size reduction of uranium enrichment process
    equipment in a scrap yard at U.S. Enrichment Corporation (the
    Portsmouth gaseous diffusion plant). The request was received from
    management and labor after routine air sampling and urinalysis
    indicated excessive worker exposure to arsenic. A potential health
    hazard was identified from respiratory, dermal, and ingestion
    exposures to arsenic. Recommendations provided included continuing
    airborne and urine monitoring for arsenic, quantitative evaluation
    of respiratory protection cleaning procedures, strict adherence to
    the existing respiratory protection program, and improvements in
    local exhaust ventilation.

> **Current Activities at Portsmouth**
>
> *Community Involvement*
>
> No current HHS community involvement activities at Portsmouth exist.
>
> *Off-Site Contamination*
>
> No current studies of off-site contamination at Portsmouth exist.
>
> *Community Health Studies and Activities*
>
> No community health activities or studies are currently being
> conducted at Portsmouth.
>
> *NIOSH Occupational Health Studies*
>
> No current NIOSH occupational health studies are occurring at
> Portsmouth.
>
> *DOE Former Workers Program*
>
> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers. There are two Former Worker Program
> projects at this site.

-   PACE's Worker Health Protection Program offers medical screening
    services and health education to former and current DOE workers from
    the Portsmouth Gaseous Diffusion Plant.

-   The University of Cincinnati offers medical screening for former and
    current construction workers from the Portsmouth Plant.

**Issues Needing Attention** **at Portsmouth**

Gaps in knowledge of the morbidity patterns of Portsmouth workers need
to be addressed.

**Proposed Activities** **at Portsmouth**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.

*New Activities for FY 2005--2010*

No new activities planned.

**Rocky Flats Plant**

Golden, Colorado

**Background**

The Rocky Flats Plant is located in northern Jefferson County, Colorado,
approximately 16 miles northwest of Denver. The facility originally
covered 2,000 acres, but a 4,550-acre buffer zone was added in 1974. The
main processing operations are confined to approximately 384 acres in
the buffer zone. The plant ceased operation in 1992.

The plant produced and assembled components for nuclear weapons. These
operations used aluminum, beryllium, plutonium, stainless steel, and
uranium. The facility also recovered plutonium and separated and
performed research on americium.

Releases of pesticides, plutonium, solvents, and tritium have
contaminated groundwater, soils, and surface water sediments at various
locations on the facility. Since 1992, site personnel have been involved
exclusively with cleanup, waste management, decontamination and
decommissioning activities.

Public health issues at Rocky Flats include plutonium exposures to
workers cleaning up the site, exposures to the public from
plutonium-contaminated soils being transported off-site during
remediation, and inadequate recordkeeping of those workers on the site
at any given time (which may impact future exposure assessments).

Because of several fires and operational releases, plutonium has
migrated off-site and contaminated soil and sediment around the
facility. Soil and groundwater have also been contaminated by leaking
waste drums that contain trichloroethene (also known as
trichloroethylene) and plutonium shavings. Public health concerns
related to these releases have led the Colorado Department of Public
Health and Environment to oversee the development of exposure
assessments and dose reconstruction activities.

**Past Activities at Rocky Flats**

*Off-Site Contamination*

· Plutonium contamination of soils and sediments has been documented
beyond the boundaries of the federally owned land. Additionally, three
evaporation ponds have contributed to nitrate contamination of
groundwater.

· An ATSDR health consultation concluded that heavy metals and
radioisotopes in environmental media associated with Operable Unit 3
(off-site and east of the fence line) are present at levels below health
hazard and that Operable Unit 3 could be safely released for public use.

*Community Health Studies and Activities*

· In October 1993, the Health Advisory Panel overseeing the Rocky Flats
Historical Public Exposures Studies drew these preliminary conclusions
about Phase I:

-   Community exposures from past Rocky Flats contaminant releases
    appear to be relatively small;

-   A 10-mile area east and southeast of the site received the highest
    radiation doses;

-   The key Rocky Flats contaminant releases were plutonium (released
    from a fire in the plant in 1957 and from the 903 Pad from 1964
    through 1969) and carbon tetrachloride (a solvent used to clean
    plutonium parts), which was emitted during routine industrial
    operations; and

-   The highest plutonium exposures occurred before 1975.

· Carl Johnson examined cancer incidence from 1969--1971 among
non-Hispanic whites in the Denver area to determine if exposure to a
small concentration of plutonium and other radionuclides had increased
the incidence of cancer. The author concluded that during the period
studied, cancer incidence increased with increasing plutonium soil
concentrations and that exposure of the public to low concentrations of
plutonium and other radionuclides may affect the incidence of total
cancer and cancers known to be associated with radiation exposure.

· Crump et al. re-examined the 1969--1971 Johnson data, and also
analyzed data from 1979--1981. The findings paralleled the earlier
Johnson results for 1969--1971. For 1979--1981, significant positive
trends were observed in males for total cancer, "radiosensitive cancer"
(as defined by Biological Effects of Ionizing Radiation III), and
respiratory cancer; and in females for total cancer, radiosensitive
cancer, and gastro-intestinal tract cancer.

> The authors examined the possible effects of urbanization on cancer
> incidence by grouping census tracts by distance from the Colorado
> State capitol building. Cancer incidence rates were found to decrease
> in all directions from the capitol, including the direction of Rocky
> Flats. After controlling for distance from the capitol, the
> statistically significant association of increases in various cancers
> among those living near Rocky Flats disappeared. When Area I, the area
> closest to the plant, was compared to the whole Denver metropolitan
> area, no excess was found in either study period for either males or
> females for total cancer, radiosensitive cancer, or respiratory
> cancer. The study did not support a correlation between cancer
> incidence and environmental exposure to plutonium from the plant.

· The Colorado Central Cancer Registry (1998) compared the incidence of
cancer for areas near the plant with cancer incidence in the remainder
of metropolitan Denver. The report found that the incidence of all
cancers combined was not higher than expected neither for each of the 10
study areas nor for all study areas combined. The study also reported
that the incidence of male lung cancer was higher than expected in two
of the study areas, but that of the groups showing increases, at least
75% were smokers. The state continues to monitor cancer incidence and
will perform additional analyses as needed.

· The Rocky Flats Historical Public Exposures Studies was completed in
September 1999. Of the 8,000 chemical and radioactive materials used at
the plant, plutonium and carbon tetrachloride releases were the major
contributors to off-site exposures. Releases were highest in the late
1960s, and inhalation was the most important route of exposure. The key
findings of the studies are summarized as follows:

-   The largest releases of plutonium from the plant came from a 1957
    fire at the plant and from a waste oil storage area in the late
    1960s. Between 10 and 50 curies (or between 130 and 670 grams) of
    plutonium were released into the air, traveling off-site,
    predominantly east of the plant, as confirmed by measurements of
    plutonium concentrations in soil.

-   People who lived near the plant and led active, outdoor lifestyles
    (such as ranchers or laborers) had the highest level of exposure to
    airborne plutonium. The increased risk of developing cancer for
    people with this lifestyle ranges between 1 in 100 million and 1 in
    10,000, with a median value of 2.5 chances in 1 million. Researchers
    are confident that the true value for this risk has a 90% chance of
    being within this range. This risk is about the same as a person\'s
    increased risk from being exposed to the plutonium in fallout from
    U.S. weapons testing.

-   Between 1,100 and 5,400 tons of carbon tetrachloride, a solvent used
    at the plant for cleaning and degreasing, was the major chemical of
    concern released from the plant. The increased cancer risk for a
    rancher or laborer was estimated to be between 6 in 10 million and 1
    in 100,000, with a median value of 2.5 in 1 million.

-   An individual's location, lifestyle, and period of exposure were
    found to have a greater effect on health risks than gender or age.
    For example, people who moved to areas near Rocky Flats after 1970
    were exposed too much smaller concentrations of plutonium, and
    people who spent more time indoors had smaller risks than a person
    who worked outdoors all day.

-   Other materials examined included beryllium, dioxin, uranium, and
    tritium. Health risks due to releases of these materials from the
    plant were considerably less than risks from plutonium or carbon
    tetrachloride.

-   The study concluded that cancer risks from all materials studied are
    low compared to cancer risks from other causes, and followup
    epidemiologic studies were not recommended. It was recommended that
    Federal, State and citizen organizations actively monitor current
    and future operations at the site to prevent unnecessary off-site
    exposures from occurring in the future. More information on the
    studies is available through the Colorado Department of Health and
    Environment web site at
    [[www.cdphe.state.co.us/rf.]{.underline}](http://www.cdphe.state.co.us/)

> *Studies of the Health of Rocky Flats Workers*
>
> · Epidemiology studies of workers at the plant showed excess mortality
> from benign and unspecified brain tumors. The relationship between the
> brain tumors and various radiation exposures has been further
> investigated but remains unclear. Additionally, workers with higher
> amounts of plutonium intake were more likely than those with smaller
> amounts to have died from lymphatic and hematopoietic cancers, as well
> as from all combined causes of death. These latter findings were not
> related to any measure of on-site radiation exposure. The Rocky Flats
> study was updated with deaths through 1995 and with cancer incidence
> data. The study was completed in 2000.
>
> · **Study of mortality among female nuclear workers (MAFN).** A study
> of female workers from 12 DOE plants, including Rocky Flats, was
> combined in a cohort mortality study, and risk estimates were
> developed for exposure to ionizing radiation or to chemical hazards.
> For the entire pooled cohort, mortality from mental disorders,
> diseases of the genitourinary system, and from ill-defined conditions
> was higher than expected. External ionizing radiation exposure in
> these workers appeared to be associated with increased relative risk
> for leukemia and, to a lesser degree, associated with increased
> relative risks for all cancers combined and for breast cancer.

-   A nested case-control study of external ionizing radiation dose and
    mortality from dementia

> within a pooled cohort of female nuclear weapons was conducted. This
> study used data assembled from the NIOSH funded grant entitled:
> **Mortality among female nuclear weapons workers (MAFN).** The
> case-control study estimated the effect of workplace exposures to
> ionizing radiation and other hazards on mortality from dementia. The
> investigator concluded that occupational exposure to ionizing
> radiation may be associated with increased risk of death from dementia
> in female workers. Because the findings were based on a small number
> of cases (91 cases, 910 controls), replication of the study with a
> larger case sample was recommended.
>
> · **Exposure assessment of hazardous waste, decontamination and
> decommissioning,**
>
> **cleanup workers (HAWW) feasibility.** Feasibility studies at seven
> DOE sites, including Rocky Flats, determined that the availability of
> records to identify workers and their primary activities, exposures,
> work histories, and medical information varied significantly from site
> to site. The necessary information to conduct exposure assessment,
> hazard surveillance, or epidemiology studies of remediation workers is
> currently not readily available. Within sites, data systems are
> fragmented and data management is inconsistent in the current
> environment of decentralized management and increased subcontracting.
>
> · **Lung fibrosis in plutonium workers (LFPW).** The National Jewish
> Center for Immunology and Respiratory Medicine, sponsored by a NIOSH
> grant, conducted a study to determine whether workers in facilities
> involving plutonium are at increased risk for developing fibrosis. The
> study found a significantly higher proportion of abnormal chest
> radiographs among plutonium workers (17.5%) as compared to
> non-plutonium workers (7.2%), p=\<0.01. Of those plutonium workers
> with absorbed lung doses greater than 10 Sv, 37.5% had abnormal chest
> x-rays compared to other plutonium workers (16.5%), p=0.04. After
> controlling for age, smoking, and asbestos exposure, the investigators
> found that a lung dose of 10 Sv or greater conferred a 5.3-fold risk
> of having an abnormal chest x-ray consistent with pulmonary fibrosis
> when compared to non-exposed individuals. The final report was
> released by NIOSH on November 7, 2002.
>
> · **Epidemiological evaluation of cancer and occupational exposure at
> Rocky Flats (RKFL).** Under a NIOSH cooperative agreement, the
> Colorado Department of Public Health and Environment and the
> University of Colorado completed an update of the mortality study, and
> a nested case-control study of lung cancer. The study examined causes
> of death among 16,303 production workers employed by the plant for 6
> months or more between 1952 and 1996. Non-significant elevations were
> found for cancers of the stomach, rectum, brain and other central
> nervous system sites, connective and other soft tissues, as well as
> unspecified tumors of the nervous system and unspecified anemias. The
> lung cancer case-control study determined a statistically significant
> excess risk for workers who received \>400 mSv lung dose up to 644
> mSv. However, those workers with higher lung doses had lower risk of
> lung cancer mortality. The final report was released by NIOSH on April
> 17, 2003.

-   **Sentinel exposure event surveillance/evaluation at DOE sites
    (SEEES).** The University

> of Colorado, under a NIOSH-funded grant, completed a project to create
> a system for
>
> Sentinel Exposure Event (SEE) Surveillance and Evaluation at DOE
> sites. Based on a
>
> job/task evaluation and analysis, the SEE system incorporates exposure
> level
>
> measurements, worker-specific task definitions, and observational data
> such as controls and
>
> conditions or exposure into a special data recording and reporting
> system. This system was
>
> designed to produce reports for worker information programs and to
> prioritize occupational
>
> exposures for intervention efforts. The SEE system has been developed
> and implemented
>
> as a pilot at the plant, and it was evaluated for its applicability at
> other DOE sites. Seven
>
> peer-review manuscripts were published in scientific literature under
> this grant.
>
> **Current Activities at Rocky Flats**
>
> *Community Involvement*
>
> The Colorado Department of Public Health and the Environment has
> established the Rocky Flats Health Advisory Panel to guide and oversee
> the dose reconstruction project. The panel sponsored extensive public
> outreach and involvement activities, some of which were increased in
> 1999 to interpret and promulgate study findings. Quarterly newsletters
> have described study progress and advertised panel meetings and other
> public meetings. Fact sheets and papers on technical topics have been
> produced to disseminate information and ask for input from
> stakeholders, and public meetings have been held. Panel members have
> spoken to many civic groups and are available for questioning.
>
> *Off-Site Contamination*
>
> · **ATSDR public health assessment.** ATSDR is conducting a public
> health assessment to determine if people are being exposed to
> hazardous substances and, if so, whether that exposure is harmful and
> should be stopped or reduced.

-   Past releases from the Rocky Flats Plant contaminated off-site
    surface soils, primarily with americium and plutonium isotopes. The
    highest off-site contamination levels occur immediately east of
    RFETS, in an area where no one lives, but contamination above
    background levels is believed to extend up to 3 miles from the site
    boundary. Though off-site surface soil contamination clearly exists,
    estimated total exposures to radiation from the soil are far lower
    than levels associated with adverse health effects and are 3,000
    times lower than the average exposure to ionizing radiation
    experienced by no apparent public health hazard for past, current
    and future exposures.

> *Off-site groundwater contamination.* Although groundwater at several
> areas beneath RFETS is contaminated, monitoring data from wells along
> the RFETS property line suggest that the groundwater contamination
> plumes remain on site.
>
> Therefore, past and current use of water obtained from off-site
> private and municipal wells presents no public health hazard.
> Recognizing that some of the groundwater contaminants found on site
> are highly mobile and that chlorinated organic compounds are already
> detected at the site boundary, albeit infrequently and at trace
> levels, ongoing monitoring is needed to ensure that groundwater
> contamination at RFETS is not a public health hazard in the future.
>
> *Off-site contamination in surface water, sediment and aquatic biota.*
> Discharges and runoff from Rocky Flats Plant caused site-related
> contaminants to flow off site in Walnut Creek and Woman Creek and
> eventually into three local reservoirs. These reservoirs supplied, or
> continue to supply, drinking water to the cities of Broomfield,
> Northglenn, Thornton and Westminster. Although the sampling data
> indicate that drinking water has contained trace amounts of
> site-related contamination, average contamination levels in these
> municipal supplies have never exceeded drinking water standards or
> relevant health guidelines, even for plutonium. Oxides of plutonium
> are extremely insoluble in water and would not have been a hazard from
> ingestion. As a result, past and current exposures via the drinking
> water pathway pose no apparent public health hazard.
>
> Residents who use the off-site surface waters for recreational
> purposes might incidentally ingest sediment and water that contains,
> or previously contained, site-related contaminants. Data collected
> from several extensive site investigations demonstrate that incidental
> contact with the surface water or sediment is not expected to be
> detrimental to one's health. Therefore, contamination in surface water
> and sediment that residents and recreational users might ingest are no
> apparent public health hazard for past and present exposures.
>
> Fish tissue sampling from Standley Lake found no evidence of
> radioactive contaminants in the fillets of channel catfish, rainbow
> trout, smallmouth bass and walleye. Trace amounts of mercury and
> pesticide residues in the fish tissues likely originated from sources
> other than RFETS. Regardless of their source, these contamination
> levels pose no apparent public health hazard to people who consume up
> to one meal containing fish from Standley Lake per week.
>
> · Patterned after the historical public exposure study and its
> oversight panel, another citizen panel is overseeing an independent
> review of the safe levels of radioactivity remaining in the soil after
> remediation. The panel is reviewing calculations used to determine how
> much radioactive material remaining in the soil will produce the
> allowable dose of 15 millirems (mrem) per year to an office worker on
> site or 85 mrem per year to a hypothetical future resident living on
> the site. Citizens were concerned about the levels set for Rocky Flats
> because the rates appeared higher than for some other sites and the
> citizens believed the rates were set without sufficient public
> involvement.
>
> · **NCEH Rocky Flats historic public exposure studies.** CDC's NCEH
> will work with the Colorado State Department of Public Health and
> Environment to complete important followup tasks from the dose
> reconstruction project. These tasks include considering developing
> interactive software to determine individual risk, applying
> environmental monitoring data for validation of movement of plutonium
> in the environment, and completing the analysis of plutonium risk
> factors. A final progress report was submitted by the grantee during
> the 1^st^ quarter of fiscal year 2004. The grantee decided not to post
> dose calculator on their website due to technical difficulties. The
> grant expired at the end of December 2003.
>
> *NIOSH Occupational Health Studies*·
>
> No current NIOSH occupational health studies are occurring at Rocky
> Flats.
>
> *DOE Former Workers Program*
>
> The DOE-funded Former Workers Program offers medical screening
> services to former DOE workers.
>
> · The University of Colorado Health Sciences Center offers medical
> screening services to former DOE workers from the Rocky Flats Plant.
> This project offers screening for chemical exposures. Other DOE-funded
> programs offer beryllium and radiation medical screening.
>
> **Issues Needing Attention** **at Rocky Flats**
>
> · The risks to the public from environmental plutonium exposures need
> to be determined. An example of potential exposure is the plutonium
> deposited in the silt of both Standley Lake and Great Western
> Reservoir within Operable Unit 3.
>
> · Morbidity studies and non-cancer studies need to be conducted.
>
> **Proposed Activities** **at Rocky Flats**
>
> *Ongoing Activities*
>
> The agencies propose to continue the previously listed projects
> already underway and to initiate new ones. Such activities will be
> implemented only if feasible and deemed appropriate and beneficial to
> the community. The agencies will establish a coordinated plan,
> schedule, and lead organization for each new public health activity.
> The plan and schedule will be presented to all potential partners for
> their comment.
>
> *New Activities FY 2005--2010*
>
> · **ATSDR health education and promotion.** ATSDR will continue to
> support and coordinate the health education activities of the Colorado
> State Department of Health and the Environment.
>
> **Salmon Test Site**
>
> Lamar County, Mississippi
>
> **Background**
>
> The 1,470-acre Salmon Test Site (formerly called the Tatum Dome Test
> Site) is located in Lamar County, 21 miles southwest of Hattiesburg,
> Mississippi. The salt dome is about 5,000 feet in diameter and 1,500
> feet below ground. The Atomic Energy Commission selected the site for
> seismic experiments. The site was deactivated in 1972.
>
> In 1964 and 1966, two nuclear detonations were exploded in the salt
> dome. The 1964 detonation created a cavity in the salt dome that was
> used for a second detonation 2 years later. The first event, a
> 5.3-kiloton ([+]{.underline} 0.5) yield nuclear detonation, imploded
> 2,710 feet below ground. The second event was a 380-ton yield nuclear
> detonation. These detonations were contained within the salt dome; all
> environmental monitoring data for tritium (the source of radiation
> exposure) immediately after the detonations and subsequently have
> shown no increase above background levels.
>
> Surrounding area residents recently raised concerns about health
> effects, primarily cancer, related to the site. DOE completed a study
> to determine if there was an association between cancer deaths in
> Lamar County and residence near the Salmon Test Site. No association
> was found.
>
> **Past Activities at the Salmon Test Site**
>
> *Site and Off-Site Contamination*
>
> · Environmental monitoring activities have been conducted at the site
> since the first test took place in 1964. Reports by the Mississippi
> State Department of Health, Division of Radiological Health and the
> EPA indicated that there were no gas or particulate releases during
> any of the nuclear detonations. The U.S. Geological Survey and a
> private contractor conducted the testing. Results of these analytic
> tests showed no increase in the normal background radiation. The
> results of the monitoring program are documented in a report prepared
> by the DOE Field Office, Nevada (DOE, 1978) and in the 1990 annual
> reports prepared by EPA and the Mississippi State Department of
> Health, Division of Radiological Health.
>
> · When the Salmon Site was deactivated in 1972, a long-term hydrologic
> monitoring program was initiated by DOE and EPA and was conducted by
> EPA\'s Environmental Monitoring Systems Laboratory (EMSL) in Las
> Vegas. In 1977, the Mississippi Division of Radiological Health
> participated in this cooperative monitoring program, which was
> designed to regularly evaluate the test site and surrounding areas to
> ensure that residue left from the tests did not affect drinking water.
>
> Since 1972, the long-term hydrologic monitoring program and the State
> of Mississippi have monitored all accessible wells, boreholes, creeks,
> and ponds on the site. EPA sampled groundwater from 20 residential
> wells and from 54 wells on- and off-site. Data from these analyses
> were compared to baseline data of samples taken when the test site was
> initially closed.
>
> The results of this monitoring program are summarized as follows:

-   Groundwater monitoring indicated that the salt dome was intact and
    that no tritium was leaking outside the dome.

-   The tritium concentrations found in deep wells, both on- and
    off-site, were similar to worldwide background levels.

-   Low levels of tritium have been measured in water from shallow
    boreholes in the area where the tests were conducted. The water in
    these boreholes was brackish and undrinkable. The tritium found
    there was from residue brought to the surface by drilling activities
    conducted immediately after the tests. No health hazard was
    identified because (1) the water was not used for drinking, (2) the
    tritium concentrations were low, and (3) the test site was off
    limits to the public.

-   The highest tritium concentration was 48 picocuries per liter
    (pCi/L); the EPA drinking water standard for tritium is 20,000
    pCi/L.

*Community Health Studies and Activities*

> DOE conducted a mortality study to determine if there were excess
> cancer deaths among former residents in the area near the Salmon Test
> Site. The Public Health Statistics Division of the Mississippi State
> Department of Health provided computerized data for all deaths among
> the approximately 27,000 Lamar County residents between January 1,
> 1980, and December 30, 1991.
>
> The study identified 562 (25.7%) deaths due to cancer and 1,623
> (74.3%) deaths due to other causes. There were too few cancer deaths
> among children to permit analysis. No apparent relationship between
> cancer death and residence near the Salmon Test Site was found. The
> risk of cancer was no higher for those living near the site than for
> those living farthest away, nor for those living in one direction
> compared to another, although there was a non-statistically
> significant increase in those living north of the site.
>
> The findings of this study are consistent with a previous
> investigation by the Mississippi State Department of Health, which
> analyzed vital data records. The study found that the age-adjusted
> mortality rates for all cancers combined and for 34 site-specific
> cancers for Lamar County were similar to those for Mississippi and
> other counties within the state for 1980--1988.

*Studies of the Health of Salmon Test Site Workers*

> No epidemiologic studies of former workers at the Salmon Test Site
> exist.

**Current Activities at the Salmon Test Site**

· No current studies are being conducted in populations near the site.
The Mississippi Department of Health continues to monitor private wells
quarterly, and DOE continues to do monitoring annually.

· A DOE report on remediation activities has been completed and is being
reviewed by the State. DOE completed a mathematical model of groundwater
monitoring of the aquifer plume. The model did not suggest any off-site
exposure.

· DOE completed a risk assessment around the site.

· DOE has agreed to fund the installation of a water system in the area.
It will be more cost-effective than continuing the water testing over
the next 50 years.

**Issues Needing Attention** **at the Salmon Test Site**

No additional issues have emerged.

**Proposed Activities at the Salmon Test Site**

No additional activities are proposed.

**Savannah River Site (SRS)**

Aiken, South Carolina

**Background**

The Savannah River Site (SRS), located in South Carolina, was built in
the early 1950s to produce materials for the manufacture of nuclear
weapons, primarily tritium and plutonium-239. The operations at the site
were adjusted to meet the country's changing defense needs. A major
operational change has been the permanent closure of the five reactors
used to produce plutonium and tritium and a shift in the late 1980s to
recycle this material to maintain the nation's supply of nuclear
weapons. This recycling activity allows the United States to stretch its
supply of tritium and reduces the need to produce more of the material.
In addition, other production, storage, and recycling operations at the
site are currently under review through an Environmental Impact
Statement Process. SRS is a DOE facility currently being operated by
Westinghouse Savannah River Company.

Although tritium has been a long-time concern at the site, potential
adverse health effects due to exposure to atmospheric and surface water
releases of chemicals and other radionuclides from the site are also of
concern. Routine and inadvertent releases occurred from the five
reactors (100 area), separations facilities (200 area), and other
operational facilities. Community residents are also concerned about
groundwater and environmental justice issues and about the health of
workers at the site.

**Past Activities at SRS**

*Off-Site Contamination*

· In January 1995, the South Carolina Department of Health and
Environmental Control, the Georgia Department of Natural Resources, and
the EPA jointly issued a fish consumption advisory to provide guidelines
for eating fish taken from selected portions of the Savannah River and
Steel Creek, Lower Three Runs Creek, and Four mile Branch. This advisory
was based on mercury levels in fish samples taken from the Savannah
River. As a result of additional sampling of fish in tributaries to the
Savannah River, the South Carolina Department of Health and
Environmental Control expanded the advisory in May 1996 to include fish
in those creeks based on measured levels of cesium-137 and strontium-90
.

· The CDC's NCEH is performing a dose reconstruction study to assess the
dose and risk to the surrounding community from past exposure to
contaminants released from the site. NCEH has completed two phases of
the Savannah River Site Environmental Dose Reconstruction Project: (1)
document retrieval and assessment; and (2) the reconstruction of
historical releases of radioactive materials and chemicals from SRS
between 1954 and 1990. In Phase I, all records stored at SRS and other
locations were searched and interviews with current workers and retirees
were conducted. Several thousand documents were found that could be used
to estimate chemical and/or radionuclide releases to the air and water
around SRS.

> The *Savannah River Site Environmental Dose Reconstruction Project;
> Phase II: Source Term Calculation and Ingestion Pathway Data Retrieval
> Evaluation for* *Materials Released from the Savannah River Site* has
> been completed by NCEH and is available on CD-Rom and on paper. During
> this phase, it was estimated that the key radionuclides released to
> air were iodine-131, iodine-129, tritium, argon-41, plutonium-239, and
> plutonium-240. Key releases to water were cesium-137, tritium,
> strontium-90, cobalt-60, phosphorus-32, and iodine-131. Also
> identified were 22 key chemicals and heavy metals released to the
> water and air from the site. None of the chemicals and radioactive
> materials released from the site have migrated off-site via
> groundwater.

*Studies of the Health of SRS Workers*

· In a recent multi-site study, sponsored by a National Institute for
Occupational Safety and Health (NIOSH) grant, the University of North
Carolina found an effect based on age. External doses received at older
ages were associated with an increased risk of multiple myeloma, but
doses at younger ages were not.

· The mortality experience of 9,860 white male SRS workers was
evaluated. They reportedly had a higher rate of leukemia than the U.S.
population through 1980. This was concentrated among hourly workers
employed before 1955 who worked from 5 to 15 years. The leukemia death
rate through 1986 was higher than expected only for those deaths
occurring from 1965 through 1969. Preliminary findings from a recent
study of SRS workers reported that the leukemia mortality rate was not
higher than the U.S. rate through 1995.

· **Exposure assessment of hazardous waste, decontamination and
decommissioning, cleanup workers (HAWW).** Feasibility studies at seven
DOE sites, including SRS, determined that the availability of records to
identify workers and their primary activities, exposures, work
histories, and medical information varied significantly from site to
site. The necessary information to conduct exposure assessment, hazard
surveillance, or epidemiology studies of remediation workers is
currently not readily available. Within sites, data systems are
fragmented and data management is inconsistent in the current
environment of decentralized management and increased subcontracting.

· **Study of mortality among female nuclear workers (MAFN).** A study of
female workers from 12 DOE plants, including SRS, was combined in a
cohort mortality study, and risk estimates were developed for exposure
to ionizing radiation or to chemical hazards. For the entire pooled
cohort, mortality from mental disorders, diseases of the genitourinary
system, and from ill-defined conditions was higher than expected.
External ionizing radiation exposure in these workers appeared to be
associated with increased relative risk for leukemia and, to a lesser
degree, with increased relative risks for all cancers combined and for
breast cancer.

· An ATSDR health consultation for the D-Area seepage basin determined
that the dioxin levels did not pose a health hazard to workers if
recommended worker precautions were taken during removal actions.

**Current Activities at SRS**

*Community Involvement*

· **Savannah River Site Health Effects Subcommittee.** NCEH and ATSDR
will continue to work with the SRS Health Effects Subcommittee. The
subcommittee is a vehicle for the public and tribal nations, including
the Catawba Tribe of South Carolina, to express concerns and provide
advice and recommendations on the agencies' public health activities and
research at SRS.

*Off-Site Contamination*

· **NCEH SRS dose reconstruction.** NCEH is currently completing Phase
III of the SRS Environmental Dose Reconstruction to determine which
contaminants and exposure pathways have the highest potential for
harming people. To accomplish this, NCEH's contractor, Advanced
Technologies Laboratories, Inc., is currently examining the literature
to identify biologically plausible health outcomes that could be related
to the radionuclides and chemical contaminants identified in Phase II.
The contractor has submitted a draft of the final report. Estimated
doses were quite small. The SRSHES will have a final meeting in the
4^th^ quarter of fiscal year 2005 to review the final report. If the
results of this risk-based screening analyses indicate the need for
additional investigation, NCEH will proceed with additional phases of a
complete dose reconstruction: In Phase IV, site-specific models and
parameter values for those contaminants and exposure pathways selected
in Phase III will be developed; and these models will be used in Phase V
to estimate environmental exposures and doses, which will include
uncertainty analyses.

> The dose models developed in Phase V may be used to develop
> probabilistic estimates of health risk (for realistic scenarios and
> for the population). NCEH is currently evaluating the information
> available to conduct these analyses, including population data,
> literature relating to select health outcomes/exposures, existing
> health outcome data for the region, and risk models. NCEH may collect
> information needed to estimate the size and dynamics of the off-site
> population and background rates of disease, develop risk estimation
> models, and estimate the lifetime risk of select cancers and other
> health effects (when possible). It is highly likely that for
> non-neoplastic health effects, only a qualitative assessment of risk
> will be possible. NCEH will develop and implement a plan to
> effectively communicate the results of the dose assessment and risk
> analysis to stakeholders.

· **ATSDR public health assessment.** As resources are available, ATSDR
will initiate work on the public health assessment for SRS to: (1)
evaluate the potential for environmental exposures to the public (past,
present, and future); (2) assess the impact on public health (past,
present, and future); and (3) prevent and mitigate further public
exposure. To avoid duplicating efforts, ATSDR will use the data and
information collected by NCEH during their dose reconstruction activity.

*Community Health Studies and Activities*

· ATSDR health education and promotion. ATSDR will continue to work with
NCEH, the SRS Health Effects Subcommittee and others to develop and
implement health

education and promotion activities for the communities near SRS. This
will include

healthcare provider education to ensure that primary care providers
receive information and resources to diagnose, treat, and counsel
persons concerned about the health impact of the site.

· ATSDR health communication strategy. ATSDR, in collaboration with
NCEH, will continue to implement a community health education and
communication strategy. The gencies will work with the Savannah River
Site Health Effects Subcommittee, Savannah River Site Citizens Advisory
Board, and the communities around the site to identify and address the
community needs for information and education.

· ATSDR community needs assessment for health education and promotion.
In FY 2002, ATSDR and the Oak Ridge Institute for Science and Education
(ORISE) completed a health education needs assessment and follow-up
health education action plan. Staff will continue working with local
health and community representatives in the counties around the site to
develop health education materials and activities to address issues that
were raised a part of the needs assessment process and new issues are
they are identified.

*NIOSH Occupational Health Studies*

-   **Multi-site case-control study of lung cancer and external ionizing
    radiation (LUNG).** This ongoing NIOSH case-control study combines
    worker information from multiple sites, including SRS, to clarify
    the relationship between lung cancer and external radiation
    exposure. Project was cancelled during fiscal year 2004 due to the
    difficulty of estimating exposures to other potential lung
    carcinogens (e.g. asbestos) for worker in the first few decades of
    reactor operations at the sites chosen for the study.

-   **Multi-site leukemia case-control study (LCCS).** This ongoing
    NIOSH case-control study combines worker information from multiple
    sites, including SRS, to explore the relationship between external
    radiation and leukemia risk among 250 workers with leukemia compared
    to similar workers who do not have leukemia. All exposure assessment
    for radiation and potential leukemogens for the 5 sites included in
    this study have been completed and final analysis should be
    completed in fiscal year 2005.

-   **Cohort mortality study of DOE chemical laboratory workers
    (CLWS).** NIOSH is studying the mortality experience of chemical
    laboratory workers from multiple sites, including SRS. Limited
    previous studies outside the DOE complex suggest an increased risk
    of cancer in these workers. The study is scheduled for completion in
    fiscal year 2005.

-   **Susceptibility and occupational radiation risks (SORR)**. The
    University of North Carolina at Chapel Hill, under a NIOSH grant, is
    conducting a study focusing on radiation-mortality associations at
    the SRS under various lag assumptions, and investigating potential
    changes with age-at-exposure in susceptibility to the carcinogenic
    effects of radiation. They will also investigate the differences
    between workers for carcinogenic effects due to non-radiologic
    exposures using a job matrix to identify workers with routine
    potential for non-radiological exposures, and examine the joint
    effects of radiological and non-radiological exposures.

*DOE Illness and Injury Surveillance of Current Workers*

> DOE's illness and injury surveillance assesses the overall health of
> the *current* DOE work force at 14 DOE sites, including SRS. The goal
> is to identify groups of workers that may be at increased risk for
> occupation-related injury and illness.

*DOE Former Workers Program*

The DOE-funded Former Workers Program offers medical screening services
to former

DOE workers. There are two Former Worker Program projects for former SRS
workers.

-   The Medical University of South Carolina offers medical screening to
    former production workers.

-   The Augusta Building Trades Medical Screening Program, led by the
    Center to Protect Workers' Rights, offers medical screening services
    to former construction workers from SRS.

**Issues Needing Attention** **at SRS**

· Depending on the results of the environmental dose reconstruction, a
determination may need to be made of the potential health risks that
might result from past exposures to chemicals and radionuclides released
from SRS to surrounding communities.

*Applicable to SRS and other Sites*

· Further epidemiologic research is needed to evaluate the protection
against potentially adverse health outcomes in the workplace provided by
current occupational radiation exposure limits. Many of these exposure
limits were developed from bomb survivor and radiation therapy exposure
data that differs in intensity, duration, route of exposure, and
frequency from that found in the workplace.

· Internal dosimetry of radiation workers requires numerous assumptions
and the relationship between internal radiation dose and health effects
needs to be evaluated.

· Results from ongoing mortality studies need to be evaluated to improve
understanding of causes of cancer and chronic diseases. Additional
studies can be proposed to focus on a single disease in worker groups.

· Complete records, including industrial hygiene and work history data
for the various levels of subcontractors at each site, must be made
available.

**Proposed Activities** **at SRS**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.

*New Activities* *for FY 2005--2010*

· **ATSDR public health assessment**. As resources are available, ATSDR
will initiate work on the public health assessment for SRS to: (1)
evaluate the potential for environmental exposures to the public (past,
present, and future); (2) assess the impact on public health (past,
present, and future); and (3) prevent and mitigate further public
exposure. To avoid duplicating efforts, ATSDR will use the data and
information collected by NCEH during their dose reconstruction activity.

**Shipyards in the Naval Nuclear Propulsion Program**

Various Locations

**Background**

The first nuclear-powered ship, the USS *Nautilus*, which went to sea in
1955, was built in Groton, Connecticut. Since then, the Shipyards in the
Naval Nuclear Propulsion Program has developed shipyard nuclear
capabilities at Kittery, Maine (near Portsmouth, New Hampshire); New
London, Connecticut; Norfolk and Newport News, Virginia; Charleston,
South Carolina; Mare Island, California; Puget Sound, Washington; and
Pearl Harbor, Hawaii. At each of these sites, nuclear-powered ships have
been constructed, overhauled, repaired, refueled, or deactivated.

**Past Activities at Shipyards in the Naval Nuclear Propulsion Program**

*Studies of the Health of Nuclear Naval Shipyard Workers*

· A first cohort mortality epidemiologic analysis of workers at the
Portsmouth Naval Shipyard (PNS) completed by NIOSH found no significant
excess mortality from any cause. Later case-control studies of lung
cancer and leukemia in this group of workers did have positive findings.
However, these findings were not, in all likelihood, linked to
occupational radiation exposure. Excess lung cancer mortality was
associated with workers with cumulative occupational doses of 1.0 to
4.999 rem. These same workers were also potentially exposed to welding
fumes and asbestos. The relative importance of welding fumes and
asbestos in the development of the lung cancers could not be determined.

> In the other case-control study, significant excesses of leukemia were
> found for welders and electricians, but no relationship was found
> between leukemia and radiation exposure.

· In 1991, researchers from The Johns Hopkins University completed an
epidemiological study of the health of workers at the six Navy shipyards
and two private shipyards that serviced Navy nuclear-powered ships. This
study evaluated 70,730 civilian workers from 1957 through 1981 and found
no evidence that the health of people involved in work on U.S.
nuclear-powered ships had been adversely affected by exposure to low
levels of radiation incidental to this work. In fact, the overall death
rate among radiation-exposed shipyard workers was less than the death
rate for the U.S. population. The death rate for cancer and leukemia
among the radiation-exposed workers was slightly lower than that for
non-radiation-exposed workers and that for the general U.S. population.
The death rate for cancer and leukemia among the radiation-exposed
workers was slightly lower than that for non-radiation exposed workers
and that for the general U.S. population. An increased rate of
mesothelioma, a rare cancer linked to asbestos exposure, was found in
both radiation-exposed and non-radiation-exposed shipyard workers,
although the number of cases was small.

· **Mortality update study of Portsmouth Naval Shipyard workers
(PNSP).** The NIOSH cohort mortality study of civilian workers at the
Portsmouth Naval Shipyard (PNS) was updated through 1996. Through an
agreement with the Naval Sea Systems Command, the cohort was expanded to
include all individuals employed (n=37,853) through 1992. In comparison
with the U.S. population, overall mortality was lower than expected
(SMR: 0.95, 95% confidence interval 0.93, 0.96) based on 12,393 deaths.
Cancer deaths were slightly elevated (SMR: 1.06, 95% confidence interval
1.02-1.10) as were lung cancer (SMR:1.11, 95% confidence interval 1.05,
1.18) and esophageal cancer (SMR: 1.36, 95% confidence interval 1.11,
1.76). Although leukemia mortality was as expected (SMR: 1.01, 95%
confidence interval 0.84, 1.22), a statistically significant positive
linear trend with increasing radiation exposures was observed. In a
statistical analysis restricted to radiation-monitored workers, a
borderline statistically significant dose-response for leukemia and
external radiation exposures was observed with an excess relative risk
of 0.109 per 10 mSv (95% confidence interval -0.009, 0388). Asbestosis
was also elevated among radiation-monitored workers.

**A Nested Case-Control Study of Leukemia and Ionizing Radiation at the
Portsmouth Naval Shipyard (PLCC). ** This case-control study was
completed among the expanded PNS cohort.  The nested case-control study
also allowed for better assessment of potential confounding exposures to
chemical leukemogens, benzene and carbon tetrachloride.  Estimates of
external radiation doses from work-related medical x-rays were included
in this analysis.  The communication and release of the final results
from this study are pending.

**Current Activities at Shipyards in the Naval Nuclear Propulsion
Program**

*Off-Site Contamination*

No ongoing studies of off-site contamination exist.

*Community Health Studies and Activities*

No ongoing community health studies exist.

*NIOSH Occupational Health Studies*

-   **A nested case-control study of lung cancer and ionizing radiation
    at the Portsmouth Naval Shipyard (PLUN).** The case-control study is
    also being completed among the expanded PNS cohort and includes
    detailed analysis of potential exposures to other lung carcinogens,
    asbestos and welding fumes. Smoking history information has also
    been collected from worker medical files for assessment in the
    analysis of the relation between external ionizing radiation
    exposures and lung caner mortality. This projected is scheduled for
    completion in fiscal year 2005.

· **International collaborative study of nuclear industry workers
(IARC).** NIOSH will contribute study data from PNS workers to an
international collaborative study of nuclear workers in 15 countries.
This study is sponsored by the International Agency for Research on
Cancer and is the largest cancer mortality study ever of nuclear
workers. Data for the PNS cohort were not provided to IARC for the
multi-national study as planned due to unforeseen circumstances.

· **Multi-site leukemia case-control study (LCSS).** This ongoing NIOSH
case-control study combines worker information from multiple sites,
including PNS, to explore the relationship between external radiation
and leukemia risk among 250 workers with leukemia compared to similar
workers who do not have leukemia. All exposure assessments for radiation
and potential leukemogens for the 5 sites included in this study have
been completed and final analysis should be completed in fiscal year
2005.

**Issues Needing Attention** **at Shipyards in the Naval Nuclear
Propulsion Program**

> The Matanoski cohort mortality study of civilian naval shipyard
> employees, including those at PNS, was funded by DOE. The study
> followed approximately 70,000 nuclear Navy workers for 13 years,
> through 1981. An update of this study at this time would add at least
> 20 years of mortality data for this cohort. This is an important
> cohort to follow up due to its size, the exceptional quality of the
> exposure information available, and because the radiation exposure to
> this cohort is without the confounding factor of internal dose. A
> leukemia nested case-control study among the Shipyard workers could
> evaluate the robustness of the positive findings among the PNS cohort.

**Proposed Activities** **at Shipyards in the Naval Nuclear Propulsion
Program**

*Ongoing Activities*

> The agencies propose to continue the previously listed projects
> already underway.
>
> *New Activities* *for FY 2005--2010*
>
> **NIOSH Occupational Health Studies (2007--2010), Nuclear naval
> shipyard workers (NNSW).** The proposed study will seek to evaluate
> the relationship between external ionizing radiation exposures and
> long-term health effects, including lung cancer and leukemia. This
> workforce is regarded as having relatively minimal exposure to
> internal depositions of radionuclides. Measures are required to
> address potential confounding exposures in the shipyards which could
> influence the health outcomes of interest. The study will require
> substantial resources and will not be initiated unless significant
> additional resources, including personnel, are allocated for this
> research effort. Access to the study shipyards and data resources will
> also need to be established.

**Agency for Toxic Substances and Disease Registry Multi-Site
Activities**

**Toxicological Profiles**

Toxicological profiles are publicly and scientifically reviewed
documents published by the Agency for Toxic Substances and Disease
Registry (ATSDR). They summarize available knowledge about a chemical or
substance and the human health consequences of exposure. Toxicological
profiles identify the full range of health effects, by duration and
route of exposure, observed in humans and animals from exposure to
particular substances. They contain relevant information on chemical,
physical, and radiological properties; production, import, export, use,
and disposal; pathways migration; potential for human exposure;
analytical methods; regulations and advisories; and toxicological data
gaps for which additional research is needed. Health guidance values are
derived, where appropriate, for route and duration-specific exposure
concentrations that are expected to be without significant human risk.
Profile recipients include the private sector, other Government
agencies, the international community, academia, citizens, and
environmental groups. The profiles are an authoritative source of
up-to-date information on the health effects of hazardous waste
components, a guide for health assessors working at hazardous waste
sites, and a tool to educate the public about the potential for health
effects. Federal agencies, such as the DOE, can use the profiles to make
better informed decisions at their sites.

**Available and Planned Toxicological Profiles**

Toxicological profiles for substances that have radioactive isotopes are
available for radium, radon, thorium, plutonium, and uranium. The first
four of these contain outdated information and are limited in scope. The
user will benefit when these profiles are updated with current science
and enhanced to include sections now contained in current profiles
(e.g., child health). As funding is provided, ATSDR plans to prepare
toxicological profiles for the substances and their radioactive isotopes
listed in the following table (in order of priority).

Table 1 identifies the substances that can be profiled by year. Table 2
identifies the DOE sites at which the radioactive substances have been
found.

**Table 1. FY 2003--2008 Plan for Developing Toxicological Profiles**

+-----------+---------+-----------+-----------+-----------+-----------+
|           |         |           |           |           |           |
+-----------+---------+-----------+-----------+-----------+-----------+
| **Toxi    | *       | **2006**  | **2007**  | **2008**  | **2009**  |
| cological | *2005** |           |           |           |           |
| P         |         |           |           |           |           |
| rofiles** |         |           |           |           |           |
+-----------+---------+-----------+-----------+-----------+-----------+
| Plutonium | i       | public    | final     |           |           |
|           | nitiate | comment   |           |           |           |
| Thorium   |         |           |           |           |           |
+-----------+---------+-----------+-----------+-----------+-----------+
| Radium    |         | initiate  | public    | final     |           |
|           |         |           | comment   |           |           |
| Radon     |         |           |           |           |           |
+-----------+---------+-----------+-----------+-----------+-----------+
| Uranium   |         |           | initiate  | public    | final     |
|           |         |           |           | comment   |           |
| Vanadium  |         |           |           |           |           |
+-----------+---------+-----------+-----------+-----------+-----------+
| T         |         |           |           | initiate  | public    |
| echnetium |         |           |           |           | comment   |
|           |         |           |           |           |           |
| Noble     |         |           |           |           |           |
| gases     |         |           |           |           |           |
+-----------+---------+-----------+-----------+-----------+-----------+
| Chlordane |         |           |           | initiate  | public    |
|           |         |           |           |           | comment   |
| C         |         |           |           |           |           |
| hloroform |         |           |           |           |           |
+-----------+---------+-----------+-----------+-----------+-----------+

> Note: Proposed profile development is based on the Agency receiving
> funding from the
>
> Department of Energy
>
> **Table 2. Sites With Chemicals Identified in the Toxicological
> Profiles**

<table style="width:100%;">
<colgroup>
<col style="width: 22%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 4%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 4%" />
<col style="width: 5%" />
<col style="width: 5%" />
<col style="width: 5%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Site</strong></td>
<td colspan="14"><strong>Chemical</strong></td>
</tr>
<tr class="even">
<td></td>
<td><strong>Am</strong></td>
<td><strong>Cs</strong></td>
<td><strong>Co</strong></td>
<td><strong>I</strong></td>
<td><strong>Gases</strong></td>
<td><strong>Ra</strong></td>
<td><strong>Rn</strong></td>
<td><strong>Sr</strong></td>
<td><strong>Tc</strong></td>
<td><strong>Th</strong></td>
<td><strong>Pu</strong></td>
<td><strong>U</strong></td>
<td><strong>V</strong></td>
<td><strong>H3</strong></td>
</tr>
<tr class="odd">
<td>Brookhaven National Laboratory</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
</tr>
<tr class="even">
<td>Fernald Environmental Management Project</td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Hanford Nuclear Reservation</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
</tr>
<tr class="even">
<td>Idaho National Engineering and Environmental Laboratory</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
</tr>
<tr class="odd">
<td>Laboratory for Energy-Related Health Research</td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
</tr>
<tr class="even">
<td>Lawrence Livermore National Laboratory</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Los Alamos National Laboratory</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Monticello Mill Tailings Site</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
</tr>
<tr class="odd">
<td>Mound Plant</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td>X</td>
</tr>
<tr class="even">
<td>Nevada Test Site</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
</tr>
<tr class="odd">
<td>Oak Ridge Reservation</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Paducah Gaseous Diffusion Plant</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Pantex Plant</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Portsmouth Gaseous Diffusion Plant</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td>X</td>
<td></td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Portsmouth Naval Shipyard</td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td>Rocky Flats</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td>Savannah River Site</td>
<td></td>
<td>X</td>
<td>X</td>
<td>X</td>
<td></td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
<td></td>
<td></td>
<td>X</td>
</tr>
<tr class="even">
<td colspan="15"><p>Am = americium, Cs = cesium, Co = cobalt, I =
iodine, Ra = radium, Rn = radon, Sr = strontium,</p>
<p>Tc = technetium, Th = thorium, Pu = plutonium, U = uranium, V =
vanadium, H3 = tritium</p></td>
</tr>
</tbody>
</table>

**ATSDR Interaction Profiles**

ATSDR is building upon its applied research program to address mixtures
of potentially hazardous substances by developing interaction profiles.
The main purpose of the interaction profiles is to evaluate mixtures
that are of special interest to environmental public health, building on
results reported in the scientific literature, on assessments based on
the weight-of-evidence methodology, and on other health assessment
tools. The interaction profiles undergo scientific review for accuracy
of presented data and validity of conclusions. They represent up-to-date
views of the U.S. Public Health Service on health assessment issues for
mixtures.

The mixtures selected for interaction profiles are relevant to the DOE
complex, and initial selections are identified in Table 3. Additional
profiles can be based on this information in the future.

**Table 3. Selected Mixture Groups and Example Locations**

+------------------+---------------------------------------------------+
| **Mixture        | **Examples of Relevant DOE Complex Locations**    |
| groups**         |                                                   |
+------------------+---------------------------------------------------+
| -   Cesium       | -   Hanford Nuclear Reservation                   |
|                  |                                                   |
| -   Nitrates     | -   Los Alamos National Laboratory                |
|                  |                                                   |
| -   Sulfates     | -   Monticello Mill Tailings Site                 |
|                  |                                                   |
| -   Uranium      |                                                   |
|                  |                                                   |
| -   Vanadium     |                                                   |
+------------------+---------------------------------------------------+
| -   Arsenic      | -   Hanford Nuclear Reservation                   |
|                  |                                                   |
| -   Cesium       | -   Lawrence Livermore National Laboratory        |
|                  |                                                   |
| -   Chromium     | -   Savannah River Site                           |
|                  |                                                   |
| -   Cobalt       |                                                   |
+------------------+---------------------------------------------------+
| -   Cadmium      | -   Savannah River Site                           |
|                  |                                                   |
| -   Cesium       |                                                   |
|                  |                                                   |
| -   Cobalt       |                                                   |
|                  |                                                   |
| -   Lead         |                                                   |
|                  |                                                   |
| -   Strontium    |                                                   |
+------------------+---------------------------------------------------+

In support of DOE programs, ATSDR completed the following interaction
profiles:

1\. Interaction profile for cesium, cobalt, polychlorinated biphenyls,
strontium, and

trichloroethylene

2\. Interaction profile for arsenic, hydrazines, jet fuels, strontium,
and trichloroethylene

The documents were finalized following public comments and released to
the public on CD-ROM together with toxicological profiles (2004). The
post-public comment version of the documents is posted on ATSDR's web
site [www.atsdr.cdc.gov](http://www.atsdr.cdc.gov/)
[(2005).]{.underline}

**ATSDR Mixtures Research**

ATSDR proposes a two-step project to determine how simultaneous exposure
to multiple hazardous substances affects toxicity. In the first step,
appropriate mixtures will be identified, and in the second step, the
toxicity of these mixtures will be assessed in combination. Data from
DOE sites will be reviewed to identify candidate radioactive and
non-radioactive substances to which individuals might be co-exposed and
which could impact common target organs (i.e., the kidneys or liver).
Relevant literature searches will be conducted to compile information on
combined toxicity of the substances in mixtures. Based on these
findings, scientific assessments will be designed and conducted to
answer specific questions concerning the effects of exposures to
mixtures of chemicals and the role radiation might play in increasing or
decreasing adverse effects of the chemical mixtures on the overall
health of human populations exposed near DOE sites.

Phase I of the project will identify pertinent mixtures found at DOE
sites through contracts, grants, and staff activities. Preliminary data
analyses have already identified several 3- and 4-component mixtures
likely to be present at DOE sites. A more comprehensive list will be
developed and assessed to identify those mixtures found in completed
exposure pathways, (i.e., those to which the public is or has been
exposed). Literature reviews will be conducted and findings summarized
in interaction profiles to document interactions between the components
of such mixtures that can impact the health of exposed human
populations. Hypotheses will then be generated regarding interactions
between mixtures of certain key chemicals and radioactive materials.

Phase II will subject the above-generated hypotheses to scientific
testing and assessment, and extend current work efforts to mixed
exposures from radioactive and chemical mixtures. Relevant
multi-radionuclide and multi-chemical mixtures will be researched
separately to identify the respective radiological and chemical health
impacts, and jointly assessed for evidence and type of interaction.
Results will be used to refine the hypotheses for general applicability.

**National Iodine-131 Education Effort**

This effort includes developing *Case Studies in Environmental Medicine:
Iodine-131 Toxicity*, distributing the document, and educating the
public and healthcare providers about iodine-131. During FY 2000,
ATSDR's national partners began developing the case studies and a
distribution plan. After finalizing the case studies, ATSDR will work
with the agencies and community members to distribute the case studies,
and to conduct health education programs for groups such as healthcare
providers, community members, and other health officials based on the
information in the case studies.

**ATSDR Public Health Assessments and Consultations at Other Sites**

ATSDR will continue to gather information to develop public health
assessments at all DOE sites on the National Priorities List (NPL) and
for sites for which petitions for public health assessments have been
accepted. If additional DOE sites are proposed for listing on the NPL or
petitions are submitted, ATSDR will rank the sites and prepare public
health assessments as mandated by the Comprehensive Environmental
Response, Compensation, and Liability Act of 1980 (CERCLA), as amended
(42 U.S.C. §9604\[I\]).

Because of insufficient resources to address all sites in one fiscal
year, a strategy was developed to determine the order in which public
health assessments would be initiated. An ATSDR site-ranking scheme was
developed that evaluates and categorizes sites according to their
potential to affect public health. This ranking scheme was published in
the *Federal Register* (57 FR 37382).

The ranking scheme evaluates the following factors that may influence
the public health implications of a site: (1) hazardous substances
present; (2) population potentially affected; (3) potential for
exposure; and (4) health outcome data and community health concerns.

In addition to public health assessments, ATSDR may initiate new health
consultations based on identified public health concerns or at the
request of DOE, the EPA, or the affected communities. Priorities factors
for health consultations include current exposure, current health
effects, impact of recommendations, data availability, time required to
prepare consultation, external resource availability, and competing
projects (i.e., what other projects will be delayed to initiate the
health consultation).

**ATSDR Health Education and Promotion Assistance with Public Health
Assessments at Other Sites**

ATSDR will determine its health education and promotion activities based
on the findings and recommendations from the draft public health
assessments and from the comments received from community residents
during the public comment release period. These activities could include
holding a public availability session for residents potentially impacted
by the site and developing community health educational materials such
as fact sheets, educational brochures, and document summaries.

Primary care providers will receive information and resources to
diagnose, treat, and counsel persons concerned about the health impact
of the site. These educational materials can be provided at local Grand
Rounds or made available through local professional organizations.

**ATSDR Health Study Activities at Other Sites**

Future health studies are contingent upon the outcome of current work
the agencies are conducting (i.e., the public health assessment and
health studies).

**National Center for Environmental Health (NCEH) Multi-Site
Activities**

**NCEH Communications Support Contract**

This contract will help support health communications activities
associated with reporting and interpreting the findings of
energy-related research conducted under the MOU.

**National Academy of Sciences Peer Review**

The National Academy of Sciences Committee on CDC Radiation Research
peer reviews many reports generated as a result of research conducted by
NCEH at DOE sites. The most recent report was from the Committee to
Assess the Distribution and Administration of Potassium Iodide in the
Event of a Nuclear Incident.

**National Institute for Occupational Safety and Health (NIOSH)
Multi-Site Studies**

**Comprehensive Nuclear Worker Roster and Exposure Data Base
Development**

HERB Epidemiological Data System (HEDS). This project will create one
uniform, centralized and secure data management system to maintain NIOSH
study data used in epidemiologic research across multiple DOE sites.
This database will increase the efficiency in the design of future
epidemiologic studies due to the work history and exposure information
for workers employed at more than one DOE site.

**Current Multi-Site Studies**

· Multi-Site Leukemia Case-Control Study (LCCS)

· Cohort Mortality Study of DOE Chemical Laboratory Workers (CLWS)

· International Collaborative Study of Nuclear Industry Workers (IARC)

· Chronic Beryllium Disease Studies (BER1)

· Beryllium Disease Natural History (BER2)

· NIOSH Occupational Radiation and Energy-Related Grants (GRNT)

**Sites to be Selected Following Further Review**

The CDC's NIOSH is proposing a number of multi-site studies for FY
2005--2010 for which specific sites have not yet been selected. Pending
initial investigations and feasibility studies, these include:

· **NIOSH Occupational Health Study (2005--2009)** **Cohort Study of
Neutron Exposed Workers (NUTR)**. Historical neutron monitoring
practices and exposure documentation would be evaluated for selected
sites along with standardized work history information in HEDS. The
feasibility of conducting an epidemiologic investigation of the
association and dose-response relationship between neutron exposures and
cancer would also be determined before launching a formal cohort study.

-   **NIOSH Occupational Health Study (2004--2006)** **Combined
    Plutonium Workers Study (CPWS).** Contingent upon the findings of
    NIOSH funded studies coming to completion that have cohort members
    with plutonium exposures, along with evaluation of foreign studies
    involving plutonium exposed workers, a feasibility effort for
    evaluating the health outcomes of a combined group of plutonium
    exposed U.S. workers may be appropriate. The feasibility study will
    utilize standardized work history information in HEDS as well as
    knowledge of historical monitoring practices for plutonium at select
    sites.

*NIOSH Occupational Health Studies (2005)*

-   **Combined Uranium Workers Study (CUWS)**. This study will examine
    health effects associated with uranium exposures in portions of the
    fuel cycle and nuclear weapons production. Workers at DOE facilities
    that have previously been studied will be combined to increase
    statistical power. Exposure assessment information for external and
    internal emitters will be included in the analysis along with
    information on the solubility and other physical properties where
    available. The study will be initiated as a feasibility analysis
    that utilizes the standardized work history information in HEDS.

Worker Surveillance Data Analysis (SURA). This project would access
information from previous NIOSH studies and available DOE data to: (1)
profile the incidence of specific morbidity and mortality outcomes and
exposures in defined worker cohorts; and (2) investigate the
associations between selected adverse health effects and exposures which
may identify additional topics for a comprehensive research program.

*NIOSH Occupational Health Studies (start up 2006)*

-   **Clean-Up Workers:  Phase 2 (HAW2)**.  A previous study of DOE
    decontamination and decommissioning workers indicated that complete
    rosters of current and former remediation workers do not exist and
    that accurate and complete exposure, work history, and medical
    records data are not readily available for this population. (See
    HAWW within the past worker studies sections at Fernald, Hanford,
    INL, Mound, Oak Ridge, Rocky Flats and Savannah River.) A
    prospective study of this workforce may be proposed since site
    remediation activities are widespread and currently employ thousands
    of workers across the DOE complex. This study could address the
    problems of decentralized and multi-formatted radiation and chemical
    exposure records across the DOE complex and characterize the
    multi-site exposures and conditions of former and current
    decontamination and decommissioning workers. 

-   **Breast Cancer Incidence Study (BCIS)**. Breast cancer has been
    associated with exposure to ionizing radiation through previous
    epidemiologic analysis. However, the risk of breast cancer from
    low-dose, protracted exposures, such as those experienced in the DOE
    workforce, is less well-understood. This project is intended to
    evaluate the relationship between exposure to low-level external
    ionizing radiation and breast cancer incidence among female workers
    at multiple DOE sites. The study will use a case-control design to
    allow adequate control of confounding factors known to be related to
    breast cancer, such as reproductive history and chemical exposures.

*NIOSH Occupational Health Studies (start up 2007)*

-   **Exposure Assessment Female Nuclear Workers (EAFN)**. Previous
    studies of the female nuclear worker population indicated that
    mortality from mental disorders, diseases of the genitourinary
    system, and from ill-defined conditions was higher than expected and
    that external ionizing radiation exposure in these workers appeared
    to be associated with increased risk for leukemia, all cancers
    combined and breast cancer. This study will examine the female
    nuclear worker cohort and create a detailed characterization of the
    exposures and working conditions for further analysis of exposure
    response relationships.

*NIOSH Occupational Health Studies (start up 2009)*

-   **Construction Workers Cohort (CONS)**: This study will assess
    cause-specific mortality among construction workers at DOE sites
    following their apparent exposures to ionizing radiation and
    asbestos, silica, beryllium, or other hazardous chemicals at DOE
    construction sites. Rates of death among specific trades will be
    compared to the U.S. population and internally to unexposed workers.
    The study will incorporate an exposure assessment for ionizing
    radiation and chemicals, including particulate levels.

-   **Brain Cancer Case Control Study (BRAN)**. Studies at individual
    DOE sites have indicated a potential link between low-level ionizing
    radiation exposures and brain cancer. However, these site-specific
    studies lacked sufficient statistical power to properly evaluate the
    exposure response relationships due to the rarity of brain cancer
    cases and the small size of the site-specific cohorts. This pooled
    case-control mortality multi-site study will consider cases across a
    sufficient number of DOE sites to more rigorously examine the
    relationship between low-level radiation exposures and brain cancer
    mortality. This study has been deferred from 2007 to 2009.

NOTE: Shipyards in the Naval Nuclear Propulsion Program. DOD multi-site
involvement. See complete write-up on page 101.

*Current NIOSH Grant Activity (Not site-specific)*

-   **Stochastic models for radiation carcinogenesis: temporal factors
    and dose-rate effects (SMRC).** The University of Washington's Fred
    Hutchinson Cancer Research Center, under a NIOSH grant, is
    continuing the development of methods for analysis of
    epidemiological data on radiation carcinogenesis based on the
    biological principles of multistage carcinogenesis. Specifically,
    this would incorporate age- and time-dependent factors, including
    protraction of exposure. In addition, the investigators intend to
    analyze the association between low-LET radiation and the incidence
    of lung and colorectal cancer using data from the Canadian National
    Dose Registry and the Comprehensive Epidemiological Data Resource
    data from DOE. The main goals of this research are to explore the
    effects of various age- and time-related factors and of protraction
    of exposure on the risk of radiation carcinogenesis.

*Past NIOSH Grant Activity (non-site-specific)*

-   **Glycophorin A biodosimetry in I-131 treated patients (GLYC).**
    This research evaluated the *in vivo* glycophorin A-based somatic
    cell mutation assay as a retrospective dosimeter for use in
    epidemiologic studies. The response of the assay as a biodosimeter
    of radiation exposure was investigated in a longitudinal study of
    patients receiving I-131 therapy for thyroid disease. Assessment of
    the glycophorin A assay in this project demonstrated that the
    biological response recorded by the glycophorin A assay is
    substantially reduced for low dose/low dose rate radiation exposures
    compared to that observed for acute exposures. The assay appears to
    be sensitive only to exposures exceeding 50 cSv. The study findings
    were released by NIOSH on September 24, 2002.

    -   **Acute radiation syndrome in Russian nuclear workers (ARSR).**
        The purpose of this study, performed in collaboration with the
        Russian Southern Urals Biophysics Institute, was to facilitate
        the acquisition of diagnostic and prognostic information to help
        non-expert medical and paramedical personnel with the early
        recognition of acute radiation syndrome in hospital and field
        conditions. The study used data from 59 acute radiation syndrome
        cases that occurred from 1948 to 1953 among workers at the Mayak
        nuclear facilities in Russia. The study findings were released
        by NIOSH on September 24, 2002.

> **Department of Energy (DOE) Health-Related Activities**
>
> DOE has several activities that are not covered under the MOU with
> HHS. Those activities that are funded through the Office of
> Environment, Safety and Health and involve workers at more than one
> DOE site include:
>
> · Illness and Injury Surveillance of Current Workers,
>
> · Former Beryllium Workers Medical Surveillance Program,
>
> · Former Workers Program,
>
> · Radiation Emergency Assistance Center/Training Site Program,
>
> · U.S. Transuranium and Uranium Registries, and
>
> · Worker Health Surveillance.
>
> **Illness and Injury Surveillance of Current Workers**
>
> DOE has the legislative authority to monitor the impact of its
> operations on the health of its workforce. Illness and injury
> surveillance monitors the health of current workers at participating
> DOE sites and evaluates the potential health impact of DOE operations
> on them. This monitoring enhances our understanding of the health of
> workers, and provides a mechanism by which worker health concerns can
> be addressed in collaboration with the affected workers, occupational
> medicine, and site management. Illness and injury surveillance
> supports DOE\'s only multi-site health information database linked to
> current workers. The program leverages existing health and safety data
> sources to maximize the use of current data, while limiting the fiscal
> burden related to data collection.
>
> Illness and injury surveillance assesses the overall health of the
> *current* DOE workforce at 14 DOE sites and facilities. The goal is to
> identify groups of workers that may be at increased risk for
> occupation-related injury and illness. In response to indications of
> excess risk, program staff can assess the need for additional
> investigations. Surveillance is based on continuous collection,
> analysis, and interpretation of selected morbidity, demographic, and
> occupational exposure data. The program is a corporate resource
> providing its customers with timely health information. Program staff
> also provide epidemiologic and public health expertise in the
> evaluation of worker health concerns. Reports summarizing the results
> of illness and injury surveillance are published annually and are
> available online. Implementation of illness and injury surveillance
> has also advanced the automation of health data management systems and
> fostered the development of state-of-the-art medical information
> management at participating sites.
>
> The surveillance program has generated reports on the following sites:
>
> · Brookhaven National Laboratory
>
> · Fernald Environmental Management Project
>
> · Hanford Nuclear Reservation
>
> · Idaho National Engineering and Environmental Laboratory
>
> · Oak Ridge Reservation (Y-12 Weapons Plant)
>
> · Pantex Plant
>
> · Rocky Flats Plant
>
> · Sandia National Laboratory-Albuquerque
>
> · Savannah River Site
>
> · ORR - East Tennessee Technology Park (K-25)
>
> · ORR - Oak Ridge National Laboratory (X-10)
>
> The surveillance program is in the process of developing reports on
> the following sites:
>
> · Los Alamos National Laboratory

-   Kansas City Plant

> · Lawrence Livermore National Laboratory
>
> · Nevada Test Site

**Former Beryllium Workers Medical Surveillance Program**

Under this program, former workers who might have been exposed to
beryllium have been offered a beryllium lymphocyte proliferation test
(BeLPT) to determine if they have beryllium sensitization and a clinical
evaluation, if required, to diagnose chronic beryllium disease (CBD).
With the July 2001 implementation of Energy Employees' Occupational
Illness Compensation Act (EEOICPA), medical followup after the first
abnormal BeLPT is (for the most part) conducted by the Department of
Labor. Individuals with a normal BeLPT are offered a followup screening
exam every 3-5 years if data analysis indicates they are members of
groups with significant risk for CBD. Because there are some sites from
which former workers have not yet been served, and in the interest of
equity for all former DOE and DOE contractors, this program will
transition to a broader, nationwide program to offer beryllium
sensitization testing and other exposure-based medical screening to
individuals from sites across the DOE complex.

DOE sites served by this program are listed below, grouped by their
corresponding DOE Field Office.

+-----------------------+-----------------------------------------------+
| **DOE Field Office**  | **DOE Site**                                  |
+-----------------------+-----------------------------------------------+
| AL                    | Kansas City Plant                             |
|                       |                                               |
|                       | Pantex\*                                      |
|                       |                                               |
|                       | Iowa Army Ammunition Plant\*                  |
|                       |                                               |
|                       | Sandia National Laboratory                    |
|                       |                                               |
|                       | Medina Plant                                  |
+-----------------------+-----------------------------------------------+
| CH                    | Ames Laboratory                               |
|                       |                                               |
|                       | Argonne National Laboratory                   |
|                       |                                               |
|                       | Argonne National Laboratory - West            |
|                       |                                               |
|                       | Brookhaven National Laboratory                |
|                       |                                               |
|                       | Fermi National Accelerator Laboratory         |
+-----------------------+-----------------------------------------------+
| OAK                   | Lawrence Livermore National Laboratory        |
|                       |                                               |
|                       | Lawrence Berkeley National Laboratory         |
|                       |                                               |
|                       | Stanford Linear Accelerator                   |
+-----------------------+-----------------------------------------------+
| OR                    | Oak Ridge National Laboratory\*               |
|                       |                                               |
|                       | Y-12\*                                        |
+-----------------------+-----------------------------------------------+
| OH                    | Mound                                         |
+-----------------------+-----------------------------------------------+
| RFETS                 | Rocky Flats Environmental Technology Site\*   |
+-----------------------+-----------------------------------------------+
| SNR                   | Knolls Atomic Power Laboratory                |
+-----------------------+-----------------------------------------------+

\* Sites covered by both the Former Beryllium Worker Medical
Surveillance Program and the Former Workers Medical Screening Program.
EH-51 staff ensures that the two programs do not offer duplicative
services to former workers at once.

**Former Workers Program**

DOE's *Former Worker Medical Screening Program* (FWP) was established
following the issuance of the FY 1993 Defense Authorization Act, which
tasked DOE with assisting workers with determining whether they had
health issues related to their prior work with DOE.

The mission of the FWP is to identify groups of former workers at risk
for occupational disease, notify these individuals, and offer them
medical screening that can lead to medical treatment. Over 28,000
individuals have been screened through this program to date.

In FY 2005 and FY 2006, EH will maintain and expand medical screening
services to former workers from all DOE sites through the following
initiatives:

1.  Retain all existing regional programs for former workers at multiple
    DOE defense nuclear facilities;

2.  Create new regional programs in Ohio at Mound and Fernald; in New
    Mexico at Sandia; in Iowa at Ames Lab; in California at LLNL and
    LBNL; in Missouri at Kansas City Plant; in Florida at Pinellas, and
    in New York at Brookhaven National Lab; and

3.  Provide supplemental medical care services, which will focus on the
    following groups of workers:

-   Former workers at locations not served by regional programs;

-   Former workers served by regional programs who do not reside in
    close proximity to the regional screening clinics; and

-   Former workers from any DOE site who would prefer to see their
    personal physician.

Data from these projects will be summarized and made available in DOE's
Comprehensive Epidemiologic Data Resource (CEDR) database for use by
other health researchers. Individual project final reports will be
available to DOE workers, communities, and other interested parties.

The following table lists the 15 ongoing projects. The new projects
mentioned above will be awarded in spring 2005.

**Table 4. Former Workers Medical Screening Projects**

  -------------------- -------------------- -----------------------------------
  **Project Title**    **Recipient**        **Project Description**

  **Awarded in                              
  September 1996**                          

  Medical Surveillance Paper,               This project includes former and
  for Former Gaseous   Allied-Industrial,   current hourly and salaried workers
  Diffusion Workers at Chemical and Energy  at the three gaseous diffusion
  the DOE Facilities   Workers              plants. The current workers at
  at Portsmouth,       International Union  Paducah and Portsmouth are now
  Paducah, and Oak     (PACE)               employed by the United States
  Ridge (K-25)                              Enrichment Corporation.

  Medical Surveillance Boston University    This project focuses on former NTS
  for Former DOE                            workers who dug, maintained, and
  Workers at the                            re-entered the tunnels and shafts
  Nevada Test Site                          used for underground nuclear
  (NTS)                                     testing. The project also focuses
                                            on beryllium workers.

  Medical Surveillance University of        This project focuses on former
  for Former DOE       Colorado Health      workers who worked at Rocky Flats
  Workers at the Rocky Sciences Center      from 1951 until 1989. Because of
  Flats Plant                               ongoing DOE surveillance programs
                                            for beryllium and radiation at
                                            Rocky Flats, the project does not
                                            monitor for beryllium or radiation.

  Oak Ridge Building   University of        This project focuses on former
  Trades Medical       Cincinnati Medical   construction workers at the three
  Screening Program    Center, Department   Oak Ridge sites. Few records exist
                       of Environmental     on former construction workers.
                       Health               Exposures varied widely and may
                                            have included beryllium, asbestos,
                                            silica, noise, radiation, welding
                                            fumes, mercury, cadmium, chromium,
                                            lead, and solvents.

  Former Hanford       University of        This project focuses on former
  Worker Medical       Washington,          production workers. These "in
  Monitoring Program   Occupational &       plant" workers operated the
                       Environmental        industrial complex which produced
                       Medicine Program     nuclear materials from 1943 until
                                            the late 1980s.

  Hanford Building     Center to Protect    This project includes former
  Trades Medical       Workers' Rights      construction workers at the Hanford
  Screening Program    (CPWR)               site. Few available records exist
                                            for these workers. Exposures varied
                                            and may have included beryllium,
                                            radiation, asbestos, silica, noise,
                                            welding fumes, mercury, cadmium,
                                            chromium, lead, and solvents.

  **Awarded Fall                            
  1997**                                    

  Former Worker        Paper,               This project focuses on former
  Medical Surveillance Allied-Industrial,   hourly and salaried production
  Program at Idaho     Chemical and Energy  workers.
  National Engineering Workers              
  and Environmental    International Union  
  Laboratory           (PACE)               

  Savannah River Site  Medical University   This project focuses on former
  Former Production    of South Carolina    production workers at the site.
  Workers Medical                           
  Surveillance Program                      

  Augusta Building     Center to Protect    This project focuses on former
  Trades Medical       Workers\' Rights     construction workers at the
  Screening Program    (CPWR)               Savannah River Site. Few available
                                            records exist for these workers.
                                            Exposures varied and may have
                                            included beryllium, radiation,
                                            asbestos, silica, cadmium,
                                            chromium, lead, and solvents.

  Medical Screening    The Johns Hopkins    This project focuses on former
  Program for Former   University School of workers, including scientists,
  Los Alamos National  Bloomberg Public     technicians, and construction
  Laboratory Workers   Health               workers.

  **Awarded Fall                            
  1999**                                    

  Amchitka Workers\'   State of Alaska with This project focuses on those who
  Medical Screening    the Alaska District  worked on Amchitka Island between
  Program              Council of Laborers  1964 and 1993. Amchitka Island was
                                            the site of three underground
                                            nuclear tests between 1965 and
                                            1971. Later, the Navy built and
                                            operated a radar installation on
                                            the island. The major concern is
                                            exposure to residual radiation from
                                            the nuclear tests.

  **Awarded Summer                          
  2000**                                    

  Medical Monitoring   University of Iowa   This project focuses on former
  of Former Atomic     College of Public    workers at the Iowa Army Ammunition
  Weapons Workers at   Health               Plant. Operations included atomic
  the Iowa Army                             weapons assembly and disassembly
  Ammunition Plant in                       from 1945 through 1975. The site
  Burlington, Iowa                          was shared with a large Department
                                            of Defense production facility that
                                            produced high explosives.

  **Awarded December                        
  2002**                                    

  Former Pantex Worker Drexel University    This project focuses on former
  Medical Surveillance School of Public     workers at the Pantex Plant. The
  Program              Health and           Pantex Plant is an active facility.
                       University of Texas  Historic operations include
                       at Tyler             assembly and disassembly of atomic
                                            weapons.

  **Awarded February                        
  2003\*\***                                

  Y-12 and ORNL        Paper,               This project is focusing on former
                       Allied-Industrial,   production workers at the Y-12 and
                       Chemical and Energy  Oak Ridge National Laboratory. The
                       International Union  needs assessment will be conducted
                       (PACE)               in 2003, followed by medical
                                            screening for former workers.

  Paducah and          University of        This project is focusing on
  Portsmouth Gaseous   Cincinnati           construction workers at the Paducah
  Diffusion Plants                          and Portsmouth Gaseous Diffusion
                                            Plants. The needs assessment will
                                            be conducted in 2003, followed by
                                            medical screening for former and
                                            current construction workers.
  -------------------- -------------------- -----------------------------------

**Radiation Emergency Assistance Center/Training Site Program**

DOE develops, produces, and maintains nuclear materials and radiation
generating devices as a major part of its strategic mission. DOE must be
prepared at all times to deal with radiation emergencies and their
consequences.

The Radiation Emergency Assistance Center/Training Site (REAC/TS)
program has been a significant part of DOE's radiation protection effort
for over 30 years. This program provides state-of-the-art medical
assistance, dosimetric assistance, and training to handle radiation
accidents that happen in the United States. The program also provides
help to other nations. Personnel experienced in clinical radiation
medicine are available on a 24-hour basis to evaluate patients directly
or in consultation with their physicians, and to provide clinical care
management, and medical followup of survivors of serious radiation
accidents (about 60 calls per year request this specialized assistance).
REAC/TS personnel can treat workers or members of the public exposed to
radiation or radioactive materials with appropriate conventional and
developmental protocols. REAC/TS's research and registry of more than
400 past accident histories and pertinent clinical data from over
133,000 exposed individuals has allowed the group to study the course of
radiation induced pathology to suggest improvements for specialized
treatment protocols. The group also conducts clinical trials and
maintains a selected inventory of chelating agents under Investigational
New Drug Applications (IND) as ameliorative options. Over 5,000
physicians, nurses, and emergency personnel have received REAC/TS
training in the medical aspects of radiation accident preparedness and
management. REAC/TS unique expertise in radiation medicine is sought
frequently by program offices in DOE and in other Federal agencies.

**U.S. Transuranium and Uranium Registries**

The U.S. Transuranium and Uranium Registries (USTUR) are a unique
program of human tissue research. The registries are a major component
of DOE's long-standing programs to ensure that radiological protection
standards and workplace control measures for occupational exposures to
plutonium, uranium, and other long-lived, radioactive materials are
protective of worker health.

Based on voluntary enrollment of occupationally exposed individuals, the
USTUR program has become a unique resource of data, radio analytical
capabilities, and research materials. The registries include the
operation of two catalogued repositories (the National Human
Radiobiology Tissue Repository and the National Radiobiology Archive of
Tissues from animal studies). This allows researchers to use donated
tissues and histopathology slides. Analysis of the distribution of
radioactive elements in the tissues donated posthumously by volunteers
provides critical information about the quantity of radioactive material
deposited in each tissue and organ, the length of time that it remained
there, and the radiation doses received by organs and systems. These
data and materials help verify and refine the world's radiation
protection standards and make the USTUR a major resource for
understanding plutonium health effects. For example, during the past 30
years, 370 volunteers have donated autopsy samples that were analyzed
for isotopes of uranium, plutonium, thorium, and americium. This
resulted in thousands of analytical measurements, which formed the basis
for more than 150 peer-reviewed articles and reports.

**Worker Health Surveillance**

The primary emphasis of worker health surveillance is to identify
workers whose health may have been adversely affected by their work at
DOE facilities and the provision of timely health information to those
workers. Voluntary screening programs conduct either broad assessments
of the health of former workers or focus on identifying workers at risk
for specific health effects, such as berylliosis. These programs offer
medical tests and evaluations selected to provide valuable health
information directly to former workers concerned with the potential
health impact of their work. Other health surveillance programs monitor
the health of current workers and assist DOE sites in investigating
worker health concerns. Ongoing analysis of health data from 70,000
current workers is used to identify trends in illness and injury and to
give workers, management, and other stakeholder's information on the
health of the current workers. Worker surveillance programs include a
complex-wide Beryllium Registry and Screening Program, the Rocky Flats
Former Radiation Workers Program, a number of former workers medical
screening programs, and the Illness and Injury Surveillance Program.

**Appendix A**

Abbreviations, Acronyms, and Symbols

**AEC** Atomic Energy Commission

**AOEC** Association of Occupational and Environmental Clinics

**ARSR** Acute radiation syndrome in Russian nuclear workers study

**ATSDR** Agency for Toxic Substances and Disease Registry

**BCIS** NIOSH breast cancer incidence study

**BER1** Chronic beryllium disease study

**BER2** Beryllium disease natural history

**BNL** Brookhaven National Laboratory

**BONE** NIOSH bone cancer case control study

**BRAN** NIOSH brain cancer case control study

**CBD** Chronic beryllium disease

**CBDMP** California Birth Defects Monitoring Program

**CDC** Centers for Disease Control and Prevention

**CDHS** California Department of Health Services

**CEDR** DOE's Comprehensive Epidemiologic Data Resource database

**CERCLA** Comprehensive Environmental Response, Compensation, and
Liability Act of 1980

**CLWS** NIOSH cohort mortality study of DOE chemical laboratory workers

**COHS** NIOSH comprehensive occupational safety and health surveillance
system

**CONS** NIOSH construction workers cohort study

**CNLS** NIOSH combined national laboratory worker study

**CNS** Central nervous system

**CONS** NIOSH construction worker mortality study

**CPWR** Center to Protect Workers' Rights

**CPWS** NIOSH combined plutonium workers study

**CUWS** NIOSH combined uranium workers study

**DDWR** NIOSH decontamination and decommissioning workers registry

**DOE** U.S. Department of Energy

**DTSC** California Department of Toxic Substances Control

**EAFN** NIOSH exposure assessment for female nuclear workers study

**EH** DOE's Office of Environment, Safety and Health

**EHI** Environmental health intervention

**EMSL** EPA's Environmental Monitoring Systems Laboratory, Las Vegas

**EPA** U.S. Environmental Protection Agency

**ERG** Eastern Research Group, Inc.

**ESRD** End-stage renal disease

**ETEC** Energy Technology Engineering Center

**ETTP** East Tennessee Technology Park

**FEMP** Fernald Environmental Management Project

**FISH** NIOSH biomarkers of dose and effect

**FMMP** Fernald Medical Monitoring Program

**FMPC** Feed Materials Production Center

**FNUP** NIOSH mortality/exposure assessment study at Fernald

**FUSRAP** Formerly Utilized Sites Remedial Action Program

**FWP** DOE's former workers medical surveillance program

**GLYC** NIOSH study of glycophorin A biodosimetry in I-131 treated
patients

**GRNT** NIOSH occupational radiation and energy-related grants

**HANF** NIOSH study of ionizing radiation and mortality among Hanford
workers

**HAW2** NIOSH cleanup workers: Phase 2

**HAWW** NIOSH exposure assessment of hazardous waste, decontamination
and decommissioning, cleanup workers

**HCHP** Hanford Community Health Project

**HEDR** Hanford Environmental Dose Reconstruction

**HES** Health Effects Subcommittee

**HHES** Hanford Health Effects Subcommittee

**HHIN** Hanford Health Information Network

**HHS** U.S. Department of Health and Human Services

**HSDN** NIOSH hazard surveillance in the defense nuclear industry

**HTDS** Hanford Thyroid Disease Study

**HTST** NIOSH multi-site study of heat stress among carpenters

**I-131** Iodine-131

**IARC** International collaborative study of nuclear industry workers

**ICHHP** Inter-tribal Council on Hanford Health Projects

**IDA** Individual dose assessment

**IDH** Idaho Division of Health

**INCU** NIOSH cohort update study for Idaho National Engineering and
Environmental Laboratory workers

**IND** Investigational New Drug Applications

**INL** Idaho National Laboratory

**INEL** NIOSH cohort mortality study of Idaho National Laboratory
workers

**K-25** East Tennessee Technology Park at Oak Ridge, Tennessee

**K25K** NIOSH multiple myeloma case-control study at ORR's K-25
facility

**LANL** Los Alamos National Laboratory

**LCCS** NIOSH multi-site leukemia case-control study

**LEHR** Laboratory for Energy-Related Health Research

**LFPW** NIOSH study on lung fibrosis in plutonium workers

**LLNL** Lawrence Livermore National Laboratory

**LUNG** NIOSH multi-state case-control study of lung cancer and
external ionizing radiation

**MAFN** NIOSH study of mortality among female nuclear workers

**MALN** NIOSH Mallinckrodt cohort study

**MCMS** NIOSH Mound cohort mortality study

**MED** Manhattan Engineer District

**mg/kg** Milligrams per kilogram

**mg/L** microgram per liter

**MOU** Memorandum of Understanding

**MSP** Middlesex Sampling Plant

**NAREL** EPA's National Air and Radiation Environmental Laboratory

**NCEH** Center for Disease Control and Prevention's National Center for
Environmental Health

**NCI** National Cancer Institute

**NCMS** NIOSH Nevada Test Site mortality study

**NEC2** NIOSH cohort study of neutron exposed workers

**NF1** Neurofibromatosis, type 1

**NIOSH** Center for Disease Control and Prevention's National Institute
for Occupational Safety and Health

**NLAW** NIOSH national laboratories accelerator workers study

**NNSW** NIOSH study of nuclear naval shipyard workers

**NPL** National Priorities List

**NTS** Nevada Test Site

**NUTR** NIOSH cohort study of Neutron Exposed Workers

**OHP** Office of Health Programs

**ORISE** Oak Ridge Institute for Science and Education

**ORR** Oak Ridge Reservation

**PACE** Paper, Allied-Industrial, Chemical and Energy Workers
International Union

**PAD1** NIOSH study of health effects of occupational exposures in
Paducah Gaseous Diffusion Plant workers

**PAS** Public availability sessions

**PCBs** Polychlorinated biphenyls

**pCi/L** Picocuries per liter

**PGDP** Paducah Gaseous Diffusion Plant

**PFRS** NIOSH radon and cigarette smoking exposure assessment in
Fernald workers

**PNS** Portsmouth Naval Shipyard

**PORT** NIOSH cohort mortality study of the Portsmouth Diffusion Plant

**ppb** Parts per billion

**PTXP** NIOSH Pantex cohort mortality study

**RADT** NIOSH reproductive biomonitoring study

**RaLa** Radioactive lanthanum

**REAC/TS** DOE Radiation Emergency Assistance Center/Training Site

**RKFL** NIOSH epidemiological evaluation of cancer and occupational
exposure at Rocky Flats

**SEE** Sentinel exposure event

**SEES** NIOSH study of Sentinel exposure event surveillance/evaluation
at DOE sites

**SEER** National Cancer Institute's Surveillance, Epidemiology, and End
Results program

**SMR** Standard mortality ratio

**SMRC** NIOSH study of Stochastic models for radiation carcinogenesis:
temporal factors and dose-rate effects

**SMSH** NIOSH study surveillance methods for solvent-related
hepatotoxicity

**SORR** NIOSH study of susceptibility and occupational radiation risks

**Sr-90** Strontium-90

**SRR** Savannah River Site

**SRS** Savannah River Site

**SRSU** Savannah River Site cohort update

**SSFL** Santa Susana Field Laboratory

**STDN** NIOSH study of prevention of stress and health consequences of
downsizing

**SURA** NIOSH worker surveillance data analysis

**TCE** Trichloroethylene

**TDH** Texas Department of Health

**TSCA** Toxic Substances Control Act

**UCD** University of California at Davis

**UCLA** University of California at Los Angeles

**USEC** United States Enrichment Corporation

**USTUR** U.S. Transuranium and Uranium Registries

**VOCs** Volatile organic compounds

**WESS** NIOSH worker exposure surveillance system

**WHEP** NIOSH study of exposure history for the construction trades

**X-10** Oak Ridge National Laboratory

**Y-12** Oak Ridge Reservation weapons plant

**Appendix B**

Glossary of Terms

  ----------------------- ------------------------------------------------------
  **Cancer**              A group of diseases which can occur when cells in the
                          body become abnormal and grow, or multiply out of
                          control. A malignant growth capable of invading
                          surrounding tissues or spreading to other parts of the
                          body.

  **Cohort**              Population of individuals who share a common
                          characteristic, such as employment at a particular
                          factory

  **Confounders**         Risk factors that are associated with both disease and
                          exposure in the source population

  **Decontamination**     The removal of hazardous material (typically
                          radioactive or chemical material) from facilities,
                          soils, or equipment by washing, chemical action,
                          mechanical cleaning, or other techniques

  **Decommissioning**     The closing of a facility, followed by
                          decontamination, entombment, dismantlement, or
                          conversion to another use

  **Deactivation**        The placement of a formerly active processing facility
                          in a safe and stable condition until it can be
                          decommissioned or dismantled

  **Dismantlement**       The disassembly or demolition and removal of any
                          structure, system, or component during decommissioning
                          and the satisfactory interim or long-term disposal of
                          the residue from all, or portions of, the facility

  **Environmental         As defined in *Environmental Management: Process &
  restoration**           Plans of the Environmental Management Program*,
                          November, 1996; DOE/EM-0317: Cleanup and restoration
                          of sites contaminated with hazardous substances during
                          past production or disposal activities. Environmental
                          restoration encompasses a wide range of cleanup
                          activities such as stabilizing contaminated soil;
                          pumping and testing groundwater; decommissioning
                          process buildings, nuclear reactors, chemical
                          separation plants, and many other facilities; and
                          exhuming sludge and buried drums of waste.

  **External radiation**  Radiation which is given off by a nuclear or X-ray
                          source outside the body

  **Genitourinary**       Pertaining to the genital and urinary organs

  **(Adverse) Health      Injury or illness that may be the result of exposure
  Effect**                to biological, physical, or chemical agents (such as
                          germs, radiation or chemicals). May include diseases
                          such as, cancers, birth defects, genetic effects, and
                          death.

  **Healthy worker        Occurs when fewer deaths are observed for workers in
  effect**                an epidemiologic study upon comparison to the U.S.
                          population; usually due to the selection of healthy
                          employees from the population and the exclusion of the
                          severely ill and chronically disabled from employment

  **Internal Radiation**  Radiation which is given off by radioactive materials
                          that have been taken into the body

  **Leiomyoscarcoma**     Cancerous tumor most commonly occurring in the
                          stomach, esophagus, or small intestine.

  **Leukemia**            A family of blood cell cancers. The diseases affect
                          different types of white blood cells, making them
                          abnormal in shape or number. Some, but not all, kinds
                          of leukemia may result from exposure to chemicals or
                          radiation.

  **Multiple myeloma**    A rare disease that is characterized by anemia,
                          bleeding, recurrent infections, and weakness. It is
                          usually regarded as a form of cancer that originates
                          in the bone marrow and involves mainly the bones. It
                          usually occurs more frequently in men than women.

  **Rhabdomyo-sarcoma**   Cancerous growth most commonly occurring in the head
                          or neck, but which can also be found in the sex
                          organs, urinary tract, legs, arms, body wall, and
                          abdomen

  **Volatile Organic      Substances which easily become vapors or gases and
  Compounds (VOCs)**      which contain carbon and different proportions of
                          other elements such as hydrogen, oxygen, fluorine,
                          chlorine, bromine, sulfur, or nitrogen. A significant
                          number of VOCs are commonly used as solvents (paint
                          thinners, lacquer thinners, degreasers, and
                          dry-cleaning fluids).
  ----------------------- ------------------------------------------------------