Atomic Bomb Dome
Hiroshima Castle
Aioi Bridge

Hiroshima Peace Memorial Park

Peace Boulevard

Radiation Effects Research Foundation

放影研 Radiation Effects Research Foundation

RERF

A BRIEF DESCRIPTION

5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815 Japan
Tel: 082-261-3131
8-6 Nakagawa 1-chome, Nagasaki 850-0013 Japan
Tel: 095-823-1121
http://www.rerf.jp/

Radiation Effects Research Foundation
A Japan-US Cooperative Research Organization

Publication date: December 2014
First revision: April 2016
Printer: Letterpress Co., Ltd.

Inside cover: (left) Radiation Effects Research Foundation in Nagasaki(right) Radiation Effects Research Foundation in Hijiyama Park, Hiroshima

Radiation Effects Research Foundation

A BRIEF DESCRIPTION

放影研

RERF

Table of Contents﻿

Table of Contents
Preface .................................................................... 1[1] Physical destruction by the atomic bombs........ 2[2] Radiation effects on human health:
Acute deaths and acute effects.......................... 4[3] RERF study cohorts and study methods ..........
[A] Study subjects and establishment of study
populations .....................................................
   1. A-bomb survivors .........................................
     (1) Life Span Study (LSS) cohort ..................
    (2) In utero cohorts .........................................
     (3) Adult Health Study (AHS) cohort ............
   2. F1 (children of A-bomb survivors)
cohorts ..........................................................
    (1) Genetics study cohort ...............................
    (2) Mortality study cohort ..............................
    (3) Clinical study cohort ................................
[B] Study methods ................................................

5
5
5
5
6
6
8
8
8
8
9

[4] Radiation dosimetry .......................................... 11[A] Physical dose measurements ......................... 11    1. Dosimetry systems andresidual radiation .......................................... 11    2. Biological effects of internal exposure ........ 15[B] Biological dosimetry ...................................... 15   1. Chromosome aberrations .............................. 15    2. Electron spin resonance (ESR)
using tooth enamel ....................................... 17[5] Radiation effects on human health:
Late effects ....................................................... 19[A] Results from studies of A-bomb survivors .... 19   1. Malignant tumors ......................................... 19     (1) Leukemia and related diseases ................. 19    (2) Solid cancers ............................................. 21(3) Site-specific cancer risks .......................... 23      a. Stomach cancer ..................................... 23      b. Colorectal cancer .................................. 23      c. Liver cancer .......................................... 23    
d. Lung cancer .......................................... 24    e. Breast cancer ......................................... 24    
f. Urinary organ cancer ............................. 25    
g. Brain and central nervous
system tumors ....................................... 25      h. Thyroid cancer ...................................... 25    2. Noncancer diseases and abnormalities(excluding deaths due to blood diseases)...... 26     (1) Mortality and incidence of circulatory
disease (heart disease and stroke) ............ 27     (2) Mortality and incidence ofliver disease .............................................. 27    (3) Thyroid disease ......................................... 28    (4) Cataract ..................................................... 28    (5) Gynecological disease .............................. 29     (6) Physical growth and development andbone and locomotor apparatus disease ..... 29    (7) Skin disease .............................................. 29    (8) Psychoneurological andpsychological effects ................................ 29    3. Abnormality in the immune system
and inflammation .......................................... 30[B] Results from studies of in utero survivors .... 30   1. Intellectual impairment ................................ 30   2. Growth impairment ...................................... 31   3. Malignant tumors ......................................... 32    4. Noncancer diseases during adulthood .......... 32[C] Results from studies of children of
A-bomb survivors (genetic effects) ............... 32    1. Birth defects (stillbirth, malformation,and neonatal death) ...................................... 32   2. Sex ratio ........................................................ 32   3. Chromosome aberrations .............................. 33    4. Genetic effects studies at the protein
level and subsequent DNA studies .............. 33    5. Epidemiological and clinical studies ........... 35    6. Prevalence of lifestyle diseases .................... 35[6] Future research themes ..................................... 38[7] Utilization of RERF study results byinternational organizations ............................... 40[8] Collaborative research programs ...................... 41[9] Research review ................................................ 42[10] Research materials .......................................... 43
Research departments ............................................. 45
Glossary .................................................................. 48
References ............................................................... 50

Preface

Preface
The Radiation Effects Research Foundation (RERF)
was established to “conduct research and studies forpeaceful purposes on medical effects of radiation andassociated diseases in humans, with a view to contributing to maintenance of the health and welfare of
the atomic bomb survivors and to enhancement of thehealth of all humankind,” as stipulated in Article 3 of the
RERF Articles of Incorporation. RERF scientists fromthe United States and Japan conduct multidisciplinary
research in numerous fields of science including epidemiology, clinical medicine, genetics, and immunology
to elucidate health effects of atomic bomb (A-bomb)radiation in cooperation with A-bomb survivors, as well
as Hiroshima and Nagasaki citizens, local medical associations, universities, and governmental agencies, among
others. Thanks to the continued understanding and cooperation of A-bomb survivors and numerous others overmany years, RERF’s research results are widely used topromote the health and welfare of A-bomb survivors,
support radiological medical research throughout theworld, and contribute to reduction of risk from medical
and other types of radiation exposures.
RERF’s predecessor organization, the Atomic Bomb
Casualty Commission (ABCC), was founded by the
U.S. National Academy of Sciences (NAS) in 1947
to conduct research in the city of Hiroshima, withfunding provided by the U.S. Atomic Energy Commission. The following year, 1948, ABCC’s Nagasaki
Laboratory was established. ABCC initiated healthstudies of A-bomb survivors in cooperation with theJapan Ministry of Health and Welfare’s National Institute of Health, which joined the research program in1948. In 1955, the Francis Committee was convened
to conduct a comprehensive review of ABCC work.
The Committee recommended that fixed cohorts beestablished to conduct population-based follow-up
studies. This recommendation laid the foundation for
the RERF research policies that remain in place today.
RERF was established under Japanese civil law
on April 1, 1975, as a nonprofit foundation under thejurisdiction of the Japan Ministry of Foreign Affairs
and Ministry of Health and Welfare. RERF is operated binationally, in accordance with an agreement
between the governments of Japan and the UnitedStates. When ABCC was reorganized to form RERF,
RERF assumed ongoing responsibility for ABCC’s
research activities. Based on RERF’s transition to a
public interest incorporated foundation on April 1,
2012, the organization was further strengthened witha management structure comprised of the Board of
Councilors, Board of Directors, and Auditors. The

Scientific Advisory Committee, consisting of both
U.S. and Japanese Advisors, makes annual recommendations that form the basis for RERF’s research
activities. RERF reports on its research activities tothe Hiroshima and Nagasaki Local Advisors and Local
Liaison Councils and strives to reflect the views andopinions of those individuals and bodies in its work.
The goal of ABCC-RERF research is to elucidate thelong-term effects of radiation on human health. RERF
research can be characterized as long-term followup studies of large well-organized cohorts. RERF’s
follow-up studies are unique in the world in termsof scale, composition, accuracy, and other important
aspects. RERF’s health effects studies are notable formaintaining a high participation rate since their initiation. As of 2014, although nearly 70 years have passed
since the atomic bombs were dropped on Hiroshima
and Nagasaki, up to 30 more years may be necessary
to complete the lifetime follow-up of all A-bomb survivors including those who were young at the time of
the atomic bombings, meaning that the foundation’s
research is not yet finished. New findings from RERF
studies have been used not only for the medical careand welfare of A-bomb survivors but also for the establishment of international radiation protection standards.
For this reason, RERF’s research remains the focus ofcontinued attention from international governmental
and private organizations and other groups.
RERF has done its best to consistently release accurate information about the aforementioned research
results. In addition to scientific presentations andjournal publications, we have issued a variety of published materials to outline our activities. As is the casegenerally for such materials, this “A Brief Description” has undergone several revisions. This time,intending to set the booklet clearly apart, we madeextensive revisions with the aim of reaching persons
who already possess basic knowledge about radiation
as well as those who are experts in the field of radiation. This revised version explains the late effects of
A-bomb radiation primarily based on ABCC-RERF
reports, under an editorial policy of introducing results
obtained thus far as well as expectations for future
research.
RERF will continue to make every effort to carryon our mission of conducting long-term follow-up
research of A-bomb survivor cohorts and producing
further research results. It is our strong desire thatscientific clarification of the health effects resulting
from A-bomb radiation will lead to the shared conviction among the world’s people that the tragedies
of Hiroshima and Nagasaki must never be repeated,
thereby laying the foundation for lasting peace.

Radiation Effects Research Foundation A Brief Description

1

【1】

Physical destruction by theatomic bombs

The atomic bomb dropped on the city of Hiroshimausing uranium-235 (235U) as fissile material exploded
with an energy equivalent to 16 kilotons of TNT. The
atomic bomb dropped on the city of Nagasaki used
plutonium-239 (239Pu) as fissile material, releasingenergy equivalent to 21 kilotons of TNT. The estimated energy yields of the bombs were comprised of
50% blast (shock wave), 35% heat wave, and 15%
radiation.
The atomic bombs fell on Hiroshima at 8:15 a.m.
on August 6, 1945, and on Nagasaki at 11:02 a.m.
on August 9, 1945. The Hiroshima bomb exploded
approximately 600 m above Shima Hospital, about
160 m southeast of the Atomic-bomb Dome (former
Hiroshima Prefectural Industrial Promotion Hall);in Nagasaki the bomb exploded 503 m above thevicinity of the Matsuyama-machi intersection in thenorthern part of the city. At the instant of explosion,
the temperature at the center of each bomb reachedmillions of degrees Celsius and the atmospheric pressure hundreds of thousands of atmospheres. A fireballformed around the exploding A-bomb and within it, asecondary nuclear reaction was underway.
Shock waves generated on the surfaces of the fireballs created by the Hiroshima and Nagasaki A-bombs
spread through the atmosphere at supersonic speeds.
The shock waves of each bomb were accompanied
by a strong blast that inflicted serious damage when
it hit the ground. The blast traveled 1 km from the
hypocenter in two seconds after the detonation, 2 km
in 4.5 seconds, and about 11 km in 30 seconds. The
velocity was estimated to be 280 m/second aroundthe hypocenter and 28 m/second at the distance of 3.2
km from the hypocenter. After the blast passed overthe vicinity of the hypocenter, the area was subjected
to negative pressure from outward wind. Inward windthen blew back through the area, giving rise to a rapid
ascending current that formed the stem of a mushroom
cloud. The combination of the shock waves and theblast caused catastrophic damage to wooden houses
within 2 km of the hypocenter. Even many reinforced
concrete buildings located within 0.5 km of the hypocenter collapsed. Due to the shock waves and blast,
many people died or were injured after being buried
under collapsed buildings or hit by heavy flying
objects or broken glass.
The surface temperature of the fireball 0.3 seconds【1】Physical destruction by the atomic bombs

after the explosion was estimated to be approximately
7,000°C, and that of the ground just below the epicenter reached approximately 3,000–4,000°C. Woodsurfaces charred by the heat waves (infrared rays)
were observed within about 3 km and 3.5 km of the
hypocenter in Hiroshima and Nagasaki, respectively.
These thermal waves burned any exposed skin ofpeople within 3.5 km and 4 km of the hypocenters in
Hiroshima and Nagasaki, respectively. In both cities,
people within approximately 1.2 km of the hypocenter and who had no shielding were fatally burned. It
is estimated that 20–30% of the human deaths were
attributable to burns caused by the thermal waves.
Various forms of ionizing radiation emitted by the
nuclear explosion of an atomic bomb, such as neutrons, α particles, β particles, and γ rays (hereinafter
known simply as “radiation”), are called primaryradiation or prompt radiation. Of these forms of primary radiation, neutrons can render bomb debris andairborne molecules radioactive. This process of activation can generate various types of radioisotopes, giving rise to secondary radiation, also known as delayed
radiation. Although this process was completed very
rapidly after the explosions, radioisotopes generated
in the fireballs continued to emit radiation for morethan one minute. During this sequence, most α and β
particles disappeared, leaving mostly neutrons and γ
rays to reach the ground.
The primary radiation explained above is also
called initial radiation or direct radiation. A-bombradiation is classified into initial radiation and residual
radiation.
Residual radiation was caused by secondary radiation resulting from radioactive materials that remainedin the environment from the nuclear detonations. This
type of radiation can further be classified into induced
radiation and fallout radiation, the latter from radioactive substances scattered in the air. Induced radiation
was caused by temporary activation of the neutrons in
the atoms making up certain substances in the metalsof some buildings and in soil. Most of the exposure
to induced radiation, excluding exceptional cases offine particle inhalation, was external, and most of theinduced radioactivity decreased rapidly within a few
days after the bombings.
On the other hand, the remaining A-bomb source
materials and secondary radioactive materials generated by the nuclear detonations rose high in the air
with the fireballs and were widely scattered in theNote) Units of radiation used in this pamphlet: Radiation units are frequently expressed as sievert (Sv), but “A Brief
Description” uses gray (Gy). For more detailed information regarding Sv and Gy, refer to the description“Weighted absorbed organ dose” in the Glossary section (on page 47).

2

Radiation Effects Research Foundation A Brief Description

【1】Physical destruction by the atomic bombs

atmosphere. A portion of the radioactive particles
suspended in the air gradually fell to the ground, withsuch movement accelerated by rain and other forms ofprecipitation. So-called “black rain” is thought to havecontained radioactive fallout. The cause of the black
rain color was actually soot from the secondary fires,and therefore the rain’s color was not directly indicative of the level of radioactivity. The possibility existsthat even the rain falling soon after the explosions
that was not black might have contained radioactive
substances and that some of the rain that was black
had essentially no radioactivity.
With regard to these particles, we need to consider
both external exposure from radioactive substancesthat remained in the air or that fell to and accumulated on the ground and internal exposure, which wascaused by direct inhalation of particles remaining in
the air and by intake of radioactive substances reaching the ground and into the body by way of various
pathways. Such internal exposure pathways included
direct intake of radioactive fallout on the groundmixed in with drinking water or vegetables and intakeof radiation that was re-concentrated in milk fromcows (or goats) feeding on grasses contaminated byradioactive fallout (principally applicable to radioactive iodine).

Radiation Effects Research Foundation A Brief Description3

Acute deaths
Acute deaths are typically defined as deaths occurring by the end of December 1945 and attributable tothe two atomic bombings in August of that year. Numbers of acute deaths are estimated to have been morethan 110,000 in Hiroshima and more than 70,000 in
Nagasaki.1 The closer victims were to the hypocenter,the higher the percentage of acute deaths attributable
to traumas and burns caused by buildings collapsed in
the blast and subsequent fires. At the same time, thecloser victims were to the hypocenter, the higher theradiation dose received, making it difficult to distinguish deaths due to radiation from deaths attributable
to traumas and burns. To exclude deaths from traumas
and burns, RERF studies focus mainly on delayed
deaths considered to be attributable to radiation.
The probability of dying directly from radiation
exposure depends on the dose received. A commonlyused index is the dose at which 50% of a population
dies (LD50 = lethal dose, 50%). At around the LD50
level, bleeding and infection due to immunodeficiency
resulting from depletion of hematopoietic stem cells
in bone marrow are the main causes of death. Suchdeaths peaked at about one month after exposure dueto the bombings. Recovery sufficient to prevent deathtypically occurred within two months.
Early estimates based on survivor interviews
calculated the LD50 in terms of distance from the
hypocenter at which 50% of people survived to be
1,000–1,200 meters in Hiroshima and 1,000–1,300
meters in Nagasaki. Relating those distances toexposure dose was not possible at that time, however, because of insufficient shielding information.
Later analyses of extensive records at RERF wereable to make estimates of shielding, and a bone marrow LD50/60 (radiation dose of 50% mortality within
60 days) was calculated to be 2.7–3.1 Gy (with theDosimetry System 2002 [DS02], the corresponding
doses are 2.9–3.3 Gy). These data originated fromabout 7,600 survivors in 2,500 households exposed
inside Japanese houses located within 1,600 meters of
the hypocenter in Hiroshima.2 Survivors inside suchhouses received special scrutiny, because the homogeneity and ubiquity of the structures allowed for better
estimation of individual radiation doses.
Based on this information from A-bomb survivors,
together with other information from cases involving
exposure to accidental radiation or radiation therapy,
the United Nations Scientific Committee on the
Effects of Atomic Radiation (UNSCEAR) has estimated the bone marrow LD50/60 at around 2.5 Gy when

4【2】Radiation effects on human health: Acutedeaths and acute effects

no medical assistance is available and ≥5 Gy whenadequate medical care is possible.

Acute effects
Symptoms collectively called “acute radiation syndrome” occur within a few hours to months after exposure to high-dose radiation (from approximately 1–2 Gy
to 10 Gy). The principal signs and symptoms include
vomiting within a few hours, followed within days toweeks by diarrhea, reduced blood cell counts, bleeding,hair loss (epilation), and temporary male sterility. Diarrhea results from damage to cells lining the intestines,
reduction in blood cells results from death of hematopoietic stem cells in bone marrow, and bleeding resultsfrom declining blood platelets generated from such stem
cells. Hair is lost due to damage to hair-root cells. Individual strands of hair do not fall out but rather becomethinner and eventually break off. Sterility occurs in men
from damage to sperm-generating stem cells.3
Except for vomiting, these signs and symptoms areclosely related to frequency of cell division, rapid cell
division being more sensitive to radiation than slow
cell division (e.g., muscle and nerve cells are examples of slowly dividing cells). If the radiation dose islow, this acute radiation syndrome will seldom if everoccur. Conversely, if the dose is high, death can occur
within 10–20 days after exposure due to severe damage to digestive organs, or within one or two months
after exposure mostly from bone marrow failure.
Figure 1 shows the association between the percentage of those with severe epilation (loss of more than
2/3 of scalp hair) and radiation dose.4 Although there
is only a small effect up to 1 Gy, epilation increases
sharply with dose thereafter. (Above 5 Gy, the declining frequency seen in the figure is considered to reflecterrors due to overestimation of dose.)100

Percent with severe epilation （％）

【2】

Radiation effects on humanhealth: Acute deaths andacute effects

80

60

40

20

0
0

1.0

2.0

3.0

4.0

5.0

6.0

Total dose ofγrays and neutrons (Gy)Figure 1. Severe epilation and radiation dose4

Radiation Effects Research Foundation A Brief Description

【3】RERF study cohorts and study
methods【A】Study subjects and establishmentof study populations
Late radiation effects are not radiation-specificsymptoms, and therefore, it is generally difficult todiscern whether observed events are attributable toradiation. For this reason, to study late effects fromradiation, it is necessary to conduct an epidemiological study that follows a fixed population of exposed
individuals in order to observe whether an excess
of specific events is occurring in the population in adose-dependent manner. The Atomic Bomb Casualty
Commission (ABCC), the predecessor to the Radiation Effects Research Foundation (RERF), establisheda follow-up cohort, called the Life Span Study (LSS),
based on data from a survey of A-bomb survivors conducted at the time of the 1950 Japan national census.
Cohorts of individuals exposed in utero and childrenof A-bomb survivors (F1) were established based on
birth registration records and the results of surveys
conducted by ABCC (Table 1). For each study cohort,individual radiation doses were assessed, and followup studies have been conducted focusing on mortality, cause of death, and cancer incidence as indices ofradiation effects. For subsets of the cohorts, information about health status has been obtained throughhealth examinations carried out at ABCC-RERF.

1. A-bomb survivors(1) Life Span Study (LSS) cohort
At the inception of ABCC, studies were conductedbased on cohorts established independently by individual research scientists. As a result, these studies
lacked consistency and continuity. The Francis Committee, convened in 1955, strongly recommended that
ABCC develop integrated research protocols with acentral focus on three platform protocols based on
fixed cohorts. As a result, using data from the supple-【3】RERF study cohorts and study methods【A】Study subjects and establishment of study populations

mental survey of A-bomb survivors conducted in conjunction with the 1950 Japan national census, a fixed
population of A-bomb survivors, the LSS cohort, wasestablished to follow mortality in the survivor population. The supplemental A-bomb survivors survey atthe time of the 1950 census identified approximately
284,000 A-bomb survivors throughout Japan (excluding Okinawa and Amami Oshima). Of this total,
nearly 200,000 survivors were residing in one of thetwo cities at the time of the census. These 200,000
survivors, together with those who were confirmed as
not present in either city at the time of the bombingsby ABCC, Hiroshima City, and Nagasaki City surveys
conducted in the 1950s, formed the basic sample forestablishment of fixed cohorts. The survivors in thebasic sample were surveyed to obtain information on
birth date, permanent domicile, address, exposure conditions, any acute symptoms, and other details. This
information formed the basis for selection of the LSS
cohort. The initial LSS cohort consisted of Japanesepeople who were included in this basic sample withpermanent domicile in either city of Hiroshima or
Nagasaki. The LSS comprises the following fourgroups: (1) all survivors who were within 2,000
meters of either hypocenter at the time of the bombings (proximally exposed); (2) all survivors who wereat 2,000–2,499 meters (semi-proximally exposed); (3)a sample of survivors at 2,500–9,999 meters, matchedto group (1) by sex and age (distally exposed); and (4)a sample of persons, age- and sex-matched to group(1) who were at least 10,000 meters from the hypocenter. Group (4) is designated as the “not-in-city”
population and includes the early entrants who entered
the cities of Hiroshima or Nagasaki within 30 days ofthe bombings.
The original LSS cohort of 99,382 persons did notinclude 9,530 survivors located less than 2,500 metersfrom either hypocenter at the time of the bombings
whose permanent domicile was not in either city ofHiroshima or Nagasaki. These 9,530 survivors wereTable 1. Major RERF research programs and population sizes
Life Span Study
Adult Health Study (Directly exposed)

120,321
24,358In Utero Study
Adult Health Study (In utero survivors)

3,638
1,021

Children of A-bomb Survivors (F1) Study
Mortality and Cancer Incidence
F1 Clinical Study
Cytogenetic Study
Biochemical Genetic Study
Molecular Genetic Study

76,814
12,451
About 16,000
About 24,000
About 1,500

Radiation Effects Research Foundation A Brief Description

5【3】RERF study cohorts and study methods【A】Study subjects and establishment of study populations

added to the LSS cohort in 1968; another 11,409
distally exposed survivors in Nagasaki were added in
1980, expanding the LSS cohort to a total of 120,321
members. This cohort consists of 93,741 survivors
who were within 10,000 meters of the hypocenters
as well as 26,580 persons who were not in the cities
at the time of the bombings. Table 2 shows estimatedradiation doses based on DS02 for the 93,741 survivors (as of 2013). Figure 2 shows exposure locationsof LSS subjects and estimated radiation doses, information that was obtained from the shielding history
and other surveys (on page 12).
Almost all survivors who were within 2,500 metersof the hypocenters at the time of the bombings areincluded in the current LSS cohort as the basic
sample; however, excluded from the basic sample
were survivors who were not residing in either cityof Hiroshima or Nagasaki at the time of the October1950 Japan national census (approximately 30% of
those who indicated in the 1950 census that they had
been exposed to the atomic bombings), survivors who
did not respond to the A-bomb survivors survey, andforeign national survivors.
(2) In utero cohorts
Two in utero cohorts were established using different sampling methods, one for a mortality follow-up
study and the other for a clinical study. The mortality follow-up cohort consists of children who wereborn during the period from the dates of the atomic
bombings (August 6 in Hiroshima and August 9 inNagasaki) to May 31, 1946, based on three information sources: the 1945–1946 birth registration survey,

ABCC’s basic roster, and an A-bomb survivors survey
conducted at the time of the 1960 national census.
This cohort, totaling 2,802 persons, consists of thefollowing five groups: (1) all survivors exposed inutero whose mothers were within 1,500 meters of the
hypocenters; and samples of individuals matched to(1) on information source, city, sex, and birth monthwhose mothers were at (2) 1,500–1,999 meters; (3)2,000–2,999 meters; (4) 3,000–9,999 meters; and (5)individuals who were not exposed in utero.
The clinical study cohort consists of survivors who
were born during the period from the dates of theatomic bombings until the end of April 1946, resident
in either city of Hiroshima or Nagasaki in 1950, andwho belong to one of the following three groups:(1) survivors exposed in utero whose mothers were
within 2,000 meters of the hypocenters, (2) survivors
exposed in utero whose mothers were at 3,000–4,999
meters of the hypocenters, and (3) individuals who
were not exposed. All eligible survivors were included
in group (1). For groups (2) and (3), a similar numberof members were selected for each group by matching them to group (1) by city, sex, and birth month.
This clinical study cohort comprises a total of 1,606
members, of whom a subset of 1,021 was incorporated
into the Adult Health Study (AHS) program in 1978.
There is some overlap between these in utero
cohorts. At present, a total of 3,638 individuals fromthese two cohorts are being followed for mortality.
(3) Adult Health Study (AHS) cohort
The AHS cohort was established to collect disease
incidence and other health information. The AHS

Table 2. LSS subject numbers by estimated radiation dose (DS02, as of 2013)
Weighted absorbed colon dose (Gy)

Hiroshima

Nagasaki

Total

21,713
17,207
5,537
6,273
3,842
2,376
1,151
436
3,449

16,823
6,227
1,005
1,270
956
1,052
614
189
3,621

38,53623,434
6,542
7,543
4,798
3,428
1,765
625
7,070

61,98431,75793,741

3,792
16,438

827
5,523

4,619
21,961

Total not in city

20,2306,350

26,580LSS total

82,214

38,107

120,321<0.0050.005–0.05
0.05–0.1
0.1–0.25
0.25–0.5
0.5–1.0
1.0–2.0>2.0
Dose unknown
Total survivors
Not in city (early entrants)
Not in city (late entrants)

6

LSS subjects

Radiation Effects Research Foundation A Brief Description

【3】RERF study cohorts and study methods【A】Study subjects and establishment of study populations

Hiroshima●<5 mGy●5–100 mGy●

100–200 mGy●

200–500 mGy●

500–1,000 mGy●

1,000+ mGy●

Dose unknown＋

Hypocenter

Nagasaki
Figure 2. Distribution of exposure doses of A-bomb survivors in the LSS cohort
The points indicate exposure locations and estimated radiation doses for 93,741 A-bomb survivors excluding persons who were not in the cities at the time of the bombings among 120,321
LSS subjects. The circles on the maps indicate distances of 2 km and 3 km from the hypocenters.

Radiation Effects Research Foundation A Brief Description

7

【3】RERF study cohorts and study methods【A】Study subjects and establishment of study populations

provides clinical and epidemiological information thatcannot be obtained from studies of cause of death andcancer incidence in the LSS cohort. The main objectives are to follow health status regarding noncancer
diseases (benign tumors, cardiovascular diseases, andother chronic illnesses), through blood test results, andthe like, and to elucidate the association between thesedata and radiation exposure, as well as the underlying
mechanisms of diseases associated with radiation andother risk factors.
When established in 1958, the AHS cohort comprised four groups drawn from the original LSS: (1)4,998 survivors who were within 2,000 meters of
the hypocenters and exhibited acute symptoms; (2)4,975 survivors who were within 2,000 meters of the
hypocenters but did not exhibit any acute symptoms;(3) 4,988 survivors at 3,000–3,499 meters from the
hypocenter in Hiroshima and 3,000–3,999 meters in
Nagasaki; and (4) 5,000 persons not in the cities at
the time of the bombings. All eligible survivors were
included in group (1). For groups (2) through (4), a
similar number of members were selected for eachgroup by matching to group (1) by city, sex, and age.
The AHS cohort has undergone several expansions.
First, the AHS cohort was augmented in 1977 by (1)all 1,185 surviving LSS members with assigned tentative 1965 dose (T65D) (refer to page 12) estimatesof ≥1 Gy who were not included in the original AHS
cohort and (2) 1,251 sex- and age-matched survivors
with assigned T65D dose estimates of < 1 Gy. The
second expansion in 1978 added (3) 1,021 survivors
exposed in utero (from the in utero clinical study
cohort) to the AHS cohort. In 2008, the AHS cohort
was again expanded by (4) 1,961 living LSS members
who were exposed at the age of less than 10 years,
resident in either city of Hiroshima or Nagasaki, andnot included in the existing AHS cohort. The total
number of AHS members to the present is 25,379;
health examinations of 5,000 persons in this group
who were not in the cities at the time of the bombings
were terminated in 1977.

2. F1 (children of A-bomb survivors) cohorts(1) Genetics study cohort
The search for evidence of genetic effects in thechildren of survivors was a primary focus of early
ABCC research. First, an interview survey was carried out during the period 1948–1954 with pregnant
women who had applied for a special provision offood rations for women at least 20 weeks into pregnancy, for the purpose of collecting information on the
exposure conditions of parents of the unborn children.
Based on the information obtained, a combined total

8of about 77,000 newborns in Hiroshima and Nagasaki
were studied for birth defects and early deaths. Subsequently, in 1962, a sex-ratio study was conducted withapproximately 71,000 newborns.
(2) Mortality study cohort
Based on the need for continued follow-up of survivors’ children, a mortality study cohort was also established. Of 180,600 children (this figure represents a
total of the members of the two genetic studies, andabout 33,600 persons born between May 1946 andthe initiation of the aforementioned studies who wereidentified on the basis of birth registration records),
individuals who met the following three conditions
were selected for this study: (1) born between May
1946 and December 1958; (2) place of residence ofparents at birth of their children was in either city ofHiroshima or Nagasaki; and (3) exposure conditionsof parents were known. Of those selected, a basic
mortality study cohort of 53,519 children of A-bomb
survivors was established by selecting the following
groups of people on the condition of single birth: a)
all eligible children with at least one parent within
2,000 meters of either hypocenter at the time of thebombings, constituting the core group; b) children
with at least one parent exposed between 2,500 and
9,999 meters; and c) children with neither parent
within 10,000 meters. Groups b) and c) each consists ofsex- and age-matched groups of children in numbers
similar to the number included in the core group.
Subsequently, selected from the expanded LSS
cohort members ≤34 years old at the time of thebombings were: i) all eligible persons whose T65D
dose estimates are ≥0.1 Gy; and ii) the same numberof persons as group i) whose T65D dose estimatesare ≥0 Gy and < 0.1 Gy. Among the children of theseselected individuals, 23,295 persons born between
January 1959 and December 1984 were included in
the expanded study cohort. As a result, a fixed cohortof 76,814 children of A-bomb survivors was established and has been followed for mortality.
The mortality study cohort did not include 11,667
children who did not meet all the required conditions.
These children were, however, born between May
1946 and December 1958 and satisfied the following
three conditions at the time of the survey: (1) boththeir parents were alive; (2) they lived in the so-calledcatchment area; and (3) they were junior-high-school
age or older. They were enrolled only in the cytogenetic study or the biochemical genetic study.
(3) Clinical study cohort
A clinical study of children of A-bomb survivors

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【3】RERF study cohorts and study methods【B】Study methods

was planned in order to investigate genetic effects
in adult-onset multifactorial diseases (diseases withcomplex, or multi-causal, etiologies including lifestyle factors) among children of A-bomb survivors.
The study consists of the Health Effects Study of theChildren of A-bomb Survivors, which was the initialstudy, and the Longitudinal Clinical Study of the F1
Offspring of A-bomb Survivors, which was conducted
as a continuation of the initial study.
i) Health Effects Study of the Children of
A-bomb Survivors

The Health Effects Study of the Children of
A-bomb Survivors consists of (a) a mail surveyand (b) a clinical health study conducted during
2002–2006. The subjects of the mail survey conducted before the clinical health study were selected
as follows. Of those who had a permanent domicile ineither city of Hiroshima or Nagasaki and maintained
a current address in Hiroshima or Nagasaki cities or
the surrounding areas, individuals satisfying the following four conditions were selected: 1) at least one
parent was exposed to ≥5 mGy (estimated with theDosimetry System 1986 [DS86]); 2) one parent was
exposed to ≥1 Gy, regardless of the other parent’s
exposure conditions; 3) both parents were known tobe survivors, with estimated DS86 doses unknown; or4) both parents were exposed to less than an estimatedDS86 dose of 5 mGy or not exposed. For group 4),
subjects were matched to groups 1) through 3) by sex,city, and birth year. Thus, a total of 17,698 persons,as indicated in 1)–4) above, were first selected for the
mail survey. In addition, the cohort was augmented
by the following two groups of people: 5) 6,785 persons with one parent exposed to an DS86 estimateddose of 5–999 mGy and the other parent either withunknown exposure conditions or without DS86 dose
estimates, and who had both permanent domiciles
and current addresses in either city of Hiroshima or
Nagasaki or the surrounding areas; and 6) 190 persons
with current addresses in either city of Hiroshima or
Nagasaki or the surrounding areas, with one or bothparents exposed to DS86 estimated doses of ≥1 Gy,
but were not included in the original mail survey
cohort because their permanent domiciles were not ineither city of Hiroshima or Nagasaki. As a result, themail survey mentioned in (a) above was conducted fora total of 24,673 persons during 2000–2005. Of the14,145 mail survey respondents who expressed their
willingness to participate in the subsequent healthexaminations, 11,951 persons actually did participate
in the clinical health study mentioned in (b) above,
which was conducted from 2002 until the end of Sep-

tember 2006.
ii) Longitudinal Clinical Study of the F1 Offspring of A-bomb Survivors

To follow up on the results from the clinical healthstudy conducted initially, the Longitudinal Clinical Study of the F1 Offspring of A-bomb Survivors
was initiated in 2010. Of the 14,145 persons who
expressed their willingness to participate in the healthexaminations of the Health Effects Study of the Children of A-bomb Survivors, 12,451 individuals (as of2013) who were alive and had a known address at theinitiation of the study are scheduled for participationin the longitudinal follow-up study.

【B】Study methods
To assess the health effects from A-bomb radiation
exposure in the mortality study cohorts of the LSS,
in utero survivors, and children of A-bomb survivors,
information on death and cause of death was obtained
to follow these cohorts starting in 1950 based on
permission from the Japan Ministry of Justice andMinistry of Health, Labour and Welfare. In addition,
information on cancer incidence has been collectedfrom local tumor registries (local cancer registry
programs of the governments of Hiroshima City andNagasaki Prefecture). These registry programs started
in 1957 in Hiroshima and 1958 in Nagasaki. For procurement of such cancer incidence data, an application is filed with the primary organization involvedin each registry program for use of the data. After theapplication is reviewed and permission is granted, theregistry data are collated with the information fromthe aforementioned study cohorts to collect cancer
incidence data of the cohort members. With regard toleukemia and other hematological disorders, collationis also made with incidence data from leukemia registries established in the 1940s by physicians and others
at Hiroshima and Nagasaki universities and hospitals,
with leukemia incidence studied since the 1950s.
Five questionnaire surveys were carried out between
1965 and 2013 for the LSS cohort members in orderto obtain information regarding lifestyle (e.g., smoking, drinking), social environment, and health status.
By using information on such risk factors other thanradiation exposure, ever more accurate assessment of
the association between A-bomb radiation and healtheffects is being carried out.
The AHS cohort has undergone biennial healthexaminations, including physical examinations,anthropometric measurements, electrocardiogram
testing, chest X-ray examinations, and basic hemato-

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【3】RERF study cohorts and study methods【B】Study methods

logical examinations such as blood cell counts since
the AHS began in 1958. Starting in the 1980s, moredetailed hematological tests and ultrasound and othersuch specialized examinations have been added to
the list of health examination items. As of March 31,
2013, nearly 60 years after establishment of the AHS
cohort, 9,178 persons (about 36%) of all AHS cohort
members (25,379 persons) were still alive. Between
70% and 80% of the AHS cohort members residing
within the catchment area, i.e., the cities of Hiroshima
and Nagasaki and their surrounding areas, participate
in the health study program.
With respect to the clinical studies of children of
A-bomb survivors, a) the Health Effects Study of theChildren of A-bomb Survivors (prevalence study)
was conducted over seven years starting in 2000 as
the starting point for the study of the association
between parental radiation exposure and prevalencesof adult-onset multifactorial diseases (hypertension,
hypercholesterolemia, diabetes, angina pectoris, myocardial infarction, and stroke) in the children; and b)
the Longitudinal Clinical Study of the F1 Offspringof A-bomb Survivors (incidence study) was initiatedin November 2010 to clarify the association between
parental radiation exposure and disease development among the children through quadrennial healthexaminations. As is the case with the AHS, the healthexamination items include physical examinations,anthropometric measurements, electrocardiogram testing, hematological examinations, urine testing, fecal
occult blood testing, chest X-ray examinations, ultrasound examinations, and gynecological examinations.

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【4】【4】Radiation dosimetry【A】Physical dose measurements

Radiation dosimetry【A】Physical dose measurements
1. Dosimetry systems and residual radiation(1) Individual dose estimates
RERF, over many years, has conducted healtheffects studies based on fixed cohorts of A-bomb survivors. In addition to health effects studies, estimates
must be made of individual doses and organ-specificdoses for the study subjects to analyze associations
between observed health outcomes and radiation
doses. For this reason, the estimation of radiation
doses constitutes one of the core research aims of
RERF. A dosimetry system is used to estimate radiation doses to which individuals were exposed.
There were two types of exposures to A-bomb radiation: one was exposure to initial radiation released at
the time of the detonations of the bombs, and the otherwas exposure to residual radiation, which happened
later. Initial radiation, also known as direct radiation,is classified into primary radiation emitted at the timeof the detonations of the bombs, and radiation emitted
as a result of secondary nuclear reactions inside thefireballs generated by the detonations. Initial radiation consisted mainly of neutrons and γ rays to whichpeople were exposed over a very short period of time,within a few seconds to several tens of seconds, whensuch radiation reached the body’s surface (external
exposure).
As explained below, it would be nearly impossible
to obtain information required for estimating residual
radiation doses. For this reason, only individual
whole-body and organ doses from initial radiation are
estimated using the dosimetry systems.
With regard to induced residual radiation, individual radiation doses can in principle be estimatedbecause temporal and geographical distributions ofradiation in the environment are generally known due
to actual measurements and complementary calculations. For such estimation, however, it is essential toobtain accurate records of individual behavior andactivity by elapsed time concerning location and duration of stay until at least one week after the A-bombings, during which time induced radiation levels weresignificantly high. However, more than 10 years after
the A-bombings at the initiation of the LSS, it wasalmost impossible to obtain reliable information for
the entire subject population to create dose estimatesof adequate quality regarding induced radiation.
For residual radiation due to radioactive substances
scattered in the air, the geographical distribution was
not uniform, and movement of fallout due to wind

and/or water runoff after it had reached the groundmakes such distribution more complex. Further complicating the estimation of radiation doses, little is
known about the geographical distribution of fallout
radiation by elapsed time, except for some measured
cases. For that reason, the estimation of dose isextremely difficult. It is not an exaggeration to conclude that the estimation of amounts of inhalation ofradioactive substances in the air and intake from foodand drink (internal exposure) is nearly impossible.
The only methods for estimation of internal exposure are thus actual measurements using whole-bodycounters and biological monitoring such as chromosome tests and measurements of tooth enamel byelectronic spin resonance (ESR). These tests, however,
have limitations in application and involve somewhat
limited accuracy. As for biological monitoring, thecollection of samples used in the monitoring process
is possible only while the survivors are still alive, andexposure to doses of ≤200 mGy cannot be detected
accurately. Moreover, while a whole-body counter
assesses internal exposure at the time of measurement
so that radiation attenuation with time has to be taken
into consideration, biological monitoring evaluates the
combined effect of both external and internal exposure
doses accumulated by the time of measurement.
(2) Principles of dose estimation from initialradiation
Information required for estimating radiation doses
comprises: 1) output of A-bomb radiation, 2) attenuation of radiation as it reached individual survivor locations at the time of the A-bombings (distance from the
hypocenter), and 3) shielding conditions determinedon the basis of the circumstances surrounding exposure to A-bomb radiation of individual survivors. To
obtain such information, several projects were carriedout including the Ichiban Project, which conductedactual measurements during atomic testing in the desert of the U.S. state of Nevada. In the Ichiban Project,output of the A-bombs, attenuation in the air, andshielding effects from houses were measured. Shielding effects in particular were measured using Japanesehouses that had been constructed with standard building materials commonly used at the time of the bombings. Computer simulation was carried out to calculate
radiation transport based on actual measurements.
Since such information on exposure and shielding
conditions of individual survivors was essential for
calculating radiation attenuation, a series of surveys
using various questionnaires as indicated in the next
section were conducted by visiting and interviewing
individual survivors.

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【4】Radiation dosimetry【A】Physical dose measurements(3) Survey of exposure status for individual
survivors
Estimates of individual radiation doses depend on
information about exposure conditions of individual
survivors. This information includes survivor location(distance from the hypocenter); presence or absence ofshielding between a survivor and the hypocenter, suchas terrain (e.g., hill) and concrete buildings; whether
indoor or outdoor; location inside a house (distancefrom a window and/or other opening in a wall); bodyorientation (standing, sitting, facing toward the hypocenter or not); and whether the survivor was a childor an adult at the time of exposure. For this purpose,
five different home-visit and interview surveys of
individual survivors were carried out between 1949
and 1965. The surveys are summarized below.
1) 1949 Radiation Census
The 1949 Radiation Census field survey was carried out between 1949 and June 1953 by means ofinterviews conducted with about 86,000 people in
Hiroshima and about 95,000 people in Nagasaki.
This Radiation Census yielded information related
to personal identification (e.g., name and birth date),
exposure conditions (location, shielding, posture,
distance, and coordinates), addresses at the time of
the A-bombings and at the time of this survey, andsurvivors’ occupations.
2) Radiation Questionnaire
The Radiation Questionnaire replaced the 1949
Radiation Census and was conducted from June 1953
to the end of 1955 to investigate radiation damage inmore detail. The survey was conducted with about
26,000 people in Hiroshima and about 14,000 people
in Nagasaki to obtain information related to personal
identification, exposure conditions, traumas and burns
as they pertained to A-bomb-related symptom history,
menstruation, onset of disease after the A-bombings,
and survivors’ health status at the time of the questionnaire.
3) Migration Questionnaire
The Migration Questionnaire was conducted
between 1955 and January 1956 with about 26,000
people in Hiroshima and about 24,000 people in
Nagasaki to obtain information related to subjects,
conditions at the time of the questionnaire, exposure
conditions, individual(s) that accompanied the survivor at the time of the A-bombings, circumstances surrounding the survivor’s entrance into the city limits,
past and current addresses, and exposure conditions offamily members.
4) Master Sample Questionnaire
The Master Sample Questionnaire was conductedfrom April 1956 to November 1961 with about

12

138,000 people in Hiroshima and about 23,000 people
in Nagasaki to obtain necessary information forestablishment of the master sample. Information was
obtained pertaining to subjects, exposure conditions,individual(s) that accompanied the survivor at the timeof the A-bombings, past and current addresses, exposure conditions of family members, A-bomb-related
symptom history, other symptoms, menstruation, andhealth status at the time of the questionnaire. This
questionnaire is a compilation of the Radiation Questionnaire and the Migration Questionnaire.
5) Shielding History
To obtain shielding information to be used as abasis for calculation of estimated radiation doses,
three different types of drawings were prepared fromFebruary 1954 to August 1965: layout drawings indicating accurate survivor location; floor plan drawings
on a scale of 1:100 depicting location, posture, orientation relative to the burst point, and shielding objects
inside a house; and cross-sectional drawings generatedusing a perspective projection method based on thefloor plan drawings. These drawings were prepared foreveryone within 1,600 m and 30% of those who wereat distances of 1,600–1,999 m from the hypocenter in
Hiroshima, and everyone within 2,000 m in Nagasaki.
There are about 20,400 such drawings for Hiroshima
and 8,500 for Nagasaki.
Of these five survey instruments, the Master Sample
Questionnaire of 4) above is the most comprehensive
and the Shielding History of 5) is the most detailed.
(4) History of the dosimetry systems
The dosimetry systems to estimate individual radiation doses based on the information collected throughthe five surveys described above have been revised
four times and thereby substantially improved (thetwo-digit number in each name denotes the year of
publication):
T57D This tentative dosimetry system was rarely
used.
T65D This dosimetry system, an improved versionof T57D, was developed on the basis ofactual measurements obtained from the Ichiban Project.
DS86 As computers became available with sufficient power to conduct a simulation of the
kinetics of neutrons and γ rays with consideration for shielding by structures and thehuman body, this highly accurate systemallowed calculation of radiation doses
received by 15 different organs of each survivor by the addition of information such as

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【4】Radiation dosimetry【A】Physical dose measurements

DS02

survivor’s location, shielding conditions, andbody position and orientation at the time of
the A-bombings.
After DS86 was adopted for use, it was suggested that some of the calculations did notmatch the neutron activation measured insamples of materials in Hiroshima, especiallybeyond 1,500 m from the hypocenter. DS02
was developed to resolve this and otherissues. The discrepancy between the calculations and measurements of neutrons beyond
1,500 m was resolved by raising the bomb’s
burst height by 20 m. Due to improved measurements of neutron activation of building
materials collected subsequently, good agreement was achieved between the calculations
and measurements up to 1,500 m from the
hypocenter.

Currently, RERF uses DS02 to assess health effects
from radiation for the LSS, AHS, and other studies.
The number of LSS subjects by exposure dose isshown in Table 2 (refer back to page 6).
(5) Effects of residual radiation on risk
assessment of A-bomb radiation
RERF has published radiation-risk information
showing associations between radiation dose and frequency of cancer development (and mortality) basedon its LSS of 120,000 people, including A-bomb survivors. These data are highly regarded internationallyand used as basic data for the establishment of radiation protection standards. For these risk calculations,only doses from initial radiation have been used. If
the residual radiation exposures were too large tobe ignored, the reliability of these risk data would
decrease in proportion to the amount of unknown
residual radiation levels. As stated below, however,there is reason to believe that the effects of residual
radiation were low enough to be considered virtually
negligible.
1) RERF researchers and many other scientists
have worked on analyses of radiation doses from the
A-bombs dropped on Hiroshima and Nagasaki. In
particular, Chapter 6 of the DS86 report5 summarizes
the results of area radiation surveys conducted withinseveral years after the A-bombings. Most were conducted from August through November of 1945, someeven before the typhoons that devastated Hiroshima.
A major importance of these studies lies in the factthat the measurements were made before the nuclear
tests conducted in various parts of the world contaminated the entire planet with radioactive fallout. After
this contamination it was very difficult or impossible
to accurately measure amounts of residual radiationfrom the 1945 atomic bombings. But such studies
have indicated that the residual radiation levels fellwithin the estimated range of error of the initial radiation doses.
2) As mentioned above, the geographical distribution of induced radiation dose by elapsed time after
the A-bombings is known. Thus, simulation of suchradiation doses has been performed, assuming various
circumstances concerning individual behavior andactivity immediately after the A-bombings. Table 3
provides examples of dose estimates for early entrants
into areas near the hypocenters. The table assumes
that a person had spent a considerable amount of timevery close to either of the hypocenters within thefirst several days after the bombings. For example, if
someone had stayed at a distance of 500 m from oneof the hypocenters for 12 hours on the day following
the A-bombing, the induced radiation doses would
have been about 15 mGy in Hiroshima and 3 mGy in
Nagasaki. On the other hand, if a person had stayed at
a distance of 1,000 m from the hypocenter, the doses

Table 3. Potential exposures of early entrants, Hiroshima and Nagasaki
Time of entrya

Distance from hypocenter and weighted absorbed colon doses (mGy)
200 m

500 m

700 m

1,000 m

1,500 mHiroshima
Day 2b
Day 3

82
40

15
8

3
2

<0.5
<0.5

<0.5
<0.5

Nagasaki
Day 2
Day 3

18
9

3
1

1
<0.5

<0.5
<0.5

<0.5
<0.5

a

The table dose estimates assume that a person arrived at the indicated distance from the hypocenter at
6:15 a.m. and stayed at that location for a full 12 hours.
b
Day 2 refers to the day after the bombing, and day 3 is the next day. For days 4, 5, and thereafter, doselevels for each successive day decreased by approximately 50% from the previous day.

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【4】Radiation dosimetry【A】Physical dose measurements

would have been inconsequential.
3) One report by NHK (Japan Broadcasting Corporation; Japan’s national public broadcasting organization) recounts a study of Japanese Kahoku military
troops that serves as an example of an actual studyof a group of people exposed to residual radiation.6
These special duty troops consisted of about 250
reservists gathered from the city of Higashi-Hiroshima
for relief activities, such as clean-up of rubble near
the hypocenter, starting August 7, the day following
the A-bombing, through August 13. RERF, Hiroshima
University, and other organizations cooperated witheach other to calculate radiation dose estimates fora Kahoku unit consisting of 99 reservists for whom
precise behavior and activity records during that
period were maintained. Data showed that most of
the radiation exposure among these individuals wasfrom induced radiation, that the estimated maximum
dose was 100 mGy based on both chromosome aberration frequencies and computer simulations, andthat the average dose for the entire unit was 13 mGy.
Moreover, a mortality study of these 99 reservists conducted over a 42-year period starting in August 1945
showed no difference in either category of all causesof death or cancer when compared with national averages.
4) Other examples of studies of residual radiation
exposure include a study of cause of death among
early entrants into the cities conducted as part of the
LSS. This study of cause of death was conductedduring 1950–1978 with 4,512 people who entered thecities of Hiroshima and Nagasaki within one monthafter the A-bombings. Results showed no evidenceof an increase in mortality due to either all causes ofdeath or cancer. In view of the fact that people could
not approach the areas near the hypocenters because
of secondary fires on the day of the A-bombings, theradiation doses of the abovementioned Kahoku troops
are considered to be the maximum plausible levels ofresidual radiation exposure.
5) Studies concerning internal exposure include
investigations conducted in collaboration with Dr.
Shunzo Okajima and other researchers from Nagasaki
University in 1969, 1970, and 1971 on subjects in the
Nishiyama district of Nagasaki, where the amount ofradioactive fallout was the largest of any location ineither Nagasaki or Hiroshima.7 Interviews were first
conducted with residents whose radiation doses wereconsidered to be the highest in this district, and then
50 residents whose internal exposure doses were considered to be the highest due to their intake of local
produce and drinking water were selected as subjects.
Nishiyama residents received a small, continuousradiation dose from the Nagasaki A-bomb’s fallout
radioisotope cesium 137 (Cs-137; the principal isotope, with a physical half-life of 30 years) due to theintake of local agricultural products. The related levelof Cs-137 declined over time in soils where crops
were grown with a half-life of about seven years,
which resulted from the physical half-life decay andthe environmental erosion from the soil of minerals
carrying the isotope. It was shown by whole-bodycounter measurements of internal exposure doses(Cs-137) that the cumulative exposure doses during
the 40 years of 1945–1985 could be estimated at 100
μGy for males and 80 μGy for females. Those cumulative doses were calculated on the basis of a halflife of 7.4 years, which was inferred from additional
measurements conducted on a portion of the relevant
population in 1981. Those low levels (i.e., 100 and 80μGy) represent only about 1/1,000 of the accumulated
40-year global background radiation dose announced
by the World Health Organization (WHO).
As previously mentioned, only estimates of initialradiation doses are used for calculation of radiation
risks at RERF, but there is considered to be errorof about 35% in individual dose estimates based on
DS02. The major reason for this uncertainty is thought
to be imprecise information obtained from interviews
conducted in shielding studies used to estimate radiation doses.
RERF’s risk evaluations of cancer incidence andmortality from A-bomb radiation depend largely on thefact that risk estimates among people exposed to highdoses of 1–4 Gy show clear radiation-dose response.
Risk estimates of people who were exposed to estimated residual radiation doses of about 10–100 mGy
would fall within the range of error, making scientificassessment difficult.
Residual radiation doses are thus much lower thanNote: Cs-137 half-lives
Physical half-life: 30 years
Environmental half-life: 7.4 years
Biological half-life: 100 days (biological half-life depends on age of the affected individual, with that in infants
and children estimated to be around 30 days). Biological half-life is a measure of the rate at which any single
intake of, for example, cesium, radioactive or non-radioactive, is eliminated from the human body by biologicalprocesses. It is the major determinant of the equilibrium level when the dietary intake of cesium is continuous.

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initial radiation doses, and there is substantial error
involved in their estimation. We therefore cannot
expect that the precision of risk estimation would
improve or the risk estimates would change materially, even were information on residual radiation
doses to be added. The numbers of cancer deaths orcancer cases, which are used as the numerators in risk
estimation, are values obtained via death certificatesand cancer registries independently of radiation dose
estimates. Therefore, if radiation doses, which serveas the denominator in the equation, are underestimatedbecause of exclusion of residual radiation, cancer risks
would be overestimated. Using such high risks forestablishment of radiation protection standards meansthat the standards would be on the safe side.

2. Biological effects of internal exposure
Residual radiation, particularly internal exposure,has attracted increased attention since the nuclear
power plant accident in Fukushima, because of thehigh frequency of thyroid cancer development amongchildren in Chernobyl as well as for other reasons. In
the era of the former Soviet Union, cover-up of radioactive contamination led to more widespread radiation
damage among the population. People drank milk
from cows that were grazing on radioactive iodinecontaminated grass without realizing that the milk
contained high radiation concentrations. In addition,
nonradioactive iodine was in short supply for use as a
blocking agent to prevent ingested radioactive iodine
from being taken up and retained in the thyroid.
Different from external exposure, internal radiation
exposure continues as long as radioactive substancestaken into the body are not discharged, even whenradiation doses decrease in accordance with the physical half-life of such substances. It is therefore important to avoid intake of radioactive substances to thefullest extent possible. However, there is no scientificbasis for concluding that internal exposure is moredangerous than external exposure. Both internal andexternal exposures are believed to contribute to lateeffects such as cancer development.
It is important to note that level of risk depends
on the radiation dose to which cells (probably, tissue
stem cells) in which cancers develop are exposed,
regardless of whether the exposure is due to external
or internal sources. In the case of external exposure,target organ doses are calculated with consideration
to shielding effects by the skin and intervening bodytissues. In the case of internal exposure, as can be seenin the relationship between the thyroid and iodine,
metabolism in the body differs by radioactive nuclide(element), which may cause uneven distribution in the

body. With all of these factors taken into account, if
the radiation dose of the target organ is the same, thelevel of risk should be the same regardless of whether
the dose is from internal or external exposure. Numerous human studies comparing the cancer effects ofinternal and external exposures confirm this assertion.8
In the case of internal exposure, radiation is emitted radially from radioactive particles taken into thebody; the doses near these particles can be very high.
However, high radiation dose at a particular site does
not necessarily increase cancer risk immediately.
Stem cells that are related to carcinogenesis do notexist in organs and tissues uniformly, and therefore
if no such stem cells exist in the immediate vicinityof radioactive particles, emitted radiation will only
pass by without becoming involved in carcinogenesis.
Also, if radiation dose for a target organ is extremely
high, cells themselves die, which conversely leads toa downturn in cancer risk. Based on these findings, theInternational Commission on Radiological Protection(ICRP) is of the opinion that cancer risk due to radiation from radioactive substances taken into the body(i.e., internal exposure) is about the same as risk fromexternal exposure if radioactive substances are distributed evenly throughout the entire body and lower
if the radioactive substances are distributed unevenly.
This hypothesis has been proven by the following
animal experiment and studies:
・A large, high-quality animal experiment showedthat comparable doses of radioactive iodine and X rayscaused similar frequencies of thyroid cancer.9
・Thyroid cancer risk estimates via radioactive iodine
intake in Chernobyl did not show a significant difference from those obtained by studies of external exposures, as can be seen below. At least, it cannot be said
that the former is higher than the latter.
1) A combined analysis of five major studies of external exposure to medical radiation and A-bombradiation reported a relative risk of 8.7 for thyroid
cancer after exposure to 1 Gy.10
2) Three major studies of the effects of radioactive
iodine exposure (internal exposure) among Chernobyl area children reported relative risk estimatesat 1 Gy of 6.2, 3.2, and 2.9, respectively.11–13【B】Biological dosimetry
1. Chromosome aberrations
Chromosomes are comprised of long thin moleculesof DNA. When cells are exposed to radiation or othercarcinogens, their DNA sometimes breaks, and thebroken ends may rejoin in different patterns fromtheir original arrangements. The abnormalities that

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【4】Radiation dosimetry【B】Biological dosimetry

cantly steeper in Hiroshima than in Nagasaki;5) The slope of the dose-response curve was significantly lower for those who were exposed inside factories in Nagasaki and those exposed outdoors without
any shielding (both cities) than for those who were
exposed inside Japanese houses.
Although there are some problems with theseresults, they do suggest that stable chromosome aberrations can be used to biologically estimate radiation
doses even a long time after exposure. Several possible reasons may account for the wide dispersion ofchromosome aberration frequencies compared withphysical dose estimates, as shown in Figure 3. These
reasons include: possible inter-observer variation in
detection capability of stable chromosome aberrations,individual differences in radio-sensitivity, effects frommedical radiation exposure, errors in physical dose
estimates, and errors in information (survivor locationand shielding conditions) obtained via interviews used
for calculation of physical doses.
In 1994, the analysis method used for the chromosome study was changed from the Giemsa staining
method to fluorescence in situ hybridization (FISH).
FISH is a technique for staining specific chromosomes based on use of DNA probes specific to thosechromosomes. With FISH, exchange-type chromosome aberrations, such as translocations, can bedetected objectively and efficiently (Figure 4). Since
the Giemsa staining method-based studies were conducted at the Hiroshima and Nagasaki laboratories
separately, possible effects on the study results frominter-observer variation in detection capability cannot
be ruled out. To reduce the possibility of similar inter-

result are termed chromosome aberrations and can beobserved when cells divide at mitosis. The frequencyof chromosome aberrations increases in proportion
to the radiation dose to which the cells are exposed,
and thus this measure is widely used as a biologicaldosimeter.
Study of the chromosomes of A-bomb survivors
began in 1967 with the objective of evaluating andcomplementing the physically estimated dose ofeach A-bomb survivor. By that time, more than 20
years after the atomic bombings, unstable chromosome aberrations, such as the relatively easy-to-detect
dicentric chromosomes, had mostly disappeared fromthe body due to their structural characteristics (halflife of just a few years). For this reason, stable chromosome aberrations, such as translocations, werechosen for study, because though difficult to detect,they change little over time. A study of stable chromosome aberration frequency using the Giemsa staining
method was conducted over the course of about 25
years until the end of 1993 to obtain information fromapproximately 3,000 A-bomb survivors in Hiroshima
and Nagasaki (Figure 3).14 The study results are summarized as follows:
1) Stable chromosome aberrations remained in Abomb survivors’ peripheral blood T lymphocytes evenseveral decades after the A-bombings;
2) The proportion of cells with chromosome aberrations increased significantly with physically estimateddoses;
3) Chromosome aberration frequencies were widelydispersed in comparison with physical dose estimates;
4) The slope of the dose-response curve was signifi-

Frequency of cells withchromosome aberrations

0.8a) Hiroshimab) Nagasaki

0.8

0.6

0.6

0.4

0.4

0.2

0.2

0.0

0.0
0

1

2

3

4

0

1

2

3

4

Weighted absorbed bone marrow dose (Gy)Figure 3. Frequency of cells with stable chromosome aberrations by the Giemsa staining
method in relation to physical dose estimates (DS86).14 Each dot represents
individual survivor data (n=1980 in Hiroshima, n=1062 in Nagasaki). The solidline indicates dose-response relationship, the dashed line 95% confidence interval, and the dotted line coefficient of variation of 50% assumed for dose estimates in addition to 95% confidence interval.

16

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【4】Radiation dosimetry【B】Biological dosimetry

Figure 4. Metaphase stained with FISH. The left metaphase shows a normal cell and the right,
a translocation indicated by arrows. Chromosomes 1, 2, and 4 are painted yellow andthe other chromosomes are stained red. All translocations between yellow and red
chromosomes can thus be detected accurately.

2. Electron spin resonance (ESR) using
tooth enamel
Measuring CO2– radicals remaining in tooth enamel
is effective for assessing individual radiation dose.
Enamel is separated from teeth that have been
extracted for medical reasons, and the presence ofradicals is quantified using electron spin resonance(ESR) or electron paramagnetic resonance (EPR).
Because the ESR signal intensity is linearly correlatedwith radiation exposure, it can be used as a direct
measure of total physical dose, regardless of exposure
modality, i.e. acute or chronic exposures. This method
is also used for estimating radiation doses in situations
like the Chernobyl nuclear accident.
With the ESR method, there initially were concerns

50
Translocation frequency per cell （％）

observer variation with the FISH method, a decision
was made to carry out all tasks except blood drawing
at the Hiroshima Laboratory. It was confirmed thatthe observed differences between the Hiroshima andNagasaki results were reduced considerably with the
FISH-based analysis results. It is highly likely, therefore, that the city difference observed with the Giemsa
staining method was attributable to inter-laboratory
variation in capability to detect aberrations. At thesame time, dispersion in chromosome aberration frequencies compared to physical dose estimates is stillas large with the FISH method as the Giemsa method,with differences in dose response observed depending
on shielding conditions.

40
30
20
10
0
0

1

2
3
Absorbed tooth dose (Gy)4

Figure 5. Translocation frequencies in lymphocytes anddose estimates using molars donated by thesame survivors.15 The curve shows a doseresponse relationship of dicentric chromosomes
obtained from an in vitro γ-ray irradiation experiment of lymphocytes (it is believed that dicentric chromosomes and translocations occur atthe same frequencies). The arrow indicates a
wisdom tooth donated by a survivor exposed to
A-bomb radiation at the age of 15. In this case,the absorbed tooth dose was 0 Gy, presumably
because the enamel on the tooth had not yet
formed at the time (note that there is large
variation among individuals in the timing of wisdom tooth development).

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【4】Radiation dosimetry【B】Biological dosimetry

about effects from diagnostic dental X-ray exposures,
but the following experiment showed that any such
effects were insignificant. Diagnostic X rays are usually applied from outside of the mouth. In this experiment, a tooth was divided into a buccal side (outside)
and lingual side (inside) for measurement, and there
proved to be no difference between these two sides in
the case of molars. There were more than a few cases
in front teeth, however, in which the ESR signal intensity of enamel separated from the buccal side was considerably larger than that from the lingual side.15 The
difference could not be explained as being caused bydiagnostic dental X rays. Possible effects from solar
ultraviolet exposure were suggested, but the cause ofthis particular result has not yet been proven.16
Doses estimated using molars donated by 60
A-bomb survivors were compared with measurements of translocation frequencies in blood lymphocytes made from the same donors (Figure 5).15 The
relationship between tooth-based dose estimates andtranslocation frequencies generally agreed well with adose-response curve predicted on the basis of in vitro
irradiation experiments of lymphocytes.

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【5】Radiation effects on humanhealth: Late effects【A】Results from studies of A-bomb
survivors
RERF periodically publishes reports on study
results of mortality and causes of death in the LSS
population as well as health examination results in
the AHS population. By 2013, 14 LSS reports17 and
8 AHS reports18 had been published, in addition toseveral thousand papers on specialized topics.
According to a report on mortality risk focusing
on the years 1950–2003 and tracking 86,611 people
with DS02 doses who were in the cities of Hiroshima
or Nagasaki at the time of the bombings,17 an estimated 50,620 people died during this period, and theexcess relative risk per Gy (ERR/Gy) was 0.22 (95%
confidence interval [CI]: 0.18, 0.26). Table 4 shows
the number of deaths observed and estimated excess
deaths from solid cancers and noncancer diseases byradiation dose in the LSS.17 Of the 10,929 deaths fromsolid cancers and 35,685 deaths from noncancer diseases among LSS subjects with dose ≥0.005 Gy, theexcess numbers of cases attributable to radiation are
estimated to be 527 and 353, respectively.

【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

Table 5 shows follow-up status by age at exposure
among all LSS subjects as of the end of 2008. At thattime, 64% of the population had died, but about 70%of those who were exposed under age 20 were still
alive.

1. Malignant tumors(1) Leukemia and related diseases
Increased leukemia incidence was the earliest delayed
effect of radiation exposure observed in A-bomb survivors. Although the leukemia risk due to radiation exposure is considered to have started increasing about two
years after the A-bombings, the follow-up of the LSS
population began in 1950, five years after exposure,with no systematic data obtained prior to that time. It isestimated that the risk increase in the LSS population
reached its peak 7–8 years after exposure and then began
to decline continuously, but the increased risk does notappear to have disappeared completely even now, morethan 50 years later. For those exposed at younger ages,
the risk increase was larger and the decline after the
peak more rapid (Figure 6).19 Of the four major leukemia subtypes (acute myelogenous leukemia [AML],
acute lymphatic leukemia [ALL], chronic myelogenous
leukemia [CML], and chronic lymphatic leukemia

Table 4. Observed and estimated excess deaths from solid cancers and noncancer diseases in the LSS cohort17
Colon dose Number of
Person-years(Gy)subjects

Solid cancers

Noncancer diseasesb

NumberNumber of
Attributableof deaths excess deathsa fraction (%)

NumberNumber of
Attributableof deaths excess deathsa fraction (%)<0.0050.005–0.1
0.1–0.2
0.2–0.5
0.5–1
1–2
2+

38,50929,961
5,974
6,356
3,424
1,763
624

1,465,240
1,143,900
226,914239,273
129,333
66,602
22,947

4,621
3,653
789
870
519
353
124

2
49
46
109
128
123
70

0.0
1.3
5.8
12.5
24.7
34.8
56.5

15,906
12,304
2,504
2,736
1,357
657
221

1
36
36
82
86
76
36

0.0
0.3
1.4
3.0
6.3
11.6
16.3

Total

86,611

3,294,210

10,929527

4.8

35,685

353

1.0

a
b

Estimated number of excess deaths calculated using the fitted model in reference 17
Non-neoplastic blood diseases were excluded from noncancer diseases.

Table 5. LSS follow-up status as of the end of 2008
Age at exposure(years)Number of subjects

Alive (%)

Dead (%)

0–9
10–19
20–29
30–39
40–49
50+

23,71725,994
15,785
17,31018,403
19,112

83.6
63.5
39.1
6.1
0.2
0.0

16.1
36.2
60.7
93.8
99.8
100.0

Total

120,321

36.2

63.6

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

Nonparametric
10 years of age at exposure
30 years of age at exposure
50 years of age at exposure

40
30
20
10
0

15
Excess relative risk

Excess relative risk

50

NonparametricLinear-quadratic curve

10

5

0
5

20

40

60

0

Time since exposure (years)

1

2

3

Weighted absorbed bone marrow dose (Gy)Figure 6. Change in sex-averaged ERR of leukemia(excluding CLL and ATL) as related to age at
exposure and time since exposure for people
who were exposed to 1 Gy19

[CLL]), risk increases among A-bomb survivors wereconfirmed for all the subtypes except CLL.20 It is considered that the risks of these three subtypes reachedtheir peaks 5–10 years after exposure. The risks of ALL
and CML then declined continuously, almost disappearing by the 1960s, whereas the risk of AML was foundto have persisted even after 2000.19 No relationshipbetween adult T-cell leukemia/lymphoma and radiationdose was observed.
Results from studies of A-bomb survivors in
Nagasaki showed that myelodysplastic syndrome(MDS) was related to exposure distance and radiation
dose.21 Although MDS is a clinical condition that has
attracted attention in recent years and requires longterm observation, MDS, like AML, tends to persist
over a long period. Thus, especially among those
exposed before adulthood, the possibility exists thatthe risk may continue throughout their lifespan.
With regard to the dose-response relationshipbetween radiation exposure and leukemia risk, it has
been shown that a linear quadratic model with concave upward curvature fits better than a linear model.

Figure 7. Dose-response relationship of leukemia
mortality riskrevised from 19

Analysis of incidence during the period 1950–2001
regarding all leukemia (except for CLL and adult
T-cell leukemia [ATL], for which no relationship withradiation has been observed19) also showed a dose
response with concave upward curvature, with a more
rapid increase in risk in the higher dose range. The
estimated ERR at 1 Gy is 1.74, with a linear termcoefficient of 0.79 (95% CI: 0.03, 1.93) and a quadratic term coefficient of 0.95 (95% CI: 0.34, 1.80) for
the ERR at age 70, after exposure at age 30 (Figure 7).
Because the frequency of AML is the highest among
the four major subtypes, the results for all leukemia
tend to mirror the results for AML.
Table 6 shows the observed numbers of all leukemia
cases except for CLL and ATL, as well as the estimated number of excess cases in the LSS population
by bone marrow dose. It is estimated that 94 of the 192
leukemia cases exposed to ≥0.005 Gy are related toradiation exposure, with the attributable fraction being
49%. Among heavily exposed survivors of ≥1 Gy, 57
of 64 cases are estimated to be related to radiation
exposure, with that attributable fraction being 89%.
The mortality study17 showed significantly elevatedrisk of malignant lymphoma among males (ERR/Gy =Table 6. Observed numbers of all leukemia cases excluding CLL and ATL and the estimated numberof excess cases in the LSS population19
Dose (Gy)

Person years

Mean dose (Gy)

Observed cases<0.0050.005–0.1
0.1–0.2
0.2–0.5
0.5–1
1–2
2+

2,039,093
957,889
201,935
206,749
117,855
64,122
25,7610.0006
0.03
0.14
0.32
0.71
1.37
2.68

Total

3,613,404

0.10

Background

Excess

120
63
16
25
24
35
29

116.9
60.7
13.7
13.6
7.5
4.0
1.5

0.1
3.6
4.1
11.1
18.2
28.4
28.6

312

217.9

94.1

* Estimated number of cases calculated using the fitted model in reference 19

20

Fitted cases*

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

4
10
30
50

3

2

1

0
20

Excess cases per 10,000
person -years -Gy

Excess relative risk at 1 Gy

Age at exposure
60

40

20

0
40

60

80

40

20

60

80

Attained age (years)

Attained age (years)

Figure 8. Change in sex-averaged ERR/Gy (left) and EAR per Gy per 10,000 person-years (right) of solidcancer incidence by attained age among those exposed at 10, 30, and 50 years of age22(2) Solid cancers
Mortality risk from all solid cancers during theperiod 1950–2003 has been reported.17 Because risksof less deadly cancers, such as breast, thyroid, and skincancers, should be evaluated based on incidence rather
than mortality, results of solid cancer incidence studies
during 1958–199822 will mainly be introduced here.
Among 105,427 people who were not in the cities at
the time of the A-bombings or for whom DS02 doses
have been estimated, and who were alive in 1958
when cancer registries were initiated in Hiroshima andNagasaki and had not been diagnosed with cancer bythen, 17,448 cases of first primary solid cancer wereidentified during the observation period. Cancer risks
among A-bomb survivors vary by sex, age at exposure, and attained age (time since exposure). Figure 8
shows changes of sex-averaged ERR and excess absolute rate (EAR) of all solid cancers by age at exposurein relation to attained age.22 (Refer to the Glossary on

page 47 for definitions of ERR and EAR.) For thesame attained age, both ERR and EAR are higher
for people with younger age at exposure, suggestinghigher radiation sensitivity among young people. ERR
decreases with attained age, and the decrease is more
rapid among people exposed at younger ages. Among
those exposed at older ages, the decrease is small andthe ERR is almost constant. As the cancer incidence
among unexposed people increases with attained age,
EAR increases with attained age.
Radiation doses to which the LSS population was
exposed range from extremely low doses to about 4
Gy. The solid cancer incidence study conducted during the period 1958–1998 showed an increase in dose
response with radiation in the range of < 2 Gy, suggesting a linear relationship. However, this increase
became slightly more gradual in the range of ≥2 Gy(Figure 9).22 The non-linearity was not significant, andthe reason for the more gradual increase is unclear, but
it may be due to uncertainty in dose estimation or tocell lethality effects (when cancer does not develop
1.5

Excess relative risk

0.70, 95% CI: 0.08, 1.7) but no elevated risk amongfemales (ERR/Gy = –0.18, 95% CI: –0.21, 0.24).
In the incidence study,19 ERR/Gy for non-Hodgkin
lymphoma, which accounts for approximately 90%
of malignant lymphoma cases in Japan, was also
marginally significant among males (ERR/Gy = 0.46,
95% CI: –0.08, 1.29), while no elevated risk was seenamong females (ERR/Gy = 0.02, 95% CI: –0.44,0.64). There is no clear explanation for these differences between males and females.
In the mortality study,17 ERR/Gy for multiple
myeloma was not significant among males (ERR/
Gy = 0.11, 95% CI: –0.28, 1.6), but a significant risk
was observed among females (ERR/Gy = 0.86, 95%
CI: 0.02, 2.5). At the same time, the incidence study19
showed no significant elevated risk (ERR/Gy = 0.38,
95% CI: –0.23, 1.36) and no sex difference.

NonparametricLinear
1

0.5

0
0

1

2

3

Weighted absorbed colon dose (Gy)Figure 9. Relationship of ERR of solid cancer incidence
to colon dose in the LSS populationrevised from 22

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

because high doses kill cells). Threshold models,
which assume no risk increase below a certain dose,
have been assessed, but no significant improvement in
the degree of fit has been shown in comparison withlinear models, with estimates showing that even werea threshold to exist, it would not exceed 0.085 Gy.
A-bomb survivors have been exposed to other carcinogenic factors besides radiation, such as smoking,and therefore not all cancers experienced by the survivors are caused by A-bomb radiation. That is why
it is important to show the degree to which the development of cancer is attributable to A-bomb radiation
among the survivors. Table 7 indicates the observed
number of all solid cancer cases and estimated excess
numbers of cases by radiation dose in the LSS popu-

lation.22 It is estimated that 850 of all the 7,851 solidcancer cases among the LSS subjects exposed to≥0.005 Gy is the excess number related to radiation
exposure, with the attributable fraction being 11%.
Limiting the subjects to those exposed to radiationof ≥2 Gy, it is estimated that 111 of all the 185 solidcancer cases is the excess number related to radiation
exposure, with that attributable fraction being 61%.
Figure 10 shows ERR/Gy of all solid cancer andsite-specific cancer incidences adjusted for sex, age,
age at exposure, and city and their confidence intervals.22 As described previously, ERRs change in relation to sex, age at exposure, and attained age. Thus,
sex-averaged risks of those whose age at exposure was
30 and whose attained age was 70 are shown hereafter

Table 7. Observed number of solid cancer cases and estimated excess number of cases in the LSS
population22
Dose (Gy)

Subjects

Person years

Cases

Backgrounda

Fitteda excess

Attributable fraction<0.0050.005–0.1
0.1–0.2
0.2–0.5
0.5–1
1–2
2–4

60,792
27,789
5,527
5,935
3,173
1,647
564

1,598,944
729,603145,925
153,886
81,25141,412
13,711

9,597
4,406
968
1,144
688
460
185

9,537
4,374
910
963
493
248
71

3
81
75
179
206
196
111

0.0%
1.8%
7.6%
15.7%
29.5%
44.2%
61.0%

Total

105,427

2,764,732

17,448

16,595b853b

10.7%cabc

Estimated number of cases calculated by fitting the model used in reference 22
Because integers are used, the sums of the individual figures do not equal the totals.
Attributable fraction means percentage of estimated excess number of cases in the number of solid cancer cases among
those exposed to ≥0.005 Gy.

All solid cancer
Bladder
Famale breast
Lung
Brain
Thyroid
Colon
Esophagus
Ovary
StomachLiver
Pancreas
RectumNon-melanoma skin
Uterus
Prostate
0.0

0.5

1.0

1.5

2.0

Excess relative risk per Gy

Figure 10. ERR/Gy for the incidence of site-specific cancers in the LSS cohort (sex-averaged).
The risk is shown for subjects at the attained age of 70 years after exposure at age
30.22 The horizontal bars indicate 90% confidence intervals.

22

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

unless otherwise specified.
ERR/Gy of all solid cancers is 0.47, and it is therefore estimated that the cancer incidence among people
exposed to 1 Gy is 47% higher than the incidence
among unexposed people. As shown in the figure,cancer risks are increased significantly in most sites,such as the oral cavity, esophagus, stomach, colon,
liver, lung, skin (non-melanoma), breast, ovary, bladder, central nervous system, and thyroid. The ERRs
for pancreas, prostate, and renal cell cancers are notstatistically significant.22 These results suggest differences in radiation sensitivity by site, but the confidence intervals of all the sites overlap, and the differences in ERR by site cannot be verified statistically.
Thus, care should be taken in interpretation. When
comparing leukemia with all solid cancers in termsof the aforementioned ERR and estimated excess
number of cases, the ERR/Gy is larger for leukemia,
while the estimated excess number of cases is larger
for solid cancers. This information indicates that solidcancers constitute a larger impact of radiation in thecohort than leukemia, despite the fact that leukemia isstrongly associated with radiation, because leukemia
is less common than solid cancers.
(3) Site-specific cancer risks
a. Stomach cancer
Until recently, stomach cancer had been the cancer
with the highest incidence among Japanese people. It
is the cancer with the highest confirmed numbers ofmortality cases and incident cases in the LSS cohort.
A significant increase in stomach cancer risk withradiation dose has been observed in both the mortality study (ERR/Gy = 0.33, 95% CI: 0.17, 0.52)17 andthe cancer incidence study (ERR/Gy = 0.34, 90% CI:
0.22, 0.47).22 ERR in the cancer incidence study was
higher in females (ERR/Gy = 0.47) than in males(ERR/Gy = 0.21), but there was no difference in
EAR between males (9.4 cases per Gy per 10,000
person-years) and females (9.7 cases). It is therefore
considered that the sex difference in ERR is caused by
the higher background risk of stomach cancer in males
compared with females.
In the study based on mail survey information,23
analyses were conducted taking into account smoking
and education. The relative risk (RR) was 1.71 (95%
CI: 1.27, 2.30) among the subgroup exposed to ≥1
Gy, and the RR increased significantly with increasingradiation dose.
Another study looked at the association between
radiation and 200 stomach cancer cases (separated
into intestinal type and diffuse type). These cases wereidentified among 4,690 people who satisfied certain

conditions such as participation in the AHS healthexaminations during the period 1981–2002, with
their blood samples stored, and who had no cancer
diagnosis prior to blood collection.24 While radiation
was significantly associated with diffuse-type stomach cancer (ERR/Gy = 0.33, 95% CI: 0.03, 0.83), no
association was observed with intestinal-type stomach
cancer (ERR/Gy = –0.06, 95% CI: –0.19, 0.21). By
examining the immunosuppressive interleukin-10 (IL10) genotype, significant association between radiation and diffuse-type stomach cancer was observed
only for the homozygous, wild-type IL-10 gene (ERR/
Gy = 0.46, 95% CI: 0.02, 1.43), while the ERR due
to radiation exposure for IL-10 variant-type homozygotes was estimated to be around 0, showing nostatistical significance. These findings indicate possible involvement of IL-10 variants in the decreaseof radiation risk for diffuse-type stomach cancer. The
results suggest that IL-10 gene polymorphisms playa role in individual differences in radiation-related,diffuse-type stomach cancer risk.
b. Colorectal cancer

Colon cancer is the third most common of the cancers in the LSS cohort in terms of number of cases.22 A
significant increase in colon cancer risk with radiationdose has been observed in both the mortality study(ERR/Gy = 0.34, 95% CI: 0.05, 0.74)17 and the cancer incidence study (ERR/Gy = 0.54, 90% CI: 0.30,0.81).22 The ERR in the mortality study was about
the same for males and females, but the risk ratio of
females to males (F/M ratio) was 0.5 in the incidence
study. It is not clear why a difference in F/M ratio
exists between the mortality and incidence studies.
Obesity is considered to be one of the risk factors
for colon cancer. However, ERR/Gy for colon cancer
estimated by an analysis allowing for body mass index(BMI) was 0.53 (95% CI: 0.25, 0.86), indicating thatthe extent of radiation effects did not change with
BMI.25 No significant association has been observed
between radiation exposure and rectal cancer risks ineither the mortality study (ERR/Gy = 0.17, 95% CI:< 0, 0.64)17 or the cancer incidence study (ERR/Gy =0.19, 90% CI: < 0, 0.47).22
c. Liver cancer

A significant increase in liver cancer risk withradiation dose has been observed in both the mortality study (ERR/Gy = 0.38, 95% CI: 0.11, 0.62) andthe cancer incidence study (ERR/Gy = 0.30, 90%
CI: 0.11, 0.55).22 In a case-control study using stored
tissue samples,26 a strong multiplicative interaction
between radiation exposure and hepatitis C virus

Radiation Effects Research Foundation A Brief Description

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors(HCV) infection was observed for the risk of hepatocellular carcinoma in subjects without cirrhosis.
A nested case-control study using the stored serumof AHS subjects27 and adjusting for alcohol intake,obesity, and smoking was also conducted. In thatstudy’s analysis, excluding those infected with hepatitis B or C virus, and taking other risk factors into
consideration, the RR of non-B non-C hepatocellular
carcinoma at a liver dose of 1 Gy was 2.74 (95% CI:
1.26, 7.04). This result indicates that radiation exposure confers an independent risk for hepatocellular
carcinoma and may also multiply the risk associatedwith HCV infection in a subset of cases.
d. Lung cancer

A significant increase in lung cancer risk withradiation dose has been observed in both the mortality study (ERR/Gy = 0.75, 95% CI: 0.51, 1.03)17
and the cancer incidence study (ERR/Gy = 0.81,
90% CI: 0.6, 1.1).22 In the cancer incidence study,22
the F/M ratio of ERR/Gy was relatively high, 4.8,
but the F/M ratio was not statistically significant for
EAR/Gy, making the high F/M ratio for ERR likely
attributable to the much lower baseline rates of lungcancer among females than among males. Unlike the
ERRs for many other sites, the ERR for lung cancer
tended to increase with increasing age at exposure.
This trend is assumed to be associated with the relationship between increased lung cancer incidence andincreased smoking rate.
A study was conducted to assess the effects ofradiation on lung cancer incidence after taking into
account smoking, the most important risk factor forlung cancer,28 based on information from smoking
A

A significant association between breast cancer risk
and radiation exposure has been observed in both themortality study (ERR/Gy = 0.90, 95% CI: 0.30, 1.78)
and the cancer incidence study (ERR/Gy = 0.87, 90%
CI: 0.55, 1.3).
It is also known that, among those exposed at an ageof < 20, breast cancer risk in those whose attained age
is between 20 and 35 increases markedly, with ERR/
Gy = 16.8 (Figure 12).29 A case-control study interviewed 196 females in the LSS cohort diagnosed withbreast cancer and 566 females without breast cancer,
who were selected from the same cohort by matchingon age at exposure, city, and estimated radiation dose.
The study showed that the same risk-reduction factors
for breast cancer confirmed among the general population (namely, first full-term pregnancy at younger age,prolificacy, and long lactation period) also reduced

2

1 Gy Nonparametric
1 Gy Generalzed multiplicative
1 Gy Simple multiplicative
1 Gy Simple addtive
0 Gy Generalzed multiplicative

10

Excess relative risk at 1 Gy*

Excess relative risk*

e. Breast cancer

B
15

5

0

1.5

1

0.5

0
0

*

histories obtained in mail surveys for 1,803 lung cancer cases in the LSS cohort ascertained by histopathological review. The ERR/Gy due to radiation exposure
among non-smokers (risk at age 70 after exposure atage 30) was estimated to be 0.59 (95% CI: 0.31, 1.0),
and decreased with attained age with no departurefrom linearity. The ERR tended to increase with age
at exposure, even after adjustment for smoking. The
joint effect of smoking and radiation was super-multiplicative among light-to-moderate smokers, but theeffect was additive or sub-additive for heavy smokers, for whom little radiation-related excess risk was
observed (Figure 11). About 1/3 of the lung cancer
cases in this population are explained as having beencaused by smoking and 7% by radiation.

10

20
Cigarettes per day

30

Gender-averaged excess risk relative to unexposed never-smoker

40

0
*

10

20
Cigarettes per day

30

40

Gender-averaged excess risk relative to unexposed person with same smoking history

Figure 11. Change in ERR in relation to the number of cigarettes smoked per day.28 The sex-averaged risk estimatesat age 70 following radiation exposure at age 30, with smoking begun at age 20. Panel A describes ERR
compared to a non-exposed non-smoker. Panel B indicates ERR for an exposure of 1 Gy compared to an
unexposed person with the same smoking history.

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

Gy = 0.11, 90% CI: –0.10, 0.54).22 The reason why
increased risk has not been detected is because prostate cancer is common among the elderly, although
the number of patients identified through follow-up todate is still small, despite a recent rise in incidence inthese populations.

Excess relative risk per Gy

18
16
14
12
10
8
6
4

g. Brain and central nervous system tumors

2

Age

at e

xpo
sur
e

0
10
20
30
40
50
60
30

40

50
60
Attained age

7080

Figure 12. Bivariate isotonic regression: Breast cancer
ERR/Gy with age at exposure and attained
age as a monotonic/non-decreasing function29

breast cancer risk in those exposed to atomic bombradiation.30 Mammary gland tissue during the time
between menarche and first childbirth is believed tobe very sensitive to carcinogenesis. However, in astudy involving the LSS cohort that compared radiation risk by time period (time between menarche andfirst childbirth, time before menarche, and time after
first childbirth) no significant difference was seen.31
In histopathological review of breast cancer cases, nodifference in pathological findings has thus far been
observed between exposed subjects and controls.32
f. Urinary organ cancer

A statistically significant increase in bladder cancer
risk with radiation dose has been observed in boththe mortality study (ERR/Gy = 1.19, 95% CI: 0.27,2.65)17 and the cancer incidence study (ERR/Gy =1.23, 90% CI: 0.59, 2.1).22 It is known that the variation in ERR of bladder cancer by age at exposure andattained age is smaller than that of other cancers. The
ERR/Gy by sex in the cancer incidence study was
0.61 for males and 1.86 for females, with the risk forfemales about three times higher than that of males.
Analysis has also been carried out to take into accountthe effects of smoking, fruit/vegetable intake, alcohol
consumption, and education.33 This analysis observed
no major changes due to radiation based on consideration of these factors in terms of estimated ERR andF/M ratio.
No statistically significant increase in prostatecancer risk with radiation dose has been observedin either the mortality study (ERR/Gy = 0.33, 95%
CI: < 0, 1.25)17 or the cancer incidence study (ERR/

A significant association of brain and central nervous system tumor risks with radiation dose has been
observed in the cancer incidence study (ERR/Gy =0.62, 90% CI: 0.21, 1.2).22 In a histopathologicalreview of central nervous system tumors diagnosed
during the period 1958–1995,34 ERR/Gy of all central
nervous system tumors was estimated to be 1.2 (95%
CI: 0.6, 2.1). In this study, the risk was estimated atage 60 after exposure at age 30. By histological type,
ERRs/Gy of meningioma, schwannoma, glioma, andpituitary tumors were 0.64 (95% CI: –0.01, 1.8), 4.5(95% CI: 1.9, 9.2), 0.56 (95% CI: –0.2, 2.0), and 0.98
(95% CI: < –0.2, 3.5), respectively, showing a strong
dose-response relationship for schwannoma.
h. Thyroid cancer

Thyroid cancer is not a very common cancer, but
it has a relatively strong association with radiation.
The association between thyroid cancer and radiation
was demonstrated the earliest (10-plus years after
exposure) of all the solid cancers observed among
A-bomb survivors.35 A significant increase in risk withradiation exposure was observed in the cancer incidence study (ERR/Gy = 0.57, 90% CI: 0.24, 1.1).22
Furthermore, a recent study36 analyzed 371 thyroid
cancer cases confirmed by histopathological review
from among 105,401 LSS subjects, and estimated
ERR/Gy to be 1.28 (95% CI: 0.59, 2.70) and EAR per
100,000 person-years-Gy to be 29.5 (95% CI: 13.8,49.6) (in both cases at age 60 after exposure at age
10). The radiation-associated thyroid cancer risk was
higher among those exposed during early childhood,suggesting continuation of the risk throughout the
lifetime, whereas no clear effects of exposure at age
20 or older were observed (Figure 13). Of the thyroid
cancer cases developing among LSS subjects exposedto ≥5 mGy at the age of < 20 years (113 cases), 36%
were estimated to be attributable to radiation.
A prevalence study based on thyroid examination of
AHS participants37 found that thyroid cancer risk also
increased with radiation dose, showing a linear doseresponse relationship (excess odds ratio per Gy =1.95, 95% CI: 0.67, 4.92). Further, an association
between thyroid microcarcinoma (diameter of < 1 cm)
and radiation exposure has also been suggested.38

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

Excess cases at 100,000 person - years - Gy

Excess relative risk at 1 Gy weighted absorbed dose8

Age atexposure

70
60
50
40
30
20
10
0

6
4
2
0
20

40

60

80

–9
10 – 19
20 – 29
30 –

20

40

Attained age

60

80

Attained age

Figure 13. Fitted temporal patterns and variation with age at exposure in radiation-associated risk for thyroid cancer inthe LSS cohort.36 The left panel presents ERR at 1 Gy and the right panel shows the fitted excess absolute
rate at 100,000 person-years-Gy. All curves and points represent sex-averaged estimates.

At RERF, characteristics of cancers induced byradiation exposure have been examined at the molecular level in a molecular oncological approach. It isthought that normal cells become cancerous dueto the accumulation of various gene abnormalities.
Generally, there are gene abnormality patterns uniqueto cancer tissue, and certain patterns (accumulationof characteristic abnormalities in particular genes)
have been observed at high frequencies particularly
in radiation-related thyroid cancer. For example, RET
and ALK gene rearrangements are observed in papillary thyroid carcinoma in exposed adults. Papillary
thyroid carcinoma with these abnormalities in generearrangements are frequently observed among survivors exposed to high doses during childhood.39,40

2. Noncancer diseases and abnormalities(excluding deaths due to blood diseases)
With regard to the effects of A-bomb radiation on
noncancer diseases, recent analysis of LSS mortality data (1950–2003) shows a statistically significant
increase with dose for death from diseases other thancancers (circulatory disease: ERR/Gy = 0.11, 95% CI:
0.05, 0.17; respiratory disease: ERR/Gy = 0.21, 95%
CI: 0.10, 0.33).17 Besides LSS mortality data, RERF
has acquired much information about noncancer diseases through AHS health examinations and special
tests. This information suggests that A-bomb radiation
effects increased the risks of heart disease, stroke,
thyroid benign tumor, hyperparathyroidism, hypertension, kidney disease, liver disease, uterine myomata,and cataract (Figure 14).

Uterine myoma
Thyroid disease
Calculus of kidney and ureter
Dementia
Chronic liver disease and cirrhosis
Myocardial infarction
Cataract
StrokeAortic aneurysm
Hypertension
Hypertensive heart disease
Gastric ulcer
Parkinson’s disease
Glaucoma
0.75

1.00

1.25

1.50

1.75

2.00

Estimated relative risk at 1 Gy

Figure 14. RR for noncancer diseases among AHS subjects exposed to 1 Gy of radiation (1958–
1998).18 The horizontal bars indicate the ranges of 95% confidence intervals.

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

tion effects on mortality due to hypertensive heartdisease and heart failure.42 Analysis of AHS data did
not indicate such associations, but suggested the possibility of a quadratic dose response for myocardial
infarction incidence among those exposed at ages < 40
(RR/Gy = 1.25, 95% CI: 1.01, 1.36).18 With regard to
stroke, using DS02-based data we analyzed the period
when prevailing diagnostic imaging techniques had
improved accuracy in diagnoses for disease classification (1980–2003) and found a radiation-associatedincrease in risk for hemorrhagic stroke (including
intracerebral hemorrhage and subarachnoid hemorrhage) but not for ischemic stroke (Table 8).43 Detailed
analysis will be necessary in the future taking into
account the possibility of increased circulatory diseaserisks mediated by the known risk factors hypertension,18 lipid metabolism abnormality,44 and kidneydisease.45

There are several caveats to keep in mind wheninterpreting the results of the noncancer diseaseresearch. First, it is necessary to consider that the LSS
mortality study examines only cause of death, andthat AHS reports are based on studies conducted onlyof those who participate in health examinations. For
example, of those who develop subarachnoid hemorrhage, which is a brain disorder, 50% die within ayear of the episode.41 On the one hand, AHS healthexaminations cannot detect those who died from subarachnoid hemorrhage between routine AHS healthexaminations and those who could not participate in
the health examinations due to the long-term effectsof subarachnoid hemorrhage. On the other hand,investigations of cause of death in the LSS might not
be able to identify the other 50% who survived after
the episode. Second, it is projected that rapid westernization of Japanese lifestyle as well as changes inmedical technology may have modified the numbersof disease cases and complicated interpretation of thestudy results.

(2) Mortality and incidence of liver disease
With respect to liver diseases, RERF has thus far
studied the prevalence of chronic liver disease (including chronic hepatitis, fatty liver, and liver cirrhosis)(refer back to Figure 14) and mortality from livercirrhosis.
A report of analysis of all disease deaths other thantumor deaths in the LSS population indicated thatmortality risk of liver cirrhosis tended to increase
with radiation dose,46–48 but pathological reviews taking into account HBV and HCV infection as well as
alcohol consumption showed that radiation effects onliver cirrhosis were not significant.49 A study based on
autopsy diagnoses indicated that association between
liver cirrhosis and radiation dose was significant orsuggestive.50–52(1) Mortality and incidence of circulatory disease (heart disease and stroke)
Circulatory disease deaths account for a majority of worldwide death totals, and interpretation of
the increased risk related to radiation exposure is an
important issue.
Recent analysis of DS02-based LSS data (1950–
2003) shows a significant association between circulatory disease mortality and A-bomb radiation exposure
throughout the relevant period, with linear-quadratic
and linear dose responses observed for stroke andheart disease, respectively (Figure 15). In addition,
subtype-specific analyses suggest significant radia-

Heart disease

LQ

0.4

0.5

0.3

0.4

L

0.2
0.1
0.0

Excess relative risk

Excess relative risk

Stroke

L
LQ

0.3
0.2
0.1
0.0

-0.1
0.0

0.5
1.0
1.5
2.0
2.5
Weighted absorbed colon dose (Gy)

L: linear, LQ: linear-quadratic

3.0

-0.1
0.0

0.5
1.0
1.5
2.0
2.5
Weighted absorbed colon dose (Gy)

3.0

L: linear, LQ: linear-quadratic

Figure 15. Dose response for circulatory disease mortality.42 The vertical bars indicate the ranges of 95% confidence
intervals.

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【5】Radiation effects on human health: Late effects【A】Results from studies of A-bomb survivors

Table 8. Age-adjusted stroke incidence43
Radiation
exposure (Gy)
Men
<0.05
0.05–1
1–2≥2
p value†
Overall
Women<0.05
0.05–1
1–2≥2
p value
Overall

Sample size

Hemorrhagic stroke¶

Ischemic stroke

EventsIncidence*

EventsIncidence*

1,539
1,266
376
130

33
37
13
5

112
81
20
8

3,311

88

12.2
17.6
21.4
25.2
0.006
15.7

40.5
38.5
34.9
46.3
0.788
39.4

2,765
2,720
531
188

66
63
8
10

6,204

147

13.1
12.4
9.3
41.9
0.098
13.1

221
173
174
33
6
386

34.4
33.9
39.8
27.9
0.930
34.4

¶

Hemorrhagic stroke includes intracerebral hemorrhage and subarachnoid hemorrhage.
* Incidence rate per 10,000 person-years†
Trend test

In the AHS population, a significant dose response
was observed for chronic liver disease (including livercirrhosis).18,53 In consideration of the fact that theInternational Classification of Diseases (ICD) coding
rules were revised in 1986, during the investigation
period, and that introduction of abdominal ultrasonography brought about a pronounced increase in thenumber of chronic liver disease cases, however, welimited our work to the period from 1986 and thereafter and found that the RR for chronic liver disease
was not significant (RR = 1.14 [95% CI: 0.84, 1.40]).
Furthermore, when chronic liver diseases were classified into fatty liver and other types, a suggestive
association with radiation dose was observed only forfatty liver risk (RR = 1.16 [95% CI: 0.99, 1.37]), indicating the possibility that the significance of the dose
response observed for chronic liver disease arose fromradiation-related fatty changes in the liver.

20 in Hiroshima and Nagasaki, analysis using T65Dbased data suggested high frequencies of benign ormalignant solitary thyroid nodules in a group exposed
to over 100 rad (1 Gy). During 2000–2003, RERF
conducted a large-scale cross-sectional study examining 4,091 people by ultrasonography (followed bycytologic diagnosis for nodules exceeding 1 cm inthe long diameter). Analysis using DS02-based data
revealed an association between the prevalence ofbenign thyroid nodules and thyroid radiation dose(excess odds ratio 1.53/Gy [95% CI: 0.76, 2.67]).
Furthermore, since a negative association was foundbetween age at exposure and ERR for benign thyroid
nodules per Gy (p = 0.002), the possibility exists thatbenign thyroid nodules increased with decreasing age
at exposure. No clear association with thyroid radiation dose was observed regarding thyroid dysfunction(hypothyroidism and hyperthyroidism).37(3) Thyroid disease
Thyroid diseases are classified into benign or malignant nodular diseases and thyroid dysfunction withinappropriate hormone secretion. Thyroid nodules areobserved at a high frequency in the general population, and when investigated by ultrasonography, such
nodules are said to be detected on average in about
20% of the Japanese adult population.54
With regard to thyroid nodules, two cross-sectional
studies were conducted as part of the AHS, one in
the 1970s and the other in the 2000s. In a thyroid
palpation study conducted during 1974–1976 among
a population of those exposed at ages younger than(4) Cataract
With ocular tissues, it is commonly understoodthat the lens is more sensitive to radiation than othertissues. One of the important late effects of radiation is lens opacity, or cataract. A short time after the
A-bombings, an increase in cataract incidence among
A-bomb survivors was reported,55 and reports about
A-bomb cataract were subsequently released bynumerous researchers.56–58 A-bomb cataract presents with a specific symptom (posterior subcapsular
opacity), and it has been assumed that the detectable
threshold values in A-bomb radiation exposure are 5
Gy for chronic radiation exposure over a prolonged

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period of time and 0.5–2.0 Gy for acute radiation
exposure.59 In recent years, we performed slit-lamp
microscopy on, and took digital images of, a portionof the AHS population, which suggested an increasein cataract other than the posterior subcapsular type.
Since such issues as the quality of the images andthe non-standardized nature of the diagnostic criteria
have become apparent, however, further study of thisparticular issue is needed.

Cumulative incidence rate (%)(5) Gynecological disease
The mail surveys conducted of LSS female subjects detected prematurity in natural menopause withincreasing radiation dose (Figure 16).60 The premature
artificial menopause observed in this study can be
explained by the increased incidence of A-bombradiation-induced uterine myoma (benign tumor of
the uterus) found in the AHS (refer back to Figure14).18 Effects of radiation on ovarian function havebeen suggested, but studies of A-bomb survivors have
not resulted in any evidence suggesting that radiation
exposure may reduce fertility or chance of giving
birth.

100
0-0.40 Gy
1 Gy
1.5 Gy75

51.9 52.2 52.6

50.1 50.4 50.9

5047.7 48.2 49.0

25

0
30

50

40

60

Age (years)

Figure 16. Cumulative incidence rate of natural menopause60(6) Physical growth and development andbone and locomotor apparatus disease
Body measurements (height, weight, chest circumference, etc.) have long been carried out at
ABCC-RERF to observe radiation effects on growthin A-bomb survivors exposed when young. Findings
show that growth retardation is a general result ofchildhood exposure to high-dose A-bomb radiation.
In the case of fetal exposure, no clear radiation effects
were seen among those who were exposed to < 1 Gy,
but doses of ≥1 Gy did cause decreased adult heightby about 6 cm (about 2.5 cm per Gy). Such an effect

was already observed at age 10 among survivors
exposed in utero. Since the gaps between individuals exposed as fetuses and unexposed people did not
widen in subsequent years, however, it is believed thatpubertal growth in height was not affected.61 According to analysis of effects of childhood exposure at various ages, average height reductions per Gy of 2.0 cm
in females and 1.2 cm in males were observed after
exposure in infancy; the corresponding values wereabout 1.0 cm and 0.6 cm, respectively, after exposure
at age 10.62 It is generally known that in females early
menarche is associated with growth in height, but noeffects of radiation on age of menarche were observed.
As shown above, disorders in physical growth anddevelopment of A-bomb survivors who were exposed
to radiation during the period of active bone growthprior to puberty have been reported, but no association
between late-life skeletal abnormality (prevalence ofosteoporosis and vertebral body fracture) and A-bombradiation has been observed among A-bomb survivors.63–65(7) Skin disease
Burns, external injuries, and dermatitis due to thethermal rays, fires, blasts, and acute radiodermatitis from the A-bombings were early skin disorders
observed among A-bomb survivors. It was reported
that harsh hygienic conditions at the time contributed
to delayed healing of such conditions.66 Furthermore,either hypertrophic cicatrix (scarring) or keloidal
tissue (pinkish, elevated scar growth) was found in
50–70% of those with scars as a result of burns.67,68
These hyperplastic scar tissue skin manifestations
afflicting A-bomb survivors, which became apparent
3–4 months after the A-bombings, peaked 2–3 years
after the bombings, and then declined with time.
ABCC conducted clinical dermatological evaluation of 10,650 AHS subjects during 1964–1966.69
Findings indicated that A-bomb survivors exhibited ahigher frequency of atrophic scars, pigmentation, anddepigmentation, and showed a tendency for fine telangiectasia (small dilated blood vessels) of the arm that
increased with increasing radiation dose. The relationship between skin changes due to aging and radiation
exposure was also examined, but it was found that any
association was limited to increases in poliosis (whitehair) and facial senile elastosis (loss of elasticity of theskin due to the degeneration of elastic fiber that helps
maintain skin turgor).
(8) Psychoneurological and psychologicaleffects
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【5】Radiation effects on human health: Late effects【B】Results from studies of in utero survivors

unprecedented disasters never before experienced byhumankind. In addition to physical symptoms, it isbelieved that the loss of or changes in human, social,
and physical environments brought about psychoneurological and psychological effects, causing post-traumatic stress disorder (PTSD) and other disturbancesamong A-bomb survivors. Such psychoneurologicaland psychological effects may persist in negatively
affecting the health of survivors over the long term.
Nevertheless, there are limited numbers of studies
and reports on psychoneurological and psychologicaleffects caused by the A-bombings.
With regard to presence and/or absence of physicalsymptoms, a self-administered questionnaire-based
survey was conducted of the AHS population during
the period 1962–1965. Analysis of the survey resultsin terms of acute radiation symptoms and distancefrom the hypocenter revealed the highest frequency ofcomplaints of various physical symptoms, fatigability,and emotional disturbances such as fear and anxiety
in the group of proximally exposed survivors who had
developed acute radiation symptoms.70,71
LSS analysis related to suicide conducted during
1950–1966, however, yielded no evidence of a highsuicide rate among A-bomb survivors.72

3. Abnormality in the immune system andinflammation
Immune system alterations observed in A-bomb
survivors mainly comprise attenuation of T-celldependent adaptive immunity and a state of low-grade
inflammation. Low-grade inflammation is thought
to be caused by activation of innate immunity.
Many related issues remain unresolved, including themechanisms behind alterations in the immune system
due to radiation exposure and how such immunechanges affect the onset of disease. However, mostAge-related alterations

radiation-related alterations in the immune system
resemble age-related attenuation of immune function (immunosenescence) (Figure 17). For example,
aging decreases production of T lymphocytes, leading to a decrease in the number of naïve T lymphocytes (immature T lymphocytes that have never been
activated) in blood but an increase in production ofmemory T lymphocytes (that have been activated)with weakened functions and decreased diversity inantigen recognition. Meanwhile, the possibility of
dose-dependent reductions in the naïve T-lymphocyte
pool and memory T-lymphocyte functions of A-bomb
survivors have been reported.73–75 Furthermore, generally speaking, the production of inflammatory proteinsand cytokines by innate immune cells and the acceleration of inflammation increase with aging. RERF
has obtained research results showing high levels ofthese inflammatory proteins and cytokines also amongpeople exposed to high radiation doses.76 These results
suggest that A-bomb radiation might have accelerated
immunosenescence.77–79【B】Results from studies of in utero
survivors
1. Intellectual impairment
Various findings from epidemiological and experimental studies have indicated that development of theembryo and fetus is adversely affected by radiation
exposure. Epidemiological data on persons exposed
to radiation in utero suggest the possibility of adverse
effects on brain development at certain gestational
ages. More specifically, high radiation exposures inutero at 8–15 weeks after conception, a time during which the cerebral cortex is developing, led tosevere intellectual impairment, decreased academic
performance and intelligence quotient (IQ) scores,

Radiation-related alterationsNaïve T lymphocytes
Memory T lymphocytes withfunctional deterioration
Diversity in antigen recognitionin adaptive immunity
Inflammatory response

Acceleration of
immunosenescence
Figure 17. Acceleration of immunosenescence due to radiation exposure

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【5】Radiation effects on human health: Late effects【B】Results from studies of in utero survivors

and increased epileptic seizures. Decreased academic
performance and IQ scores as well as excess casesof intellectual impairment were also observed among
those exposed in utero at 16–25 weeks after conception (Figures 18 and 19). DS86-based assessment
suggests the possibility of a threshold for severe
intellectual impairment when exposure takes place inutero at 8–25 weeks after conception. There has been
no evidence to indicate effects on brain disorders fromin utero exposure among individuals exposed at lessthan 8 weeks or at 26 weeks or later after conception.80
Five survivors with intellectual impairment exposed
in utero at 8–15 weeks after conception underwent

Risk of severe intellectual impairment (%)

70
60
8 –15 weeks
50

All gestational
ages

40
30
20

16 –25 weeks

100
0 0.10 0.20 0.30

0.50

1.00

1.50

Weighted absorbed uterine dose (Gy)Figure 18. Severe intellectual impairment as related toradiation dose and gestational age among
A-bomb survivors exposed in utero.81 The
vertical bars indicate 90% confidence intervals.

magnetic resonance imaging (MRI) of the brain. Of
these five survivors, two exposed in utero at 8–9
weeks after conception were found to have a large
region of ectopic gray matter. This finding may indicate erroneous nerve cell migration to the function site
during cerebral development. Therefore, exposure inutero at such gestational ages is suggested to give rise
to structural abnormalities in the brain.81

2. Growth impairment
Effects from in utero radiation exposure have beenstudied and reported as growth indices in terms ofphysical measurements such as head circumference,seated height, and standing height. Small head circumference suggests underdevelopment of the cranium
and possibly of the brain. To study the correlation
between intellectual impairment and small head circumference observed among in utero survivors, headcircumference of these survivors was measured. Of
the 1,473 in utero survivors whose head circumference was measured at ages 9–19, 62 were found tohave a small head circumference (i.e., more than
two standard deviations [SD] smaller than the cohort
average by sex and age at the time of measurement).
Radiation effects on the frequency of small headcircumference were observed at 0–15 weeks afterconception. No apparent radiation effects on the frequency of small head circumference, however, wereobserved at 16 weeks or later after conception. Since asmall head circumference does not necessarily equate
to intellectual impairment, an embryologic difference
between the development of small head circumference
and intellectual impairment is suggested.82
As for other physical measurements, annual body

130

Mean IQ score

120
110
100
90
Control（<0.01 Gy）
0.01 -0.09
0.10 -0.49
0.50 -0.99
>1 Gy

80
70

All ages

0-7

8-15

16-25

26+

Age in weeks after conception

Figure 19. Mean IQ scores as related to uterine radiation dose (DS86) and gestational age among A-bomb
survivors exposed in utero.81 The vertical bars indicate 95% confidence intervals.

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【5】Radiation effects on human health: Late effects【C】Results from studies of children of A-bomb survivors (genetic effects)

measurements of survivors exposed in utero have also
demonstrated an overall reduction in adult height andweight (at age 18) as well as seated height and chest
circumference among in utero survivors with smallhead circumference.83

3. Malignant tumors
The cancer incidence study84 conducted during
1958–1999 (attained age: 12–55 years) indicated asignificant increase in cancer risk among in utero
survivors as adults (sex-averaged ERR/Gy = 0.42 at
attained age of 50, 95% CI: 0.0, 2.0), which is lessthan that for survivors exposed as children (ERR/
Gy = 1.7, 95% CI: 1.1, 2.5). When EAR from bothgroups was compared, EAR increased significantlywith attained age for survivors exposed as children,
while EAR for in utero survivors remained nearly
unchanged. EAR per Gy per 10,000 person-years =6.8 (95% CI: 0.002, 48) at attained age of 50 for inutero survivors is significantly lower than EAR per Gy
per 10,000 person-years = 56 (95% CI: 36, 79) for
survivors exposed as children. It had been supposedthat the younger the child was at the time of the bombings, the higher the risk of radiation-induced cancer,
and that such a risk would be even higher for in utero
survivors. However, the study results obtained thus far
suggest that the lifetime risk of solid cancers among
in utero survivors may be lower than that of survivors
exposed as children (Figure 20).84
Nevertheless, in utero survivors have just recently
entered their cancer-prone ages, and the numbers ofcancer cases and deaths ascertained to date account forless than half of the predicted lifetime risk. Conductof a continuation of follow-up is therefore necessary
to clearly define in utero cancer risk.

Excess relative risk per Gy

15

In utero survivors
Survivors exposed as children
10

5

0
10

20

30

40

50

60

Attained age (years)

Figure 20. Change in ERR/Gy for solid cancer incidence
of in utero survivors and those exposed as
children in relation to attained age84

32

4. Noncancer diseases during adulthoodA study of in utero survivors with a focus on noncancer diseases that occurred during adulthood up to
the age of 60 provided no evidence of radiation effects
on the prevalence of thyroid diseases or cataracts noron the development of hypertension, hypercholesterolemia, or cardiovascular diseases (cerebral infarction
and myocardial infarction).85 Considering that the subjects were relatively young at the time of the study, theincidences of these diseases and conditions could wellincrease in the future, making it important to continue
the follow-up study of in utero survivors.

【C】Results from studies of children of
A-bomb survivors (genetic effects)
1. Birth defects (stillbirth, malformation,and neonatal death)
During the period 1948–1954, ABCC conducted alarge-scale neonatal study to investigate the possibilityof germ cells being affected by A-bomb radiation thatmight result in an increase in birth defects among thechildren of A-bomb survivors.86
In the study, more than 77,000 newborns during
the first two weeks after birth were examined byphysicians in Hiroshima and Nagasaki. Table 9 shows
percentages of malformations diagnosed in these
examinations.86 Of the 65,431 newborns who met suchconditions as no blood relationship between parents,
594 (0.91%) had malformations, but no association
with parental radiation exposure was found. Malformations seen during the examination of the newborns
included anencephaly, cleft palate, club foot, cleft lip
with or without cleft palate, polydactyly, and syndactyly. These malformations were commonly seen inother populations, and the frequency of 0.91% wasclose to the result (456/49,654 = 0.92%) obtained
from a general population studied by the Tokyo
Red Cross Hospital during 1922–1940. Other birthdefects (stillbirth, neonatal death, death within ninemonths after birth) also showed no association withparental radiation exposure. Reanalysis conducted
subsequently using DS86 estimated doses showed thesame results (Table 10).87 Some of the newborns were
examined again at ages 8–10 months. Again, there
was no evidence of association between malformation
frequency and parental radiation dose.86
2. Sex ratio
In the past, lethal mutations of the X chromosome
in sperm and eggs caused by radiation exposure were
thought to give rise to a disproportionate birth sex

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【5】Radiation effects on human health: Late effects【C】Results from studies of children of A-bomb survivors (genetic effects)

Table 9. Malformation frequency in relation to parental exposure conditions86
Father’s exposure condition

Mother’s exposure condition
Not in cities
Low-to-moderate doses
High doses

Not in cities

Low-to-moderate doses

High doses

294/31,904 (0.92%)
144/17,616 (0.82%)
19/ 1,676 (1.1%)

40/4,509 (0.89%)
79/7,970 (0.99%)
6/ 463 (1.3%)

6/534 (1.1%)
5/614 (0.81%)
1/145 (0.7%)

Table 10. Birth defects (malformations, stillbirths, and neonatal deaths within two weeks ofbirth) among children of A-bomb survivors87
Father’s weighted absorbed dose (Gy)*Mother’s weighted absorbed dose
(Gy)*
<0.01
0.01–0.49
≥0.50

<0.01

0.01–0.49≥0.50

2,257/45,234 (5.0%)260/ 5,445 (4.8%)
63/ 1,039 (6.1%)

81/1,614 (5.0%)
54/1,171 (4.6%)
3/ 73 (4.1%)

29/506 (5.7%)
6/133 (4.5%)
7/ 88 (8.0%)* DS86 estimated dose, neutron RBE = 20

ratio. This idea prompted a sex-ratio study of thechildren of A-bomb survivors.86 An early study (1948–
1953) suggested that there was a decrease in sex
ratio (number of male babies per 100 female babies)
from 104.1 to 101.4 with increasing radiation dosewhen mothers were exposed to A-bomb radiation andan increase from 104.1 to 106.4 when fathers were
exposed. These results, however, were not statisticallysignificant. Data collection continued through 1962.
Information ultimately obtained from a total of morethan 140,000 births showed no significant association
between parental radiation exposure and the birth sex
ratio of their children.

doses < 0.01 Gy) or not in the cities at the time of thebombings. Eighteen persons in the exposed group and25 controls carried stable aberrations (Table 11). Subsequent tests of parents and siblings showed that mostaberrations were pre-existing and inherited from oneof the parents. Only one individual from each group
had a newly arisen aberration. The origin of aberrations in 16 cases could not be determined because theparents had either died or did not wish to participate
in the study. Dose distributions, however, were similar
in tested and untested parents, and therefore refusal toparticipate in the study did not likely cause a bias in
the result.

3. Chromosome aberrations
Extensive chromosome analyses have been carriedout in the children of A-bomb survivors (F1 offspring)to determine whether stable aberrations were inducedby radiation in parental germ cells (reciprocal translocations and inversions). No evidence has been foundto suggest increased aberrations in this F1 population.
Studies compared 8,322 persons having one or bothparents within 2,000 meters of the A-bomb hypocenters (estimated doses ≥0.01 Gy) and 7,976 persons
with both parents beyond 2,500 meters (estimated

4. Genetic effects studies at the protein
level and subsequent DNA studies(1) Blood protein mutations (1975–1985)
In 1976, when technologies for direct screening of
DNA mutations were not yet available, RERF used
two kinds of protein alterations as potential markers ofmutation. One was a rare electrophoretic variant arising from base substitution mutations and was detectedby one-dimensional electrophoresis. The other was an
enzyme-deficient protein variant caused by deletion
mutations.

Table 11. Stable chromosome aberrations in children of A-bomb survivors88

Total number of children withstable aberrations
Inherited from either parent
Newly arisen
Parental origin untested

Controls (7,976 children)

Exposed (8,322 children)

25 (0.31%)

18 (0.22%)

15 (0.19%)
1 (0.01%)9 (0.11%)10 (0.12%)
1 (0.01%)7 (0.08%)

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【5】Radiation effects on human health: Late effects【C】Results from studies of children of A-bomb survivors (genetic effects)

Over the course of 10 years, a total of about 24,000
children of LSS survivors or controls were screenedin an electrophoretic study of variants of 30 blood
proteins (Table 12); approximately 10,000 of thesechildren were also tested for mutations with decreased
enzyme activity (Table 13). The children were classified into two groups according to the combined parental gonadal dose for each child: ≥0.01 Gy (exposedgroup) or < 0.01 Gy (control group). The results indicated that only five electrophoretic variants (two in
the exposed group and three in the control group) and
one enzyme-deficient variant (in the exposed group)
originated from new mutations in parental germ cells.
These protein-level studies did not show a significant difference in mutation rates between the exposedand control groups, meaning that they were unable toestablish the presence of genetic effects from radiation.
(2) DNA studies (1985–present)
For DNA studies of parents and all available children of 1,000 families, 500 with one or both parents
exposed to doses of ≥0.01 Gy and 500 with neither
parent exposed to doses as high as 0.01 Gy, biological samples were collected. DNA was extracted fromcell lines established from peripheral blood B lymphocytes. Uncultured lymphocytes and polymorphonuclear leukocytes were also preserved in anticipation of improved methods through advances in DNA
analysis techniques in the future. Pilot studies havebeen conducted using DNA from 100 families, 50
having only one parent exposed to high doses (≥0.5Gy) and 50 controls with unexposed parents, to exam-

ine mutations in short tandem repeats (STR) and to
conduct mutation studies using DNA two-dimensional
electrophoresis and microarrays.
STRs, common throughout the human genome,
are highly repetitive short sequences of DNA. STRs
often indicate polymorphisms with different repeated
numbers. Of those, genetically unstable and highly
polymorphic STRs with a high background mutation rate are known as microsatellites with repeatedsequences of 1–5 base pairs and minisatellites withrepeated sequences of 6–100 base pairs. Throughthese STRs, researchers believed that radiation effects
might be observable with a relatively small numberof subjects. Eight highly polymorphic human minisatellite loci were studied in 61 children with exposedparents (mean dose: 1.47 Gy), and 58 children of thecontrol group and their parents. The mutation rates
were 2.6% for the exposed group and 2.8% for thecontrol group, indicating no genetic effects (Table14).92 Microsatellite loci also have a high backgroundmutation rate. A study looking at 40 microsatellite lociamong 66 children of an exposed group (mean dose:
1.56 Gy) and 63 children of a control group and theirparents showed mutation rates of 0.39% and 0.35%
for the exposed and control groups, respectively, but
the difference was not significant. The study thus
indicated no genetic effects from parental exposure
to radiation.93
Most genome mutations caused by ionizing radiation are believed to be deletion mutations. Screeningof deletions was conducted using an improved DNA
two-dimensional electrophoresis system for analysesof whole genome DNA.94 Using this method, DNA

Table 12. Results of protein electrophoretic study89–91

Number of children examined
Loci tested
New mutations
Mutation rate/locus/generation

Controls(<0.01 Gy)

Exposed*(≥0.01 Gy)

12,297589,5063
0.5×10–5

11,364
544,7792
0.4×10–5* Mean parental gonadal dose = 0.49 Gy (DS86), neutron RBE = 20

Table 13. Results of screening for mutations with decreased
enzyme activity90

Number of children examined
Loci tested
New mutations
Mutation rate/locus/generation

34

Controls(<0.01 Gy)

Exposed(≥0.01 Gy)

5,026
61,7410
0

4,989
60,5291
2×10–5

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【5】Radiation effects on human health: Late effects【C】Results from studies of children of A-bomb survivors (genetic effects)

Table 14. Mutations at eight STR (minisatellite) loci92

Number of children examined
Minisatellite loci tested
Mutations detected
Mutation rate/loci/generation

Controls(<0.01 Gy)

Exposed*(≥0.01 Gy)

58
1,403
39
2.8%

61
496
13
2.6%

* Mean parental gonadal dose = 1.47 Gy (DS86), neutron RBE = 10

fragments produced with the restriction enzyme NotI
are electrophoresed, and approximately 2,000 DNA
fragments can be potentially analyzed in one run tosearch for deletion mutations. Upon analysis of 62
children from 50 control families, and 66 children
from 50 exposed families (mean dose: 1.7 Gy) andtheir parents, one deletion mutation was detectedamong 56,176 loci from the control group, but nomutations were detected among 59,942 loci from theexposed group.
In early 2000, a study was initiated to detectchanges in copy number variations (CNVs) using the
microarray-based comparative genome hybridization(CGH) method. A pilot study was conducted toinvestigate 40 children each from the exposed andcontrol groups, using microarrays containing about
2,500 human genomic DNA clones (termed PAC or
BAC) selected as probes at intervals of approximately
1,200 kb. The array CGH method was performed,
resulting in a total of 251 CNVs being detected. However, they were not de novo mutations, as it was later
confirmed that all of these CNVs were pre-existingand inherited from one of the parents.95
Studies are ongoing using high-density microarraysthat can detect small-to-large mutations in the entire
genome at an individual genomic level. We are also
exploring the possibility of risk assessment based onwhole genome sequencing. Researchers expect that
more detailed, genome-wide findings pertaining to
genetic effects from radiation will be obtained in thenear future.

5. Epidemiological and clinical studies
No effects from parental radiation exposure havethus far been observed in mortality studies of A-bomb
survivors’ children (second-generation A-bomb survivors), as measured at birth and in childhood,96 under
the age of 20,97 and at 20 years of age or older (average age: 46).98 Long-term follow-up studies will benecessary, however, since the cumulative mortalityof those in the latest study, conducted on the cohort
consisting of participants aged 56 years or younger,
was only 3.5%.

Studies of childhood leukemia and early-onset solidcancers among the original follow-up cohort haveshown no effects from parental radiation exposureon the onset of either condition among those younger
than age 2099 or between ages 20–40.
The latest cancer incidence study100 does not clearly
indicate effects of parental radiation exposure on thechildren’s cancer incidence. Incidences of leukemia
and lymphoma up to the age of 20 among A-bomb
survivors’ children whose paternal radiation dose was
5–49 mGy did not show any significant differencecompared to those whose paternal radiation dose was< 5 mGy (RR = 1.07, 95% CI: 0.36, 3.13). Nor was asignificant difference observed in A-bomb survivors’
children whose maternal radiation dose was 5–49
mGy as compared to those with maternal dose < 5
mGy (RR = 1.55, 95% CI: 0.59, 4.28). There wereno leukemia or lymphoma cases diagnosed among
the A-bomb survivors’ children younger than age 20
whose paternal and/or maternal radiation dose was≥50 mGy. Among the A-bomb survivors’ children
aged 20–40, no significant difference in leukemia
or lymphoma incidence has been observed for those
whose paternal radiation dose was 5–49 mGy, 50–149
mGy, 150–499 mGy, or at least 500 mGy, as compared to those whose paternal dose was < 5 mGy(Figure 21). Moreover, no significant difference has
been observed for maternal radiation dose. The same
comparison was made for solid cancer incidence forthose less than age 20 as well as those aged 20–39,
and no significant difference was observed for either
age group. However, considering that the cohort isjust at the beginning of the age range during which
adult-onset cancers (mainly solid cancers) commonlyoccur, it is still premature to reach any conclusions,and therefore further studies should be conducted.

6. Prevalence of lifestyle diseases
The Clinical Health Study of the Children of
A-bomb Survivors (cross-sectional study) conductedduring 2002–2006 by RERF is the first epidemiological study to look at the genetic effects of radiation on
adult-onset lifestyle diseases (excluding cancers). In

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【5】Radiation effects on human health: Late effects【C】Results from studies of children of A-bomb survivors (genetic effects)

All solid cancers
Age at onset Paternal dose

Age 1-19

0-4 mGy
5-49 mGy

Age 20+0-4 mGy
5-49 mGy
50- mGy
150- mGy
500+ mGy

Relative risk
0.1

1

Leukemia, etc.
10

Age at onset Maternal dose

Age 1-19

0-4 mGy
5-49 mGy

Age 20+0-4 mGy
5-49 mGy
50- mGy
150- mGy
500+ mGy

Age at onset Paternal dose

Age 1-19

0-4 mGy
5-49 mGy

Age 20+0-4 mGy
5-49 mGy
50- mGy
150- mGy
500+ mGy

Relative risk
0.1

1

10

Age at onset Maternal dose

Age 1-19

0-4 mGy
5-49 mGy

Age 20+0-4 mGy
5-49 mGy
50- mGy
150- mGy
500+ mGy

Figure 21. Parental radiation dose and risk of cancer incidence in A-bomb survivors’ children born during 1946–
1984 (follow-up period: 1958–1997).100 The horizontal bars indicate 95% confidence intervals.

this study, we investigated the association between
prevalence of adult-onset multifactorial diseases andparental radiation exposure in 11,951 A-bomb survivors’ children in Hiroshima and Nagasaki. Thus far,however, no association has been observed between
parental radiation exposure and adult-onset multifactorial diseases collectively among these children.101
Moreover, no evidence has been observed showing an
association with increase in the prevalence of any oneof the multifactorial diseases separately.102 Multifactorial disease is a generic term for diseases commonly
seen in adulthood, the onset of which is typically associated with lifestyle factors, and is defined by either
the history or presence of hypertension, diabetes,
hypercholesterolemia, myocardial infarction, angina,
or stroke. The mean age of the cross-sectional study
participants was 48.6 years, and 54% were in their
50s. The prevalences of multifactorial diseases at thetime of health examination were 59.8% and 49.9% for
men and women, respectively, with hypercholesterolemia and hypertension the most commonly observed
conditions.
We analyzed the association of prevalence of multifactorial diseases with both paternal and maternalradiation doses, after adjusting for factors such as
age at the time of health examination of A-bomb
survivors’ children, city, sex, BMI, smoking anddrinking habits, occupational category, menopause,and paternal and maternal history of multifactorialdiseases. The odds ratios of the prevalence of multifactorial diseases among the children of A-bomb
survivors were 0.91 (95% CI: 0.81, 1.01, p = 0.076)

36

and 0.98 (95% CI: 0.86, 1.10, p = 0.71) for paternal
and maternal doses per Gy, respectively, with neither
showing significant dose-response relationships (Table
15).101 The analysis results by sex suggested a negative association between paternal dose and the prevalence of multifactorial diseases for men (odds ratio:
0.76, 95% CI: 0.65, 0.89). No statistically significant
relationship was observed between maternal dose andthe prevalence of multifactorial diseases for men or
between parental doses and the prevalence of multifactorial diseases for women (Table 15). In addition,
no evidence was found of a radiation risk in children
depending on parental age at the time of exposure,time elapsed between exposure and birth, or parental
multifactorial disease history. The analysis results bysex suggested only a negative association between theprevalence of multifactorial diseases and paternal dose
for male children of A-bomb survivors.
Caution is required in interpreting these results,
however, since it is not an easy task to judge whether
they are significant from a biological standpoint or
simply the result of a self-selection bias, which is
caused by differences in participation in the healthexaminations affected by such conditions as healthstatus and parental radiation exposure. A review ofself-selection bias was important considering thatamong the study subjects contacted only about half
participated in the health examinations. In our review
of self-selection bias, no association was observed
between cancer history and parental doses for malestudy participants. However, in terms of self-selection
bias, we observed a positive association between can-Radiation Effects Research Foundation A Brief Description

【5】Radiation effects on human health: Late effects【C】Results from studies of children of A-bomb survivors (genetic effects)

cer history and maternal dose for female participants.
We then compared the participation rate of those who
self-reported disease(s) in the mail survey (including
both the participants and non-participants of healthexaminations) with parental doses and found that theparticipation rate was high among people who selfreported hyperlipidemia and whose mother’s dosewas > 0 Gy, but no association was observed between
maternal dose and the participation rate of those withmultifactorial diseases other than hyperlipidemia. No
association was observed between paternal dose andthe participation rate of the study subjects with anyof the multifactorial diseases. From such results, noeffects of self-selection bias on the analysis results
were observed.
In summary, we cannot say at the present timethat there is evidence of an increase in multifactorialdisease risks for the children of A-bomb survivors
associated with parental radiation exposure. Considering that history and incidence of multifactorial diseases typically increase with age, continuation of theinvestigation of genetic effects of radiation is crucial.
RERF initiated a study on the incidence of such multifactorial diseases due to parental radiation exposure
starting in 2010 as the Longitudinal Clinical Study ofthe F1 Offspring of A-bomb Survivors.

Table 15. Association between parental radiation dose and prevalence of multifactorialdiseases* among A-bomb survivors’ children (odds ratio)101
Odds ratio per Gy and 95% confidence interval

Paternal dose
Maternal dose

All participants

Male

Female0.91
0.81–1.01
0.98
0.86–1.10

0.76
0.65–0.89
0.97
0.81–1.17

1.04
0.90–1.21
0.98
0.83–1.16* Multifactorial disease is defined as having a history of, or being affected by, at least one of thefollowing diseases/conditions: hypertension, diabetes, hypercholesterolemia, myocardial infarction, angina pectoris, and stroke. Multifactorial disease is a generic term for a group of diseases
that generally develop during adulthood in association with lifestyle.

Radiation Effects Research Foundation A Brief Description37

【6】Future research themes【6】Future research themes【6】

Future research themes

RERF studies are expected to achieve new potential
through the use of valuable biosamples from A-bomb
survivors to understand the risks revealed during thecourse of our epidemiological research. Our future
research activities are projected to focus on moreaccurate risk assessment for the diseases that haveincreased due to radiation exposure, and biologicalverification of the mechanisms behind the onset ofthese diseases.

1. Radiation risk among A-bomb survivors
and mechanistic elucidation
RERF scientists are expected to actively conduct
research to review risk models for radiation exposureand elucidate effects of risk modifiers such as age at
the time of bombing, time elapsed since exposure,age at onset, environmental factors including lifestyle,and genetic susceptibility. In cases of childhood/fetal
exposure to radiation, age at the time of bombing isan especially important factor.
Researchers in fields such as radiation protection
and radiobiology are interested in how radiation
affects disease onset and what the mechanisms are
involving factors related to such disease.
(1) Progress in research integrating molecular epidemiology with clinical/pathologicalinformation
Our ultimate goal is to identify molecular oncological characteristics that allow distinctions to be madebetween cancers attributable to radiation exposure andthose due to other causes. New analytic techniques are
required for achieving this goal. To this end, we are
currently working to analyze genes and proteins incancer tissue samples from A-bomb survivors, establishing methods that take into account clinical andpathological information, and clarifying characteristics of radiation-related cancers at the molecular level.
(2) Research on genetic susceptibility toradiation-related disease and epigenetic
alterations
It has been theorized that individual differences
exist in terms of sensitivity to radiation-induced disease and that these differences are partly attributableto subtle differences in the structures of individual
genomes. Researchers around the world are intent
on studying the association between onset of various
kinds of disease and genomic structure with the aimof disease prevention and drug development. RERF
genomic research aims specifically at elucidation of38

mechanisms behind the onset of radiation-relateddiseases. Epigenetic alterations (i.e., changes in
the genomic structure without DNA base sequencechanges), which are also affected by aging and environmental factors, are thought to sometimes serve as
causes of multiple diseases including cancer. RERF
is currently investigating the possibility that previous
radiation exposure might affect epigenetic alterations,leading to an increase in disease risks.
(3) Research on cardiovascular disease (CVD)
The results of various studies of A-bomb survivors
suggest correlations between radiation and increased
risks for hypertensive cardiovascular disease and cerebral stroke, as well as hypertension, a condition thatplays a role in the pathogenesis of these diseases. On
the other hand, studies of low-dose radiation exposure,including occupational radiation exposure among
nuclear facility workers and environmental low-doseradiation exposure, have shown inconsistent results.
Researchers in the fields of radiation protection,
radiobiology, and cardiology are exhibiting interestin this issue. RERF has consequently established a
cardiovascular disease research project, coordinating
multidisciplinary investigations to determine whether
the risk of cardiovascular lesions truly increases withincreasing radiation dose. As part of this work, we areusing model animals that have been irradiated at precise levels to examine these events and elucidate themechanisms behind any such increased risk.

2. Review of uncertainty in radiation dose
estimates
In the case of A-bomb survivors exposed in concrete buildings or bomb shelters or under complicatedshielding conditions (e.g., Nagasaki factory workers),
it was impossible not only to generalize shielding conditions but also to calculate individual doses, resulting in about 7,000 “dose unknown” cases in the LSS
population. From among these cases, it is necessary
to review the possibility of making dose calculations
for at least 2,000 concrete building shielding cases
and 1,600 bomb shelter shielding cases, as well as the
Nagasaki factory shielding cases. We have completedorgan dose calculations for 15 organs, but it also will
be necessary to calculate organ doses for the heart andother vital organs in the future. We will also further
consider the refinement of dose calculations for childhood radiation exposure.
3. Review of genetic effects in children of
A-bomb survivors
With regard to adult-onset diseases among children

Radiation Effects Research Foundation A Brief Description

【6】Future research themesof A-bomb survivors that are attributable to parental
radiation exposure, we are continuing the conduct of
our epidemiological research project, and follow-up
will require several decades to establish definitive
results.
Recent developments in genome analysis techniques are expected to contribute to better detectionof the genetic effects of A-bomb radiation. It is also
expected that use of model animals and analysis using
whole-genome DNA sequencing technology will
enable more comprehensive and accurate assays ofthe frequency of molecular genetic effects of radiation
exposure in the children of A-bomb survivors.

Radiation Effects Research Foundation A Brief Description

39

【7】

Utilization of RERF study
results by international organizations

The findings obtained from studies of the longterm health effects of A-bomb radiation conducted at
ABCC-RERF have contributed significantly to healthrisk assessment of radiation exposure by internationalorganizations. In particular, the findings have played acentral role as a source of information on assessmentsof the latest findings regarding radiation health risks
for the United Nations Scientific Committee on the
Effects of Atomic Radiation (UNSCEAR). Among themany studies in the world that provide basic data inthis area, ABCC-RERF research represents the mostreliable and comprehensive information on radiation
health risks through accurate dose estimates and longterm incidence and mortality follow-up studies.
Risk assessment by UNSCEAR has provided thescientific basis for recommendations by the International Commission on Radiological Protection (ICRP)
regarding radiation protection standards for radiation
workers and the general public and for international
standards established by the International Atomic
Energy Agency (IAEA), as well as laws and regulations in various countries.
ABCC-RERF research results have also played
an important role in assessment carried out by theCommittee on Biological Effects of Ionizing Radiation (BEIR) of the U.S. National Research Council(NRC), which conducts risk assessment similar to thatof UNSCEAR.

Contribution of ABCC-RERF research torisk assessment by UNSCEAR
Since its establishment in December 1955,
UNSCEAR has carried out detailed examination ofdata on radiation health risks obtained throughout theworld, evaluated the results scientifically, and published comprehensive reports, including more than
20 major reports. Its first report, published in 1958,
already included a summary of the leukemia risks in
Hiroshima and Nagasaki. Subsequent reports, mostof which were based on the results of ABCC-RERF
analyses, introduced many findings from the studies ofA-bomb survivors in Hiroshima and Nagasaki.
In 2008, the UNSCEAR 2006 Report, Vol. I, which
included reports titled “Epidemiological studies ofradiation and cancer” and “Epidemiological evaluation of cardiovascular disease and other noncancer
diseases following radiation exposure,” was published.
With regard to cancer, results from mortality studies(1950–2000) and incidence studies (1958–1998)
based on LSS analysis using DS02 were prominent

40【7】Utilization of RERF study results by internationalorganizations

sections of that volume. Findings involving the LSS
in the UNSCEAR report included: 1) In risk analysis
using the new DS02, solid cancer risk decreased byabout 7% compared with analysis based on DS86, butthere were no changes in the patterns of dose responseor temporal variation in risk; 2) Due to extension of
the follow-up period and the resulting increase in
number of cancer cases, the accuracy of statisticalestimation has improved, making it possible to examine the shape of the dose-response curve at even lower
doses. Further extension of the follow-up period will
provide more information on low-dose risks; and 3)
Extension of the follow-up period has shed light onlong-term risks after exposure, especially risks among
those exposed at young ages.
In this report, UNSCEAR conducted its own analysis using mortality and cancer incidence data published by RERF, and investigated the minimum doses
at which risk increases could be detected.
For the report on noncancer diseases, the results
obtained by RERF in the LSS and the AHS have
proven to be valuable. The report concludes that thedata currently available are insufficient to prove a
causal relationship between exposure to radiation of
up to 1–2 Gy and cardiovascular diseases, because asof 2006, the only data showing an association between
exposure to those levels of exposure and fatal cardiovascular diseases are A-bomb survivor data in Japan,
because there is no consistency among the resultsfrom other studies, and because details of related biological mechanisms are unknown.
Results of the health effects studies on A-bomb
survivors also played an important role in the section
titled “Effects of ionizing radiation on the immune
system” in the UNSCEAR 2006 Report, Vol. II.
Furthermore, with respect to the effects of radiation
exposure in children, the findings from the LSS andAHS conducted by RERF are featured prominently in
the UNSCEAR 2013 Report, Vol. II.

Contribution of ABCC-RERF research to
ICRP
ICRP, an international organization that makes
recommendations on radiation protection from thestandpoint of specialists, was founded in 1928. ICRP
has published numerous reports on issues related toradiation protection. In particular, the organizationcompiled basic guidelines concerning radiation protection and issued major recommendations in 1958,
1964, 1966, 1977, 1990, and more recently in 2007.
Although ICRP does not have binding legal authority,
its recommendations are internationally authorita-

Radiation Effects Research Foundation A Brief Description

【8】Collaborative research programs【8】Collaborative research programs【8】
tive and have served as the basis for IAEA safety
standards, as well as laws, ordinances, and guidelines
regarding radiation protection in numerous countries
worldwide.
One example of use of the results of health effects
studies of A-bomb radiation in the preparation ofmajor ICRP recommendations is a reduction of theannual dose limit for radiation workers that appearedin the organization’s 1990 recommendations. The
annual dose limit of 50 mSv for workers, which wasestablished in 1956, remained effective until 1990,
when it was reduced to an annual average of 20 mSv
over the course of five years (or up to 50 mSv forany one of those years) based on the risk estimatesobtained from the LSS data collected by ABCC-RERF
through 1985.
In the ICRP 2007 recommendations, results ofthe cancer incidence studies (1958–1998) based on
analysis using DS02 also played an important role.
These major recommendations focused on incidence
data because those data were thought to provide morereliable estimates of cancer risks. The cancer risk
estimates in the 1990 recommendations were applied
to the major 2007 recommendations, and inclusion ofcancer incidence data from the LSS provided a stronger basis for risk modeling.
As described above, ABCC-RERF research achievements accumulated over many years have served as
the core sources of information for past UNSCEAR
reports and major ICRP recommendations, and theirimportance is expected to continue into the future.
Given such responsibility, RERF takes seriously its
obligation to continue releasing fair, neutral, and accurate scientific information.

Collaborative research programs

Domestic and international collaborative studies
RERF engages in collaborative projects together
with external research organizations in Japan andoverseas for expansion of the foundation’s breadth ofresearch and confirmation of the research results fromits studies of A-bomb survivors.
An epidemiological project carried out in collaboration with the U.S. National Cancer Institute (NCI)
as one of RERF’s major international collaborative
studies has continued for many years and generated
numerous manuscripts on radiation effects, while providing frequent opportunities for researcher exchanges
between the organizations. Another large-scale collaborative research project in recent years focuses onradiation and immunity with support from the U.S.
National Institute of Allergy and Infectious Diseases(NIAID).
A partnership program on epidemiological andstatistical research of A-bomb radiation effects is
ongoing among the University of Washington (U.S.),
Kurume University (Japan), and RERF. This program
has produced several manuscripts, created opportunities for researcher exchange, and contributed to theeducation of young scientists through lectures by
RERF researchers for university graduate students.
RERF takes part in the Asian Cohort Consortium(ACC), a large cohort study organized by the U.S.
Fred Hutchinson Cancer Research Center, participating in several studies of low-incidence cancers and soon. RERF is also engaged in the Thyroid Studies Collaboration, consisting of 17 cohorts numbering about
70,000 people in such locations as Europe, America,
Australia, and Asia, with the aim of studying fromvarious perspectives the risks caused by abnormal
thyroid function.
In addition, RERF conducts studies and has produced numerous papers in collaboration with the
University of Oxford (U.K.), Maastricht University(Netherlands), University of Rochester (U.S.), University of Hong Kong (China), National Institute on
Aging (U.S.), Helmholtz Institute (Germany), andothers.

Radiation Effects Research Foundation A Brief Description

41

【9】Research review【9】Research review【9】Research review

From planning of research to publication of results
1. Research protocol preparation
Scientific research at RERF is initiated, in principle,
on the basis of approval of research protocols (RPs).
Proposed RPs are reviewed by the Research Protocol
Review Committee and the Human Investigation
Committee, and when appropriate, by the Ethics Committee for Genome Research, the Committee on Biological Samples, the Recombinant DNA Experiment
Safety Committee, and the Experimental Animal Care
Committee. RPs are ultimately reviewed and approvedby the Executive Committee. Likewise, in the case ofcollaborative studies with external researchers, RPs
must be prepared and reviewed by various committees before data are shared. Through such proceduresfor internal and external scientific review, this systemprovides assurance of scientific relevance and qualityof the RPs, guards against the exploitation of humanstudy participants, and ensures that high standards of
ethics are met and that personal information is strictly
protected.
The basic data collected through long-term followup studies such as the LSS, AHS, and studies of children of A-bomb survivors are designated separately as
platform protocols.
2. Study conduct and scientific review (Scientific Advisory Committee)
When ABCC was reorganized into RERF in 1975,
the need to continue research based on full partnership
between Japan and the United States was reaffirmed.
At this time, the Scientific Council, consisting ofexperts from Japan as well as the United States, wasestablished to review the appropriateness of researchand to make recommendations. The Scientific Council
was renamed as the Scientific Advisory Committee
when RERF changed its status to a public interest
incorporated foundation in 2011, and this Committee
continues to function today.
The objectives of the Scientific Advisory Committee are to review RERF’s scientific research programs
and make recommendations to the RERF Board of
Directors and Board of Councilors with respect todirection of new research programs, and/or continuation or alteration of programs in progress. The
Scientific Advisory Committee consists of U.S. andJapanese experts in RERF’s research fields, including
medicine, epidemiology, radiobiology, genetics, andstatistics. The Scientific Advisory Committee cur-42

rently has 10 members, five from the United Statesand five from Japan. These Scientific Advisors areeach appointed to serve a five-year term and may
be reappointed once. To achieve close assessment of
RERF’s research programs, the Scientific Advisorsserve two terms whenever possible, with one member
each from the United States and Japan being replaced
every year. The independence and neutrality of the
Scientific Advisors is respected, and the Committee operates under the leadership of two co-chairs,
one Japanese citizen and one U.S. citizen, who are
selected from among the members.
The Scientific Advisory Committee convenes once a
year to receive a report on RERF’s scientific activities,
to visit research departments for presentations fromresearch scientists, and to review research activities.
Detailed review results are compiled into a report, andthe evaluation and recommendations are presented by
one of the co-chairs to the Board of Councilors. A newreview method has recently been introduced in which
designated research departments undergo an in-depth
review on a three-year, rotating basis. For this review,
when necessary, experts in relevant research fields areinvited to serve as Special Scientific Advisors.

3. Publication of study results
Scientific papers are prepared on the basis ofstudy results. Through arrangement by the Scientific
Reports Review Committee, RERF research scientists
specializing in the fields concerned, and external
specialists if needed, review scientific papers, and the
RERF chairman grants final approval for submissionof manuscripts to scientific journals. Upon approval,
the manuscripts are submitted to scientific journals inJapan as well as abroad. Prior to publication in suchjournals, the scientific papers undergo review by thejournal reviewers.
In this way, RERF research findings are widely
publicized and distributed worldwide through publication in national and international journals, throughpublication as technical books, and through oral andposter presentations at national and international scientific meetings.
Data for risk estimation of A-bomb-related cancers
that are used in reports from major studies such as
the LSS can be downloaded from the RERF website,making it possible to recalculate risk estimates forverification. These data are made available in a form
ensuring that individuals cannot be identified. All such
personal information is closely safeguarded by RERF.

Radiation Effects Research Foundation A Brief Description

【10】Research materials【10】 Research materials

Archiving epidemiological data and biological samples
The ABCC-RERF LSS cohort is a fixed populationconsisting of individuals covering a wide age range.
When the LSS follow-up is completed, RERF will
possess a database of medical information obtained
through a lifetime follow-up study following radiation exposure of one of the largest fixed cohorts in theworld representative of a general population.
In addition, RERF stores biosamples such as blood,
blood fractions, and urine collected at the time ofhealth examinations from the AHS population andfrom the F1 Clinical Study population comprisingchildren of A-bomb survivors. When this collection
process is completed, RERF will possess an important historic research resource for elucidating radiation health effects and for conducting other medical
research, permitting retrospective analysis of clinicalsamples for understanding the natural history of diseases following observation of all health events.

1. Archiving epidemiological data
The recorded data obtained through cohort studies such as the LSS, AHS, in utero study, and F1
study consist of basic information regarding the subjects (name, date of birth, sex, permanent domicile,
A-bomb exposure conditions, etc.), death information, cancer incidence information, information frommedical interviews with AHS and F1 Clinical Study
subjects including medical histories, and health examination results such as diagnosis and observations,electrocardiographic findings, X-ray images, and soon. While these cohort members are alive, the volume
of such information continues to increase. Since allsuch data represent confidential personal information,
they are strictly safeguarded, with the majority of theinformation coded and stored electronically. These
epidemiological data have been stored as electronic
information since the establishment of ABCC. The
system has progressed, beginning with the punchedcard system, then mainframe computers, and evolving into the present-day workstation-based distributed
processing system. RERF started using a network
system in 1985. By the early 1990s, this system wascompleted and covered the entire foundation, significantly contributing to integrated management of dataon a foundation-wide basis.
2. Management of epidemiological data
RERF databases are classified into two independentand separately managed categories: resource-management databases and research databases. As a result, 1)
the burden on database servers is reduced, 2) direct
effects on research databases can be avoided fromadditions and changes of examination items to theresource-management databases requested by both the
Departments of Epidemiology and Clinical Studies,and 3) personal information leaks are prevented more
rigorously by using completely different ID numbers
for the two types of databases.
These databases are managed in an integrated manner based on their respective ID numbers, and datatransfers and links between the databases are carriedout fully automatically while personal information
protections are enforced at a high level.

3. Storage of biosamples
Biosamples from the AHS and F1 Clinical Study
participants are stored in ultra-low temperature deep
freezers at –80°C (about 75 deep freezers in Hiroshima
and about 25 in Nagasaki) or in large automated liquid
nitrogen storage tanks (liquid/vapor phase) at approximately –190°C. For a portion of these biosamples,
single samples were divided for storage in both
Hiroshima and Nagasaki.
On April 1, 2013, the Biosample Center was established with full-time staff assigned to manage biosamples in an integrated fashion and to make themmore readily available to researchers.
Biosamples stored at the Biosample Center are
defined as the following:✧ Blood samples: Serum and lymphocyte samples donated by AHS and F1 Clinical Study
participants.
✧ Urine samples: Urine samples donated by
AHS and F1 Clinical Study participants.
✧ Pathological samples: Pathological tissue
samples from surgery or autopsies are stored
as paraffin embedded blocks or stained slides.
In collaboration with pathologists at major
hospitals in Hiroshima and Nagasaki, RERF
has begun to construct an archival system for
surgical cancer samples from A-bomb survivors.
✧ Cytogenetic samples: Slides of chromosome
spreads derived from blood lymphocytes ofthe subjects in the AHS and the F1 ClinicalStudy.
✧ Extracted teeth: Teeth collected from individuals of the AHS cohort for the purpose of
estimating radiation doses using ESR.
These biosamples stored at the Center are madeavailable for use by investigators both inside and out-

Radiation Effects Research Foundation A Brief Description

43

【9】Research review

side of RERF. Additional biosamples used in ongoingstudies are entrusted to the Center by the responsible
investigators for temporary safekeeping. Moreover,
the Center is responsible for, as a rule, 1) preparationof biosamples, 2) duties associated with storage anduse of biosamples, and 3) development and management of a biosample-related database system that isaccessible by the public.
For storage of such biosamples, an emergency
management system has been established that includes
backup electric power generators in case of suspension of electrical power and temperature-monitoring
devices affixed to each of the deep freezers.

4. Use of biosamples
Biosamples stored at RERF are used with strict
consideration given to protection of personal information in compliance with regulations and guidelines
concerning research ethics. As it continues to establish
regulations pertaining to policies, procedures, andother matters regarding the use of these integrated
but limited biosamples, RERF will establish procedures involving how to make databases available tothe public, and how research protocols using suchbiosamples should be screened and approved, basedon the consensus of society. These efforts are expected
to result in broader use of RERF’s globally uniqueresearch resources.

44

Radiation Effects Research Foundation A Brief Description

Research departments

Research departments
doses calculated by DS02.

Department of Clinical Studies
The Department of Clinical Studies conducts
follow-up studies of participants in the AHS, which
is a selected subset of the LSS and in utero cohorts,
in order to focus analysis on the relationship between
radiation and the development of noncancer diseases.
Currently, studies based on comprehensive healthexaminations are also conducted to follow the F1 clinical cohort.
In addition to standardized health examinations androutine laboratory tests of blood and urine, special
tests are conducted to evaluate endocrine diseases,
gynecological diseases, skeletal and cognitive impairments, ophthalmological diseases, cardiovascularabnormalities, and so on. Thus, the AHS is among
the most comprehensive clinical follow-up studies ofradiation effects ever undertaken. Examinations arevoluntary, and participation rates are regularly as highas 70%–80%. All of the clinical and epidemiological
data and biological specimens are stored for utilizationin health effects studies.
Participants are fully informed of examination
results, which are used for referral to local physicians
when necessary. In this way, health examination studies are conducted not only for the purpose of clinicaland epidemiological research but also to contributeto the long-term assessment of the health status of
A-bomb survivors and maintenance of their health.
Department of Molecular Biosciences
The Department of Molecular Biosciences performs
basic science research involving studies of genetic
effects and carcinogenesis mechanisms. Using blood
specimens provided by survivors and their children,
the department is investigating whether or not mutation frequencies in offspring are affected by parental
radiation exposure. Utilizing molecular biological
techniques, the department is also examining mutations of oncogenes and tumor suppressor genes in cancer tissue specimens (thyroid, colon, and lung) stored
over several decades at RERF or at local hospitals in
Hiroshima and Nagasaki.
The department is also making efforts to identify
and evaluate biomarkers linking radiation exposure
to diseases among A-bomb survivors. Biomarkers
currently being assessed involve immune functions,
genetic factors, unrepairable DNA radiation damage,
DNA methylation, and transcription. Chromosome
aberrations in lymphocytes as well as the electron spinresonance signals from tooth enamel are also assessedto provide information on uncertainties in individual

Department of Epidemiology
The Department of Epidemiology has the primarytask of clarifying through epidemiological studies therisks associated with radiation exposure in humans.
For almost 60 years, follow-up studies of more than
200,000 survivors and their children have been conducted through the LSS cohort of A-bomb survivors,
the cohort of people who were in utero at the time of
the bombings, and the F1 cohort of persons conceived
after the bombings. Analyses focus on mortality andcancer incidence in relation to radiation dose, allowing for risk factors other than radiation. The LSS is
the most important epidemiological study of radiation
effects in humans in the world because of the size andwell-characterized nature of the study population, thewide range of radiation doses and ages, and the duration and completeness of the follow-up studies. The
in utero and F1 cohorts are the only such fixed cohorts
in the world with follow-up into the adult years.
The department is also entrusted by the governments of Hiroshima City, Hiroshima Prefecture, andNagasaki Prefecture to manage local tumor registries.
The collected data serve as a unique source of information on cancer incidence for both A-bomb survivors
and the general population.
Department of Statistics
The Department of Statistics analyzes informationcollected by other departments on radiation effects,
provides statistical support and advice to researchscientists in other RERF departments, and assists withdata management. Members of the department aid indesigning studies and develop and apply statisticalprocedures appropriate for analyzing RERF’s uniqueresearch data. Management of the dose informationand calculation of individual doses are further responsibilities of the department.
Department of Information Technology
The Department of Information Technology comprises the Systems Technology Section and the
Library and Archives Section.
The Systems Technology Section provides, maintains, and integrates RERF computers, maintains the
RERF network under secure conditions, and develops
various databases and database application programs
necessary for RERF researchers. The section is also
involved in technological cooperation in various fields
both inside and outside of Japan.
The Library and Archives Section supervises
RERF’s professional library, with its focus on radia-

Radiation Effects Research Foundation A Brief Description

45

Research departmentstion medicine and biology, and carries out work
related to the publication of RERF research papers inscientific journals. The section records and manages
research papers and academic meeting presentations,as well as collects, stores, and makes available for
perusal other important ABCC-RERF archival materials. It also responds to inquiries and requests for
distribution from both inside and outside of RERF
regarding the above papers and documents.

46

Radiation Effects Research Foundation A Brief Description

Research departments

Organization of RERF

Board ofCouncilors
Scientific Advisory
Committee

Auditors

Local Advisors

Board ofDirectors

Local Liaison
Councils

Hiroshima
Laboratory

Nagasaki
Laboratory

Department ofClinical Studies

Department ofClinical Studies

Department of
Molecular Biosciences

Department of
Epidemiology

Department of
Epidemiology

Biosample Center

Department of
Statistics

Secretariat

Department ofInformation Technology
Radioisotope
Facility

Biosample Center

Secretariat(as of January 2016)

Radiation Effects Research Foundation A Brief Description

47

Glossary

Glossary
increased with radiation exposure.

Physical dose
The gray (Gy; 1 Gy = 1,000 mGy) is a unit used tomeasure radiation dose. One gray is equal to 1 joule
absorption per kilogram of a given material. One grayis equal to 100 rad (rad, or 100 erg per gram, is a unit
previously used to measure radiation dose).
Weighted absorbed organ dose
The majority of A-bomb radiation that reached theground consisted of γ rays, with a small fraction ofneutrons that accounted for only a small percentageof the total dose. Because neutrons affect living tissue more strongly than do γ rays per unit dose, RERF
uses, for each organ, weighted absorbed dose, whichis the sum of the neutron dose multiplied by 10 (aweighting factor that reflects its greater impact) andthe γ-ray dose. Weighted absorbed dose is useful for
expressing a more biologically meaningful dose. For
example, if the colon received 1 Gy of γ rays and 0.1
Gy of neutrons, the weighted absorbed colon dosewould be 1 + 0.1 × 10 = 2 Gy. Weighted absorbed
dose is the same as the commonly used equivalentdose and was once expressed in units of Sv, a unit
used for equivalent dose. However, RERF now uses
weighted absorbed organ dose, expressed in units ofGy, because the unit for the effective dose is also thesievert (Sv). Effective dose, which is the equivalentdose weighted for varying degrees of radio-sensitivityof individual tissues and organs exposed to radiation,
is used as an indicator for the purpose of radiation
protection.
Relative risk (RR)
Relative risk is used here to refer to the ratio ofrisk (mortality or incidence) from an event occurring
among members of a population exposed to radiation
relative to that in an unexposed population, or control
population. An RR of 1 implies that exposure has had
no effect on risk.
Relative risk (RR) =Mortality (incidence) in radiation-exposed population
Mortality (incidence) in unexposed population

Excess relative risk (ERR)
Excess relative risk is used here to refer to theincrease in the ratio of an event (mortality or incidence) occurring among members of a population
exposed to radiation as compared to that in an unexposed population. In other words, ERR is the valueof RR minus 1, indicating how many times risk is

48

Excess relative risk (ERR) =Mortality (incidence) in radiation-exposed population―1
Mortality (incidence) in unexposed population

Excess absolute rate (EAR) (Note: also
expressed as excess absolute risk)
Excess absolute rate is calculated by subtracting
mortality (or incidence) in an unexposed populationfrom mortality (or incidence) among members of a
population exposed to radiation. In other words, EAR
is the absolute value of the increase in rate.
Excess absolute rate (EAR) = (Mortality or incidence rate
in radiation-exposed population) – (Mortality or incidence
rate in unexposed population)

Attributable fraction
Attributable fraction is used here to refer to theincrease in proportion in the outcome rate of mortality or disease incidence due to radiation exposure in
the population under observation. An estimated modelis used for calculation. Total attributable fraction forleukemia, for example, is estimated to be nearly 50%,
and for solid cancers a little less than 10%, among
LSS survivors who received ≥0.005 Gy. Estimatedattributable fraction (in total) measures the excess
event rate in the LSS cohort that is assumed to be
attributable to radiation exposure. It should be notedthat the attributable fraction varies depending onradiation dose distribution, sex/age distribution, andother factors within the cohort. It is also known as
population attributable fraction.
Attributable fraction = the proportion of the total numberof events or the overall rate due to the exposure observed in
the entire cohort, including exposed and nonexposed, that isin excess (ERR) above the number or rate in the nonexposed

Prevalence versus incidence
Prevalence refers to the proportion of patients diagnosed with a disease or medical condition at a given
point in time, regardless of when the disease or medical condition first developed. Incidence refers to therate of patients newly diagnosed during a given time
period (typically one year).
Hypocenter
Hypocenter refers to the location on the grounddirectly below the bomb air-burst point.

Radiation Effects Research Foundation A Brief Description

Glossary

Proximally versus distally exposed
According to the definition used to establish the
LSS cohort, persons exposed to the atomic bombings
within 2.5 km of the hypocenters are referred to as
proximally exposed, and those at distances of 2.5 to
10 km as distally exposed. Since the average estimatedradiation dose for those exposed at approximately 2.5
km of the hypocenter in Hiroshima and those at 2.7
km in Nagasaki is 5 mGy, the figure of 5 mGy issometimes used as the line of demarcation between
proximally and distally exposed groups. In more general applications, these terms are sometimes used withno specific reference to the above definitions.

Radiation Effects Research Foundation A Brief Description

49

References

References【2】Radiation effects on human health:
Acute deaths and acute effects
1.

Sasaki H, Ito C, Kamada N, Shigematsu I: Acute death
and acute effects. Hiroshima International Council for
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A-bomb Radiation on the Human Body, 2nd Edition.
Tokyo: Bunkodo; 2012. pp 10–3. (Japanese)
Fujita S, Kato H, Schull WJ: The LD50 associated with
exposure to the atomic bombing of Hiroshima andNagasaki. J Radiat Res 1991; 32(Suppl):154–61.
Kusama T, Kai N, Ban N: Radiation and Health Sciences.
Tokyo: Kyorin Shoin; 1995. (Japanese)
Stram DO, Mizuno S: Analysis of the DS86 atomic bombradiation dosimetry methods using data on severe epilation. Radiat Res 1989; 117:93–113.

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【4】Radiation dosimetry【A】Physical dose measurements
1. Dosimetry system and residual radiation
5.

Okajima S, Fujita S, Harley JH: Radiation doses fromresidual radioactivity. Roesch W, ed. US-Japan Joint Reassessment of Atomic Bomb Radiation Dosimetry in
Hiroshima and Nagasaki Final Report. Volume 1.
Hiroshima: Radiation Effects Research Foundation; 1987.
pp 205–26.
NHK Hiroshima Bureau, A-bomb Project Team,
Maruyama T, Kato H, Watanabe T, et al.: 42 Years of
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Relief Party. Tokyo, NHK Publishing Co., Ltd.; 1988.
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Okajima S, Takeshita K, Antoku S, et al.: Effects of theradioactive fallout of the Nagasaki atomic bomb. ABCC
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Little MP, Hall P, Charles MW: Are cancer risks associated with exposures to ionising radiation from internal
emitters greater than those in the Japanese A-bomb survivors? Radiat Environ Biophys 2007; 46:299–310.
Lee W, Chiacchierini RP, Shleien B, et al.: Thyroid tumors
following 131I or localized X irradiation to the thyroid andpituitary glands in rats. Radiat Res 1982; 92:307–19.
Ron E, Lubin JH, Shore RE, et al.: Thyroid cancer after
exposure to external radiation: A pooled analysis of sevenstudies. Radiat Res 1995; 141:259–77.
Tronko MD, Howe GR, Bogdanova TI, et al.: A cohort
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Chornobyl accident: Thyroid cancer in Ukraine detectedduring first screening. J Natl Cancer Inst 2006; 98:897–903.
Zablotska LB, Ron E, Rozhko AV, et al.: Thyroid cancer
risk in Belarus among children and adolescents exposed toradioiodine after the Chornobyl accident. Br J Cancer
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Brenner AV, Tronko MD, Hatch M, et al.: I-131 dose
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the Chornobyl accident. Environ Health Perspect 2011;
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50【B】Biological dosimetry
1. Chromosome aberrations

14. Kodama Y, Pawel D, Nakamura N, et al.: Stable chromosome aberrations in atomic bomb survivors: Results from
25 years of investigation. Radiat Res 2001; 156:337–46.

2. Electron spin resonance (ESR) using tooth
enamel

15. Nakamura N, Miyazawa C, Sawada S, et al.: A close correlation between electron spin resonance (ESR) dosimetry
from tooth enamel and cytogenetic dosimetry from lymphocytes of Hiroshima atomic-bomb survivors. Int J
Radiat Biol 1998; 73:619–27.
16. Nakamura N, Cullings HM, Kodama Y, et al.: A method
to differentiate between the levels of ESR signals inducedby sunlight and by ionizing radiation in teeth from atomic
bomb survivors. Radiat Res 2006; 165:359–64.

【5】Radiation effects on human health:
Late effects【A】Results from studies of A-bomb survivors

17. Ozasa K, Shimizu Y, Suyama A, et al.: Studies of themortality of atomic bomb survivors, Report 14, 1950–
2003: An overview of cancer and noncancer diseases.
Radiat Res 2012; 177:229–43.
18. Yamada M, Wong FL, Fujiwara S, et al.: Noncancer disease incidence in atomic bomb survivors, 1958–1998.
Radiat Res 2004; 161:622–32.

1. Malignant tumors(1) Leukemia and related diseases(See also reference17.)19. Hsu WL, Preston DL, Soda M, et al.: The incidence ofleukemia, lymphoma and multiple myeloma among
atomic bomb survivors: 1950–2001. Radiat Res 2013;
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20. Preston DL, Kusumi S, Tomonaga M, et al.: Cancer incidence in atomic bomb survivors. Part III. Leukemia,
lymphoma and multiple myeloma, 1950–1987. Radiat Res
1994; 137(2 Suppl):S68–97.
21. Iwanaga M, Hsu WL, Soda M, et al.: Risk of myelodysplastic syndromes in people exposed to ionizing radiation:
A retrospective cohort study of Nagasaki atomic bomb
survivors. J Clin Oncol 2011; 29:428–34.

(2) Solid cancers(See also reference 17.)

22. Preston DL, Ron E, Tokuoka S, et al.: Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res
2007; 168:1–64.

(3) Site-specific cancer risks
a. Stomach cancer(See also references 17 and 22.)

23. Sauvaget C, Lagarde FAA, Nagano J, et al.: Lifestyle factors, radiation and gastric cancer in atomic-bomb survivors (Japan). Cancer Causes Control 2005; 16:773–80.
24. Hayashi T, Ito R, Cologne JB, et al.: Effects of IL-10
haplotype and atomic bomb radiation exposure on gastriccancer risk. Radiat Res 2013; 180:60–9.

b. Colorectal cancer(See also references 17 and 22.)

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25. Semmens EO, Kopecky KJ, Grant EJ, et al.: Relationshipbetween anthropometric factors, radiation exposure, andcolon cancer incidence in the Life Span Study cohort ofatomic bomb survivors. Cancer Causes Control 2013;24:27–37.

c. Liver cancer(See also reference 22.)

26. Sharp GB, Mizuno T, Cologne JB, et al.: Hepatocellular
carcinoma among atomic bomb survivors: significant
interaction of radiation with hepatitis C virus infections.
Int J Cancer 2003; 103:531–7.
27. Ohishi W, Fujiwara S, Cologne JB, et al.: Impact of radiation and hepatitis virus infection on risk of hepatocellular
carcinoma. Hepatology 2011; 53:1237–45.

d. Lung cancer(See also references 17 and 22.)

28. Furukawa K, Preston DL, Lonn S, et al.: Radiation andsmoking effects on lung cancer incidence among atomic
bomb survivors. Radiat Res 2010; 174:72–82.

e. Breast cancer

29. Land CE, Tokunaga M, Koyama K, et al.: Incidence offemale breast cancer among atomic bomb survivors,
Hiroshima and Nagasaki, 1950–1990. Radiat Res 2003;
160:707–17.
30. Land CE, Hayakawa N, Machado SG, et al.: A case-control interview study of breast cancer among JapaneseA-bomb survivors. II. Interactions with radiation dose.
Cancer Causes Control 1994; 5:167–76.
31. McDougall JA, Sakata R, Sugiyama H, et al.: Timing of
menarche and first birth in relation to risk of breast cancerin A-bomb survivors. Cancer Epidemiol Biomarkers Prev
2010; 19:1746–54.
32. Tokuoka S, Asano M, Yamamoto T, et al.: Histologic
review of breast cancer cases in survivors of atomic
bombs in Hiroshima and Nagasaki, Japan. Cancer 1984;
54:849–54.

f. Urinary organ cancer(See also references 17 and 22.)

33. Grant EJ, Ozasa K, Preston DL, et al.: Effects of radiationand lifestyle factors on risks of urothelial carcinoma in theLife Span Study of atomic bomb survivors. Radiat Res
2012; 178:86–98.

g. Brain and central nervous system tumors(See also reference 22.)

34. Preston DL, Ron E, Yonehara S, et al.: Tumors of thenervous system and pituitary gland associated with atomic
bomb radiation exposure. J Natl Cancer Inst 2002;
94:1555–63.

h. Thyroid cancer(See also reference 22.)

35. Socolow EL, Hashizume A, Neriishi S, et al.: Thyroid
carcinoma in man after exposure to ionizing radiation. A
summary of the findings in Hiroshima and Nagasaki. N
Engl J Med 1963; 268:406–10.
36. Furukawa K, Preston D, Funamoto S, et al.: Long-term
trend of thyroid cancer risk among Japanese atomic-bomb
survivors: 60 years after exposure. Int J Cancer 2013;
132:1222–6.
37. Imaizumi M, Usa T, Tominaga T, et al.: Radiation doseresponse relationships for thyroid nodules and autoim-

mune thyroid diseases in Hiroshima and Nagasaki atomic
bomb survivors 55–58 years after radiation exposure.
JAMA 2006; 295:1011–22.
38. Hayashi Y, Lagarde F, Tsuda N, et al.: Papillary microcarcinoma of the thyroid among atomic bomb survivors:
Tumor characteristics and radiation risk. Cancer 2010;
116:1646–55.
39. Hamatani K, Eguchi H, Ito R, et al.: RET/PTC rearrangements preferentially occurred in papillary thyroid cancer
among atomic bomb survivors exposed to high radiation
dose. Cancer Res 2008; 68:7176–82.
40. Hamatani K, Mukai M, Takahashi K, et al.: Rearranged
anaplastic lymphoma kinase (ALK) gene in adult-onset
papillary thyroid cancer amongst atomic bomb survivors.
Thyroid 2012; 22:1153–9.

2. Noncancer diseases and abnormalities(excluding deaths due to blood diseases)(See also references 17 and 18.)

41. Kubo M, Kiyohara Y, Kato I, et al.: Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese community: The Hisayama Study.
Stroke 2003; 34:2349–54.

(1) Mortality and incidence of circulatory disease (heart disease and stroke)(See also reference 18.)

42. Shimizu Y, Kodama K, Nishi N, et al.: Radiation exposureand circulatory disease risk: Hiroshima and Nagasaki
atomic bomb survivor data, 1950–2003. BMJ 2010;
340:b5349.
43. Takahashi I, Abbott RD, Ohshita T, et al.: A prospective
follow-up study of the association of radiation exposure
with fatal and non-fatal stroke among atomic bomb survivors in Hiroshima and Nagasaki (1980–2003). BMJ Open2012; 2:e000654.
44. Wong FL, Yamada M, Sasaki H, et al.: Effects of radiationon the longitudinal trends of total serum cholesterol levelsin the atomic bomb survivors. Radiat Res 1999; 151:736–
46.
45. Sera N, Hida A, Imaizumi M, et al.: The association
between chronic kidney disease and cardiovascular disease risk factors in atomic bomb survivors. Radiat Res
2013; 179:46–52.

(2) Mortality and incidence of liver disease(See also reference 18.)

46. Shimizu Y, Pierce DA, Preston DL, et al.: Studies of themortality of atomic bomb survivors. Report 12, part II.
Noncancer mortality: 1950–1990. Radiat Res 1999;
152:374–89.
47. Shimizu Y, Kato H, Schull WJ, et al.: Studies of the mortality of A-bomb survivors. 9. Mortality, 1950–1985: Part
3. Noncancer mortality based on the revised doses (DS86).
Radiat Res 1992; 130:249–66.
48. Preston DL, Shimizu Y, Pierce DA, et al.: Studies of mortality of atomic bomb survivors. Report 13: Solid cancer
and noncancer disease mortality: 1950–1997. Radiat Res
2003; 160:381–407.
49. Sharp GB, Mizuno T, Fukuhara T, et al.: Lack of association between acute exposure to ionizing radiation and livercirrhosis. Int J Radiat Biol 2006; 82:231–40.
50. Beebe GW, Yamamoto T, Matsumoto YS: ABCC-JNIH
pathology studies, Hiroshima-Nagasaki. Report 2. October

Radiation Effects Research Foundation A Brief Description

51

References

1950–December 1965. ABCC Technical Report 8-67.
1967.
51. Schreiber WM, Kato H, Robertson JD: Cirrhosis of theliver, Hiroshima-Nagasaki, 1 October 1961–31 December
1967. ABCC Technical Report 17-69. 1969.
52. Asano M, Kato H, Yoshimoto K, et al.: Primary liver
carcinoma and liver cirrhosis in atomic bomb survivors,
Hiroshima and Nagasaki, 1961–75, with special reference
to hepatitis B surface antigen. J Natl Cancer Inst 1982;
69:1221–7.
53. Wong FL, Yamada M, Sasaki H, et al.: Noncancer disease
incidence in the atomic bomb survivors: 1958–1986.
Radiat Res 1993; 135:418–30.

(3) Thyroid disease(See also reference 37.)

54. Shimura H: Frequency and course of thyroid tumors inJapan: Data from complete medical examinations. Nihon
Kojosen Gakkai Zasshi [J Jpn Thyroid Assoc] 2010;
1:109–13. (Japanese)(4) Cataract

55. Cogan DG, Donaldson DD: Experimental radiation cataracts. I. Cataracts in the rabbit following single X-ray
exposure. AMA Arch Ophthalmol 1951; 45:508–22.
56. Masuda Y: Current status of atomic bomb cataracts in
Hiroshima. Nihon Ganka Gakkai Zasshi [Acta Soc Ophtalmol Jpn] 1955; 59:899. (Japanese)
57. Tokunaga T: Atomic bomb radiation cataract in Nagasaki.
Nihon Ganka Gakkai Zasshi [Acta Soc Ophthalmol Jpn]
1959; 63:1211–30. (Japanese)
58. Tokunaga T: Remote study results on atomic bomb cataracts in Nagasaki. Nihon Ganka Gakkai Zasshi [Acta Soc
Ophthalmol Jpn] 1968; 72:1774–81. (Japanese)
59. International Commission on Radiological Protection:
1990 Recommendations of the International Commission
on Radiological Protection. ICRP Publication 60. Ann
ICRP 21 (1-3); 1991.

(5) Gynecological disease(See also reference 18.)

60. Sakata R, Shimizu Y, Soda M, et al.: Effect of radiation onage at menopause among atomic bomb survivors. Radiat
Res 2011; 176:787–95.

(6) Physical growth and development andbone and locomotor apparatus disease

61. Nakashima E, Carter RL, Neriishi K, et al.: Height reduction among prenatally exposed atomic-bomb survivors: A
longitudinal study of growth. Health Phys 1995; 68:766–
72.
62. Nakashima E, Fujiwara S, Funamoto S, et al.: Effect ofradiation dose on the height of atomic bomb survivors: A
longitudinal study. Radiat Res 2002; 158:346–51.
63. Blackard WG, Seigel DG: Peripheral osteoporosis in the
ABCC-JNIH Adult Health Study, Hiroshima-Nagasaki,
November 1961–June 1962. ABCC Technical Report
17-63. 1963.
64. Ross PD, Fujiwara S, Huang C, et al.: Vertebral fracture
prevalence in women in Hiroshima compared to Caucasians or Japanese in the US. Int J Epidemiol 1995;
24:1171–7.
65. Huang C, Ross PD, Fujiwara S, et al.: Determinants ofvertebral fracture prevalence among native Japanesewomen and women of Japanese descent living in Hawaii.

52

Bone 1996; 18:437–42.

(7) Skin disease

66. Committee for the Compilation of Materials on Damage
Caused by the Atomic Bombs in Hiroshima and Nagasaki,ed. Hiroshima and Nagasaki: The Physical, Medical andSocial Effects of the Atomic Bombings). Tokyo: Iwanami
Shoten; 1979. (Japanese).
67. Hatano S, Watanuki K: Report on effects of the A-bombing of Hiroshima, with special reference to keloid formation. The Special Committee for the Investigation of theEffects of the Atomic Bomb, National Research Councilof Japan, ed. Medical Report on Atomic Bomb Effects.
Tokyo: Japan Society for the Promotion of Science; 1953.
pp 621–31. (Japanese)
68. Shirabe R, Tezuka H: Burns and scars induced by A-bomb
and treatment thereof. Hiroshima Igaku [J Hiroshima Med
Assoc] 1959; 12:897–902. (Japanese)
69. Johnson MT, Land CE, Gregory PB, et al.: Effects of ionizing radiation on the skin, Hiroshima-Nagasaki. ABCC
Technical Report 20-69. 1969.

(8) Psychoneurological and psychologicaleffects
70. Yamada M, Kodama K, Wong FL: The long-term psychological sequelae of atomic-bomb survivors in Hiroshima
and Nagasaki. Ricks RC, Berger ME, O’Hara FM, eds.
The Medical Basis for Radiation-Accident Preparedness
III. The Psychological Perspective. Amsterdam: Elsevier;1991. pp 155–63.
71. Yamada M, Izumi S: Psychiatric sequelae in atomic bomb
survivors in Hiroshima and Nagasaki two decades after
the explosions. Soc Psychiatry Psychiatr Epidemiol 2002;
37:409–15.
72. Beebe GW, Kato H, Land CE: JNIH-ABCC Life Span
Study, Hiroshima-Nagasaki. Report 5. Mortality andradiation dose, October 1950–September 1966. ABCC
Technical Report 11-70. 1970.

3. Abnormality in the immune system andinflammation

73. Kusunoki Y, Yamaoka M, Kasagi F, et al.: T cells of
atomic bomb survivors respond poorly to stimulation by
Staphylococcus aureus toxins in vitro: Does this stemfrom their peripheral lymphocyte populations having adiminished naïve CD4 T-cell content? Radiat Res 2002;
158:715–24.
74. Kusunoki Y, Yamaoka M, Kasagi F, et al.: Long-lastingchanges in the T-cell receptor V beta repertoires of CD4
memory T-cell populations in the peripheral blood ofradiation-exposed people. Br J Haematol 2003; 122:975–
84.
75. Yamaoka M, Kusunoki Y, Kasagi F, et al.: Decreases inpercentages of naïve CD4 and CD8 T cells and increases
in percentages of memory CD8 T-cell subsets in the
peripheral blood lymphocyte populations of A-bomb survivors. Radiat Res 2004; 161:290–8.
76. Hayashi T, Morishita Y, Kubo Y, et al.: Long-term effectsof radiation dose on inflammatory markers in atomic
bomb survivors. Am J Med 2005; 118:83–6.
77. Kusunoki Y, Hayashi T: Long-lasting alterations of theimmune system by ionizing radiation exposure: Implications for disease development among atomic bomb survivors. Int J Radiat Biol 2008; 84:1–14.

Radiation Effects Research Foundation A Brief DescriptionReferences

78. Kusunoki Y, Yamaoka M, Kubo Y, et al.: T-cell immunosenescence and inflammatory response in atomic-bomb
survivors. Radiat Res 2010; 174:870–6.
79. Hayashi T, Morishita Y, Khattree R, et al.: Evaluation ofsystemic markers of inflammation in atomic-bomb survivors with special reference to radiation and age effects.
FASEB J 2012; 26:4765–73.

【B】Results from studies of in utero survivors
1. Intellectual impairment
80. Otake M, Yoshimaru H, Schull WJ: Prenatal exposure toatomic radiation and brain damage. Cong Anom 1989;
29:309–20.
81. Otake M, Schull WJ, Yoshimaru H: Brain damage among
the prenatally exposed. J Radiat Res 1991; 32(Suppl):249–
64.

2. Growth impairment

82. Otake M, Schull WJ: Radiation-related small head sizes
among prenatally exposed A-bomb survivors. Int J Radiat
Biol 1993; 63:255–70.
83. Nakashima E: Relationship of five anthropometric measurements at age 18 to radiation dose among atomic bomb
survivors exposed in utero. Radiat Res 1994; 138:121–6.

3. Malignant tumors

84. Preston DL, Cullings H, Suyama A, et al.: Solid cancer
incidence in atomic bomb survivors exposed in utero or as
young children. J Natl Cancer Inst 2008; 100:428–36.

4. Noncancer diseases during adulthood

85. Tatsukawa Y, Nakashima E, Yamada M, et al.: Cardiovascular disease risk among atomic bomb survivors exposed
in utero, 1978–2003. Radiat Res 2008; 170:269–74.

【C】Results from studies of children of
A-bomb survivors (genetic effects)
1. Birth defects (stillbirth, malformation, andneonatal death)86. Neel JV, Schull WJ: The Children of Atomic Bomb Survivors: A Genetic Study. Washington, D.C.: National
Academy Press; 1991.
87. Otake M, Schull WJ, Neel JV: Congenital malformations,stillbirths, and early mortality among the children of
atomic bomb survivors: A reanalysis. Radiat Res 1990;
122:1–11.

2. Sex ratio
See reference 86.
3. Chromosome aberrations

atomic-bomb survivors: Final report. Am J Hum Genet
1988; 42:663–76.
91. Neel JV, Satoh C, Goriki K, et al.: The rate with which
spontaneous mutation alters the electrophoretic mobilityof polypeptides. Proc Natl Acad Sci (USA) 1986; 83:389–
93.

(2) DNA studies (1985–present)

92. Kodaira M, Izumi S, Takahashi N, et al.: No evidence ofradiation effect on mutation rates at hypervariable minisatellite loci in the germ cells of atomic-bomb survivors.
Radiat Res 2004; 162:350–6.
93. Kodaira M, Ryo H, Kamada N, et al.: No evidence ofincreased mutation rates at microsatellite loci in offspringof A-bomb survivors. Radiat Res 2010; 173:205–13.
94. Asakawa J, Kuick R, Kodaira M, et al.: A genome scanning approach to assess the genetic effects of radiation inmice and humans. Radiat Res 2004; 161:380–90.
95. Takahashi N, Tsuyama N, Sasaki K, et al.: Segmental
copy-number variation observed in Japanese by arrayCGH. Ann Hum Genet 2008; 72:193–204.

5. Epidemiological and clinical studies

96. Kato H, Schull WJ, Neel JV: A cohort-type study of survival in the children of parents exposed to atomic bombings. Am J Hum Genet 1966; 18:339–73.
97. Neel JV, Kato H, Schull WJ: Mortality in the children of
atomic bomb survivors and controls. Genetics 1974;
76:311–26.
98. Izumi S, Suyama A, Koyama K: Radiation-related mortality among offspring of atomic bomb survivors: A halfcentury of follow-up. Int J Cancer 2003; 107:292–7.
99. Yoshimoto Y, Neel JV, Schull WJ, et al.: Malignant tumors
during the first 2 decades of life in the offspring of atomic
bomb survivors. Am J Hum Genet 1990; 46:1041–52.
100. Izumi S, Koyama K, Soda M, et al.: Cancer incidence inchildren and young adults did not increase relative toparental exposure to atomic bombs. Br J Cancer 2003;
89:1709–13.

6. Prevalence of lifestyle diseases

101. Fujiwara S, Suyama A, Cologne JB, et al.: Prevalence ofadult-onset multifactorial disease among offspring ofatomic bomb survivors. Radiat Res 2008; 170:451–7.
102. Tatsukawa Y, Cologne JB, Hsu WL, et al.: Radiation riskof individual multifactorial diseases in offspring of theatomic-bomb survivors: A clinical health study. J Radiol
Prot 2013; 33:281–93.

88. Awa AA, Honda T, Neriishi S, et al.: Cytogenetic study ofthe offspring of atomic bomb survivors, Hiroshima andNagasaki. Obe G, Basler A, eds. Cytogenetics: Basic andApplied Aspects. Berlin: Springer; 1987. pp 166–83.

4. Genetic effects studies at the protein leveland subsequent DNA studies(1) Blood protein mutations (1975–1985)

89. Neel JV, Satoh C, Hamilton HB, et al.: Search for mutations affecting protein structure in children of atomic
bomb survivors: Preliminary report. Proc Natl Acad Sci(USA) 1980; 77:4221–5.
90. Neel JV, Satoh C, Goriki K, et al.: Search for mutations
altering protein charge and/or function in children of

Radiation Effects Research Foundation A Brief Description

53

Atomic Bomb Dome
Hiroshima Castle
Aioi Bridge

Hiroshima Peace Memorial Park

Peace Boulevard

Radiation Effects Research Foundation

放影研 Radiation Effects Research Foundation

RERF

A BRIEF DESCRIPTION

5-2 Hijiyama Park, Minami-ku, Hiroshima 732-0815 Japan
Tel: 082-261-3131
8-6 Nakagawa 1-chome, Nagasaki 850-0013 Japan
Tel: 095-823-1121
http://www.rerf.jp/

Radiation Effects Research Foundation
A Japan-US Cooperative Research Organization

Publication date: December 2014
First revision: April 2016
Printer: Letterpress Co., Ltd.