HEALTH CONSEQUENCES OF AND

LESSONS LEARNED FROM

MEDICAL RESPONSE TO
SELECTED RADIATION ACCIDENTS

Module XIX
Chernobyl
 Accident at Chernobyl NPP
(26 April 1986)
Moscow
RUSSIAN
FEDERATION
Kaluga
BELARUS Bryansk
Gomel
? Chernobyl

Kiev UKRAINE

Map of area studied

Module Medical XIX-(15) 2
 Chernobyl reactor
accident

Total contaminated surface (> 1 Ci/km 2): 1 000 000 km 2

Near zone (<100 km): deposition of heavy particles ( Sr, Pu...
Far
Module Medicalzone
XIX-(15) (up to 2000 km) : deposition of volatile elements (I, Cs) 3
 Chernobyl disaster: radionuclides
released
Radionuclide Half life Estimated activity
PBq MCi
Sr-89 50 d 20–80 0.6–2.2

Sr-90 28 y 1–8 0.03–0.22

I-131 8d 630–1660 17–45

I-132/Te-132 3d 400–1800 10–50

I-133 20 h 2500 68

Cs-134 2y 18–48 0.5–1.3

Cs-137 30 y 30–90 0.8–2.4
Module Medical XIX-(15) 4
 Main radionuclides contributing
to health effects
iodine - 131 caesium-137
volatile volatile
T1/2: 8 day T1/2: 30 years
disappears from stays long in
environment in 2 environment
months body elimination in
inhalation and about 100 days
ingestion homogenous
concentrates in distribution in all
thyroid organs and soft
tissues
Module Medical XIX-(15) 5
 Biological effects of exposure to
ionizing radiation
Deterministic effects
occur when the dose is above given threshold
(characteristic for the given effect)
severity increases with the dose
many cells die or have function altered
examples: erythema, fibrosis, marrow depletion, cataract
Stochastic (probabilistic)
have no known threshold
probability of occurrence increases with dose
may result from alteration in only one or few cells
examples: carcinogenic - various neoplasms
genetic - various hereditary disorders
Module Medical XIX-(15) 6
 Erythema on a Chernobyl fireman on Day 17
(primarily from beta radiation)

Module Medical XIX-(15) 7

 Severe multiple necrotic-ulcerative
radiation burns in Chernobyl fireman on
Day 40 after the accident

Module Medical XIX-(15) 8

 Module Medical XIX-(15) 9
Lloyd, D.C.: Chromosome analysis to assess radiation dose, Stem Cells, 15: 195-201, 1997
 DISTRIBUTION OF 237 CHERNOBYL PATIENTS TREATED
FOR ACUTE RADIATION SYNDROME BY THE SEVERITY
OF SICKNESS AND RANGE OF WHOLE BODY EXPOSURE

Degree Number Deaths in Whole body

of ARS of patients 3 months dose, Gy
IV 21 20 6-16
III 22 7 4-6
II 50 1 2-4
I 41 0 1-2
I-IV 134 28 1-16
Not confirmed 103 0 <2
Ref.: Ilyin L.A.: Chernobyl - Myth and reality, Megapolis, Moscow, 1995
Wagemaker G. et al., IAEA/WHO/CEC Chernobyl Conf. Vienna, 1996
Module Medical XIX-(15) 10
 14 death in 106 confirmed
ARS patients, 1987-2000
In 1987-2000 14 confirmed ARS patients died
for different reasons

Cause of death only in three cases

(Myelodysplastic syndrome) may be
associated with II-III degree of ARS

◼ [Ref.: UNSCEAR Report 2000, Part II, Table 55,

p.542, United Nations, New York, 2000]

Module Medical XIX-(15) 11

 BMT/CHERNOBYL
CRITERION FOR TRANSPLANTATION IN CHERNOBIL:
IRREVERSIBLE MYELOSUPPRESSION (OVER 5,6 Gy)

BMT CONTROL
DOSE PATIENT DIED SURVIVED PATIENT DIED SURVIVED
(Gy)
< 6,5 4 3 1 (5,6 Gy) 5 0 5
6,5-9 3 2 1 (8,7 Gy) 4 3 1
>9 6 6 0 5 5 0
TOTAL 13 11 2 14 8 6

Module Medical XIX-(15) 12

 Human data on
radiation cancerogenesis
Population Leukemia Thyroid Lung Breast Bone Skin
groups
A-bomb + + + +
survivors
Ra-dial +
painters
Early +
radiologist
U-miners +

Exposed in +
a nuclear
accident

Module Medical XIX-(15) 13

 Thyroid cancer and
ionizing radiation

Chernobyl accident shows that exposure

to iodine isotopes may cause increase in
prevalence of thyroid carcinoma
In 1990-2000 about 1800 thyroid cancers
observed in 18 million children and
adolescents, i.e. under 18 years old,
living in the most contaminated areas of
Belarus, Ukraine and Russia

Module Medical XIX-(15) 14

 Post-Chernobyl
thyroid cancer
• increase observed mainly in
children under 15
• incidence rates increased by 100 in
the most affected areas (Gomel,
Belarus and North of the Ukraine)
in 1990-94
• incidence rate multiplied by 3 in
adults (Belarus)
Module Medical XIX-(15) 15
 Childhood thyroid cancer around
Chernobyl in 1986-1998 (children
<15 years old at diagnosis)
Annual number of cases in children

100
90
(<15 yrs old at diagnosis)

80
70
60
50
40
Belarus
30
20 Ukraine
10 Russia
0
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
[UNSCEAR: Exposures and Effects of the Chernobyl Accident, Annex J, New York, 2000]

Module Medical XIX-(15) 16

 Incidence of childhood thyroid cancer
(<15 years old at diagnosis)
around Chernobyl in 1986-1998

Incidence, number of new cases in 100 000 children per year

6
5
4
3 Russia
2 Belarus
1 Ukraine
0
86
87
88
89
90
91
92
93
94
95
96
97
98
19
19
19
19
19
19
19
19
19
19
19
19
19
[UNSCEAR: Exposures and Effects of the Chernobyl Accident, Annex J, New York, 2000]
Module Medical XIX-(15) 17
 Thyroid cancer around Chernobyl in
1986-1998 (Annual number of cases
among ~18M citizens <18 years old in 1986)
at diagnosis)
<18inyrs

180 100
Annual num ber of cases

160
cases

80
140
being
1986)

120
60
ber of
yrsinold

100
citizens

80 40 Belarus
children (<15old
ong num

60
Ukraine
40 20
Annual

20 Russia
0 0
(am

1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1990 1991 1992 1993 1994 1995 1996 1997 1998

[UNSCEAR: Exposures and Effects of the Chernobyl Accident, Annex J, New York, 2000]
Module Medical XIX-(15) Total No. of thyroid cc. in 13 years =1791 18-
 Clinical and epidemiological features of
childhood thyroid carcinomas diagnosed in
Belarus Chernobyl accident
less influenced by gender
◼ female/male ratio was 1.4:1.0 (spontaneous:
2.5/1)
mean age
◼ At time of first diagnosis: 9.4±2.8 years
◼ At time of the accident: 3.8 ± 2.4 years
◼ More than 90% of the patients were less than 6
years old and 3% were still in utero at time of
accident.

Module Medical XIX-(15) 19

 Morphological analysis of post-Chernobyl
childhood thyroid carcinomas

Large majority are papillary carcinomas, very

few follicular histotype. Among papillary type,
many (33%) solid and follicular variants
Focal micropapillary hyperplasia frequently
found in post-Chernobyl thyroid glands

J Clin endocrinol Metab 1997;82:3563

Cancer 1994;74:748
J Clin Endocrinol metab 1996;81:9-14

Module Medical XIX-(15) 20

 Distribution of thyroid doses in children and
adolescents in Belarus and the Ukraine

% 60

50
40

30 Ukraine: 67475
subjects
20 Belarus: 15000
subjects
10

0
1-2 Gy

2-5 Gy

>10 Gy
5-10 Gy
0-0,3 Gy

0,3-1 Gy

Module Medical XIX-(15) 21

 Thyroid doses in
I-131 therapy vs radiation induced
thyroid carcinoma

-500 Gy I-131 therapy of

differentiated thyroid
carcinoma

-250 Gy

-100 Gy I-131 therapy of

-70 Gy hyperthyroidism

-0.15-5.7 Gy radiation induced

thyroid carcinoma

Module Medical XIX-(15) 22

 Other factors contributing to the
increased rate of childhood thyroid
cancer around Chernobyl

moderate to severe iodine deficiency

late iodine prophylaxis (or thyroid
blocking in many villages and towns not
evacuated)
active screening (ultrasound, fine needle
biopsy) manifesting also the occult cases
awareness (parents request more thyroid
examinations of their children than before)

Module Medical XIX-(15) 23

 Leukemia and
other cancer
No significant increase in leukemia or cancer
other than thyroid; solid tumor observed in
Chernobyl cleanup workers*

Tendency for elevated leukemia rates, however,

among those who received significant doses
while working on site in 1986 and 1987. So far
statistically significant leukemia excess reported
for Russian cleanup workers only**

Module Medical XIX-(15) 24

 Psychological disorders
Significant psychological disorders
caused by mental distress, among most
frequent consequences of accident
Psychological effects of Chernobyl
accident mainly due to lack of reliable
public information
Distress caused by misperception of
radiation risk extremely harmful

Module Medical XIX-(15) 25

 Lifetime mortality in population of all
ages from fatal cancer after
exposure to low doses
O r g a n o r t is s u e F a ta l C a n c e r
P r o b a b ilit y
C o e f f ic ie n t
-4 -1
(1 0 S v )
B la d d e r 30
B o n e M a rro w 50 * general public (all age
B o n e S u rfa c e 5 groups) only
B re a s t 20
C o lo n 85 Summary factor of cancer risk
L iv e r 15 for working population taken to
Esophagus 30 be 400x10-4 Sv-1
O v a ry 10
S k in 2 Reference ICRP, Publ. 60,
S to m a c h 110 1991
T h y r o id 8
R e m a in d e r 1 50

T o ta l 500*

Module Medical XIX-(15) 26

 Attributable lifetime risk of fatal cancer
Attributable lifetime depending on age at exposure
risk, % per sievert

Age at time of exposure

Module Medical XIX-(15) 27
 PREDICTIONS OF BACKGROUND AND EXCESS DEATHS
FROM CANCER DUE TO CHERNOBYL
Population Number of Excess dose,
group persons mSv/70 yrs
Clean-up workers 200,000 100
Evacuees (30 km z.) 135,000 10
Residents at 137Cs: 270,000 50
(>555 kBq/m 2)
Residents at 137Cs: 6,800,000 7
(<555 kBq/m 2)

Total 7.4 M ps --- background cancer death = 932,500

--- excess from Chernobil = 8,900
Ref.: Cardis et al: Estimated Long Term Health Effects of the Chernobyl Accident, in: (< 1 %)
“One Decade after Chernobyl”, EC/IAEA/WHO, Vienna, 8-12 April, 1996 , 241-279

Module Medical XIX-(15) 28

 PREDICTIONS OF BACKGROUND AND EXCESS
CANCER DEATHS AND HEREDITARY DISORDERS
DUE TO CHERNOBYL

In 7 .4 M p erso n s ex p o sed a n d liv in g in co n ta m in a ted a rea s

--- b a ck g ro u n d ca n cer d ea th = 9 3 2 ,5 0 0
--- ex cess fro m C h ern o b y l = 8 ,9 0 0
(< 1 % )
U p p er lim it o f th e
--- b a ck g ro u n d h ered ita ry d iso rd ers = 2 8 4 ,0 0 0
--- ex cess risk fro m C h ern o b y l = 275
(< 0 .1 % )
R e f.: C a rd is e t a l: E stim ate d L o n g T e rm H e alth E ffec ts o f th e C h e rn o b y l A c cid e n t, in :
“ O n e D ec ad e afte r C h e rn o b y l” , E C /IA E A /W H O , V ie n n a, 8 -1 2 A p ril, 1 9 9 6 , 2 4 1 -2 7 9

Module Medical XIX-(15) 29

 Chernobyl conclusions
Radiation burns frequent
Burns over 50% of body surface led to death in
19 of 28 cases
Internal contamination present in most patients
but was significant in few
Sepsis was uniform cause of death
BMT –very limited indication
Some radiation burns did not re-epithelialize,
required surgery

Module Medical XIX-(15) 30