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The Risk: Health Effects
The Risk: Health Effects

 Measuring Human Exposure
 Studying Radiation's Effects on Humans
 Human Health Effects of Ionizing Radiation
 Health Effects of Radon
 Radiation-Related Health Effects from Living near Nuclear Power Plants
 Accidental Releases
 Determining Levels of Risk
 Balancing the Benefits and Risks of Radiation

Tables and Figures

 Table 2: Biological Effectiveness Factor by Radiation Type
 Figure 18: Ionization of an Atom
 Figure 19: Atomic Bomb Explosion
 Table 3: Estimated Lifetime Cancer Risk from Increased Radiation Exposure
 Figure 20: Genetic Damage from Radiation
 Figure 21: Annual Deaths from Natural Radiation and Selected Other Causes
 Figure 22: Nuclear Power Plant

Ionizing radiation is intricately woven into the fabric of modern life. But living and working with radiation can be hazardous. If we want to continue enjoying the benefits that radiation brings, we may have to accept some additional risk to our health and environment.

How much risk is acceptable to us as a society? This is a subject of constant and often heated debate. To participate constructively in that debate, we must:

  • Understand the risks — how and to what extent the different kinds and sources of radiation can affect our health and environment.
  • Learn what the producers and users of radiation, the government, and each of us as individuals, can do to minimize those risks.

Measuring Human Exposure

Several factors are involved in determining the potential health effects of exposure to radiation. These include:

Amount of the Dose
The most important factor is the amount of the dose — the amount of energy actually deposited in your body. The more energy absorbed by cells, the greater the biological damage. Health physicists refer to the amount of energy absorbed by the body as the radiation dose. The absorbed dose, the amount of energy absorbed per gram of body tissue, is usually measured in units called rads.

The amount of the dose depends on such factors as:

  • The number and energy level of the radiation particles emitted by the source (the source's activity, measured in units called curies)
  • The distance from the source (Distance is especially important with alpha radiation; more than a few centimeters from the source, the amount of the dose approaches zero.)
  • The amount of exposure time
  • The degree to which radiation dissipates in the air or in other substances between the source and the recipient
  • The penetrating power of the radiation

Ability to Harm Tissue.
Health physicists also must take into account the ability of the type of radiation involved to harm human tissue. To do this, they multiply the absorbed dose by a biological effectiveness factor, the Q factor, to come up with a measurement of harm called the dose-equivalent. (Table 2) the Q factor is a "consensus factor" agreed upon by experts and used for regulatory purposes.

Table 2. Biological Effectiveness
Factor by Radiation Type

Type of Radiation
Q Factor
Alpha particles
20
Beta particles
1
Gamma radiation
1
Protons, fast neutrons
10
Slow (thermal) neutrons
2

In the United States, dose-equivalent is commonly expressed in rem, which stands for radiation equivalent man. Small doses are measured in thousandths of a rem or millirem. The United States and international scientific communities also use units called Sieverts, which are each equal to 100 rem.

Which Organs are Affected.
The potential health effects of radiation also depend on which organs of the body are most likely to absorb radiation.

(Adapted from Ionizing Radiation-It's Everywhere! Los Alamos Science, Los Alamos National Laboratory, Number 23, 1995.)

Studying Radiation's Effects on Humans

There are a number of studies of the effects of radiation on humans, among them are:

After rigorous peer review, the information from the studies is published in medical and scientific journals and made available to the public. Because of these and other studies, more is known about the health effects of ionizing radiation than of any other carcinogen.

Human Health Effects of Ionizing Radiation

Ionization
Most atoms are electrically neutral; they have the same number of positively charged protons in their nucleus as negatively charged electrons orbiting the nucleus. However, when ionizing radiation passes through a material, it can transfer some of its energy to an electron; this "knocks" the electron out of its orbit. The free negative electron leaves behind a positively charged ion. (Figure 18) This process is called ionization.

Figure 18. Ionization of an Atom
ionization of an atom
Source: The Ohio State University Extension

Knowing about ionization is important for two reasons.

Exposure to Ionizing Radiation
Exposure to high levels of ionizing radiation is dangerous, even deadly. Acute exposure to radiation in the range of 300,000 to 500,000 millirems can destroy cell tissue almost immediately, causing death within a few days or weeks for more than half of the exposed population. Fortunately, the chance of the average citizen receiving such a large dose of radiation is extremely small.

Doses above 5,000 millirem are known to substantially increase the risk of infection and cancer and potentially cause genetic damage to the exposed person and his or her offspring. Cataracts, premature aging, hair loss, skin burns, and a shortened life span are other known consequences of high-level exposure. Since a radiation-induced cancer cannot be distinguished from cancer caused by other factors, however, it is difficult to single out radiation as the cause of any particular cancer.

The average person in the United States receives an exposure of approximately 360 millirems per year. While exposure above 5,000 millirem can cause observable biological effects (and at higher doses can be fatal), there is little evidence of health or safety effects at exposure levels below 1,000 millirem. Any exposure to radiation, however, may pose some risk.

Many scientific studies have demonstrated a relationship between the amount of radiation and the likelihood of adverse health effects. To minimize human health effects, regulators assume that there is some risk associated with any level of radiation, and set exposure standards accordingly.

High-Dose Effects
In the first decades after the discovery of radioactivity and xrays in the 1890s, the health effects of ionizing radiation were not recognized. Scientists and others who worked with radioactive materials took no special precautions to protect themselves.

Skin cancers in scientists who were studying radioactivity were first reported in 1902. By 1912, researchers found leukemia in humans and animals exposed to radiation, and by 1930 genetic effects were identified.

In the 1930s, the occupational hazards of working with radiation became apparent. A 1931 report described cases of bone cancer in women who licked the brushes (to get a better brush point) they used to paint radioactive radium on watch dials. In 1944, the first cases of leukemia were reported in physicians and radiologists who used radiation in their work. By 1951, thyroid cancer was reported in persons exposed to radiation as children.

In 1945, Japanese citizens were exposed to high doses of radiation (up to 500,000 millirem or more) during the bombings of Hiroshima and Nagasaki. (Figure 19)

Figure 19. Atomic Bomb Explosion
atom bomb

Studies of the atomic bomb survivors and other people exposed to high levels of radiation have shown that acute exposure to ionizing radiation can cause cancer, sterility, and genetic damage; and damage to bone marrow, the central nervous system, and the gastrointestinal system.

In the years since the bombing on Hiroshima and Nagasaki, scientists have tracked the health histories of more than 75,000 survivors. The studies indicate that radiation was a factor in approximately 12 percent of all the cancers (including leukemia, breast cancer, thyroid cancer, and skin cancer), and approximately 9 percent of the 6,000 fatal cancers that developed among the atomic bomb survivors. In sum, this means approximately 500 more cancer deaths occurred among the exposed population than an unexposed population of the same size.

Other effects that appeared in the exposed population include the suppression of the immune system and cataracts. An increased rate of mental retardation has been found in atomic bomb survivors whose mothers were between 8 and 25 weeks pregnant at the time of exposure. (The brain tissues of a fetus are especially sensitive to radiation at certain stages of development.) So far, however, the children and grandchildren of exposed survivors have shown no greater incidence of genetic problems than unexposed populations. More than 56 percent of the exposed survivors were still alive in 1990, when the most recent cycle of mortality information was completed.

These studies have made it possible for scientists to record the long-term effects of a wide range of radiation doses, including doses comparable to an average person's lifetime dose from naturally occurring background radiation, about 20,000 millirem (300 millirem a year for 70 years).

Among the most important findings from the human health studies are:

Low-Dose Effects
Determining the health effects of exposure to low levels of radiation has been much more difficult than determining the effects of high-level exposure, for two reasons.

  • Cells can repair some damage caused by low levels of radiation absorbed over long periods of time.
  • It is difficult to tell whether a particular cancer was caused by radiation, by one of the more than 300 other known carcinogens in the environment, or by other unknown factors.

Dr. Arthur C. Upton, former chairman of the New York University Medical Center, Department of Environmental Medicine, has compared efforts to detect the effects of low-level radiation with "trying to listen to one violin when the whole orchestra is playing. You can't hear it."

The numerous studies of potential health effects in people exposed to low-level radiation (that is, below about 10,000 to 40,000 millirem) have yielded inconclusive results. For example, studies have been conducted in populations living with background radiation several times higher than the United States. These studies have not found any statistically significant evidence of a correlation between cancer mortality and levels of background radiation.

Many scientists and policy makers take the position that any amount of radiation exposure, even at background levels, poses some increased risk of adverse health effects. Just how much risk, however, is still unknown and is the subject of continuing debate.

Although no health effects have been observed at very low doses, regulators assume that any amount of radiation may pose an increased risk for causing cancer and hereditary effects. They also assume that there is a one-to-one, or linear relationship between a radiation dose and its effect. That is, small doses have a small risk in direct proportion to the known effects of large doses.

This technique, known as the linear no-threshold hypothesis, uses mathematical models to estimate the risks of very low exposures based on the known risks of high-level exposures. Some scientists question the linear hypothesis because of the lack of evidence of health effects from low radiation doses, as well as the fact that many other hazardous substances harmful at high doses have little or no effect at low doses. The U.S. Committee on the Biological Effects of Ionizing Radiation (BEIR), convened by the National Academy of Sciences (NAS), acknowledged in 1990, that there is no data showing that low doses of radiation cause cancer.

The BEIR Committee, however, recommended the use of the linear no-threshold hypothesis because it is consistent with other approaches to public health policy. The United States and other countries use linear estimates to set limits on all potential exposures to radiation, both for the public and for workers in jobs that expose them to ionizing radiation.

In 1998, the BEIR Committee reported that recent epidemiological studies of radiation and cancer warrant a reevaluation of the health risks associated with low-level doses of radiation. The committee will review all relevant data and develop new risk models to try to determine more definitively the health risks, if any, from low-level doses of radiation.

Lifetime Risk of Cancer from Increased Radiation Exposure
The BEIR Committee estimated the lifetime risk of cancer to individuals from high-level and low-level exposures to radiation. (Table 3)

Table 3. Estimated Lifetime Cancer Risk from Increased Radiation Exposure

Type of exposure to whole-body external radiation Increase in cancers per 1,000 people (above that expected for a similar but unexposed population)
Single, high-level exposure to 10,000 millirem
8 cancers (about 3%)
Continuous low-level exposure to 500 millirem
5.6 cancers (about 2%)
Source: National Academy of Science

These estimates used the linear no-threshold hypothesis to develop average cancer estimates over all possible ages at which a person might be exposed, weighted by population and age distribution. The calculation compares the estimated increase in cancers due to whole-body external radiation from a single, high-level exposure (10,000 millirem), and from continuous low-level exposure (500 millirem, the current upper limit for individual exposure recommended by federal guidance).

Because of the extensive scientific research on radiation and the large number of studies of exposed persons, these estimates have a higher degree of certainty than the risk estimates for most chemical carcinogens.

Genetic Effects
Both high-level and low-level radiation may cause other adverse health effects besides cancer, including genetic defects in the children of exposed parents or mental retardation in the children of mothers exposed during pregnancy. The risk of genetic effects due to radiation exposure, however, is much lower than the risk of developing cancer. By breaking the electron bonds that hold molecules together, radiation can damage human DNA, the inherited compound that controls the structure and function of cells. Radiation may damage DNA directly by displacing electrons from the DNA molecule, or indirectly by changing the structure of other molecules in the cell, which may then interact with the DNA. When this happens, a cell can be destroyed quickly or its growth or function may be altered through a change (mutation) that may not be evident for many years. (Figure 20)

Figure 20. Genetic Damage from Radiation

damage from radiation

Source: U.S. Environmental Protection Agency

At low radiation doses, however, the possibility of such a change causing a clinically significant illness or other problem is believed to be remote.

In addition, cells have the ability to repair the damage done to DNA by radiation, chemicals, or physical trauma. How well cellular repair mechanisms work depends on the kind of cell, the type and dose of radiation, the individual and other biological factors.

Health Effects of Radon

Radon accounts for more than half of our total average annual exposure to radiation, about 200 millirem per year. (Figure 21)

Figure 21. Annual Deaths from Natural Radiation and Selected Other Causes
annual deaths

*An estimated 20,000 from radon and 15,000 from natural sources other than radon.

Source: U.S. Environmental Protection Agency (radiation estimates) and National Center for Health Statistics (1997 data).

Radon is a known cause of lung cancer in humans. The most recent National Academy of Science (NAS) report on radon, The Health Effects of Exposure to Radon (the BEIR VI Report, published in 1999), stated that radon is the second leading cause of lung cancer and a serious public health problem. The NAS report estimated that about 12 percent of lung cancer deaths in the United States are attributable to exposure to radon in indoor air — about 15,000 to 22,000 lung cancer deaths each year. In a second NAS report published in 1999 on radon in drinking water, the NAS estimated that about 89 percent of the fatal cancers caused by radon in drinking water were due to lung cancer from inhalation of radon released to indoor air, and about 11 percent were due to stomach cancer from consuming water containing radon.

Radon decay products can attach themselves to tiny dust particles in indoor air, which are easily inhaled into the lungs. The particles then attach to the cells lining the lungs and emit a type of ionizing radiation called alpha radiation. This can damage cells in the lungs, leading to lung cancer. Our knowledge of the health effects of radon comes from extensive studies of miners and of people exposed to radon in their homes. Experimental studies in animals and molecular and cellular studies provide supporting evidence and some understanding of the mechanisms by which radon (i.e., alpha radiation) causes lung cancer.

A person's risk of getting lung cancer from radon depends upon several variables, including the level of radon in the home, the amount of time spent in the home, and whether the person is a smoker. The risk of lung cancer is especially high for cigarette smokers exposed to elevated levels of indoor radon. NAS found evidence of an interaction between radon and cigarette smoking that increases the lung cancer risk to smokers beyond what would be expected from the additive effects of smoking and radon. In most cases, radon in soil under homes is the biggest source of exposure to radon. However, there are public health concerns associated with drinking water containing radon. When radon in water is ingested, it is distributed throughout the body. Some of it will decay and emit radiation while in the body, increasing the risk of cancer in irradiated organs (although this increased risk is significantly less than the risk from inhaling radon).

Most of the damage is not from radon gas itself, which is removed from the lungs by exhalation, but from radon's short-lived decay products (half-life measured in minutes or less). When inhaled, these decay products may be deposited in the airways of the lungs and subsequently emit alpha particles as they decay further. The increased risk of lung cancer from radon primarily results from alpha particles irradiating lung tissues. When an alpha particle passes through a cell nucleus, DNA is likely to be damaged, and available data indicate that a single alpha particle passing through a nucleus can cause genomic changes in a cell, including mutation and transformation. Since alpha particles are more massive and more highly charged than other types of ionizing radiation, they are more damaging to the living tissue.

An important finding of the BEIR VI report is that even very small exposures to radon can result in lung cancer. The NAS concluded that no evidence currently exists that shows a threshold of exposure below which radon levels are harmless, that is, a level below which it is certain that no increased risk of lung cancer would exist.

Radiation-Related Health Effects from Living near Nuclear Power Plants

Nuclear power plants expose people living near them to small amounts of radiation, less than one millirem per year. (Figure 22)

Figure 22. Nuclear Power Plant
nuclear power plant

In the United States, the EPA sets strict standards governing radiation emissions, which are enforced by the Nuclear Regulatory Commission. Radiation levels at nuclear power plants are monitored 24-hours-a day. Neighboring soil, cows' milk, fish, and sediment in rivers and lakes are monitored periodically.

In September 1990, a National Cancer Institute study found no evidence of an increase in cancer mortality among people living in 107 counties that host or are adjacent to 62 nuclear facilities in the United States. The research, which evaluated mortality from 16 types of cancer, showed no increase in childhood leukemia mortality rates in the study counties after nuclear facilities were opened. The NCI surveyed 900,000 cancer deaths in counties near nuclear facilities that operated for at least five years prior to the start of the study (the minimum time considered sufficient for related health effects to appear).

The conclusions of the NCI study, the broadest ever conducted, are supported by many other scientific studies in the United States, Canada, and Europe.

Accidental Releases

Many people worry about the risks of radiation not so much because of routine, low-level exposures, but because of the possibility of an accident at the plant. What if an explosion or meltdown at a nuclear reactor released deadly amounts of radiation or radioactive materials into the environment? Public anxiety was heightened in March 1979 by the accident at the Three Mile Island nuclear power plant in Pennsylvania. That accident was followed by a much worse catastrophe at the Chernobyl nuclear power plant in the former Soviet Union in April 1986.

Three Mile Island
Three Mile Island is the only major accident in the history of U.S. commercial nuclear energy. Although some radioactive material escaped from the reactor containment building, the accident caused no deaths or injuries. It resulted in an average dose of eight millirems to people living within 10 miles of the plant (about the same as a chest xray) and only 1.5 millirem to people living within a 50-mile radius. The maximum individual dose was less than 100 millirem. Subsequent studies have found no evidence of increases in cancer (including childhood leukemia), thyroid diseases, or other health effects as a result of the accident.

Chernobyl
The Chernobyl accident, however, was much more serious than Three Mile Island. There was no containment building around the reactor. A chemical explosion set the reactor core on fire, directly releasing large amounts of radioactivity into the atmosphere. Thirty-one plant workers and firefighters, who received doses up to 1.6 million millirem, died from the accident, and more than 130 plant workers and rescuers suffered from confirmed cases of acute radiation sickness. The average radiation dose to the 135,000 people evacuated from the region was 12,000 millirem. The doses included external gamma radiation, beta radiation to the skin, and internal doses to the thyroid.

During the first year after the accident, excess radiation doses to adults in seven Western European countries ranged from 130 millirem in Switzerland, to 95 millirem in Poland, to 2 millirem in southern England. Nearly 3 million acres of farmland in Ukraine were contaminated by radioisotopes and plutonium, and may be unusable for decades. Chernobyl was a graphic example of just how serious the health and environmental consequences of a catastrophic nuclear accident can be.

Could such an accident happen again? While there are still some Chernobyl-type reactors operating in Eastern Europe that are cause for concern, remedial measures were taken to enhance the safety of these reactors. Safety upgrades, performed between 1987 and 1991, essentially remedied the design deficiencies that contributed to the accident.

Reactor Safety Standards
Most of the world's nuclear power plants are built differently than Chernobyl and operate according to much stricter safety standards. They have redundant safety systems to prevent the kind of explosion and fire that released radioactive material into the environment at Chernobyl. National and international nuclear regulatory bodies keep a watchful eye on reactor operations and target potentially unsafe conditions and practices. If companies do not take prompt action to correct such safety problems, they can be forced to shut down their reactors.

As new reactors replace older reactors, the new designs will include safety features such as the use of gravity and convection in cooling water systems rather than mechanical pumps and motors that might fail. New control room designs will also reduce the possibility of human error, a significant factor in both the Three Mile Island and Chernobyl accidents. The Nuclear Energy Institute, an industry group, argues that the advanced plants will be able to meet safety goals that are more than 100 times more stringent than those of current nuclear plants.

The haunting specters of Chernobyl and, to a lesser extent, Three Mile Island, will linger in the public's memory for years to come. But there are other issues related to nuclear power, particularly the management and disposal of highly radioactive waste that pose potential risks to public safety and the environment. These issues are discussed in the Radioactive Waste page.

Determining Levels of Risk

To establish standards for protecting the public from environmental hazards, including radiation, regulators often use a type of analysis called risk assessment. Risk Assessment includes four steps:

  1. Hazard identification. In this step, researchers determine whether a substance causes cancer or other health effects. Human data has confirmed that ionizing radiation can cause cancer in the human body. Factors to determining the hazard associated with exposure to particular radiation include the following:
    • Amount of radioactivity
    • Type of radiation involved
    • Duration of exposure
    • Distance from the source

    Other factors that contribute to the risk of harm resulting from exposure to radiation include:

    • Types of cells and specific parts of the body that absorb the radiation
    • The exposed person's age, sex, physical condition, and genetic tendency either to resist or be affected by radiation

  2. Dose-response assessment. This step determines the relationship between the amount of exposure and the likelihood of developing cancer and other health effects. The accuracy of this assessment is based on the quality of information available from similar exposures. The data on radiation dose-response relationships are very reliable at high doses. Scientists extrapolate the known dose-response relationship to estimate risk at low levels of exposure. This method is considered by many to be reasonably conservative, but has its critics who consider it either too liberal or too conservative.

  3. Exposure assessment. This step involves estimating the extent to which people could be exposed to radiation emitted by the source. It includes estimating:
    • How much of the source exists,
    • How radiation from the source will reach people (e.g., through the air, water, or food), and
    • How big a dose they will receive from each medium the radioactive material travels through (e.g., How much contaminated air will they breathe? How much contaminated water will they drink?).

Balancing the Benefits and Risks of Radiation

Governmental Risk Assessments and Standards
Because exposure to high-level ionizing radiation is known to cause cancer and other health problems, public health regulators have taken a cautious approach. They assume that any exposure could cause similar effects. They have established protective standards by directly extrapolating the risks from high doses of radiation to minimize the risks of exposure to low doses. Much of the current controversy surrounding radiation is based on whether we should assume low doses also cause health affects.

Since most scientists assume that any radiation exposure entails some risk, how do we decide what level of risk is justified by the benefits of its use? In life, there is always a statistical chance that some people will contract certain diseases. Scientists and public health professionals perform risk assessments to determine the additional likelihood of being harmed from exposure or from certain behaviors. For a carcinogen such as radiation, risk is the additional likelihood of contracting cancer from exposure.

Over the years since radiation was first discovered and used, the government has constantly tightened the standards that limit the amount of radiation to which workers and the public can be exposed. The national and international regulatory standards for radiation exposure are based on more research and more direct evidence of health effects than for almost any other hazardous substance. By setting and enforcing strict exposure standards, governments have tried to balance the benefits of using radiation with the risks.

Individual Judgments
Making judgments on safety for society as a whole is primarily the government's responsibility. But each of us as individuals can also avoid unnecessary exposure to radiation, so that we derive the benefits from radiation and do not undergo more risk than necessary.

It is always prudent to avoid unnecessary exposure. However, refusing xrays or radiation therapy may cost more money, time, convenience, or health problems, than taking advantage of radiation's unique diagnostic and healing properties. Each of us must make such decisions based on our tolerance for risk, and our confidence in doctors and their medical advice.

Society's Judgments, Pro and Con
Society as a whole must balance the risks and benefits associated with nuclear energy, including the use of radiation. Nuclear advocates argue that nuclear power is a proven, secure, and inexhaustible long-term source of energy. They argue that nuclear energy creates little air pollution, and contributes almost nothing to global warming.

Nuclear energy could become increasingly important in the twenty-first century as global energy demands continue to rise, and nonrenewable energy sources, such as fossil fuels and natural gas, are slowly depleted. Proponents say that nuclear power, if properly managed, can benefit humanity and the environment with a level of risk no greater than that we routinely accept as part of our normal lives.

Critics of nuclear power, however, ranging from environmentalists to antiwar activists, point to a variety of problems with nuclear energy, including:

Some opponents of nuclear energy argue that the problems are so serious that we should shut down the nuclear power industry. A better alternative, nuclear critics claim, would be to focus attention and resources on developing safe, nonpolluting, renewable energy sources such as solar, wind, and geothermal power.

Future Prospects for Nuclear Power
Partly because of these disagreements, the future of nuclear power is mixed. Even advocates acknowledge that few if any new nuclear power plants are likely to be built in the United States in the next decade. In part, this is due to the lack of public support. A March 1999 Associated Press poll, taken 20 years after Three Mile Island, showed that only 45 percent of Americans support the use of nuclear energy, 10 percent fewer than in 1989.

Recent energy supply problems in California, however, have sparked some renewed interest in nuclear power. Another limiting factor is the high cost of building new nuclear plants. In addition, many of the existing plants now nearing the end of their useful lives are unlikely to be replaced, at least right away. Many will seek licenses to operate for a longer time period.

Government and industry experts continue to design safer reactors, work to improve techniques for decontaminating older reactors, and find safer, more secure ways to handle and dispose of radioactive wastes. Some proponents expect nuclear energy to contribute to a growing share of the world's increasing energy needs in spite of continued protests and controversy. (For more information, see Nuclear Energy Institute.)


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December 11, 2002

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