Uranium mining and health

Dr. Thompson of the CNSC has chosen to criticize serval points in our article "Uranium Mining and Health" Canadian Family Physician, May 2013 vol. 59(7):727. We would like to respond to these criticisms.

Regarding the quote in our article, we are determining whether it has been attributed to the wrong reference. The reference cited, Tomasek et al., 2008 does deal with the effect on lung cancer rates of modifying factors such as time since exposure and age at exposure. They start with the acceptance that there are elevated rates of lung cancer due to radon exposure in mining. This represents a health hazard and a cost to individuals, families and to society, and is consistent with our point.

Dr. Thompson takes exception to our contention that the hazards of uranium mining to surrounding populations has not been properly studied. Her literature search revealed six studies, five by the same author. We have several others. This does not constitute a database. It compares very poorly with the body of literature for instance on tobacco use and lung cancer, or lifestyle and heart disease. Uranium mining has gone on for just over 100 years in Europe, and for shorter periods in other regions. A handful of studies, most of them small and limited in statistical power, is not enough.

Small studies have the added drawback in that they often do not achieve statistical significance, even in the presence of a real and non- chance effect. This conveniently allows detractors to trivialize and ignore a real effect.

It is very important, in the context of human health, to appreciate that while a high degree of certainty, usually expressed in terms of statistical significance, is required to add a piece of information to the edifice of human knowledge, even a moderately high level of suspicion (such as a collection of non-significant positive findings) should be enough to disallow an exposure that may be harming otherwise healthy individuals.

The Kerala study does in fact demonstrate increases in Down's syndrome, autosomal dominant congenital anomalies and other things. A careful reading of their conclusion will reveal that large parts of South India are at risk for inbreeding and that in fact the study population and the adjacent control community were well matched in socioeconomic and social parameters, including marriage and migration patterns. Inbreeding is thus not a valid reason to discredit these findings.

In their analysis, the authors of the study state: "There is no reliable database on the spontaneous incidence of single-gene anomalies in human populations. The genetic risk of ionizing radiation is estimated from animal data." (Why is this?) And: " WHO recommended detailed prospective studies in the Kerala HBRR some four decades ago, but this has not yet been done." What are we waiting for?

It is important to note that the WHO was arm-twisted into an agreement in 1959 with the IAEA (International Atomic Energy Agency) which prohibited it from doing or publicizing information on radiation and human health without the approval of the IAEA. The latter is, by stated mandate, a proponent of the nuclear industry.

In her next criticism, Dr. Thompson indicates that "extensive reviews by international scientific bodies" reveal no evidence of inheritable defects in humans due to radiation exposure. The two bodies she quotes are either party to the same 1959 agreement, or closely affiliated with those who are. Perhaps they have failed to find these effects because they have not properly looked. See above.

Lastly, we "fear monger" by claiming that by-products of uranium in the nuclear power industry are used in nuclear weapons. They are. Telling the truth is not fear mongering, no matter how unpleasant the truth. There is no source for plutonium, or other than trace amounts of tritium, on this planet other than inside a nuclear reactor. All nuclear reactors that use U-235 as fuel produce them. There is no reason to enrich uranium, other than to fuel a reactor or produce a bomb, and without highly enriched uranium, or plutonium or tritium you cannot build a bomb. The connection is obvious.

To assume that non-proliferation treaties are going to guarantee that "our" resources are not going to be used in this way once they leave our borders is naive.

To return to her initial statements, her attempt to discredit us as "known anti-nuclear activists" is an ad hominem argument that has no place in scientific discourse. "Activists" quite often can and do speak the truth, and what they have to say should be assessed on its own merit. Most of us have "appeared before the CNSC on multiple occasions" in the context of scheduled Public Hearings, often as invited speakers by other organizations who value our expertise. The CNSC would do well to evaluate its own biases.

Conflict of Interest:

none

All three of the authors are replying or have already submitted replies.

I am wondering when we can expect them to be printed.

In our opinion, this is an egregious attack by an industry spokesperson on our character, our science and our motivations. As physicians, we must be vigilant to industrial (as we have to pharmaceutical) interests insinuating themselves into and imposing themselves upon us.

Conflict of Interest:

Other than the aforementioned retirement funds in uranium mining

The first thing that I notice is that Patsy Thompson states "no competing interests". The CNSC itself has competing interests; it is both a promoter of and regulatory body for all things radioactive in Canada. It oversees the safety of mining, milling, transportation and use of uranium. It also promotes its use.

I also note that she refers to the authors as "activists", a term used by the nuclear industry and, for that matter, any industry that desires to move forward with environmental destruction for monetary reward, to denote derision for those who oppose their goals. With that term, our expertise, our education, and our concern for health becomes reduced to sign-carrying annoyances.

Ms Thompson claims to be the "health expert" on the CNSC panel yet she has no specific qualifications for that - she has not had any health care training. She was overheard at a hearing in Ottawa saying that "there are no effects of exposure to anything under 100 mSv per year". Obviously not a health-care perspective. She also stated that the increases in leukaemia around German nuclear power plants was due to "a virus" - same thing, a virus that has particular virulence around nuclear power plants.

This letter has all the biases of the industry. I would like to believe that UNSCEAR were unbiased but the report on Fukushima - delayed by months and then years indicates that they are not the rapid response and emergency containment advisors that we had hoped they would be - just as CNSC is conflicted about its purpose, so is UNSCEAR.

When we did the PubMed literature search in 2012, we found very little in good solid research on uranium and health. We stand by that statement and by the statement that most studies had flaws - probably most importantly the ones quoted in the CNSC "Synopsis report". We will be more than delighted to conduct a second review.

Conflict of Interest:

None declared

Physicians have no vested interest in "fear-mongering" and in our daily work we look at available evidence and act accordingly in order to help our patients maintain good health. Part of preventative medicine involves helping our patients protect themselves from toxins in the environment, and radiation is a known teratogen and carcinogen. The studies quoted do indeed provide evidence that radiation from nuclear facilities, including uranium mines, damages the health of local people. The CNSC, a clearly pro-nuclear agency of the federal government, is ignoring a plethora of evidence showing harm from radiation in the daily activities of the nuclear power industry. Rather than calling us "anti- nuclear activists" we could be accused of being good doctors whose goal is to keep our patients safe and healthy.

Conflict of Interest:

None declared

Family physicians have an important responsibility in educating the public as well as their patients on health risks. This counsel must be based on sound, scientific evidence. The commentary by Drs. Dewar, Harvey and Vakil on Uranium Mining and Health (1) in the May 2013 issue of the Canadian Family Physician contains false and misleading information, demonstrating personal bias. These known anti-nuclear activists have appeared before the Canadian Nuclear Safety Commission (CNSC) on multiple occasions and we are compelled once again to set the record straight and provide your readers with the accurate and objective information.

Drs. Dewar, Harvey and Vakil misquote a study of Czech and French uranium miners saying the study concluded excess lung cancer, reduced pulmonary function and emphysema due to alpha irradiation from radon and radon progeny (2). In fact, the referenced study did not analyze or publish findings on either reduced pulmonary function or emphysema; it focused on the impact of the quality of the exposure information and the effects of modifying factors (age at exposure, time since exposure) on lung cancer risk.

The authors also falsely claim that the hazards of uranium mining to surrounding populations have not been studied. In fact, a basic literature search of PubMed returned six relatively recent studies of cancer incidence and mortality in populations living near uranium mine, mill and processing operations (3-8). These studies concluded there was no clear or consistent evidence that the nuclear activities had adversely affected the health of residents.

They also claim that genetic effects in humans have been clearly documented, quoting the example of the Kerala, India cohort study of a population exposed to higher levels of natural background radiation which has shown increased incidences of Down syndrome and autosomal dominant congenital anomalies (9). However, the authors neglect to say that the study concluded the higher risk was most likely due to geographic inbreeding of the population (9). In fact, many studies and extensive reviews by international scientific bodies (10, 11) generally conclude that no heritable effects in humans due to radiation exposure have been explicitly identified (10, 11, 12). Specifically, there has been no statistically significant evidence for genetic effects in over 40,000 offspring of the atomic bomb survivors (13). To date, the risk of mortality of cancer and non-cancer diseases among these children was associated with neither fathers' nor mothers' radiation dose (14).

Finally, the authors fearmonger with the claim that by-products of uranium in the nuclear power industry are used in nuclear weapons. This is simply untrue for Canada. Canada is a signatory to the 1970 Nuclear Non- Proliferation Treaty whose objective is to prevent the spread of nuclear weapons. As the Canadian nuclear regulator, the CNSC strictly controls nuclear exports to ensure they do not contribute to the development of weapons or other nuclear explosive devices.

One of the main fundamentals of the CNSC's mandate is to provide objective scientific, technical and regulatory information to the public on nuclear-related health and safety topics, which the authors of the commentary have sorely neglected to do. We invite your readers to visit our website for scientific studies and accurate information on uranium mining and health. http://www.nuclearsafety.gc.ca/eng/resources/health/index.cfm

References

1. Dewar D, Harvey L, Vakil C. Uranium mining and health. Can Fam Physician. 2013 May; 59(5):469-71. Erratum in: Can Fam Physician.2013 Jul;59(7):727.

2. Tomasek L, Rogel A, Tirmarche M, Mitton N, Laurie D. Lung cancer in French and Czech uranium miners: radon-associated risk at low exposure rates and modifying effects of time since exposure and age at exposure. Radiat Res 2008;169(2):125-37.

3. Chen J, Moir D, Lane R, Thompson P. An ecological study of cancer incidence in Port Hope, Ontario from 1992 to 2007. J Radiol Prot. 2013 Mar;33(1):227-42. doi: 10.1088/0952-4746/33/1/227. Epub 2013 Jan 16. PubMed PMID: 23324463.

4. Boice JD Jr, Mumma MT, Blot WJ. Cancer incidence and mortality in populations living near uranium milling and mining operations in grants, New Mexico, 1950-2004. Radiat Res. 2010 Nov;174(5):624-36. doi: 10.1667/RR2180.1. Epub 2010 Sep 13. PubMed PMID: 20954862.

5. Boice JD Jr, Cohen SS, Mumma MT, Chadda B, Blot WJ. A cohort study of uranium millers and miners of Grants, New Mexico, 1979-2005. J Radiol Prot. 2008 Sep; 28(3):303-25. doi: 10.1088/0952-4746/28/3/002. Epub 2008 Aug 20. PubMed PMID: 18714128.

6. Boice JD Jr, Cohen SS, Mumma MT, Chadda B, Blot WJ. Mortality among residents of Uravan, Colorado who lived near a uranium mill, 1936-84. J Radiol Prot. 2007 Sep; 27(3):299-319. Epub 2007 Aug 29. PubMed PMID: 17768330.

7. Boice JD Jr, Mumma MT, Blot WJ. Cancer and noncancer mortality in populations living near uranium and vanadium mining and milling operations in Montrose County, Colorado, 1950-2000. Radiat Res. 2007 Jun;167(6):711- 26. PubMed PMID: 17523851.

8. Boice JD Jr, Mumma M, Schweitzer S, Blot WJ. Cancer mortality in a Texas county with prior uranium mining and milling activities, 1950-2001. J Radiol Prot. 2003 Sep;23(3):247-62. PubMed PMID: 14582717.

9. Padmanabhan VT, Sugunan AP, Brahmaputhran CK, Nandini K, Pavithran K. Heritable anomalies among the inhabitants of regions of normal and high background radiation in Kerala: results of a cohort study, 1988-1994. Int J Health Serv 2004;34(3):483-515.

10. ICRP. Risk estimation for multifactorial diseases. ICRP Publication 83. Annals of the ICRP 29(3-4). International Commission on Radiological Protection, Pergamon Press, Oxford, 1999.

11. UNSCEAR. Hereditary Effects of Radiation. UNSCEAR 2001 Report. United Nations Scientific Committee on the Effects of Atomic Radiation, 2001 Report to the General Assembly, with scientific annexes. United Nations, New York, 2001.

12. UNSCEAR. Sources, effects and risks of ionizing radiation. Volume II Scientific Annex B: Effects of radiation exposure of children. UNSCEAR 2013 Report. United Nations Scientific Committee on the Effects of Atomic Radiation. New York, NY: United Nations, 2013.

13. Izumi, S., Suyama, A. and Kodama, K. Radiation-related mortality among offspring of atomic bomb survivors: a halfcentury of follow-up. Int. J Cancer 107, 292-297 (2003).

14. Izumi, S., Koyama, K., Soda, M. and Suyama, A. Cancer incidence in children and young adults did not increase relative to parental exposure to atomic bombs. Br. J. Cancer 89, 1709-1713 (2003).

Conflict of Interest:

None declared

With regards to radon and lung cancer:

The article states "Radon gas is responsible for up to 20% of cases of lung cancer in Canada". We use radon in this sentence to illustrate the carcinogenicity of inhaled alpha emitters. Although radon is a decay product of uranium, we did not intend to imply that radon in homes thousands of miles from mining sites occurs because of uranium mining.

On a personal note, we have excessive levels of uranium in our (farm) water supply. To the best of our knowledge, neither the potash nor the uranium extractive industries are not responsible.

Conflict of Interest:

As a Saskatchewan resident, my RRSP has funds invested in uranium mining. At the time of writing the article, I was Executive Director of Physicians for Global Survival.

In the article "Uranium mining and health", the authors state that 20% of cases of lung cancer in Canada are due to radon. Recent data from Health Canada estimate that about 16% of lung cancer cases are due to radon, and unlike what is implied in the article, most of the radon from residential exposures is naturally occurring. It is difficult to predict from province to province, from neighbourhood to neighbourhood, or even from house to house, who will have high levels of radon that will require remediation. Radon is, indeed, an important issue that requires more interest and action. But to attribute all of these lung cancer cases to uranium mining is simply misleading. Please refer to Cross-Canada Survey of Radon Concentrations in Homes - Final Report (2012): http://hc-sc.gc.ca/ewh-semt/pubs/radiation/survey- sondage/index-eng...

Conflict of Interest:

None declared