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A Sample Chapter From
Radioactive Baby Teeth: The Cancer Link

By Joseph J. Mangano, MPH, MBA


On a warm June day in 2001, Joe Mangano sat in his office, located in his New York City apartment. The day was proceeding normally when the phone rang in the afternoon. It was Danny Kohl, a biology professor at Washington University in St. Louis. Mangano was a researcher with the group Radiation and Public Health Project (RPHP). He had been in touch with Kohl, who had been at Washington University for over 40 years, and had shared his recollections of the old St. Louis tooth project with Mangano.

The call was quite unremarkable, in the minds of both Kohl and Mangano. Kohl had gotten word from university officials who contacted him as they looked for storage space. "The University has boxes of teeth" revealed Kohl, "at Tyson Valley, a World War II gunnery range near St. Louis, now owned by the school." Mangano knew this meant baby teeth left over from the landmark study of radioactive Strontium-90 from atomic bomb tests in bodies. The study led to passage of the treaty that halted bomb tests above the ground, but had ended in 1970. Kohl had first phoned Barry Commoner, a biology professor who had directed the study, to ask if he was interested in the teeth. Commoner replied that he wasn't, but that Mangano's group, the Radiation and Public Health Project, should be contacted, since it was conducting another study of baby teeth of children living near nuclear reactors.

Mangano wanted to know how many teeth were at the site, and Kohl answered

"I don't really know. I'll drive out soon to check them out, and maybe I'll take Rosenthal with me" (referring to Harold Rosenthal, who ran the laboratory in the 1960s. Rosenthal had retired but still lived in St. Louis).

The phone call ended after no more than ten minutes. Mangano resumed his work, thinking the discovery was interesting, but nothing more. That all changed the following day when Kohl phoned Mangano again, and took away Mangano's breath with what he revealed:

"I went to Tyson Valley, and there are probably 200 cardboard boxes that look like long shoe boxes, each filled with maybe 100 teeth. They're in this storage bunker. Some are moldy, but they haven't fallen apart. The boxes are in good shape. I took one with me to examine, they are teeth from people born in 1956."

Unlike the day before, Mangano's eyes widened. This was big, big news, a jackpot. There were thousands, maybe tens of thousands of teeth that hadn't been used in the old study, quietly slumbering away for over three decades. Washington University wasn't interested in them, and if there had been no takers, they would have thrown them away. When Kohl asked if RPHP was interested in the teeth, Mangano responded with a "my God, yes." His mind began to race. The teeth could still be tested for Strontium-90. The tooth donors weren't children any more, but in their 40s. This could mean an incredible health study, tracking the health of St. Louis kids who had donated teeth, to see if those with high Sr-90 levels as children were more likely to have died or developed cancer by middle age.

This kind of health study is known as a prospective, or longitudinal study, considered the gold standard of health research. Humans are identified for risk factors and their health is tracked over time. Probably the most famous prospective study is the Framingham heart disease study. In 1948, federal officials signed up 5,000 residents of the Massachusetts town bearing the study's name. As time went on, researchers began to see that those with heart disease were more likely to be smokers, overweight, sedentary, and have high-fat diets. These patterns held up over 50 years, for both men and women. Much of what scientists know about heart disease risk today is from the Framingham study.

The big problem with prospective studies like Framingham is that they often take many years and require large sums of money. As a result, not many are attempted. But the St. Louis teeth offered a chance for an "instant" prospective study that would be much less costly than others. Tooth donors hadn't been followed since they gave their teeth, but death records and health histories could provide the same information as if they had been continually tracked. The ability to detect levels of Strontium-90 (or other slow-decaying radioactive chemicals) would allow "high-risk" and "low-risk" children to be identified. And with thousands of teeth, significant samples would not be hard to obtain.

Things began to happen quickly. Mangano phoned his colleagues at RPHP, including Jay Gould, Ernest Sternglass, and Bill McDonnell. As the excitement spread within the group, each was sworn to silence: not a word was to be breathed. After all, they were still the property of Washington University. Moreover, nobody knew if the health study was feasible, until it was determined that either death records or health histories of tooth donors were needed.

The first step was to get the teeth. Ralph Quatrano, the chairman of the University's biology department, agreed to release the teeth to RPHP, and to pay for the shipping. RPHP supporter Marcia Marks volunteered to go to St. Louis and supervise the packing. Marks was a social worker who lived in Maryland who had taken an interest in RPHPs work. She had grown up in St. Louis and returned periodically to visit family. In a grueling effort on a hot July day, she made sure the movers placed the teeth boxes in bigger boxes, and that they were sent to McDonnell, who was to store the teeth in his office. Marks recalls that day:

"The bunker was made of cinder blocks, and there was a musty smell to the room. But the boxes were in good shape, except the ones that touched the floor, which were somewhat mildewed."

Most boxes were sent to McDonnell, who had the space to store them, but 12 were sent separately to Mangano, just in case the unthinkable happened and the teeth were damaged or lost. They arrived safe and sound, however, and Mangano and McDonnell began to dig through the boxes. The biggest finding was that Kohl's estimate was very, very low - the actual number was 85,000 or more. McDonnell estimated that about 90% of the teeth were persons born 1954-1963, with 55% born in 1958, 1959, and 1960. Probably 95% or more had cards attached to the teeth with information identifying the donor that was legible, thus making it possible to use the teeth in a research project.

The visual effects of old 3 x 5 cards paper-clipped to small manila envelopes were strong, like going back into time. When the 86 year old Gould was hospitalized shortly after the teeth were sent from St. Louis, Mangano paid a visit and brought along some teeth. Gould was in a downcast mood, feeling trapped in his hospital bed. But when Mangano produced several teeth envelopes and cards, Gould's eyes bulged and his jaw dropped. "Oh my" he said over and over as he handled the teeth, before breaking into a hearty laugh.

Mangano and Gould attended a board meeting of Standing for Truth About Radiation, the Long Island anti-nuclear group. Mangano made a brief presentation, and passed around several tooth envelopes and cards for board members to examine. Model Christie Brinkley, a member of the group's board, immediately saw an opportunity. She began posing with the teeth, in a parody of modeling, as a camera snapped pictures and everyone laughed.

Despite all the excitement, RPHP had work to do before making the discovery public. In particular, was it possible to do a health study in which tooth donor's health history could be followed up? The first question was whether it was possible to find which donors were deceased. The results were positive. The National Center for Health Statistics informed Mangano that it kept records of all deaths in the U.S. beginning in 1979, including the name of the deceased, date of death, and cause of death. All that was needed to locate someone who died was their first and last names (maiden name for women), date of birth, and parent names - each of which was on the cards attached to tooth envelopes. If RPHP wanted to spend less money, the state of Missouri also kept records of all deaths beginning in 1979, for deaths that occurred in Missouri.

Deaths alone might make a good follow up study. About 5% of the baby boomers who were young children in the 1960s had died by their late 40s, about 7% of the males and 3% of the females. But a substantial number of these were from causes that had nothing to do with radiation exposure, like accidents, homicide, and suicide. What about those who were still alive but suffering from cancer or other diseases? There were probably as many cancer survivors as there were cancer deaths. To find out which tooth donors were sick, they needed to be contacted at their current address.

Before the Internet was invented, it probably would have been impossible to find these people. But now, companies could take a person's name and birth date and locate their current address. Gould financed a trial in which 100 St. Louis tooth donors were randomly selected and a search firm attempted to find them. The search for girls did not turn out well, probably due to the fact that many had married and changed their name since they had donated a tooth. But there was good success with boys, as a current address was produced for 82% of them.

RPHP then mailed a draft survey to these boys, asking if their birth date and parents names were correct, and if they would be willing to participate in a follow up survey. About 35% responded, all indicating the information was correct and that they would be glad to join such a survey. RPHP believed the 35% figure could be boosted; there was nothing on the return address to indicate the letter had to do with the baby teeth survey, so some may have dismissed it as junk mail and thrown it away. In addition, letters were sent while the country was in the midst of a panic after deadly anthrax was sent to Congress through the mail in the wake of the 9/11 terrorist attacks.

The final step before going public was to see if Sr-90 could be detected in the teeth. McDonnell sent a sample of teeth to radiochemist Hari Sharma, who had been testing teeth for the RPHP study in his laboratory. McDonnell deliberately did not tell Sharma that these teeth were over 40 years old, only that they were baby teeth. Using the study protocol of testing each tooth for about seven hours to get as accurate a reading as possible, Sharma came up with an accurate Sr-90 measurement for the majority of them. Some readings were inaccurate because of the lack of healthy enamel.

There was also the possibility of testing for other radioactive chemicals aside from Sr-90 in the St. Louis baby teeth. One lab advised that Plutonium-239 could be detected, and with a half life of 24,000 years, virtually all of it from the bomb tests would still be in the teeth. This gave RPHP another option for a health study.

With all preliminary questions answered, the health study was now feasible. And RPHP decided to let the country know about the discovery of the treasure of teeth.

In early November, the St. Louis Post-Dispatch was contacted. This was the same newspaper that had covered the tooth study throughout the 1960s. And even though the project had ended years ago, its editors hadn't forgotten its importance, or the sense of pride it instilled in the city. On November 9, with the nation focused almost exclusively on the terrorism issue, the Post-Dispatch nonetheless placed a long article squarely in the middle of page one. The story began with the theme of a treasure hunt:

"Washington University researchers on a spring cleaning mission in May swung open the door to a dark, musty ammunition bunker in southwest St. Louis County and re-discovered a scientific gold mine."

The article went on to describe the opportunity to perform a follow-up health study on tooth donors. It quoted Harold Rosenthal as saying "we still don't know the effect of that on health," referring to atomic bomb test fallout.

The Post-Dispatch had its scoop, and the story hit the Associated Press wires and spread like wildfire through the U.S. media. All four major St. Louis television stations covered it, as did KMOX and other radio stations in the city. Newspapers from many cities wrote articles, including the Denver Post, Las Vegas Review Journal, Los Angeles Times, Omaha World Herald, Pittsburgh Post-Gazette, Salt Lake City Tribune, San Diego Union Tribune, San Francisco Chronicle, and Washington Post. Gould was interviewed by National Public Radio, and the British Broadcasting Company aired a story. In January, USA Today, with the largest circulation of any daily U.S. newspaper, published a lengthy article.

The San Francisco Chronicle even published an editorial supporting the idea of a follow-up health study.

"After World War II, the United States exploded 100 nuclear bombs above ground, mostly in Nevada. At the time, peace activists - then discredited as Nervous Nellies - worried that strontium-90, a byproduct of nuclear testing, might pollute children's milk. . . Now workers at Washington University in St. Louis have unearthed those long-forgotten baby teeth. The New York-based Radiation and Public Health Project is attempting to find the adults who once donated them to science.

There is a lesson here: Nervous Nellies who warn of environmental and health risks may drive government officials crazy, but they are not always wrong."

Most, but not all, the publicity was positive. The Washington Post article was headlined "Revival of Baby Teeth Study Denounced: Bid to Explore Effects of '60s Radiation on Donors in Later Years Called 'Junk Science'." But by and large, most of the coverage was an exciting account of the discovery and prospects for a health study.

The Post-Dispatch article included RPHPs address, phone number, and email address for those interested in the follow up study. The response was overwhelming, as 1900 emails flooded the group over the next three months, along with another 200 letters and 100 phone calls. Most were from the Baby Boomers who had donated teeth years before, or from their parents. The memories came flooding back and many recounted stories of how they gave teeth years earlier, and how they received buttons saying "I Gave My Tooth to Science."

"A picture on the front page of the St. Louis Post-Dispatch caught my eye this morning. It was a little drawing of a kid missing some teeth with the words 'I gave my tooth to science.' I have a button just like that! I think I may be one of the donors of the 85,000 baby teeth that were collected and recently found at Washington University."

Some former residents of St. Louis who lived across the country wrote to RPHP after reading about the discovery of the teeth:

"Wow!!! I clearly remember my mother donating every baby tooth of mine from the time that I began losing them back in 1958. (I remember it vividly because I would get so angry at my mom for sending them off)! . . . It is so funny too, at my last class reunion, many of us talked about this very same thing. You can imagine my surprise when I read the article about your discovery this morning in the Fresno Bee."

A number of respondents, some of whom were researchers or scientists, immediately saw the possibility and importance of doing a follow up health study for tooth donors:

"I understand the huge task in front of you and wish you well on your search for funding. Your project is fascinating and I think it is of tremendous importance while so many of us are still alive to discuss our health problems with you. Good luck and happy hunting!"

"I am a physicist at Princeton University now working on technical arms control and nonproliferation issues . . . We were just discussing the famous 'baby teeth' controversy in class today, so I thought it quite a coincidence to see the USA Today article."

But by far the most heartfelt correspondence came from those Baby Boomers who were suffering from cancer or other diseases, or had lost a loved one to cancer at an early age. About 130 emails and letters were of this type. A sampling of some of these responses follows. The most common type of cancer reported was thyroid cancer, which is strongly linked with radioactive iodine in bomb test fallout:

"When I was 18 years old I came down with papillary carcinoma of the thyroid. At the time I was told it was very rare for an 18 year old to develop the disease. I wonder, after I read the article in today's paper, if my cancer came from nuclear testing."

"I have a keen interest in this because my son, born 1958, developed thyroid cancer about 20 years later, and I've had a hunch for a long time that the radioactive fallout had something to do with it."

"I am very interested in the tooth study, even if you don't find any of my (six) children's teeth. It is significant that two of them have had thyroid cancer."

"Glad you are doing this. . . One sister and I had thyroid cancer of the type caused by exposure to external radiation. We have eliminated all possible sources, dentists, shoe measurements, genetic predisposition, etc. - except the fallout."

"My daughter Kathleen (who died of thyroid cancer in 2000) was convinced that the large number of her friends in the 50 year old age group suffering from cancer, would have to have some common exposure to some carcinogenic agent."

"I am very interested to hear the results of the study. I was diagnosed with breast cancer in 1996 at age 35 and then again in 2000 at age 39. I had genetic testing done to see if I have the BRCA 1 or the BRCA 2 gene , and it was inconclusive. . . I have no family history of breast cancer."

"My older sister Ann Lynn died of Lymphoma in 1995. Since the family had no history of cancer, the doctors thought she may have contracted the disease through the 'environment.' Since I read your article, I wonder if it could have been caused by fallout."

"My (first) husband was born in 1959, and was diagnosed with Mylo-monocytic Leukemia in 1989, sadly he died after a 3 year battle. He was a strong athletic man. I guess we are all still looking for answers. . .if there are any. He left behind 3 children."

"I've lived in St. Louis all my life. I have come down with chronic lymphocytic leukemia and have always wondered if it came from the milk and strontium 90 which we heard a lot about back then or fallout from the A bombs. It would be interesting research to me."

"My oldest sister was diagnosed with non-Hodgkins Lymphoma in 1990 and died in 1995. We also have other instances of cancer in our family. I had heard that there are no genetic factors that would explain the lymphoma in our family, so I have to wonder if it is environmental."

"I was born in 1951 in St. Louis. . . I remember receiving a little button with a gap tooth smiling boy with 'I gave my tooth to science.' In 1991 I was diagnosed with squamous cell cancer of the left tonsil. . . I was told I had the tonsils of a 60 year old smoker and I've never smoked or drank in my life. I've had a suspicion for a long time that this had been more 'environmental' in nature."

Other letters were from people who did not have cancer, but suspected that bomb fallout may have harmed them.

"I would be interested in helping with any survey you might need. I have some autoimmune problems which are currently unexplained. Maybe someday a connection might be found."

"My sister. . . has had serious problems with her thyroid and had it removed approximately 5 years ago. Nobody else in the family has experienced any problems. I think that there may be a correlation between her health problems and the subject(s) that you are looking into."

"I have Hashimoto thyroiditis which is when the body thinks the thyroid is a foreign body and starts attacking it - I wonder if there is any correlation between that and the strontium 90?"

Not surprisingly, there was criticism of any potential health study - even though RPHP had not yet agreed on how to proceed. Physicist Dade Moeller, a long time critic of the group, wasted no time in pouncing. "They have an agenda to pursue, and they will leave nothing undone to achieve their goals," he proclaimed. Stephen Musolino, a physicist who worked at Brookhaven National Laboratories, said "Their aim is well known; they dislike anything nuclear."

But these critics were overwhelmed by public support for a study of St. Louis baby tooth donors. It seemed almost certain that a follow up study would be funded. Years earlier, Gould had received support for his first book Deadly Deceit from the Deer Creek Foundation, a St. Louis charity that funded liberal causes. RPHP placed an application to Deer Creek, proposing to study a sample of the St. Louis tooth donors. A number of people who were leaders of the study 40 years ago sent in letters of support.

One day Mangano received a phone call from Deer Creek. They had read the account of the St. Louis tooth discovery in the newspapers, and were impressed. But something had bothered them. Barry Commoner, the former Washington University biology professor who led the original study, was skeptical about the possibility to evaluate health risks from Strontium-90 in old baby teeth. "To use this for an epidemiological link is very iffy," said Commoner, who was still active professionally in his mid-80s. "They mean well, but I have never associated myself with their results."

These comments were strange, given that Commoner had suggested the teeth be given to RPHP. Moreover, years ago he had argued strenuously for a study evaluating childhood cancer risk from bomb fallout by studying Sr-90 in teeth, only to be told by Harold Rosenthal that such a study was not possible with the lab instruments then available. Nobody at RPHP had any explanation for Commoner's thoughts. Soon after the phone call, Deer Creek rejected the RPHP proposal. Several other applications followed in St. Louis and elsewhere, but all were rejected. The prevailing reason was that such a study had little relevance - bomb testing above the ground had ended with the 1963 Treaty.

But in truth, the issue is a current one still unresolved decades later. About 140 million Americans exposed to bomb fallout are still alive. Virtually all of them have a family member or friend who has suffered from cancer, and many still don't know the cause.

The U.S. government insisted that bomb fallout hadn't harmed one single American until 1997, when the National Cancer Institute issued a report. (The report had begun 15 years before, and had been completed 5 years earlier, only to sit on the desk of the U.S. Energy Secretary). The massive, 100,000 page study, whose release was forced by Energy Department official Robert Alvarez, made estimates of Iodine-131 exposures from Nevada bomb tests in the 1950s and 1960s for all Americans, according to their place of residence, birth date, gender, and milk drinking habits.

The findings were shocking. The doses from iodine-131 were more than 100 times greater than government estimates years earlier. Some counties in Idaho and Montana received hundreds of times more exposure than in less-hard hit areas, such as much of the west coast and desert southwest. The estimate from the report was that between 11,000 and 212,000 Americans developed thyroid cancer just from I-131 exposure from the Nevada tests. The report was a landmark, but it did not cover the dozens of other radioactive chemicals, nor did it examine harm from U.S. tests in the Pacific, and Soviet tests in Siberia.

Some hoped that the 1997 study would be a springboard for more analyses - but exactly the opposite happened. The following year, an expert panel at the Institute of Medicine reported that there is no good way to identify just which Americans developed cancer from bomb tests. The panel also sought to soften the 1997 study by stating that the number of thyroid cancer cases caused by fallout was probably at the low end of the National Cancer Institute estimate, and that thyroid cancer was rarely fatal. "Tell that to my brother," shot back U.S. Senator Tom Harkin, whose brother had died of the disease.

The U.S. Department of Health and Human Services released a study in 2003 concluding that at least 11,000 cancer deaths were caused by bomb fallout in the past half century. This was a tiny number, considering that tens of million Americans were exposed to fallout, including the susceptible Baby Boomers born during the bomb test era, when fallout from American and Soviet explosions amounted to 40,000 Hiroshima bombs.The final blow came in 2005, when federal funding was terminated for a study of effects of bomb fallout being done by Dr. Joseph Lyon of the University of Utah. Even long after the Cold War had ended, the U.S. government had cut and run on the issue of health effects of bomb test fallout. The answer to the question of what fallout - both from weapons tests and reactors operations - had done to Americans is largely an emphatic "nobody knows."

The St. Louis baby teeth offer a good chance to answer that question. There is probably no other way quite as accurate to identify the buildup of fallout in American bodies. Certainly, there is no other sample of similar size. And with nearly four decades having passed since the study ended, and with the ability to find death records of deceased tooth donors and health histories of living ones, now is an ideal time to make such a study.The flurry of recent events surrounding the discovery of St. Louis baby teeth extends a journey that has lasted half a century. Scientists and citizens alike have wanted to understand how much man made radioactivity - from nuclear weapons and reactors - have entered human bodies, and to understand how it has harmed health. Much has been accomplished, but there is a long way to go. The story of the quest for this knowledge is related in this book.