Testimony of Joseph J. Mangano, MPH MBA
To The New Jersey Commission on Radiation Protection
February 16, 2005
Good morning commissioners,
and thank you for the opportunity to make this presentation. My name is
Joseph Mangano, and I’m the National Coordinator of the Radiation
and Public Health Project, a non-profit research organization based in
New York. RPHP, which consists of scientists and health professionals,
is dedicated to studying health risks of ionizing radiation. To this end,
since 1994 our members have published 21 medical journal articles, letters,
and conference proceedings, along with five books, on this topic.
RPHP has long been concerned about two trends in our society: First, the
incidence rate of cancer in American children under 15 has risen 33% from
1975 to 2001. (1) This increase is largely driven by 32% and 63% rises,
respectively, in leukemia and brain cancer. Each year approximately 9,000
American children and their families must hear the dreaded words: you
have cancer. To date, researchers have few answers about what factors
may be causing this unsettling trend. Some experts believe that environmental
causes account for at least part of this increase. A 1997 New
York Times front page article ran the headline
“Increase May be Tied to New Chemicals in the Environment.”
(September 27, 1997).
Second, environmental radioactivity levels in the U.S. appear to be rising.
From the late 1980s to the early 2000s, the average gross beta activity
in precipitation has increased 54%, covering approximately 60 stations
where the U.S. Environmental Protection Agency makes monthly measurements.
(2) Gross beta is a composite of all beta-emitting radioactive chemicals,
such as Strontium-90. This trend indicates that a current source, not
a past source like atmospheric atomic weapons testing in Nevada, is emitting
more radioactivity into the environment.
Even average levels of Sr-90 in pasteurized milk may be rising. At 31
U.S. sites reporting an annual concentration in each year during the mid-1990s,
the 1995 average of 0.77 picocuries of Sr-90 per liter of milk rise to
0.93 and 0.84 picocuries in 1996 and 1997. This increase was a departure
from long-term declines. Unfortunately, after 1997 the EPA reported no
Sr-90 milk readings for 1998 or 1999; and replaced publication of its
annual Sr-90 measurement with a sample of just 8 to 10 cities each year
beginning in 2000. Tracking Sr-90 in milk can no longer be done adequately.
While levels of environmental radioactivity remain low, there is an extensive
body of literature indicating that low dose radiation exposure raises
the risk of childhood cancer. All radioactive products are carcinogenic,
and the developing fetus, infant, and child are perhaps 10 or more times
more vulnerable than adults are to the same dose. (3) Specifically, pelvic
X-rays to pregnant women were found to increase the risk of cancer during
early childhood, and were discontinued as a diagnostic method in favor
of ultrasound. (4-11) Elevated cancer rates in children have also been
linked with having a parent who works in a nuclear plant (12-17) and exposure
to atomic bomb test fallout (18).
I have cited 15 medical journal articles that have arrived at that conclusion.
Each of the articles cited are examples of low-dose radiation to the fetus
and infant, which at one time were presumed to be harmless but were subsequently
shown to raise cancer risk. Journals that published these articles include
the esteemed Journal of the American
Medical Association, New
England Journal of Medicine, Lancet,
and British Medical Journal.
Each is a case-control study, a commonly-used method in health research
that compares characteristics of children with and without cancer.
Three other articles have been published on case-control studies of low-dose
Strontium-90 in human bone. (19-21) These studies are obscure; they were
written in the 1960s, use small sample sizes, include few children, and
are inconclusive. Thus, the question of whether low dose radiation in
the body increases cancer risk remains unstudied and unanswered. Health
professionals owe it to suffering children and their families to conduct
such studies and obtain answers.
Understanding how harmful in-body radiation is to American children has
been impossible until recently – because it has been many years
since in-body measurements have been taken. There have been two government-sponsored
programs to measure in-body radiation levels in children. The study of
Sr-90 in St. Louis baby teeth ran from 1958-1970, and a program of measuring
Sr-90 in bones of children in 30 cities ran from 1962-1971; both were
supported by the U.S. Public Health Service until it removed funding (22-23).
The studies documented a sharp rise in Sr-90 in the bodies of children
as atomic bomb tests continued; and an equally sharp decline in the first
few years after testing above the ground was banned by the 1963 treaty
signed by President John F. Kennedy.
This lack of a program monitoring in-body radioactivity, along with rising
levels in the environment and rising childhood cancer, led RPHP to begin
the Tooth Fairy Project in 1998. The effort had two initial goals. One
is to understand differences in average Sr-90 levels in various parts
of the U.S., and the other is to document if current levels are rising
or falling. After 4,000 baby teeth were collected and tested for Sr-90
by the REMS Inc. laboratory, RPHP found that Sr-90 levels were 30-50%
higher in counties closest to nuclear plants, and had risen 50% from the
late 1980s to the late 1990s. Again, a currently-produced source of radioactivity
can only account for this increase. Atomic bomb test fallout is not the
explanation. According to the EPA Sr-90 from bomb tests has decayed “so
that current levels from these tests are very low.” (24) RPHP's
results, which were validated by a second laboratory, were published by
four different medical journals, one of which had published similar studies
of Sr-90 in baby teeth from Greece, the Ukraine, and the United Kingdom
in the 1990s. (25-28). Thus, the Tooth Fairy Project has been deemed worthy
of publication by experts who recommended that journals publish the articles
RPHP moved on to the next goal of the project: to assess whether Sr-90
increases risk for certain diseases. We began with childhood cancer. In
several areas, including Ocean and Monmouth Counties, RPHP found that
trends in Sr-90 in baby teeth were matched by similar trends in cancer
diagnosed in children under age ten after a lag of four to five years.
Most teeth from New Jersey came from Ocean and Monmouth.
RPHP also decided to compare Sr-90 levels in children with and without
cancer. To do this, the group began collecting baby teeth from children
who have been diagnosed with the disease. The eventual goal is to create
a case-control study, using Sr-90 level as the studied characteristic,
a method similar to that used in the 18 radiation-childhood cancer case-control
studies mentioned earlier. We have succeeded in collecting and testing
162 such teeth to date. The enthusiasm with which we are received by parents
of stricken children has been amazing. Some teeth have been donated by
parents of deceased children. Despite their ordeal, all parents strongly
have a singular desire: I want to know why my child developed cancer,
and will do anything to find out, so that others don’t have to endure
what I’ve gone through.
In 2003, the New Jersey legislature included a grant of $25,000 in its
omnibus budget bill to support the collection and Sr-90 testing of 50
baby teeth from children with cancer in the state. The grant was announced
at a November 2003 press conference at the Hackensack University Medical
Center, with Governor James McGreevey as the keynote speaker. Due mostly
to the diligent efforts of the Deirdre Imus Environmental Center for Pediatric
Oncology at Hackensack, 52 teeth were collected, along with other teeth
from children without cancer, and all teeth were tested in the lab at
the same time. Results were included in a lengthy report submitted by
RPHP to the Cancer Institute of New Jersey in November 2004. While I won’t
repeat all the findings, we documented a higher Sr-90 average in children
with cancer under age ten, especially those with leukemia. Average Sr-90
was highest in children with cancer in Ocean and Monmouth Counties.
Unfortunately, none of the results achieved statistical
significance due to the small number of teeth. So rather than publish
results in medical journals, RPHP will collect more teeth from children
with cancer in New Jersey and elsewhere in the U.S., to further test the
theory that children with cancer have higher Sr-90 levels than those who
In summary, I hope that our work is joined by others dedicated to understanding
causes of the plague known as childhood cancer. While improved therapies
have enabled more children to live, treatments are often harsh and agonizing.
Even survivors often must live with physical and emotional problems. Moreover,
the treatment is expensive, and society may not be able to subsidize the
costs of care as more children develop cancer. A 2003 article in the New
York Daily News features the predicament of Columbia-Presbyterian
Medical Center’s pediatric oncology unit, which was facing an operating
deficit of over half a million dollars, and the possibility of laying
off physicians, nurses, and other personnel. (29) Clearly, preventing
childhood cancer is the best way of dealing with the disease. A 1987 editorial
appeared in the New England Journal of Medicine, in an issue that included
articles on the risks of low-dose benzene and lead that “confirm
the suspicion that very low levels of toxins are capable of causing serious
health effects.” The editorial stated “perhaps it is time
to reexamine whether scientific standards of proof of causality –
and waiting for the bodies to fall – ought not give way to more
preventive public health policies that are satisfied by more realistic
conventions and that lead to action sooner.” (30)
While some experts support our study, others are quite critical. I have
answered many of these criticisms in the November 2004 report to the Cancer
Institute. While RPHP welcomes all comments, we hope that they are offered
constructively and not destructively. Those who dismiss the Tooth Fairy
Project would leave the U.S. with no program measuring in-body radioactivity
in American children; they are accomplishing nothing, and may even be
prolonging the agony of children with cancer. We hope that all will join
with RPHP in making constructive comments in how to improve the study,
and will also conduct their own research on this much-neglected topic.
Thank you, and I am available to answer any questions you may have.