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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 don’t.

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.

1. Ries LAG, Eisner MP, Kosary CL, et al. (eds). SEER Cancer Statistics Review, 1975-2001, National Cancer Institute. Bethesda MD, http://seer.cancer.gov/csr/1975_2001. 2004.

2. National Air and Radiation Environmental Laboratory. Environmental Radiation Data Report. Montgomery AL: U.S. Environmental Protection Agency, quarterly volumes 1975-2001. Also on www.epa.gov/narel. Data calculated in Mangano et al (reference # xxx).

3. U.S. Environmental Protection Agency.

4. Stewart A, Webb J, Giles D, et al. Malignant disease in childhood and diagnostic irradiation in utero. Lancet 1956;2:447.

5. Stewart A, Webb J, Hewitt. A survey of childhood malignancies. British Medical Journal 1958;1:1495-1508.

6. MacMahon B. Prenatal X-ray exposure and childhood cancer. Journal of the National Cancer Institute 1962;28(5):1173-91.

7. Grufferman S, Gula MJ, Olshan AF, et al. In utero X-ray exposure and risk of childhood rhabdomoysarcoma. Pediatric Perinatal Epidemiology 1991;5:A6-7.

8. Sternjfeldt M, Berglund K, Lindsten J, et al. Maternal smoking and irradiation during pregnancy as risk factors for child leukemia. Cancer Detection and Prevention 1992;16(2):129-135.

9. Rodvall Y, Pershagen G, Hrubec Z, et al. Prenatal X-ray exposure and childhood cancer in Swedish twins. International Journal of Cancer 1990;46(3):362-5.

10. Magnani C, Pastore G, Luzzatto L, et al. Parental occupation and other environmental factors in the etiology of leukemias and non-Hodgkin’s lymphomas in childhood: a case control study. Tumori 1990;76(5):413-9.

11. Harvey EB, Boice JD, Honeyman M, et al. Prenatal X-ray exposure and childhood cancer in twins. New England Journal of Medicine 1985;312(9):541-5.

12. Gardner MJ, Snee MP, Hall AJ, et al. Results of case-control study of leukaemia and lymphoma among young people near Sellafield nuclear plant in West Cumbria. British Medical Journal 1990;300(6722):423-9.

13. Dickinson HO, Parker L. Leukaemia and non-Hodgkin’s lymphoma in children of male Sellafield radiation workers. International Journal of Cancer 2002;99(3):437-44.

14. Meinert R, Kaletsch U, Kaatsch P, et al. Associations between childhood cancer and onizing radiation: results of a population-based case-control study in Germany. Cancer Epidemiology, Biomarkers & Prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 1999;8(9):793-9.

15. Draper GJ, Little MP, Sorahan T, et al. Cancer in the offspring of radiation workers: a record linkage study. British Medical Journal 1997;315(7117):1181-8.

16. Pobel D, Viel JF. Case-control study of leukaemia among young people near La Hague nuclear reprocessing plant: the environmental hypothesis revisited. British Medical Journal 1997;314(7074):101-06.

17. Roman E, Watson A, Beral V, et al. Case-control study of leukaemia and non-Hodgkin’s lymphoma among children aged 0-4 years living in West Berkshire and North Hampshire Health Districts. British Medical Journal 1993;306(6878):615-21.

18. Stevens W, Thomas DC, Lyon JL, et al. Leukemia in Utah and radioactive fallout from the Nevada test site: a case-control study. Journal of the American Medical Association 1990;264(5):585-91.

19. Aleksandrowicz J, Tutaj M, Wazewska-Czysewska M, et al. The amount of Sr-90 in the bones of people who have died of leukemias. Blood 1963;22(3):346-50.

20. Woodard HQ, Harley JH. Strontium-90 in the long bones of patients with sarcoma. Health Physics 1965;11:991-8.

21. Sato C, Sakka M, Hashizume T. The quantity of strontium 90 in the bone of leukemia patients. Tohoku Journal of Exp. Medicine 1968;94:45-53.

22. Rosenthal HL. Accumulation of environmental strontium in teeth of children. In Proceedings of the Ninth Annual Hanford Biology Symposium at Richland WA, May 5-8 1969. Washington DC: US Atomic Energy Commission;1969.

23. U.S. Public Health Service, Division of Radiological Health. Radiological Health Data and Reports, quarterly volumes, 1962-1971.

24. Strontium-90. . .the basics. U.S. Environmental Protection Agency. Available at http://www.epa.gov/radiation/topics/understand/radionuclides/strontium.htm.

25. Gould JM, Sternglass EJ, Sherman JS, et al. Strontium-90 in deciduous teeth as a factor in early childhood cancer. International Journal of Health Services 2000;30:515-39.

26. Gould JM, Sternglass EJ, Mangano JJ, et al. The strontium-90 baby teeth study and childhood cancer. European Journal of Oncology 2000;5:119-25.

27. Mangano JJ, Sternglass EJ, Gould JM, et al. Strontium-90 in newborns and childhood disease. Archives of Environmental Health 2000;55:240-5.

28. Mangano JJ, Gould JM, Sternglass EJ, et al. An unexpected rise in strontium-90 in US deciduous teeth in the 1990s. The Science of the Total Environment 2003;317:37-51.

29. Sherman W. City’s hospitals are bleeding red ink. New York Daily News, February 9, 2003, 8.

30. Ashford NA. New scientific evidence and public health imperatives. New England Journal of Medicine 1987;316(17):1084-5.