Panel Likely To Reject Fallout Checkups Thyroid Experts Fear Unnecessary Surgeries Would Result From The Screening Of Those Possibly Affected By Bomb Tests

Thyroid experts advising the National Cancer Institute will probably reject a proposed medical screening program for millions of Americans exposed to fallout from nuclear bomb tests.

Their fear: triggering a wave of unnecessary thyroid surgeries that could do more harm than good.

The report from the Institute of Medicine, a branch of the National Academy of Sciences, is expected to be released this week in Washington, D.C.

“This will trigger a huge debate when it comes out. There are some big ethical issues here,” said Tim Connor of Spokane, research director of the Northwest Environmental Education Foundation.

Connor is a member of a U.S. Department of Health and Human Services citizens advisory committee on nuclear-related health studies, which is preparing a critique of the Institute of Medicine report.

The fallout that spread across America in the 1950s from atomic explosions at the Nevada Test Site put hundreds of thousands of Americans at increased risk for developing thyroid disease.

The National Cancer Institute estimates there will be 11,300 to 211,000 extra thyroid cancers nationwide as a result.

Because thyroid cancer is a slow-developing disease, many of those cancers in people exposed as children to the fallout aren’t yet detected.

The medical debate over what to do for America’s fallout victims has been intense since the NCI fallout study was released last year, said Dr. H. Jack Geiger, emeritus professor of community medicine at City University of New York and a reviewer of the Institute of Medicine draft report.

“The institute brought together the people who know the most about thyroid disease,” Geiger said.

“They said there’s no evidence that early detection changes the outcome in the case of thyroid cancer. That’s the opposite of breast cancer and colon cancer,” Geiger said.

If early detection doesn’t change the outcome, “it’s hard to see the benefits,” Geiger said.

The thyroid-screening issues are similar to prostate cancer, a slow growth that affects many men in old age. The risks of surgery for that disease - impotence and incontinence - may be worse than leaving an enlarged prostate alone, doctors say.

There are also risks in thyroid surgery, including a reaction to anesthesia, damage to the laryngeal nerve near the thyroid and side effects from lifetime hormone replacement therapy, Geiger said.

He and Christine Gebbie, the former Washington Department of Health director and Clinton administration AIDS coordinator, were invited to advise the institute on what to do for fallout victims.

They suggested following the “offer-but-discourage” treatment policy similar to what Group Health of Seattle does for prostate cancer detection, Geiger said.

At Group Health, men are given the facts about the disease and are asked to weigh them against the risks of prostate surgery.

Public interest and nuclear watchdog groups are uncomfortable with the pending Institute of Medicine recommendation, Connor said.

“The IOM is saying ‘we can’t screen because people will overreact.’ This may be used to justify inaction,” he said.

Connor is especially concerned about the effect of such a recommendation on a proposal by the Agency for Toxic Substances and Disease Registry in Atlanta to screen 14,000 Hanford downwinders for thyroid disease.

The National Cancer Institute should locate the people who received the highest fallout exposures and offer them monitoring, said Trisha Pritikin, a Berkeley, Calif., attorney and member of Connor’s committee.

“Narrowing it to a subgroup makes it financially feasible and not out of control. It also would be socially just,” she said.

A do-nothing recommendation also will fuel more suspicion about the NCI fallout study, Connor said.

Requested by Congress in 1983, it was largely completed a decade later when scientists finished collecting fallout data for each of nearly 3,100 U.S. counties. But it wasn’t released until 1997 - and only after pieces of its disturbing data were leaked to reporters.

The controversy has led to an investigation by the Senate Government Affairs Committee.

A Sept. 17 hearing is scheduled in Washington, D.C., to explore criticisms of why the NCI study took so long and why Americans weren’t warned earlier about the hazards of fallout.

“There’s a political problem here. The Atomic Energy Commission muzzled the U.S. Public Health Service when the fallout occurred for fear the public would react and stop the weapons program,” Connor said.

“It’s an irony that after that history, we now aren’t going to have people’s thyroids checked for fear they are going to make the wrong decision,” Connor said. “We are playing Big Brother.”