agenda for research on chernobyl health - ARCH

ARCH DELIVERABLE 3

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Table of Contents
INTRODUCTION ............................................................................................................................ 7
ORGANISATION OF WORK ........................................................................................................ 10
ARCH MEMBERSHIP...................................................................................................................11
IMPROVEMENTS OF INTRASTRUCTURES - CHERNOBYL LIFE SPAN COHORT................... 13
Background............................................................................................................................................. 13
Objective ................................................................................................................................................. 13
Justification ............................................................................................................................................. 13
Proposal.................................................................................................................................................. 13
Study design....................................................................................................................................... 13
Dosimetry............................................................................................................................................ 14
Feasibility............................................................................................................................................ 14
Next steps and prioritisation.................................................................................................................... 14
Background............................................................................................................................................. 14
Objective ................................................................................................................................................. 14
Justification ............................................................................................................................................. 14
Proposal.................................................................................................................................................. 14
Study design....................................................................................................................................... 15
Dosimetry............................................................................................................................................ 15
Feasibility............................................................................................................................................ 15
Next steps and prioritisation.................................................................................................................... 15
Background............................................................................................................................................. 16
Objective ................................................................................................................................................. 16
Justification ............................................................................................................................................. 16
Proposal.................................................................................................................................................. 16
Study design....................................................................................................................................... 16
Dosimetry............................................................................................................................................ 16
Feasibility............................................................................................................................................ 16
Next steps and prioritisation.................................................................................................................... 17
TISSUE BANKS............................................................................................................................ 18
Background............................................................................................................................................. 18
Proposal and prioritisation ...................................................................................................................... 18
INVENTORY OF DOSIMETRIC INFORMATION FOR POPULATION GROUPS MOST AFFECTED
BY THE CHERNOBYL ACCIDENT............................................................................................... 19
Introduction ............................................................................................................................................. 19
Objective ................................................................................................................................................. 19
Rationale................................................................................................................................................. 19
Proposed methodology and prioritisation ............................................................................................... 19
THYROID CANCER AND THYROID DISEASES.......................................................................... 20
Background............................................................................................................................................. 20
General ............................................................................................................................................... 20
Thyroid cancer and thyroid disease following the Chernobyl accident .............................................. 20
Iodine deficiency, age, genetic susceptibility – factors which may modify radiation risks ............. 21
The evolution of the Chernobyl thyroid cancer endemic................................................................ 22
Treatment of childhood thyroid cancer........................................................................................... 22
Molecular studies ........................................................................................................................... 23
Exposure of adults.......................................................................................................................... 23
Other thyroid diseases ................................................................................................................... 24
Objectives ............................................................................................................................................... 25
Specific relevance (value-addedness) of Chernobyl population(s) ........................................................ 25
Proposed approaches - Objective 1a ..................................................................................................... 26
Population........................................................................................................................................... 26
Study Design ...................................................................................................................................... 26
Doses.................................................................................................................................................. 26
Feasibility............................................................................................................................................ 26
Proposed approaches - Objective 1b ..................................................................................................... 27
Population........................................................................................................................................... 27
Study Design ...................................................................................................................................... 28

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Doses.................................................................................................................................................. 28
Biological samples.............................................................................................................................. 28
Data collection .................................................................................................................................... 28
Molecular markers .............................................................................................................................. 28
Feasibility............................................................................................................................................ 28
Proposed approaches - Objective 2........................................................................................................ 28
Study Population................................................................................................................................. 29
Study Design ...................................................................................................................................... 29
Doses.................................................................................................................................................. 29
Data collection .................................................................................................................................... 29
Biological samples.............................................................................................................................. 29
Molecular markers .............................................................................................................................. 29
Feasibility............................................................................................................................................ 29
Proposed approaches - Objective 3........................................................................................................ 30
Study Population................................................................................................................................. 30
Study Design ...................................................................................................................................... 30
Data collection .................................................................................................................................... 30
Biological samples.............................................................................................................................. 30
Feasibility............................................................................................................................................ 30
Proposed approaches - Objective 4........................................................................................................ 30
Study Population................................................................................................................................. 30
Study Design ...................................................................................................................................... 31
Doses.................................................................................................................................................. 31
Data collection .................................................................................................................................... 31
Biological samples.............................................................................................................................. 31
Molecular markers .............................................................................................................................. 31
Feasibility............................................................................................................................................ 31
Proposed approaches - Objective 5........................................................................................................ 31
Study Population................................................................................................................................. 31
Study Design ...................................................................................................................................... 31
Doses.................................................................................................................................................. 32
Biological samples.............................................................................................................................. 32
Data collection .................................................................................................................................... 32
Molecular markers .............................................................................................................................. 32
Feasibility............................................................................................................................................ 32
Prioritisation ............................................................................................................................................ 32
LEUKAEMIA AND LYMPHOMA....................................................................................................33
Background............................................................................................................................................. 33
General ............................................................................................................................................... 33
Studies of leukaemia and lymphoma in the post-Chernobyl period................................................... 34
In utero exposure ........................................................................................................................... 34
Childhood exposure ....................................................................................................................... 35
Adulthood exposure ....................................................................................................................... 36
Clean-up workers ........................................................................................................................... 36
Objectives ............................................................................................................................................... 37
Specific relevance (value-addedness) of Chernobyl populations........................................................... 37
Proposed approach – Objective 1........................................................................................................... 37
Population and study design .............................................................................................................. 37
Dosimetry............................................................................................................................................ 38
Biological samples.............................................................................................................................. 38
Molecular markers .............................................................................................................................. 38
Pathology............................................................................................................................................ 38
Feasibility - Roadblocks that need to be overcome............................................................................ 38
Ethics requirements............................................................................................................................ 38
Statistical power.................................................................................................................................. 38
Prioritisation........................................................................................................................................ 38
Proposed approach - Objective 2 ........................................................................................................... 39
Population and study design .............................................................................................................. 39
Doses.................................................................................................................................................. 39
Biological samples.............................................................................................................................. 39
Molecular markers.......................................................................................................................... 39
Pathology ....................................................................................................................................... 39

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Feasibility - Roadblocks that need to be overcome............................................................................ 39
Ethics requirements............................................................................................................................ 39
Prioritisation........................................................................................................................................ 39
OTHER TUMOURS THAN THYROID (BENIGN AND MALIGNANT)............................................ 41
Background............................................................................................................................................. 41
General ............................................................................................................................................... 41
Brain tumours including meningioma ................................................................................................. 41
Chernobyl related studies................................................................................................................... 42
Parathyroid adenoma and other benign tumours............................................................................... 43
Objectives ............................................................................................................................................... 43
Specific relevance of Chernobyl populations.......................................................................................... 44
Proposed approach - Objective 1 ........................................................................................................... 44
Population and study design .............................................................................................................. 44
Doses.................................................................................................................................................. 45
Roadblocks that need to be overcome............................................................................................... 45
Ethics requirements............................................................................................................................ 45
Proposed approach - Objective 2 ........................................................................................................... 46
Population and study design .............................................................................................................. 46
Dosimetry............................................................................................................................................ 46
Biological samples.............................................................................................................................. 46
Pathology............................................................................................................................................ 46
Roadblocks that need to be overcome............................................................................................... 46
Ethics requirements............................................................................................................................ 46
Statistical power.................................................................................................................................. 47
Proposed approach - Objective 3 ........................................................................................................... 47
Population and study design .............................................................................................................. 47
Doses.................................................................................................................................................. 47
Biological samples.............................................................................................................................. 47
Roadblocks that need to be overcome............................................................................................... 47
Ethics requirements............................................................................................................................ 47
Prioritisation ............................................................................................................................................ 47
RADIATION-INDUCED CATARACTS........................................................................................... 49
Background............................................................................................................................................. 49
General ............................................................................................................................................... 49
Chernobyl ........................................................................................................................................... 50
Objective(s)............................................................................................................................................. 51
Specific relevance of Chernobyl population............................................................................................ 51
Proposed approach – Objective 1........................................................................................................... 51
Study population................................................................................................................................. 51
Study design....................................................................................................................................... 52
Dosimetry............................................................................................................................................ 52
Biological samples.............................................................................................................................. 52
Molecular markers .............................................................................................................................. 52
Feasibility............................................................................................................................................ 52
Statistical power.................................................................................................................................. 52
Ethic requirements.............................................................................................................................. 52
Proposed approach – Objective 2........................................................................................................... 52
Study population................................................................................................................................. 53
Dosimetry............................................................................................................................................ 53
Biological samples.............................................................................................................................. 53
Molecular markers .............................................................................................................................. 53
Feasibility............................................................................................................................................ 53
Ethic requirements.............................................................................................................................. 53
Statistical power.................................................................................................................................. 53
Prioritisation ............................................................................................................................................ 53
CARDIOVASCULAR AND CEREBROVASCULAR DISEASES .................................................... 54
Background............................................................................................................................................. 54
General ............................................................................................................................................... 54
Chernobyl ........................................................................................................................................... 54
Objectives ............................................................................................................................................... 55
Specific relevance (value-addedness) of Chernobyl populations........................................................... 55

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Proposed approaches............................................................................................................................. 55
Study Population................................................................................................................................. 55
Study Design ...................................................................................................................................... 56
Dosimetry............................................................................................................................................ 56
Data and biological sample collection ................................................................................................ 56
Feasibility............................................................................................................................................ 56
Ethical Considerations........................................................................................................................ 57
Study Power ....................................................................................................................................... 57
Prioritization........................................................................................................................................ 57
IMMUNOLOGICAL EFFECTS ...................................................................................................... 58
Background............................................................................................................................................. 58
General ............................................................................................................................................... 58
Chernobyl observations...................................................................................................................... 59
Liquidators...................................................................................................................................... 59
Studies in children .......................................................................................................................... 59
Objectives ............................................................................................................................................... 60
Specific relevance of Chernobyl population(s) ....................................................................................... 60
Proposed approach................................................................................................................................. 60
Population........................................................................................................................................... 60
Study design....................................................................................................................................... 60
Dosimetry............................................................................................................................................ 61
Biological samples.............................................................................................................................. 61
Feasibility............................................................................................................................................ 61
Ethics requirements............................................................................................................................ 61
Statistical power.................................................................................................................................. 61
Prioritisation ............................................................................................................................................ 61
ACUTE RADIATION SYNDROME SURVIVORS .......................................................................... 62
Background............................................................................................................................................. 62
Objectives ............................................................................................................................................... 64
Specific relevance (value-addedness) of Chernobyl population(s) ........................................................ 64
Potential approaches .............................................................................................................................. 64
Population........................................................................................................................................... 65
Study design....................................................................................................................................... 65
Dosimetry............................................................................................................................................ 65
Biological samples.............................................................................................................................. 65
Molecular markers.......................................................................................................................... 65
Pathology ....................................................................................................................................... 65
Feasibility............................................................................................................................................ 65
Ethics requirements............................................................................................................................ 65
Statistical power.................................................................................................................................. 65
Prioritisation ............................................................................................................................................ 65
NONTARGETED RADIATION EFFECTS IN CHERNOBYL POPULATIONS INCLUDING
PRECONCEPTIONAL IRRADIATION........................................................................................... 66
Background............................................................................................................................................. 66
Somatic effects ................................................................................................................................... 66
Hereditary effects (in the germ line) ................................................................................................... 67
Evidence of non-targeted effects in Chernobyl populations............................................................... 69
Justification of the methods to be applied in the study........................................................................... 70
Objectives ............................................................................................................................................... 71
Populations and approaches .................................................................................................................. 72
Dosimetry................................................................................................................................................ 73
Ethical issues of the proposal ................................................................................................................. 74
Roadblocks to be overcome ................................................................................................................... 74
Prioritisation ............................................................................................................................................ 74
MENTAL RETARDATION FOLLOWING IN UTERO EXPOSURE AS A RESULT OF THE
CHERNOBYL ACCIDENT ............................................................................................................ 75
Background............................................................................................................................................. 75
General ............................................................................................................................................... 75
Chernobyl-related studies................................................................................................................... 76
Objectives ............................................................................................................................................... 77