Public Health Activities Site Plan
Draft for Public Comment
Monticello Mill Tailings Site
and Monticello Vicinity Properties Site
Monticello, Utah

Background

The Monticello Mill Tailings Site, an abandoned uranium processing mill, was the source of contamination in soils and buildings throughout the city of Monticello, Utah. Initially, the site served as an ore-buying station. Ore production increased sufficiently to justify mill construction in 1941. The mill produced vanadium (1942-1943), uranium-vanadium sludge (1943-1946), and uranium (1949-1960).

Contaminated soils were taken from the mill site and used as fill for open lands; backfill around water, sewer, and electrical lines; and sand mix in concrete, plaster, and mortar. As a result, residents have been exposed to low levels of uranium, radium-226, radon-222, and associated radiation. A total of 449 properties are being remediated. The total tonnage of uranium mill tailings removed from the mill site for construction purposes was never documented. However, contaminated material from the vicinity properties is estimated at 156,000 cubic yards.

What have we learned from our studies and assessments about Monticello?

Off-Site Contamination

• Hazardous substances include yellow cake (uranium oxides), black cake (vanadium oxides), and uranium. The tailings that remain on the mill site would be considered a public health hazard today if the public had access to the mill site. However, access is strictly controlled. The mill site, therefore, currently does not pose a direct threat to area residents.

Community Health Studies and Activities

• The Utah Cancer Registry is part of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. Utah has the lowest cancer incidence in the SEER system and the lowest overall cancer mortality rate of any state. The main reason seems to be the low smoking rates and the associated low rates of smoking-related cancers. Since becoming part of the SEER system, Utah has had an incidence rate approximately 16% below national rates, while mortality rates are approximately 28% below the national average.

• The Agency for Toxic Substances and Disease Registry (ATSDR) reviewed available health outcome data and identified increased risk for the following causes of death in San Juan County compared to other Utah counties: (1) renal failure in women only, (2) breast cancer in women, and (3) cancer associated with the respiratory tract.

Studies of the Health of Monticello Workers

• Industrial hygiene surveys performed when the mill was operating reported that conditions were dusty at the mill and workers were exposed to radioactive dusts at levels that were above allowable concentrations (Holaday et al. 1952; Archer et al. 1973). Because of the known exposure to workers, a urine sampling and assaying program was begun at the mill in 1956 which would have detected uranium exposure. Workers in areas with higher air dust levels, all males, were sampled weekly.

• In occupational cohort studies of uranium mill workers, mortality due to lung cancer, lymphoma, and nonmalignant respiratory disease has been reported.

• A more recent survey of health conditions among American Indian and non-Indian former uranium mill and mine workers reported that a majority of these workers reported respiratory diseases or symptoms which included chronic obstructive pulmonary disease, emphysema, fibrosis, persistent cough, pneumoconiosis, and silicosis.

What are the current studies and public health activities at Monticello?

Community Involvement

• ATSDR is developing a community involvement program. The goal of the program is to establish a working group to help guide decisions on ongoing investigations, future surveillance, further health studies, or other health activities. Potential members include community representatives, staff members from ATSDR and other federal agencies, and state and local representatives from the environmental health or public health community.

Off-Site Contamination

• DOE is continuing remediation of the Monticello vicinity properties.

Community Health Studies and Activities

• ATSDR is updating the health outcomes identified in the public health assessment. Health outcome analyses includes (1) age-adjusted death rate due to renal failure; (2) incidence of end-stage renal disease; and (3) incidence of breast cancer, kidney cancer, leukemia, lymphoma, and respiratory cancer for 5-year periods from 1967-1996. ATSDR will calculate standardized incidence ratios for these outcomes in San Juan County compared with the rest of Utah, in addition to examining trends in incidence rates over the past two decades.

Occupational Health Studies

• The National Institute of Occupational Safety and Health (NIOSH) is conducting a follow-up study of former uranium mill workers, although Monticello is not included because employment records could not be located. The study will focus on the Four Corners area (the point of intersection for Arizona, Colorado, New Mexico, and Utah) and will attempt to identify 500 exposed workers and 100 controls in order to conduct a cross-sectional medical survey. The outcomes of interest are pulmonary and renal effects. The University of New Mexico Medical Center will send a mobile van out to communities in this area to carry out the medical component of this study.

What are the gaps in our knowledge and what important issues need to be addressed?

• There is a need to determine whether the current occupational radiation exposure limits are adequate for radiation workers.

• Internal dosimetry of radiation workers is not well characterized or understood, and the relationship between internal radiation dose and health effects needs to be evaluated.

• Results from ongoing mortality studies need to be evaluated to improve understanding of causes of cancer and chronic disease. Additional studies can be proposed to focus on a single disease in worker groups.

• There is a need to ensure that complete records, including industrial hygiene and work history data for the various levels of subcontractors at each site, are available.

Proposed Activities

Ongoing Activities

The agencies propose to continue the projects already underway which were listed previously and initiate the following new projects. Such activities will be implemented only if feasible and deemed appropriate and beneficial to the community. The agencies will establish a coordinated plan, schedule, and lead organization for each new public health activity. The plan and schedule will be presented to all potential partners for their comment.

New Activities for FY 1999 and FY 2000

• ATSDR will work with the Monticello communities to complete a health education needs assessment and implement educational activities to assist the communities in understanding the effects of exposure to low doses of radiation associated with the Monticello site.

• Based on results from an updated health outcome data review, ATSDR staff members will collaborate with community representatives to determine the feasibility of and interest in conducting epidemiologic studies of selected cancers or end-stage renal disease. In addition to cancer and renal disease, early stage kidney disease as assessed by the use of biomarkers may be a possible outcome to evaluate.

Public Health Activities Site Plan
Draft for Public Comment
Mound Plant
Miamisburg, Ohio

Background

The Mound Plant is a U.S. Department of Energy (DOE) production facility located in Montgomery County, Ohio, within the city limits of Miamisburg. While the research and production areas of the site once occupied 306 acres, most of Mound's DOE activities have been terminated or relocated to other DOE facilities, and parcels of the original property are being turned over to private ownership as they become available. Miamisburg, a community of 18,000 people, is 10 miles southwest of Dayton. A Consolidated Rail Corporation (Conrail) freight line is along the western border of the plant. The Miamisburg Community Park and an abandoned part of the old Miami-Erie Canal are farther west of the Conrail tracks. The Miami River is approximately a half mile from the Mound Plant.

Mound was built in the late 1940s under the auspices of the war department. Until recently, the mission of the Mound Plant included research and development and the manufacture of components for nuclear weapons. Scientists at the plant conducted many research and development projects, including a program conducted from the mid-1950s until 1985 to study radioactive isotopes, such as those of uranium and thorium. DOE either ended these programs or transferred them to other facilities. The one remaining active production program at the site is the manufacture of electric power sources. These power sources, which utilize plutonium-238, are used in satellites and spacecraft. Much of DOE's work at the Mound Plant is related to environmental cleanup of the site.

Public health issues at the Mound Plant include past exposures to both workers and residents in the community to a wide range of radioactive and chemical contaminants including polonium-210, plutonium-238, and tritium. Current exposures are to workers involved in the cleanup of the site.

What have we learned from our studies and assessments of the Mound Plant?

Off-Site Contamination

• The Agency for Toxic Substances and Disease Registry (ATSDR) conducted a public health assessment of possible off-site exposures to hazardous materials released from the Mound Plant and determined that the plant currently poses no apparent public health hazard. Insufficient information, however, made it impossible for ATSDR to determine whether releases of polonium or nonradioactive materials from the site during the 1950s ever posed a public health hazard.

• After being notified by ATSDR as part of the public health assessment process that levels of plutonium-238 were elevated in the Miami-Erie Canal and the Miamisburg Community Park, the city of Miamisburg closed the fishing pond as a public health precaution.

Community Health Studies and Activities

• An environmental health workshop was developed through a cooperative agreement with the Boston University School of Public Health to educate and assist communities and health care providers near DOE sites in evaluating the usefulness and practicality of collecting and assessing health outcome data. A workshop for the community surrounding the Mound Plant was presented in Miamisburg, Ohio, on May 19, 1995. ATSDR does not currently anticipate a need for further health education activities in the community around the Mound Plant unless new information becomes available.

Studies of the Health of Mound Workers

• Mortality among more than 4,000 Mound facility workers was investigated. Excess numbers of deaths were discovered for lung, pharyngeal, prostate, and thyroid cancers. Excess numbers of lung cancer deaths were found among polonium workers employed from 1943 through 1959. Among workers employed for less than two years between 1943 and 1959, significant elevations were found in the numbers of deaths from lung cancer and for the categories classified as all causes and all injuries.

• A second mortality study looked at the same Mound worker group. No increase in overall mortality or site-specific cancers was noted. In a subgroup of 3,229 workers monitored for external radiation, a dose-response relationship based on small numbers of deaths was observed for lymphopoietic/hematopoietic cancers and for all leukemias. As a result, followup of this cohort is necessary to verify the dose-response relationship.

• Polonium-210 workers and their 1944-1972 urine data were studied. The mortality rate for all causes of death combined was less than the rate for the U.S. general population through 1983. The mortality rate for cancers of the esophagus, lung, lymphatic system, oral cavity, thyroid, and rectum were greater, but not statistically significant compared to the rates for the U.S. general population through 1983. Among the persons employed during World War II, increased mortality rates for all causes of death combined, all cancers combined, all injuries, all respiratory diseases combined, cancer of the rectum, chronic rheumatic heart disease, and lung cancer were statistically significant. No dose-response relationship was noted between mortality and exposure to polonium-210.

What are the current studies and public health activities at Mound?

Community Involvement

• Currently there are no ongoing studies with community involvement.

Off-Site Contamination

• Currently there are no ongoing studies assessing off-site contamination.

Community Health Studies and Activities

• A local citizens group, Miamisburg Environmental Safety and Health, is conducting a neighborhood health survey.

Occupational Health Studies

• Exposures encountered at Mound and other sites by decontamination and decommissioning workers are being characterized by NIOSH. Working conditions and research needs are being identified at each study site in this Phase I feasibility study. These results are relevant to current workers and support development of surveillance activities.

• The State University of New York, sponsored by a NIOSH grant, is conducting a mortality study of female nuclear workers at 12 facilities. This study will be the largest study of mortality among the 80,000 women ever employed in the DOE work force. Risk estimates will be developed for exposure to ionizing radiation and chemical hazards.

What are the gaps in our knowledge and what important issues need to be addressed?

• There is a need to improve assessment of exposure to polonium-210 using current models that were not available during the previous cohort study.

• There is a need to assess the extent of off-site contamination from polonium-210, plutonium-238, and tritium releases.

• There is a need to determine whether the current occupational radiation exposure limits are adequate for radiation workers.

• Internal dosimetry of radiation workers is not well characterized or understood, and the relationship between internal radiation dose and health effects needs to be evaluated.

• Results from ongoing mortality studies need to be evaluated to improve the understanding of causes of cancer and chronic disease. Additional studies can be proposed to focus on a single disease in worker groups.

• There is a need to ensure that complete records, including industrial hygiene and work history data for the various levels of subcontractors at each site, are available.

Proposed Activities

Ongoing Activities

The agencies propose to continue the projects already underway which were listed previously and initiate the following new projects. Such activities will be implemented only if feasible and deemed appropriate and beneficial to the community. The agencies will establish a coordinated plan, schedule, and lead organization for each new public health activity. The plan and schedule will be presented to all potential partners for their comment.

New Activities for FY 1999 and FY 2000

• ATSDR will prepare a health consultation which addresses historic records that were unavailable during the preparation of the public health assessment. The records primarily cover the period 1950-1959.

• ATSDR will prepare a toxicological profile for tritium. Tritium was released during past site operations and is still at the site. The toxicological profile will identify the full range of health effects observed in humans and animals from exposure to those substances, as well as data gaps for which additional research is needed.

• There will be a NIOSH Update of Cohort Mortality Study of Mound Workers. The Mound Plant has engaged in operations involving exposures to polonium-210, plutonium-238, and tritium. A mortality study through 1979 showed elevated levels of lung cancer mortality in workers employed from 1943-1959 and a significant dose-response relationship between polonium-210 exposure and lymphopoietic/hematopoietic cancers and leukemia. An update would provide an additional 16 years of followup and the use of validated bioassay data.

Public Health Activities Site Plan
Draft for Public Comment
Nevada Test Site
Nye County, Nevada

Background

The Nevada test site (NTS) is in Nye County in southern Nevada. The site contains 1,350 square miles of federally owned land, and access to the site is restricted. The site was created in 1952 from a portion of the land that the Air Force used as a bombing and gunnery range; the gunnery range is now known as the Nellis Air Force Range. The Nevada test site was created to accelerate the development of nuclear weapons. The combined area of the Nevada test site, the Nellis Air Force Range, and the contiguous Tonopah Test Range is one of the largest unpopulated land areas in the United States, approximately 5,470 square miles.

NTS has an extensive history of nuclear weapons tests, with 119 atmospheric tests conducted in the years 1951-1958 and 809 underground tests conducted in 1961-1992. The atmospheric tests resulted in radioactive fallout being deposited downwind and across the world. The underground tests resulted in large quantities of radionuclides being retained in the soil and groundwater. There have been low-level radioactive waste shipments from other U.S. Department of Energy (DOE) facilities to two NTS waste site disposal locations. One disposal site opened in the late 1960s and the other in 1978. The proposed Yucca Mountain high-level radioactive waste repository is also located on the property of the Nevada test site. There could be a significant increase of shipments of low-level radioactive wastes (more than 200,000 by some estimates) if plans are approved for designating the Nevada test site as a regional waste disposal center.

What have we learned from our studies and assessments of the Nevada test site?

Off-Site Contamination

• In 1997, the National Cancer Institute (NCI) published estimated thyroid doses for populations of each U.S. county due to releases of iodine-131 during atmospheric nuclear weapons testing at NTS in the 1950s and 1960s. For the entire U.S. population, the average cumulative thyroid dose was about 2 rads. The average thyroid dose in the 24 counties with the highest exposures (located in Nevada, Utah, Idaho, and Montana) ranged from 9-12 rads. The National Academy of Sciences Institute of Medicine reviewed the cancer study and concluded that resources be focused on designing an education and information program about health consequences of exposure to fallout from the site. The Institute of Medicine did not recommend conducting widespread thyroid screening programs.

Community Health Studies and Activities

• During the 1980s, scientists at several national laboratories collected all records and data pertaining to U.S. atmospheric nuclear weapons testing into a single collection. This collected material was housed in the DOE Coordination and Information Center in Las Vegas, and made available to the public. From this data, a dosimetric evaluation of areas in the region was developed. The study was characterized by community/locale and age/occupation. The study found that residents in southwest Utah closest to the Nevada test site received the highest exposures (whole body doses of less than 10 rems), but that residents of urban northern areas received a higher mean dose. Subsequent epidemiologic studies used this methodology and the models and data to estimate doses for certain cohorts and populations.

• A number of studies have examined the possibility of adverse health effects from radioactive fallout to people living near the Nevada test site; these studies have usually focused on thyroid disease and leukemia in children downwind of the site. Early studies of thyroid diseases found no association between occurrence of disease and living near the site. However, a 1993 study that included calculated thyroid doses found a positive dose-response trend for thyroid neoplasms. Studies of cancer and leukemia have generally found excesses in forms of leukemias considered radiogenic. The latest study, a 1990 case-control study of leukemia deaths in Utah, found a positive dose-response relationship for the acute leukemias (acute lymphocytic in particular). However, the excess was confined primarily to a single, sparsely populated county.

Studies of the Health of Workers

• There are no studies of the health of workers at the Nevada test site.

What are the current studies and public health activities at the Nevada test site?

Community Involvement

• There are no community involvement activities at this site.

Off-Site Contamination

• There are no current studies of off-site contamination.

Community Health Studies and Activities

• There are no community health studies or activities at the site.

Occupational Health Studies

• Boston University, in a cooperative agreement with the National Institute for Occupational Safety and Health (NIOSH), is evaluating the effects of job stressors including downsizing and reorganization in a multisite study. Organizational climate, worker health, and performance at four DOE sites will be assessed.

• The first phase of the DOE Medical Surveillance for Former Workers at NTS reviewed available information that will help determine whether former workers might develop health problems due to their employment at the site. The focus is on construction workers in underground and excavation work and re-entry workers who were employed there from 1951-1992. About 15,000 workers who were represented by six construction trade unions were identified for the cohort study. Exposure information and health data are being collected, and the former workers are being contacted. In the second phase of the study, Boston University investigators will determine which workers might possibly be at significant risk for health problems related to their exposure and those workers will be offered an opportunity to participate in a free medical screening program.

What are the gaps in our knowledge and what important issues need to be addressed?

• There is a need to determine whether the current occupational radiation exposure limits are adequate for radiation workers.

• Internal dosimetry of radiation workers is not well characterized or understood, and the relationship between internal radiation dose and health effects needs to be evaluated.

• Results from ongoing mortality studies need to be evaluated to improve understanding of the causes of cancer and chronic diseases. Additional studies can be proposed to focus on a single disease in worker groups.

• There is a need to ensure that complete records, including industrial hygiene and work history data for the various levels of subcontractors at each site, are available.

Proposed Activities

Ongoing Activities

The agencies propose to continue the projects already underway which were listed previously and initiate the following new projects, if feasible and beneficial to the community. The agencies will establish a coordinated plan, schedule, and lead organization for each new public health activity. The plan and schedule will be presented to all potential partners for their comment.

New Activities for FY 1999 and FY 2000

• In February 1998, Governor Bob Miller requested technical assistance from the Agency for Toxic Substances and Disease Registry (ATSDR). ATSDR agreed to provide technical assistance and review the environmental and health concerns.

• ATSDR will prepare toxicological profiles for elements and radioactive isotopes including cesium, cobalt, iodine, strontium, and tritium. Toxicological profiles identify the full range of health effects observed in humans and animals from exposure to those substances, as well as data gaps for which additional research is needed.

• ATSDR, the National Center for Environmental Health, and the National Institute for Occupational Safety and Health will work with other U.S. Department of Health and Human Services agencies in developing educational materials and programs for the public, health care providers, media, public health agencies, and professional organizations related to health risks from past exposures to environmental releases of hazardous materials from the Nevada test site.

• ATSDR, the National Center for Environmental Health, and the National Institute for Occupational Safety and Health will coordinate the development of a community health communication strategy and ensure that findings from their NTS-related activities are communicated to all interested stakeholders and the public.

Activities for Which the Funding Source is External to Memorandum of Understanding Between the U.S. Department of Energy and U.S. Department of Health and Human Services

As a result of the publication of the National Cancer Institute report on doses from radioiodine in fallout from the Nevada test site, there is national concern about the doses and resulting risks from contamination across the United States due to other radionuclides contained in fallout from the site. Public health recommendations to the U.S. Department of Health and Human Services have been drafted by the National Academy of Sciences' Institute of Medicine. The conclusions presented in this report include the following. (1) The NCI county-specific dose estimates are too uncertain to be used for estimating individual exposure; (2) A systematic screening program for thyroid cancer is not recommended for the populations exposed to iodine-131 from NTS fallout; and (3) There should be a focused program of public information and education about the consequences of the NTS fallout. The following activities address fallout from the Nevada test site.

• The National Center for Environmental Health (NCEH) will work with the University of Utah to conduct a second followup of the cohort of former Utah schoolchildren who were previously evaluated for thyroid disease in relation to fallout exposures from the Nevada test site.

• Congress has directed NCEH, with the support of the National Cancer Institute, to study the health consequences to the American people of nuclear weapons tests conducted by the United States and other nations. NCEH is beginning an initial assessment of the feasibility and public health implications of such a study. This assessment will address major issues such as radiation dose estimation and risk assessment, appropriate epidemiologic investigations, and health communication strategies for promoting better understanding of the research by the general public. In developing the assessment, design, and conduct of the study, NCEH will include input from the public and the Advisory Committee on Energy-Related Epidemiologic Research. In conducting the study, NCEH will give high priority to examining in both general and high-risk populations the health consequences of exposure to the full range of radionuclides produced by a nuclear weapons test. NCEH will inform Congress of the study's progress on a regular basis and give Congress a final report on feasibility by July 1, 2000.

• NCEH will collaborate with the National Cancer Institute in implementing the public health outreach recommendations contained in the report prepared by the National Academy of Sciences and Institute of Medicine on the effects of NTS-related radioactive iodine exposures to people across the United States.

Public Health Activities Site Plan
Draft for Public Comment
Nuclear Naval Shipyard Workers

Background

The U.S. Nuclear Navy Shipyards (NNS) built the first nuclear-powered ship, the USS Nautilus, which went to sea in 1955. Since that time, the Navy has developed shipyard nuclear capabilities at Kittery, Maine (near Portsmouth, New Hampshire); New London, Connecticut; Norfolk and Newport News, Virginia; Charleston, South Carolina; Mare Island, California; Puget Sound, Washington; and Pearl Harbor, Hawaii. At each of these sites, nuclear-powered ships have been constructed, overhauled, repaired, refueled, or inactivated. Approximately 700,000 civilians have been employed at these facilities.

The U.S. Environmental Protection Agency (EPA) has listed or proposed for listing five sites which include nuclear naval shipyards on the National Priorities List (NPL): the New London Submarine Base, the Norfolk Naval Shipyard, the Pearl Harbor Naval Complex, the Portsmouth Naval Shipyard, and the Puget Sound Naval Shipyard Complex.

The New London Submarine Base covers 1,412 acres on the east bank of the Thames River, at New London, New London County, Connecticut. The area around the base is mixed industrial, commercial, and residential property. The base was established in 1916, and it now serves primarily as an operation and support base for submarine activities in the Atlantic Ocean. According to Navy tests conducted in 1984, sediment and surface water in and around an area known as Area A are contaminated with lead, cadmium, 4,4-dichlorodiphenyldichloroethane (DDD), and 4,4-dichlorodiphenyltrichloroethane (DDT).

The Norfolk Naval Shipyard (NNSY) dates to 1767 and was the largest shipyard in the world devoted exclusively to ship construction, repair, and overhaul. Lying along the southern branch of the Elizabeth River near the mouth of Chesapeake Bay, the shipyard is centrally located in the tidewater region of southeastern Virginia. Fisheries, wetlands, and other sensitive environments are located downstream from the site.

The Pearl Harbor Naval Complex occupies at least 6,300 acres in Pearl Harbor on the Island of Oahu, Honolulu County, Hawaii. Land around the complex supports agriculture, aquaculture, and industry as well as commercial and residential usage. The Pearl Harbor Naval Complex began operation in 1901 when the Navy received an appropriation to acquire land for a naval station. After the Japanese attack on the base on December 7, 1941, industrial activity at the complex skyrocketed and 24,000 civilians were employed by mid-1943.

The Portsmouth Naval Shipyard (PNS) is located on Seavey Island in the Piscataqua River in Kittery, York County, Maine. The PNS property also includes the undeveloped Clark's Island, which is connected by a bridge to Seavey Island. The Portsmouth shipyard was established in 1690 and became a Navy shipyard in 1800. During its operational history, the shipyard was used for the construction of ships and submarines. Currently the shipyard overhauls and refurbishes attack submarines and nuclear propulsion fleet ballistic missile submarines. Dredged sediment samples collected in the late 1970s near the industrial outfalls were found to contain elevated concentrations of metals, polychlorinated biphenyls (PCBs), and other contaminants. In addition, hazardous substances attributable to PNS are present at elevated levels in wetlands bordering Seavey Island.

The Puget Sound Naval Shipyard Complex is located in Bremerton, Washington, along Sinclair Inlet on Puget Sound, approximately 15 miles west of Seattle. The Navy has owned and operated facilities at this location since 1891. The complex consists of a naval shipyard and a naval supply center and employs more than 12,000 people. EPA has identified 58 known or potential sources of contamination at the complex. In 1990 and 1991, the Navy found elevated levels of heavy metals, semivolatile organic compounds, PCBs, and pesticides in surface soils, subsurface soils, and groundwater in a number of areas throughout the complex, as well as in sediments of Sinclair Inlet adjacent to the shipyard.

What have we learned from studies and assessments of nuclear naval shipyards?

Off-Site Contamination

• In a public health assessment for the New London Submarine Base, the Agency for Toxic Substances and Disease Registry (ATSDR) determined that in the past, watercourses downstream from Area A posed a public health hazard to children who came in contact with sediment contaminated with DDT and lead. A security fence installed by the Navy now prevents children from coming in contact with the contaminated sediment, and therefore the site is no longer a public health hazard.

  Based on data the Navy collected from 23 off-base private residential wells, ATSDR considers the concentration of lead in one of the 23 wells to be a public health hazard for children and the fetuses of pregnant women. Sodium levels in six residential wells are of public health concern for persons on salt-restricted diets.

• Five of the six major waste sources at the Norfolk Naval Shipyard are located along or near Paradise Creek. Analysis of samples of sediments in Paradise Creek collected in 1986 and 1992 detected the presence of metals, PCBs, pesticides, and semivolatile organic compounds in reaches of the creek adjacent to the sources evaluated.

• At the Pearl Harbor Complex, tetrachloroethene was found 15.2 feet below ground surface in one area. Soils beneath the site are permeable, facilitating movement of contaminants into groundwater. Approximately 110,700 people obtain drinking water from wells within 2 miles of the six sources.

  In 1988, the Navy detected bis(2-ethylhexyl)phthalate in sediment samples taken from a national wildlife refuge area that borders an abandoned Navy landfill. The refuge contains wetlands and is the habitat for four endangered species. Pearl Harbor and nearby portions of the Pacific Ocean contain recreational and commercial fisheries; water-contact recreation areas; wetlands; and habitats for endangered species.

• ATSDR has been providing assistance to the Portsmouth Naval Shipyard since 1993. ATSDR conducted a public health consultation on possible contamination of local seafood in fiscal year 1995. Agency analysis concluded that fish and shellfish from the areas near the shipyard do not present any health hazard to the general population. ATSDR made specific recommendations regarding maximum consumption levels for subsistence consumers and pregnant and nursing mothers.

Community Health Studies and Activities

• ATSDR has evaluated information in the Connecticut Tumor Registry Data Base to determine if an elevated cancer incidence exists within the towns of Groton and Ledyard near the New London Submarine Base. In Groton and Ledyard, in the male "all types" category (all types of cancer combined), cancer rates are slightly elevated as compared to the rate for state of Connecticut.

Studies of the Health of Nuclear Naval Shipyard Workers

• A cohort mortality epidemiologic analysis of workers at the Portsmouth Naval Shipyard completed by the National Institute for Occupational Safety and Health (NIOSH) found no significant excess mortality from any cause. However, later case-control studies of lung cancer and leukemia in this group of workers did have positive findings. Excess lung cancer mortality was associated with external radiation for workers with cumulative occupational doses of 1.0 to 4.999 rem. These same workers were also potentially exposed to welding fumes and asbestos. The relative importance of these three agents in the development of the lung cancers could not be determined. In the other case-control study, significant excesses of leukemia were found for welders and electricians.

• In an unpublished study, Matanoski et al. completed an epidemiologic study of workers at nuclear naval shipyards. Excess numbers of pleural mesothelioma were observed among radiation and non-radiation workers. No association was found between ionizing radiation exposures and risk of death from leukemia or any other type of cancer.

What are the current studies and public health activities at the nuclear naval shipyards?

Community Involvement

• The U.S. Department of Defense (DOD) has established restoration advisory boards at the sites that are listed on the NPL.

Off-Site Contamination

• There are no ongoing studies of off-site contamination.

Community Health Studies and Activities

• There are no community health studies for these sites.

Occupational Health Studies

• The NIOSH cohort mortality study of the Portsmouth Naval Shipyard, a mortality study of civilian employees at PNS, will be updated through 1997. Through an agreement with the Naval Sea Systems Command, the cohort has been expanded to include all individuals employed through 1992. Case-control studies will also be done, as indicated by a review of the data. The study will also determine whether external ionizing radiation is related to the risk of death from leukemia or lung cancer and whether asbestos exposure or other known carcinogens present at the shipyard are confounding these relationships.

• A case-control study for leukemia, the largest of its kind, is exploring the relationship between external radiation and leukemia risk among 250 workers with leukemia compared to similar workers without leukemia. About 250 leukemia deaths have been identified from four Department of Energy (DOE) sites and the Portsmouth Naval Shipyard. Confounding exposures to internal radiation, chemicals, and electromagnetic fields will be evaluated for all cases and controls.

• NIOSH will contribute study data from PNS workers to an international collaborative study of nuclear workers in 14 countries. This study is sponsored by the International Agency for Research on Cancer (IARC) and is the largest cancer mortality study ever of nuclear workers.

What are the gaps in our knowledge and what important issues need to be addressed?

• There is a need to determine if wastes released from PNS have resulted in off-site exposures at levels that could cause adverse health affects.

• There is a need to determine whether the current occupational radiation exposure limits are adequate for radiation workers.

• Internal dosimetry of radiation workers is not well characterized or understood, and the relationship between internal radiation dose and health effects needs to be evaluated.

• Results from ongoing mortality studies need to be evaluated to improve understanding of the causes of cancer and chronic diseases. Additional studies can be proposed to focus on a single disease in worker groups.

• There is a need to ensure that complete records, including industrial hygiene and work history data for the various levels of subcontractors at each site, are available.

• The Matanoski cohort mortality study of civilian naval shipyard employees, including those at PNS, was funded by DOE. The study followed approximately 700,000 nuclear Navy workers for 13 years, through 1981. An update of this study at this time would add at least 15 years of mortality data for this cohort. Recently, the DOE Office of Naval Reactors has requested that this large study be updated. Following an analysis of existing information, which has never been published, and related gaps, NIOSH will ascertain the costs and merits as well as funding mechanisms for the study. The proposed study would then require approval by the Advisory Committee for Energy-Related Epidemiologic Research.

Proposed Activities

Ongoing Activities

The agencies propose to continue the projects already underway which were listed previously.

New Activities for FY 1999 and FY 2000

• There are no new activities planned for FY 1999 and FY 2000.

Activities for Which the Funding Source is External to the Memorandum of Understanding Between the U.S. Department of Energy and the U.S. Department of Health and Human Services

• Within the constraints of available Department of Defense funding, ATSDR will be conducting public health assessments to evaluate the potential health hazards, if any, from activities at the Norfolk Naval Shipyard, the Pearl Harbor Naval Complex, the Portsmouth Naval Shipyard, and the Puget Sound Naval Shipyard Complex.

• ATSDR will provide health consultations to DOD, DOE, and the community as requested. These consultations will evaluate and address specific questions regarding site remediation or community concerns.

Public Health Activities Site Plan
Draft for Public Comment
Oak Ridge Reservation
Oak Ridge, Tennessee

Background

The Oak Ridge Reservation currently occupies approximately 37,000 acres of land in two counties, Anderson and Roane, in east central Tennessee. Most of the reservation is within the limits of the city of Oak Ridge. The federal government established the Oak Ridge Reservation in 1942 as part of the Manhattan Project, the World War II effort to build the atomic bomb. Originally, the site was 58,000 acres. There are three major installations on the reservation: the Y-12 weapons plant; East Tennessee Technology Park, formerly known as the K-25 site; and the Oak Ridge National Laboratory, formerly known as the X-10 site. These installations occupy about 30% of the reservation property. The remainder of the property, which was never used for nuclear weapons production, research processes, or waste management, is designated as a National Environmental Research Park.

In the early years, the Oak Ridge Reservation missions were plutonium production and uranium enrichment. After the war, the installation's role broadened widely to include a variety of nuclear research and production projects vital to national security. In recent years, the facilities and expertise developed and maintained in the interest of the national defense have been downsized. Presently, missions include environmental restoration, decontamination and decommissioning, waste management, research and development related to energy, technology transfer, government and industry partnerships, and national security programs.

In addition, operations at the Oak Ridge Reservation have left a legacy of radioactive and chemical waste requiring management and disposal. Old waste sites occupy 5% to 10% of the reservation. Most of these waste sites lack engineered containment structures. The chemical and radioactive materials in these waste sites have contaminated soil, groundwater, and surface water both on and off the reservation.

What have we learned from our studies and assessments about Oak Ridge?

Off-Site Contamination

• In 1983 the Tennessee Department of Health and Environment and the Centers for Disease Control and Prevention (CDC) National Center for Environmental Health (NCEH) conducted a pilot survey in Oak Ridge in response to community concerns about mercury contamination in the East Fork Poplar Creek floodplain and the sewer line beltway. The pilot survey concluded that residents and workers in Oak Ridge, Tennessee, are not likely to be at increased risk for having significantly high mercury levels. Mercury concentrations in hair and urine samples were below levels associated with known health effects.

• In 1992 an Oak Ridge physician requested the Agency for Toxic Substances and Disease Registry (ATSDR) to review clinical data and medical histories of 45 patients in the Oak Ridge area. ATSDR and the Tennessee Department of Health reviewed the data and concluded that the case series referred by the physician did not provide sufficient evidence to associate low levels of metals with the diseases presented in the physician's patients. In addition, Howard Frumkin, MD, DrPH, of the Emory University School of Public Health, conducted individual clinical evaluations of the Oak Ridge physician's patients and did not report any hazardous substance exposure to public health agencies.

• In 1991, the Tennessee Department of Health entered into an Oak Ridge health study agreement with the U.S. Department of Energy (DOE), and decided to perform an environmental dose reconstruction study to evaluate all past operations and releases of hazardous substances from the Oak Ridge Reservation. After screening the releases of hundreds of substances used at the Oak Ridge Reservation, five were studied in further detail. The more detailed studies were needed to estimate the amounts of the hazardous substances released and to estimate past (prior to 1990) exposure (or doses) of these substances to people off the reservation. These estimated doses will be used to determine which off-site populations were exposed to hazardous substances and what resulting adverse health effects they might experience. In 1999 the following study conclusions were reported.
  • Radioactive iodine releases were associated with radioactive lanthanum processing at X-10 during 1944 through 1956. Results indicate that children born in the area in the early 1950s who drank cow's or goat's milk had an increased risk of developing thyroid cancer. Within a 25-mile radius of Oak Ridge, it is likely that these children had an increased risk of more than 1 in 10,000 of developing thyroid cancer.

  • The study evaluated mercury releases associated with lithium separation and enrichment operations at the Y-12 plant during 1955 through 1963. Results indicate that during the years mercury releases were highest (mid-1950s to early 1960s), individuals may have engaged in activities that resulted in their receiving annual averages doses of mercury that exceeded the reference dose. The reference dose for a substance is an estimate of the largest amount of a substance that a person can take in on a daily basis without experiencing adverse health effects.

  • Additional studies were conducted on polychlorinated biphenyls (PCBs) in fish from the East Fork Poplar Creek, Clinch River, and the Watts Bar Reservoir. Preliminary results indicated that individuals who consume a large amount of fish from these waters may have received doses that exceeded the reference dose for PCBs.

  • Radionuclides associated with various chemical separation activities at X-10 from 1943 through the 1960s were released via White Oak Creek. Eight radionuclides deemed more likely to carry significant risks were studied. Preliminary results indicate that consumers of large amounts of fish caught in Clinch River near the entry of White Oak Creek may have an excess lifetime risk of cancer incidence of 2 in 1,000 to 2 in 100,000.

  • Uranium was released from uranium enrichment operations, primarily the Y-12 plant from 1944-1988. Because uranium was not initially given high priority as a contaminant of concern, a Level II screening assessment for all uranium releases was performed. Preliminary screening indices are slightly above the decision guide of one chance in 10,000, indicating that more work may be needed to better characterize uranium releases and possible heath risks.

• Additional studies were conducted of hazardous substances in East Fork Poplar Creek. Following are some of the conclusions of a 1993 ATSDR health consultation. Soil and sediments in certain locations along the East Fork Poplar Creek floodplain are contaminated with levels of mercury that pose a public health concern. Fish in the creek contain levels of mercury and PCBs that pose a moderately increased risk of adverse health effects to people who eat fish frequently over long periods of time. The state of Tennessee has posted no fishing signs, however, and the creek is not normally used as a source for fish. Although shallow groundwater along the East Fork Poplar Creek floodplain contains metals at levels of public health concern, this water is not used for drinking or other domestic purposes.

• A 1995 ATSDR health consultation concluded that the East Fork Poplar Creek floodplain soil clean-up level of 400 milligrams per kilogram (mg/kg) for mercury is protective of public health and will pose no health threat to children or adults. In 1996, DOE cleaned up all areas along the East Fork Poplar Creek floodplain where the soil was contaminated with mercury at levels above 400 mg/kg.

• A 1996 ATSDR health consultation on the Watts Bar Reservoir reported the following conclusions. Fish in the reservoir contain PCBs, and frequent and long-term ingestion of these fish poses a moderately increased risk of cancer. Frequent and long-term ingestion may also increase the possibility of developmental effects in infants whose mothers consume fish regularly during gestation and while nursing. Current levels of contaminants in the surface water and sediment of the reservoir were not at levels of public health concern, and the reservoir was determined to be safe for swimming, skiing, boating, and other recreational purposes. Water from the municipal water systems was determined to be safe to drink. The health consultation reported that public health would be protected by DOE's remedial actions, which included maintaining the fish consumption advisories; continuing environmental monitoring; implementing institutional controls to prevent disturbance, resuspension, removal, or disposal of contaminated sediment; and providing community and health professional education on PCB contamination.

• A 1997 ATSDR exposure investigation on the Watts Bar Reservoir reached the following conclusions. The serum PCB levels and blood mercury levels in participants in the investigation (these were people who consumed moderate to large amounts of fish or turtles from the reservoir) are very similar to levels found in the general population. Only 5 of the 116 people tested (4%) had PCB levels higher than 20 micrograms per liter (20 parts per billion), which is considered to be an elevated level of total PCBs. Of the 5 participants who exceeded 20 micrograms per liter, 4 had levels of 20-30 micrograms per liter. Only one participant had a serum PCB level of 103.8 micrograms per liter, which is higher than the general population distribution. Only one participant in the exposure investigation had a total blood mercury level higher than 10 micrograms per liter, which is considered to be elevated. The remaining participants had mercury blood levels that ranged up to 10 micrograms per liter, as might be expected to be found in the general population.

• Additional studies were conducted for East Tennessee Technology Park. A 1997 Governor of Tennessee's Independent Panel Report on the DOE Toxic Substances Control Act (TSCA) Incinerator at the East Tennessee Technology Park concluded that the TSCA incinerator facility and operating conditions were in harmony with its permit and had experienced few operating violations. The amount of waste actually burned is a small fraction of the volume that the incinerator was designed for and permitted to process. The highest concentrations measured by the site monitors were but a small fraction of the permissible levels, and most pollutants that were measured were not primarily from the TSCA incinerator.

Community Health Studies and Activities

• The Tennessee Department of Health conducted a health statistics review to compare mortality rates and cancer incidence rates of counties surrounding the Oak Ridge Reservation to rates from the rest of the state. The review concluded that some rates were elevated and others were low compared to the state rates and that no patterns were identified as related to the Oak Ridge Reservation.

• The ATSDR health education program was conducted to inform local residents and physicians of the health risks associated with PCBs in fish in the Watts Bar Reservoir. The education program consisted of a number of activities and programs including a community health education meeting held in Spring City, Tennessee. A physician and health professional education meeting was sponsored in Oak Ridge, Tennessee, for health care providers in the vicinity of the Watts Bar Reservoir. Copies of two publications from the ATSDR series of Case Studies in Environmental Medicine, "Polychlorinated Biphenyls" and "Taking an Exposure History" were sent to health specialists in the area. ATSDR, using input from a collaborative effort of local citizens, organizations, and state officials, developed an instructive brochure on the Tennessee Department of Environment and Conservation fish consumption advisories for the Watts Bar Reservoir.

• This ATSDR physician education program was conducted to provide information regarding the health impacts of possible cyanide intoxication and to assist community health care providers in responding to health concerns expressed by employees working at the East Tennessee Technology Park (ETTP). An environmental health education session for physicians was held at the Methodist Medical Center in Oak Ridge. ETTP employees and physicians were given copies of the ATSDR Case Studies in Environmental Medicine publication on cyanide toxicity, the final health hazard evaluation by the National Institute of Occupational Safety and Health, and the ATSDR public health statement for cyanide. ATSDR instituted a system through which local physicians could make patient referrals to the Association of Occupational and Environmental Clinics (AOEC).

• A 1998 CDC health investigation concluded that the results of a Scarboro community health survey indicated elevated rates of asthma and wheezing. The asthma rate was 13% among children in Scarboro, compared to national estimates of 7% among all children aged 0-18 years and 9% among African American children aged 0-18 years. The wheezing rate among children in Scarboro was 35%, compared to international estimates which range from 1.6% to 36.8%. No statistically significant association was found between exposure to common environmental triggers of asthma (such as environmental tobacco smoke, pests, unvented gas stoves, and the presence of dogs or cats in the home) or potential occupational exposures (for example, living with an adult who works at the Oak Ridge Reservation or living with an adult who works with dust and fumes and brings exposed clothes home for laundering) and asthma or wheezing illness. The physical examinations of 23 Scarboro children indicated that all were generally healthy and no urgent health problems were identified. Only one child had any lower respiratory illness, and none were wheezing at the time of the physical examination.

Studies of the Health of Oak Ridge Workers

There have been numerous studies of health effects among workers at the Oak Ridge Reservation facilities. These studies, initially funded by DOE, have been conducted by researchers at the National Center for Occupational Safety and Health (NIOSH) and various collaborators including the Oak Ridge Associated Universities, the University of North Carolina, and the University of Michigan. Study findings to date include the following.

• The University of North Carolina, sponsored by a NIOSH grant, found that workers employed at the X-10 (ORNL) facility between 1942 and 1972 have experienced a statistically significant excess of leukemia and overall cancer deaths, compared to the general U.S. population. The excess number of deaths were found to be related to the external and internal ionizing radiation doses received by workers at these sites.

• In some studies, lung cancer mortality has been found to be elevated among workers at the Y-12 nuclear weapons fabrication facility who were employed for longer periods of time or hired at older ages. This increased lung cancer mortality may be related to exposure to uranium dust.

• Research performed by Oak Ridge Associated Universities under contract to NIOSH found that workers exposed to mercury at the Y-12 facility have shown no excess mortality compared to unexposed workers; however, there is evidence the exposed group has experienced long-lasting declines in neurological function.

• Workers employed at the K-25 gaseous diffusion facility, some of whom were exposed to epoxy resin, nickel oxides, and uranium dust, were found to have elevated rates of overall mortality. These workers also have experienced higher rates of death from bone cancer, mental disorders, and respiratory cancers and other respiratory illnesses.

• Several studies of combined DOE facilities have included workers at Oak Ridge facilities. These studies have found elevated rates of death from emphysema, lung cancer, respiratory diseases, and "all causes" compared to the general population. Another combined study found no relationship between cumulative internal dose and lung cancer mortality.

• A recent study, conducted by the University of North Carolina under contract to NIOSH, including workers at X-10 and several other DOE sites, found an association between external radiation and death from multiple myeloma (a cancer of blood-forming cells in the bone marrow) among workers exposed at older ages.

• A study of the potential association between paternal exposure to ionizing radiation and risk of childhood cancer found no evidence of a link between leukemia and paternal employment at Oak Ridge. Children whose fathers worked at Hanford were more likely to get CNS (central nervous system) cancer than children whose fathers worked at other sites, but this finding was based on small numbers and was not statistically significant.

• A NIOSH health hazard evaluation, requested by K-25 site employees, investigated possible worker exposure to cyanides. The evaluation indicated that employees are not occupationally exposed to hydrogen cyanide, cyanide salts, or a wide variety of other compounds that contain the cyanide ion.

• The Oak Ridge National Laboratory, sponsored by a NIOSH grant, investigated statistical estimation of dose from daily and weekly dosimetry data for Oak Ridge radiation workers included in previous epidemiologic studies. The study found that bias in previous exposure estimates was substantial, and recommended methods of reducing uncertainty for some estimates.

• The Oak Ridge Associated Universities, under a NIOSH grant, developed a project at the Oak Ridge site to develop a system for the prioritization of industrial hygiene and medical surveillance efforts. The Worker Exposure Surveillance System (WESS) was designed for easy data merger with traditional occupational health systems utilizing environmental level analyses, occupational titles, and area descriptors.

• The University of Cincinnati, sponsored by a NIOSH grant, created exposure histories for the construction trades at the Oak Ridge site. This study developed techniques for improving the characterization of worker occupational exposures over time, especially worker recall of complex occupational exposures across a large number of short-term workplace assignments. These new techniques, including graphic displays of work site locations and detailed building histories, will be validated at another DOE site and used to establish guidelines and formats for the maintenance of personal work histories.

What are the current studies and public health activities at Oak Ridge?

Off-Site Contamination

• The ATSDR public health assessment on the Oak Ridge Reservation will assess the public health impact on off-site populations from releases of hazardous substances from the Oak Ridge Reservation and determine which public health actions or studies are indicated. On an ongoing basis, ATSDR is conducting the public health assessment to identify and characterize both current and past exposures of off-site populations to radiologic and chemical contaminants. ATSDR will also evaluate morbidity and mortality data to identify increased rates of health outcomes associated with contaminants of concern. The public health assessment will (1) identify people exposed at levels of health concern; (2) identify increased rates of health outcomes; (3) address community health concerns; and (4) recommend follow-up public health actions or studies.

Occupational Health Studies

• The DOE Beryllium Worker Medical Surveillance Program is designed to detect and diagnose chronic beryllium disease (CBD) among current and former workers exposed to beryllium throughout the DOE complex, including Oak Ridge. Information from this program is used to improve and evaluate worker protection and control measures, to monitor trends in CBD frequency, and to strengthen work planning to minimize worker exposures. This program includes an intensive, coordinated health-risk communication effort.

• DOE's Former Worker Program is a pilot program designed to provide medical surveillance for selected former DOE workers at risk of work-related illness as a result of exposures while working at DOE facilities. Two projects are underway in Oak Ridge.
  • The former construction workers project is led by Dr. Eula Bingham of the University of Cincinnati in cooperation with the United Brotherhood of Carpenters Health and Safety Fund, the Center to Protect Workers' Rights, and Duke University Medical Center. The Phase I assessment identified approximately 800 former construction workers. Phase II will focus on medical screening of workers exposed to asbestos, beryllium, noise, silica, solvents, and heavy metals.

  • The second project involving former production workers from the Oak Ridge K-25, Paducah, and Portsmouth gaseous diffusion plants is led by Dr. Steven Markowitz of Queens College, City University of New York, and Mr. Robert Wages of the Oil, Chemical, and Atomic Workers International Union, in cooperation with the University of Massachusetts at Lowell. The Phase I assessment identified approximately 1,260 former production workers as potentially at high risk. The Phase II will focus on medical screening of workers exposed to asbestos, beryllium, bladder carcinogens, chlorinated solvents, fluorine compounds, nickel, noise, silica, uranium, welding fumes, and heavy metals.

• An independent panel of nationally recognized occupational health physicians is conducting individual medical evaluations to assess occupational health complaints and symptoms of 53 current and former Lockheed Martin Energy Systems workers at the East Tennessee Technology Park (formerly called the Oak Ridge K-25 site). These medical evaluations of the workers include reviews of prior health studies; visits to workers' workplaces and environs; work history interviews with individual workers; reviews of worker medical records; physical examinations; and specialized follow-up inquiries and testing. Recommendations from the physicians are expected within the next six months.

• Boston University, in a cooperative agreement with NIOSH, is evaluating the effects of job stressors including downsizing and reorganization in a multisite study. Organizational climate, worker health, and performance at four DOE sites will be assessed.

• The United Brotherhood of Carpenters Health and Safety Fund, sponsored by a NIOSH grant, is conducting a study of carpenters and other construction workers at Oak Ridge. The study will assess the effects of heat stress associated with wearing protective clothing. Physiologic and neurobehavioral changes of workers will be measured during actual work conditions. Carpenters and other construction workers in remediation and hazardous waste work will benefit from this information.

• The State University of New York, sponsored by a NIOSH grant, is conducting a study of mortality among female nuclear weapons workers. This study of female workers from 12 DOE plants will be the largest study of mortality among the 80,000 female workers who have ever been in the DOE work force. Risk estimates will be developed for exposure to ionizing radiation and chemical hazards.

• Two ongoing NIOSH case-control studies combine worker information from multiple sites including Oak Ridge to answer study questions about specific cancers. One study is being conducted to clarify the relationship between lung cancer and external radiation exposure. The second case-control study, the largest of its kind, is exploring the relationship between external radiation and leukemia risk among 250 workers with leukemia compared to similar workers without leukemia.

• Limited previous studies outside the DOE complex suggest an increased risk of cancer in chemical laboratory workers. In this NIOSH cohort mortality study, potential worker exposures to groups of chemicals and ionizing radiation will be assessed and their relationship to mortality patterns will be investigated.

• Exposures encountered by decontamination and decommissioning workers at Oak Ridge and other sites are being characterized by NIOSH. Working conditions and research needs are being identified at each study site in this Phase I feasibility study. These results are relevant to current workers and support development of surveillance activities.

• A NIOSH multiple myeloma case-control study at Oak Ridge's K-25 facility will increase understanding of the relationship between multiple myeloma and different types of radiation exposure. A previous study at the University of North Carolina examined the relationship between multiple myeloma and exposures to external radiation and chemicals. The current NIOSH study will look at the relationship between multiple myeloma and exposures to internal radiation and chemicals.

• An excess number of bladder cancer cases have occurred among workers involved in construction of gas centrifuge components at Oak Ridge's K-25 facility. To more clearly define the risk of bladder cancer, a follow-up study by NIOSH researchers will examine additional exposure data to determine whether cases of bladder cancer are associated with exposures to specific agents. Progress on this study will be coordinated with the DOE-sponsored worker medical surveillance program.

What are the gaps in our knowledge and what are the important issues which need to be addressed?

• A more effective public forum should be developed with the broader Oak Ridge community and state and federal agencies with regard to public health activities at the Oak Ridge Reservation.

• The level of contamination of soils in all Oak Ridge areas should be better characterized.

• Potential current exposure of local residents to hazardous substances needs to be identified and characterized.

• Exposure of subcontractor workers and clean-up workers needs better elucidation.

• The five dose reconstruction studies in the Oak Ridge Health Studies need to be independently reviewed.

• Physician followup is needed for a few of the Scarboro children who received a physical examination during the Scarboro Community Health Investigation.

• There is a continuing need to address environmental justice issues.

• Health effects of simultaneous exposures to low levels of chemicals and/or radiation and other risk factors should be addressed among workers.

• There is a need to determine whether the current occupational radiation exposure limits are adequate for radiation workers.

• Internal dosimetry of radiation workers is not well characterized or understood, and the relationship between internal radiation dose and health effects needs to be evaluated.

• Results from ongoing mortality studies need to be evaluated to improve understanding of causes of cancer and chronic disease. Additional studies can be proposed to focus on a single disease in worker groups.

• There is a need to ensure that complete records, including industrial hygiene and work history data for the various levels of subcontractors at each site, are available.

Proposed Activities

Ongoing Activities

The agencies propose to continue the projects already underway which were previously mentioned and initiate new projects to address the health conditions of the Oak Ridge area. New activities will be implemented only if feasible and deemed appropriate and beneficial to the community.

New Activities for FY 1999 and FY 2000

• The highest priority for the state and federal agencies at the Oak Ridge Reservation is to develop a forum whereby community members, local interest groups, and state and federal agencies can work collectively to make informed recommendations regarding the public health agenda for the Oak Ridge Reservation. This forum will enable state and federal agencies to interact with local interest groups. The agencies will have the opportunity to present to community members the results of previous studies, analyses of exposure pathways, results of the health statistics review, and the criteria used to select and conduct appropriate public health activities. Community members will help prioritize public health issues and community concerns and provide input into the choices to be made between current and historical exposures and different public health activities. Discussion between the groups will provide an opportunity for education and collaboration. Local interest groups and state and federal agencies can work together in developing the health agenda for Oak Ridge. The agencies will address the public health concerns of the community and will present and discuss their findings and any recommendations for further studies or additional public health actions.

• ATSDR will have the five dose reconstruction studies in the Oak Ridge Health Studies reviewed by an independent panel.

• Based on the results of previous studies involving Oak Ridge workers, NIOSH has proposed two additional studies, each of which will focus on a single disease. Case-control studies for brain and breast cancer would combine worker information from multiple sites, possibly including Oak Ridge, to answer study questions about the relationship of these specific cancers to low-level ionizing radiation.

Public Health Activities Site Plan
Draft for Public Comment
Paducah Gaseous Diffusion Plant
Paducah, Kentucky

Background

The Paducah Gaseous Diffusion Plant (PGDP) is a uranium enrichment facility covering approximately 1,350 acres in western McCracken County. It is approximately 10 miles west of Paducah, Kentucky, and about 3 miles south of the Ohio River. The Paducah plant began operating in 1952. Previously the site and surrounding areas were used as a World War II-era ordnance facility known as the Kentucky Ordnance Works. Currently, the plant is leased and operated by the United States Enrichment Corporation (USEC) to produce low-enriched commercial power reactor fuel. The U.S. Department of Energy (DOE) owns the site and retains responsibility for environmental remediation activities and waste generated prior to July 1, 1993, when USEC assumed responsibility.

The entire PGDP reservation covers a total of 3,424 acres, with approximately 750 acres in a fenced security area and an uninhabited buffer zone surrounding the fenced area. Beyond the DOE-owned buffer zone is an extensive wildlife management area of 2,100 acres deeded or leased to the Commonwealth of Kentucky.

PGDP performs the first step in the uranium enrichment process, enriching uranium-235 (U-235) in a physical separation process. The separation process is based on the fact that U-235 diffuses through a barrier at a faster rate than the heavier uranium-238. Subsequent to the separation processing at the Paducah plant, the uranium is further enriched at another DOE gaseous diffusion plant. Extensive support facilities are required to maintain the Paducah diffusion process, including a steam plant, four major electrical switchyards, four sets of cooling towers, a building for chemical cleaning and decontamination, a water treatment plant, maintenance facilities, and laboratory facilities. The site also includes a raw-water treatment plant, a residential landfill, an inert landfill, a former sanitary landfill, and two industrial treatment lagoons.

What have we learned from our studies and assessments of PGDP?

Off-Site Contamination

• In August 1988, DOE found technetium-99 (Tc-99) in an off-site drinking water well north of the Paducah plant site. Trichloroethylene (TCE) has also been detected in nearby private wells and on-site and off-site monitoring wells. The contaminated residential wells are no longer being used. Approximately 1,400 people obtain drinking water from public and private wells within 4 miles of the plant.

• Plant operations have generated hazardous, nonhazardous, and radioactive wastes, including chromium, polychlorinated biphenyls (PCBs), Tc-99, TCE, and uranium (multiple isotopes). DOE has detected PCBs in on-site surface water and downstream of the plant in Big Bayou Creek and in Little Bayou Creek. These creeks pass through the West Kentucky Wildlife Management Area, which is adjacent to the plant and to private property. Access to Little Bayou Creek is currently restricted, but Big Bayou Creek is occasionally used for fishing. In 1989, the commonwealth of Kentucky's Division of Water warned against consumption of fish caught in Little Bayou Creek and in several of the ponds in the wildlife management area.

Community Health Studies and Activities

• There are no community health studies or activities at the Paducah site.

Studies of the Health of PGDP Workers

• There are no health studies of workers at the Paducah plant.

What are the current studies and public health activities at PGDP?

Community Involvement

• Community involvement activities initiated by the Agency for Toxic Substances and Disease Registry (ATSDR) have included written correspondence, telephone conversations, informal meetings, and public availability sessions. ATSDR has also participated in and encouraged community involvement in DOE-sponsored public meetings. ATSDR solicited public concerns through direct mail inquiry, mailing approximately 1,700 packages. Approximately 500 responses were received from community members. Among other educational material, information on methods of preparing fish to reduce the possibility of PCB-exposure was provided to community members during the public availability sessions.

Off-Site Contamination

• ATSDR is conducting a public health assessment at PGDP. The main public health issues around the plant are potential off-site exposures to air releases, contaminated biota, surface water releases, and contaminated groundwater. The contamination includes both chemicals and radioactive materials. ATSDR is also looking at potential hazards presented by the outdoor storage on the site of thousands of cylinders, the majority of which contain depleted uranium hexafluoride.

Community Health Studies and Activities:

• There are no community health studies.

Occupational Health Studies

• The DOE Former Worker Medical Surveillance Program at DOE Gaseous Diffusion Plants involves former production workers from the Oak Ridge K-25, Paducah, and Portsmouth gaseous diffusion plants. The project is led by Dr. Steven Markowitz of Queens College, City University of New York, and Mr. Robert Wages of the Oil, Chemical, and Atomic Workers International Union, in cooperation with the University of Massachusetts at Lowell. The Phase I needs assessment was completed in 1997. The Phase II medical screening began in late 1998 and is scheduled to run through 2001. Initially, approximately 200-300 former Paducah production workers were identified as potentially at high risk for lung disease. A second priority group includes approximately 2,000 workers at Paducah. Exposures of concern that were identified in Phase I and that will be focused on during the Phase II medical screening include asbestos, beryllium, bladder carcinogens, chlorinated solvents, fluorine compounds, nickel, noise, silica, uranium, welding fumes, and heavy metals (for example, cadmium, lead, and mercury).

What are the gaps in our knowledge and what important issues need to be addressed?

• For many of the off-site samples, there is no information to identify whether they were collected on or near residential properties.

• There is inadequate air monitoring data for hexavalent chromium, sulfur dioxide, and nitrogen oxides: chemicals that are released or have potential for release at levels of concern.

• Health outcome data for the immediate area around PGDP is not available. The data available cover an area that is too large to demonstrate impact from the site.

• There is a need to determine whether the current occupational radiation exposure limits are adequate for radiation workers.

• Internal dosimetry of radiation workers is not well characterized or understood, and the relationship between internal radiation dose and health effects needs to be evaluated.

• Results from ongoing mortality studies need to be evaluated to improve understanding of the causes of cancer and chronic diseases. Additional studies can be proposed to focus on a single disease in worker groups.

• There is a need to ensure that complete records, including industrial hygiene and work history data for the various levels of subcontractors at each site, are available.

Proposed Activities

Ongoing Activities

The agencies propose to continue the projects already underway which were listed previously and initiate the following new projects. Such activities will be implemented only if feasible and deemed appropriate and beneficial to the community. The agencies will establish a coordinated plan, schedule, and lead organization for each new public health activity. The plan and schedule will be presented to all potential partners for their comment.

New Activities for FY 1999 and FY 2000

• Based upon the review of data used in developing the public health assessment, drinking water exposure to TCE via residential wells has been documented at levels of concern. Fish consumption advisories are in effect due to PCB and mercury contamination. Other contaminants of concern are chromium, PCBs, uranium, and Tc-99. ATSDR will review the exposure pathways and evaluate the potential health impact to consider appropriate follow-up health activities. The population closest to the site and potentially affected by these contaminants is estimated to number less than 100.

• ATSDR will implement health care provider training in the Paducah community. Primary care providers will be given information and resources on diagnosing, treating, and counseling to increase their capacity to assist community members who are concerned about the health impact of the plant.

• ATSDR will implement community health education and communication strategy. Working with the Paducah community to identify the community's needs for information and education, a comprehensive health education outreach program will be developed. The purpose of this program will be to assure that community members know the issues of concern for the Paducah site; understand the science and the process of the various site studies; know how to protect themselves from exposure; know where to get their questions answered; and will be able to share their knowledge with others. Local community infrastructure, including schools, churches, community organizations, media, or other avenues identified by the communities, will be used to provide community health education outreach.

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