British Nuclear Test Veterans Association

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Mortality and Morbidity of Members of the British Nuclear Tests Veterans Association and the New Zealand Nuclear Tests Veterans Association and their Families

SUE RABBITT ROFF
University of Dundee Centre for Medical Education

Published in Medicine, Conflict and Survival (Volume 15, Supplement 1, July-September 1999)

Recommendations

• It is recommended that a full longitudinal prospective family and clinical follow-up study be undertaken for at least the ten per cent sub-sample of veterans of UK nuclear weapons tests for whom contact addresses are available. A ten per cent sample is used for provisional estimates of mortality for selected causes of death by the US National Center for Health Statistics in their monthly forecasts,²¹ and the use of such samples is widespread in clinical audit.^119-120 The sample of more than 2,000 men and their families would permit comparisons with, among others, the study of the causes of death among 2,068 patients treated with X-irradiation for metropathia haemorrhagica in Scotland.^13-14
• This study has shown an increased incidence of multiple myeloma (further cases have been notified since the study was closed). The incidence of multiple myeloma is raised in both the SAPHO syndrome and after spinal irradiation for ankylosing spondylitis. The occurrence of multiple myeloma among veterans of nuclear weapons tests must therefore be explored more fully. This may well increase the understanding of the induction and course of multiple myeloma, especially when triggered by radiation exposure. The role of bone marrow depression in the possible progression from the SAPHO-type syndrome and multiple myeloma should also be examined.
• The sample of UK nuclear tests veterans should be compared with those patients who were treated by spinal irradiation for ankylosing spondylitis.^98-105
• The UK nuclear veterans for whom contact addresses are held - or the full cohort - should be compared with the survivors of the bombings of Hiroshima and Nagasaki, in whom longstanding longitudinal studies are now reporting a very similar mortality and morbidity pattern.^83-86 The findings should also be compared with observations of mortality and morbidity of Soviet nuclear workers and Chernobyl liquidators.^17-19107-112
• The 75 cases of cataract reported in the UK and NZ veterans provide an opportunity to extend studies of radiation-induced cataracts already begun by the National Radiological Protection Board.
• The biological mechanisms of the postulated SAPHO-type syndrome should be examined together with the possibility that they have been triggered by exposure to ionizing radiation. The role of ingested or inhaled alpha irradiation should be particularly examined; the Ministry of Defence acknowledges that the veterans were never monitored for this or other forms of internal radiation of any type. This study should take into account the carcinogenetic potential of alpha-particles.^121-122
• Given the incidence of spina bifida and other neural tube defects, the present sub-sample, and indeed the full cohort, should be studied for the possibility of radiation-induced genomic instability with its cytogenetic implications.
• An independent tissue and body depository should be established as soon as possible to respond to the present sample's willingness to donate their remains to medical science.
• Now that there are radiobiological techniques^116-118 available which can assess radiation-induced cytogenetic changes, including genomic instability, samples should be drawn from the present study population to investigate further the possibility of a radiogenic basis for the health burden reported here.

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