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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)

Part Three

Mortality and Morbidity among Children and Grandchildren of Members of the British Nuclear Tests Veterans Association

Information was also sought in the questionnaires about impaired fertility (failure to achieve a pregnancy within a year of wanting to do so) and the health of those children born to the partners of the men.

The conditions reported for the 2,261 live born children and 2,342 grandchildren of the 1,041 men who responded to the questionnaire were databased, coded and analysed in a simple descriptive manner.

Impaired fertility

'We were told at the time that after effects in future generations were unknown, but that there could be problems and defects of birth in our grandchildren.'

'We were told not to start a family for at least a year after leaving.'

'We weren't told anything about the genetic effects.'

'We're all signed up and ready to go.'

'To offer up our testicles for UNO' composed by journalists en route to observe the Bikini tests in 1946.'

'There was the usual Service banter about sterility.'

'Do not start a family straight away on return to UK.'

The first 1,000 questionnaires²⁰ returned have been analysed for reports of impaired fertility. 128 of the respondents (12.8%) report having no children at all. An additional 50 (5%) report having no children after their return from the tests. While not all men wanted a family, or regretted not having children, or did not want more children after returning from the tests, many did and these data suggest a post-test infertility level of about 15%. This is similar to the figure estimated in a questionnaire survey of 2,440 Australian respondents who had been present at the tests.²²

Foetal loss and neonatal deaths

'I felt a tingling in my scrotum immediately after the detonation.'

The population surveyed reported 2,261 live births, 257 miscarriages, 34 stillbirths and 25 neonatal deaths. There were 53 deaths of young children reported.

Children's health

There were a total of 2,261 live-horn children. A total of 1,431 conditions were reported for these children. 180 were born before 1955 (8%) and experienced 46 conditions (3%); 2,081 children were born in 1955 or later (92%) and experienced 1385 conditions (97%). For 1,368 children (60.5%), no health problems were reported. Health problems were reported for 893 (39.5%) - or two in five children. Fifty-three (2%) of the children were reported to have died as infants and 7 as adolescents or young adults (0.3%). Hearing problems were reported in 48 children and 47 reported emotional problems. Dental conditions (including both excess and missing teeth) were reported for 26, while 11 reported early hair loss and 13 excess body hair. Five of the offspring were already suffering from cataracts, and 23 from diabetes. Five children had thyroid conditions, another five cerebral palsy, while two children are Down's syndrome sufferers and two have muscular dystrophy. There was one case each of lupus, cystic fibrosis, multiple sclerosis and San Fillipo disease and three children have breast deformities. Blood conditions were reported for ten children and 48 had cardiovascular disorders including 23 heart murmurs. Ninety-three children were reported to have respiratory conditions, mainly asthma. One hundred and twenty-nine of these children of veterans, now mostly in their twenties and thirties, reported reproductive problems, including 24 ovarian conditions including cancer. Non-cancerous brain disorders were reported for 24 of the offspring and 41 were reported to have poor mental development. There were also 41 reports of epilepsy. Forty cancers were reported in the offspring, of which four each were of the brain, the breast or leukaemia and two were adrenal cancers.

Grandchildren's health

Two thousand three hundred and forty-two grandchildren have been born so far to the 2,261 children of the veterans (most of whom were born less than 30 years ago). No birth date was given for 3% of the grandchildren; 8% (197) were born in the 1960s and 1970s; 42% (986) were born in the 1980s and 47% (1,093) were born from January 1990 to December 1997.

Health problems were reported for 484 (21%) of the grandchildren. Seven hundred and five conditions were reported for these 484 children including 13 children with dental problems, 30 with impaired hearing, 50 with impaired vision, 30 with heart conditions and 149 with respiratory disorders, mostly asthma. Nine grandchildren were reported to have blood 'disorders' and three leukaemia, including one case of acute myeloid leukaemia. Two grandchildren had neuroblastomas. There were four cases of spina bifida and five cases of hydrocephalus. Eight grandchildren had cerebral palsy and six Down's syndrome. Dermatological conditions were reported in eighty-eight grandchildren, especially eczema. There were 19 gastric conditions. Of the 104 musculo-skeletal conditions reported, 11 were hip deformities, six spinal deformities with two cases of scoliosis, and 34 deformities of hand, feet and toes. Thirty-five of the grandchildren were already presenting with reproductive problems.

Fertility

Radiation-induced infertility and impaired fertility have been identified for well over 50 years in animals. A National Survey of Congenital Malformations Resulting from Exposure to Roentgen Radiation among American Radiologists was reported in 1953⁶² and British radiologists' reproductive outcomes were studied at the same time⁶³ (that is, in the years of the nuclear weapons tests). More recently a range of fertility and sexual function problems have been reported in 12 men with chronic radiation dermatitis following the Chernobyl accident.⁶⁴

It has been pointed out that 'In males, fractionated irradiation of the testes may be more harmful than acute, at least up to total doses of about 600cGy (60rad). Fractionated doses greater than 35cGy cause aspermia, the time taken for recovery increasing with doses, and after more than 200cGy aspermia may be permanent.'⁶⁵

The author also notes that:
It should he remembered that although human fertility may be retained after substantial doses of radiation, there is always the risk of radiation-induced inheritable damage which may persist for many generations. According to the ICRP (1977) the risk of serious hereditary ill health within the first two generations following the irradiation of either parent is about 100 cases per million per cGy of LET [Low energy transfer] radiation and the additional damage to later generations is of about the same magnitude.

A report on the effects of pesticides and radiation on the outcome of pregnancy⁶⁶ states that 'The known mutagenic effects of ionizing radiation make a sperm-mediated influence on fetal development plausible [referring to Ash above]. The recent observations relating ionizing radiation exposure to neural tube defects could also be interpreted as reflections of such a process' (referring to the Hanford studies discussed below).

The health of children born to medical radiographers has been studied by postal questionnaire.⁶⁷ The study population comprised 6,370 members of the UK College of Radiographers who were at the time of the survey aged between 30 and 64 years and on the current membership file, and resident in Britain. The authors note that 'People under 30 years were not approached because they would have had few pregnancies...' but it is not clear if this assumption is justified. The observed frequencies of reproductive events were broadly in line with findings from other studies: of 9,208 pregnancies, 83% were live births, 12% were miscarriages, 1% were stillbirths and 1% were rarer spontaneous adverse events such as ectopic pregnancy, blighted ovum and hydatiform mole. Among children the overall risks of major congenital malformation and cancer were as expected on general population rates. The study detected a borderline excess of chromosomal anomalies other than Down's syndrome in the children of female radiographers (Relative Risk 3.9) and cancer in the children of male radiographers (RR 2.7). Three per cent of respondents (166) said they had not succeeded in starting a pregnancy; this figure was similar for men and women. There were 163 major malformations in the 9,208 pregnancies, of which 35 were of the limbs and other musculoskeletal. Sixteen malignancies were reported in the offspring of which seven were leukaemia and lymphomas. Four cases of Turner's syndrome were reported.

In a study of congenital malformations and death among the offspring of a cohort of all 4,939 female pharmacy assistants in Denmark under the age of 40 years who were members of the national union in 1979 to 1984,⁶⁸ there were 2,007 single births to the 4,585 respondents. There were 23 malformations, including one case each of spina bifida and hydrocephalus and four hip dislocations. There were nine stillbirths, two of whom were malformed. There were six perinatal deaths and five neonatal deaths; 13 more children died in the first year of life. Overall the frequency of malformations for this cohort was 1.1% compared with 1.5% for children of all Danish women in 1981.

In chemical applicators and agriculture contractors in New Zealand⁶⁹ the miscarriage rates were similar for the two groups, with a rate of 86 miscarriages per 1,000 births for the chemical applicators and 93 per 1,000 births for the agricultural contractors. There were three stillbirths reported or seven per 1,000 live births, which was lower than the NZ rate for 1969-78 of 8.9 per 1,000.

A prospective study of the reproductive outcome, live birth, miscarriage or nine-month infertility in 585 participating Australian couples⁷⁰ reports, 'There were no associations with radiation exposure other than through Xrays. For X-rays, there was no association with infertility but significant associations were found between miscarriage and abdominal (including back) X-rays in both males and females ... The association for male exposure was highly significant' for 24 exposed individuals. X-rays to other areas of the body were not significant in either males or females. The authors comment:
...exposure of the genital regions, in the course of diagnostic X-rays to the abdomen or back, is the likely cause of many spontaneous abortions. Our data suggests that the risk of X-rays to males is about 2.3 times the risk to females. The increased risk to males is not unexpected if it is assumed that vulnerable meiotic and post-meiotic stage cells are always present in the male whereas in the female, oocytes at dictyotene might not be vulnerable. X-rays are known to be effective germ-cell mutagens in both male and female mice and the findings of this study suggest a similar vulnerability in humans.

Skeletal disorders

Nearly half the morbidity among the offspring of the nuclear weapon test veterans reported here consists of dermatological, musculo-skeletal and gastrointestinal conditions. It is proposed that these are compatible with the SAPHO syndrome and its variants.

More than 200 skeletal abnormalities were reported, including over 30 cases of short stature. Eighteen spinal problems were reported, mostly curvature. More than 100 skin conditions were reported, mostly eczema and dermatitis, in many cases described as congenital. More than 50 of the children were already suffering from arthritis and similar problems, although they are only now entering their thirties. Hip deformities were reported for 19 children; kneecap deformities for 14 children. The observed⁷¹ rate of congenital dislocation of the hip in Benton and Franklin (counties around the Hanford Nuclear Site in the USA) was 1.20 per 1,000 live births, compared with 3.10 per 1,000 live births in the three state Birth Defects Monitoring Programme.

Neural tube defects

Fifteen cases of spina bifida were reported, of which six were associated with hydrocephalus. Five other cases of hydrocephalus were reported. A study of congenital defects and miscarriages among the offspring of 989 New Zealand 2,4,5-T sprayers⁶⁹ revealed two cases of spina bifida in 2,294 births. The overall birth defect rate was 20 per 1,000 among the chemical applicators, and 16 per 1,000 among the agricultural contractors, which 'are close to those reported in three previous New Zealand studies'. Of chemical applicators listed with the NZ Chemicals Board, 548 (89%) responded to a questionnaire and 441 (83%) from small agricultural contracting firms. 'The response rates of 89% and 83% for agricultural contractors were achieved with up to two reminder letters, newsletters from the Contractors Federation of which many are members, and extensive media coverage by newspaper, radio and television.' But they did not consider that the media coverage confounded their results or resulted in selective sampling.

In a case-control study of congenital malformations and occupational exposure to low-level ionizing radiation in two counties in south-eastern Washington State where the Hanford site has been a major employer,⁷² there were 672 cases of malformation. Twelve specific malformation types were analysed for evidence of association with employment of the parents at Hanford and with occupational exposure to ionizing radiation. Two defects, congenital dislocation of the hip and tracheoesophageal fistula, showed statistically significant association with employment of parents at Hanford, but not with parental radiation exposure. Neural tube defects showed a significant association with parental preconception exposure, on the basis of a small number of cases. The authors note that 'Neural tube defects include a genetic component in their etiology and thus an association of these defects with radiation exposure is plausible'.

The same researchers also reported⁷¹ the prevalence at birth of congenital malformations in communities near the Hanford site from 1968 to 1980. They detected 454 malformation cases among 23,319 births (of which 243 were foetal deaths), giving a malformation rate of 19.6 per 1,000 births, a rate similar to that reported in other studies. A statistically significant elevated rate of neural tube defects was observed (1.72 per 1,000 live births v 0.99 per 1,000 in their controls). The overall congenital malformation rate was not greater than the usually reported rate of from 2 to 3 per cent of all births. The authors comment:
The etiology of neural tube defects is unknown but is considered to involve both genetic and nongenetic (environmental) factors ... In terms of what we know about the epidemiology of neural tube defects, what are the possible explanations for the increased rates observed in this area? One is the presence of an environmental factor(s) that increases the rates, either through a direct effect on the developing embryo or through modification of the parental genome that leads to a transmissible genetic alteration, i.e. a mutation.

A review of the epidemiology of birth defects⁷³ comments, in summarizing the familial risks of various congenital malformations, that 'the central nervous system malformations (anencephaly and spina bifida) showed the least familial component, implying that both polygenic and nongenetic factors should be considered'. Furthermore 'a certain baseline level of these malformations (anencephaly and spina bifida) behaved in a fashion that resembled a genetic etiology, and that higher background rates were probably produced by environmental agents that affected the inheritance mechanism instead of by agents that were simple teratogens'. It is concluded that 'Thus, the methods of genetic epidemiology should provide a promising approach to conditions of multifactorial etiology; i.e. genetic factors influencing susceptibility to reratogens or other environmental factors may be identified through clinical-genetic studies of families'.

Reproductive disorders

More than a hundred of the children of the test veterans reported reproductive problems; 24 women reported problems with their ovaries. Given the incidence of shortness of stature and deformities of the hands and feet, the incidence of Turner's syndrome needs to be investigated more fully.

A large case-control study⁷⁴ of spontaneous abortion considered that follow-up prospective studies would require a cohort of 270 exposed subjects to detect an increase in the spontaneous abortion rate from 15-25% or 134 to detect a doubled rate (with 80% power).

Grandchildren

Conditions compatible with the 'SAPHO variant' account for a third of the conditions reported for the grandchildren of the veterans surveyed to date, with a particular emphasis on skeletal problems. There is a higher incidence of CNS disorders in the grandchildren than in the children of the veterans. Three of the spina bifida cases also showed hydrocephalus, and there were two other cases of hydrocephalus. The reproductive system problems were equally divided among males and females; given the incidence of shortness of stature, the clinical suspicion of Turner's syndrome should also be checked. Twenty-two deaths have been reported in this group of grandchildren.

Read Part Four