Date:

March 31, 2000

Memorandum To:

Ron Minsk
National Economic Council

From:

David Michaels, PhD, MPH
Assistant Secretary
for Environment, Safety and Health

Subject:

Work Products from Inter-Agency Working Groups

Attached are work products from two Inter-Agency Working Groups formed by the National
Economic Council in response to President Clinton’s direction for a study of occupational disease
among the Department of Energy (DOE) contractor workers.
As you know, on July 15, 1999, Secretary Richardson announced that the Administration would
propose legislation to establish a new program to compensate victims of beryllium disease. At the
same time, the President tasked the National Economic Council to coordinate an interagency
process to examine whether other illnesses would warrant inclusion in such a program and how
this should be accomplished. Experts in the fields of occupational medicine, public health, and
social insurance were assembled to examine these issues. Staff from the Departments of Health
and Human Services, Labor, Justice and Defense joined DOE in these efforts; the results do not
therefore reflect the views of any particular agency.
The first paper examines the link between exposure to occupational hazards and illnesses in the
DOE contractor workforce. The second reviews benefits available to DOE contractor personnel
from state workers’ compensation programs. The efforts of these two groups provide important
input that will be useful in crafting a sound, science-based approach to the issues raised by the
President: whether there are other occupational illnesses in DOE nuclear weapons complex, and,
if so, how workers with these conditions should be compensated.
If you need additional information, please do not hesitate to contact me.

 Executive Summary
The Link Between Exposure to Occupational Hazards and Illnesses
In the Department of Energy Contractor Workforce
I.

Background

This memo examines whether there is evidence of occupational illness in current and
former contract workers at the US Department of Energy (DOE) from exposures to occupational
hazards in nuclear weapons production and evaluates the strength of that evidence. To
accomplish this task, an interagency panel of experts in the fields of public and occupational
health reviewed the following sources of information related to the DOE workforce: 1)
epidemiological studies completed and published either in the peer-reviewed literature as well as
in technical reports; 2) information on the types and levels of exposures to workplace hazards; 3)
special medical monitoring programs for workers with the highest exposures to ionizing
radiation; 4) medical screening programs for former DOE contractor workers exposed to
radiation as well as physical and chemical hazards; and 5) reports of illnesses presented to the
DOE in public meetings or reported in the press.
The DOE and its predecessor agencies, principally the Manhattan Engineering District
and the Atomic Energy Commission, consist of a nationwide network of 40 contractor-operated
industrial sites and research laboratories that historically have employed over 600,000 workers in
the production and testing of nuclear weapons. Because of this weapons production mission,
health studies of DOE workers have focused primarily on the adverse health effects of exposure
to ionizing radiation. Other non-radiation hazards have been studied at DOE sites only to a
limited extent.
As a particular health outcome of concern associated with exposure to ionizing radiation
is cancer, the panel also consulted the scientific literature in this regard. The 1994 United
Nations Scientific Committee on the Effects of Atomic Radiation noted that cancers for which
statistically significant excess risks have been determined from the Life Span Study mortality
data are leukemia, breast, bladder, colon, liver, lung, esophagus, ovary, multiple myeloma and
stomach. In addition, significant excess risk has been determined for the incidence of thyroid
and skin cancers. The known and possible associations between radiation exposure and the
above cancers tend to be based on populations exposed to relatively high levels of ionizing
radiation (e.g., Japanese atomic bomb survivors, and recipients of selected diagnostic or
therapeutic medical procedures). The question of cancer risk for chronic low dose levels or
periodic higher levels of ionizing radiation exposure (e.g., such as may occur in certain
occupational settings at DOE facilities) has not yet been completely studied. Other Health and
Human Services literature suggests a possible association between ionizing radiation exposure
and cancers of the prostate, nasal cavity/sinuses, pharynx/larynx, and pancreas. However, other
National Cancer Institute literature indicates that other chemical and physical hazards and
lifestyle factors (to include smoking, alcohol consumption, diet) contribute to many of these
same diseases.

 The panel examined all studies related to hazards and adverse health outcomes related to
DOE’s nuclear weapons production activities. The panel did not evaluate information on nonDOE populations, such as atomic bomb survivors or populations with occupational radiation
exposures such as shipyard workers and medical personnel. Determining the causal links
between an exposure and an illness was not considered to be within the mandate of this panel.
II.

Findings

There is evidence from health studies of DOE workers that suggests that some current
and former contractor workers at DOE nuclear weapons production facilities may be at increased
risk of illness from occupational exposures to ionizing radiation and other chemical and physical
hazards associated with the production of nuclear weapons. For certain facilities and for certain
subgroups of workers within these facilities, some evidence suggests a strong association
between employment and adverse health outcomes. Some studies indicate an increased risk of
adverse health outcomes with increased levels of exposure to ionizing radiation.
Most DOE studies concerning the health status of its workers have been mortality studies.
Evidence of health problems potentially related to exposures based on mortality studies is limited
to specific facilities and causes of death. The identification of excesses of some types of cancers
at some facilities and other types of cancers at other facilities is not surprising given the
differences in past and present production processes, levels of exposure, and types of radiation
and chemical hazards at these DOE facilities. Results from epidemiological studies must be
interpreted with caution since a finding of a statistically significant elevation of disease does not
alone imply causality. Conversely, the lack of a finding of excess disease in study does not
imply that occupationally-related disease is absent in the study population. In addition, based on
the studies reviewed, it is not possible to answer questions about the relationship between an
individual’s illness and that worker’s occupational exposures.
Information evaluated by the panel from morbidity studies and medical surveillance
programs for current and former DOE contract workers also provide evidence that these workers
have suffered material impairment of health as a result of performing their jobs. However,
before attempting to draw conclusions as to the health status of the overall population of former
workers using this information, a number of factors must be considered. For example, the
former worker medical surveillance program is in its initial phase with only preliminary results
available. Further, participants in this program are selected from potential high-risk job
categories and thus their health status may not be representative of the workforce as a whole.
Nevertheless, the results from this program provide strong evidence that participating former
workers at some facilities have experienced adverse health outcomes, particularly in the form of
nonmalignant lung diseases. Mortality studies have also shown evidence that workers at several
facilities have experienced excesses of nonmalignant lung diseases.
While the panel found credible evidence of occupational illness in current and former
workers at DOE facilities, linking these illnesses to workplace exposures is limited by several
factors: 1) there may have been inaccuracy and inconsistency in the radiation dosimetry
monitoring program at certain facilities and during certain time periods; 2) there is a general lack
of industrial hygiene monitoring data for chemical and physical hazards as well as other
-2-

 important non-occupational exposures such as smoking history; 3) not all workers at a given
facility (such as female and minority workers) nor all facilities were included in the studies; 4) in
some studies there may be a insufficient length of follow-up for some health outcomes (with
long latencies) and for some worker cohorts (where they are not reaching the age where certain
diseases such as cancers more commonly occur); 5) the potential that a healthy worker effect
may obscure associations in some studies; 6) there was a tendency in these studies to focus on
mortality, an extreme manifestation of injury or illness, yet most health conditions do not tend to
be immediately fatal; and 7) often the size of a study population at a given facility decreases the
ability to detect a health problem (a problem that cannot be overcome by grouping various
cohorts together from different facilities due to the substantial variation in work tasks, processes
and exposures from site to site).

-3-

 The Link Between Exposure to Occupational Hazards and Illnesses
In the Department of Energy Contractor Workforce

I.

Background

On July 15, 1999, President Clinton issued a Memorandum to the Secretaries of
Defense, Labor, and Energy, the Attorney General, the Director of the Office of
Management and Budget, and the Assistant to the President for Economic Policy
regarding occupational illness compensation for DOE contractor personnel. The
Memorandum indicated the Administration’s intent to submit legislation to create a
program to give DOE contractor employees with chronic beryllium disease (CBD) and
beryllium sensitivity compensation benefits similar to those available to Federal
employees. Such legislation was submitted to Congress on November 17, 1999. In
addition, the July 15th memorandum established an interagency review coordinated by the
National Economic Council (NEC) to assess, by March 31, 2000, whether there are other
illnesses that warrant inclusion in this program and how this should be accomplished.
In determining whether and how other illnesses should be included in this
program, three tasks were designated. The first task is the subject of this memo.
From October 1999, through January, 2000, a panel of experts from a wide
spectrum of federal agencies (Appendix 12) met to address the following questions:
1. What is the evidence that current and former contractor workers at DOE
facilities are at increased risk of illness resulting from exposures to
occupational hazards uniquely associated with nuclear weapons production?
2. How strong is this evidence?
To answer these questions, they examined and evaluated information and data
from a variety of sources including current and historical exposure hazards at DOE
facilities related to nuclear weapons production, as well as epidemiologic, other health
studies and surveillance activities conducted among DOE contractor workers. In
evaluating these data, the panel considered reviews of DOE’s epidemiologic research
program that have been conducted by different groups.1, 2, 3 Although data from other
radiation exposed cohorts, most notably nuclear shipyard workers, were discussed by the

1

Geiger HJ, Rush D, Michaels D. Dead Reckoning: A Critical Review of the Department
of Energy’s Epidemiologic Research. Physicians for Social Responsibility. Washington, DC.
1992.
2

Report to the Secretary. The Secretarial Panel for the Evaluation of Epidemiologic
Research Activities for the US Department of Energy. March 1990.
3

US General Accounting Office. Problems in assessing the cancer risks of low-level
ionizing radiation exposure (2 volumes). Washington DC: GPO, January 2, 1981.

 panel members, the results of these studies are not included in this report due primarily to
the limited focus and charge of this panel.
The findings expressed in this document represent the views of the technical
experts who were members of the panel and not the individual agencies that provided the
panel members.

II.

Nuclear Weapons Production & DOE Operations

The Department of Energy and its predecessor agencies, principally the
Manhattan Engineering District and the Atomic Energy Commission, have been engaged
primarily in an extensive industrial enterprise to build and test nuclear weapons. For
more than half a century, DOE has owned and its contractors have operated a nationwide
network of heavy industrial sites as well as research laboratories involved in every aspect
of weapons production from the refining of raw materials to the eventual testing of the
bombs, and ultimately to the management of the weapons stockpile and the
environmental consequences of nuclear production and testing.4 It has been estimated
that 5.5 trillion dollars (in 1996 dollars) have been spent since 1940 on U.S. nuclear
weapons and weapons-related programs5 and that upwards of 600,000 workers were
involved in the construction, maintenance, operations, and scientific activities at DOEowned facilities.
Figure 1 (Appendix 1) summarizes the process used to produce nuclear weapons.
At each stage of the nuclear weapons cycle, from refining the raw materials to weapons
assembly and finishing, to waste management and disposal, the principal materials used
and primary exposures are listed. This figure is by no means a complete inventory of the
potential health hazards that exist during the complex process of producing a nuclear
weapon. For a more complete understanding of the potential chemical hazards involved
in its operations, DOE has published a description of chemical vulnerabilities at its sites.6
In addressing its charge, the NEC Task 1 panel examined evidence of illnesses from two
classes of exposure: radiation and chemicals.

II.

Radiation Exposures

Radiation protection and control programs have constituted a major focus of
worker safety and occupational health efforts at DOE sites. Since the inception of the
Manhattan Project, scientists have cautioned that exposure to ionizing radiation may
4

Linking Legacies. Connecting the Cold War Nuclear Weapons Production Processes to
their Environmental Consequences. DOE/EM-0319 US Department of Energy. January 1997.
5

Atomic Audit, the Costs and Consequences of U.S. Nuclear Weapons since 1940. S.I.
Schwartz, editor. The Brookings Institution, Washington, D.C. 1998.
6

Chemical Safety Vulnerability Working Group Report, 1994, U.S. Department of
Energy, DOE/EH-0396P; DOE/EH-0398P

-2-

 involve some risk. The National Committee on Radiation Protection and Measurements
in 19547 and the International Commission on Radiological Protection in 19588 both
recommended that exposures should be kept as low as practical and that unnecessary
exposure should be avoided to minimize this risk. This has been a guiding principle of
radiation exposure protection programs for the nuclear weapons workforce.
The majority of reported DOE radiation exposure data is based on dosimeters
worn by contractors to measure external ionizing radiation. These dosimeters were
primarily film badges until the early 1970s when solid state thermoluminescent detectors
(TLDs) were adopted. The unit of measurement for external whole-body radiation
exposure is the Deep Dose Equivalent (DDE) which is defined as the dose equivalent (the
product of the absorbed dose and quality factor for the radiation) at a depth of 1 cm in
tissue. The time period between badge readings was largely determined by the
occupational standards of the time. In the 1950s the occupational limit was a weekly
limit, in the 1960s a quarterly limit was established and since the 1970s the primary limit
is an annual limit. Each DOE site has been expected to determine who needs to wear a
dosimeter and how often to exchange dosimeters based on working conditions at that site.
As a result, dosimetry badging practices varied from site to site and from contractor to
contractor. In addition, there are reputable reports of isolated instances of incomplete and
inaccurate personnel radiation dosimetry records.9, 10
Dose records go as far back as the establishment of the Manhattan Engineering
District. These records are available at the sites and have been used in published health
studies. Prior to 1974 annual doses of less than 10 mSv (1 rem) did not have to be
reported to the Atomic Energy Commission (AEC). Starting in 1974 the AEC began
collecting data on the number of individuals with measurable exposure (greater than the
limit of detection for the monitoring system) which is a subset of all monitored
individuals. Many personnel were monitored as a matter of prudence although a
significant fraction did not receive a measurable exposure. The number of individuals
with measurable exposure is a better indicator of the exposed workforce.
Personnel dosimetry was not necessarily provided to all DOE contract workers.
The current version of Chapter 10 of the Code of Federal Regulations, Part 835
(§835.402(a)) prescribes issuing personnel dosimeters to radiological workers if they are
7

National Committee on Radiation Protection and Measurements Report 17, “Permissible
Dose from External Sources of Ionizing Radiation.”
8

International Commission on Radiation Protection Publication 1, “Recommendations of
the International Commission on Radiological Protection” (Adopted September 9, 1958),
Pergamon Press, 1959.
9

Worker Safety at DOE Nuclear Sites,” Hearing before the Subcommittee on Oversight
and Investigation of the Committee on Energy and Commerce, U.S. House of Representatives,
March 17, 1994.
10

D.J. Strom et.al, “Doses to Workers in the United States Nuclear Weapons Program due
to External Irradiation at the Dawn of the Atomic Era (1940-1960), Health Physics, 1996; 71:5057.

-3-

 likely to receive “an effective dose equivalent to the whole body of 100 mrem (0.001 Sv)
or more in a year.” Hence, individual dosimeters need not be issued to workers who are
not expected to receive radiation exposures in excess of this limit. Consequently, there
can be gaps in the data for radiological exposures to DOE contract workers.
The authors of a 1993 DOE technical report note that “it appears that there was a
systematic underestimation of doses for Oak Ridge National Laboratory workers” and
that “workers employed prior to 1957 are likely to have had doses that were higher than
those recorded.”11 Therefore, it is possible that there may have been some inaccuracy
and inconsistency in the radiation dosimetry program at certain DOE facilities during
certain time periods.
The historic distribution of dose for the DOE workforce is shown in the figure
below. The decline in average dose between 1986 and 1991 was due to the cessation of
nuclear weapons production and the shutdown of numerous reactors used in their
production.
Historic External Dose Distribution for the DOE Workforce

Trend
Average Deep Dose Equivalent per Monitored Worker
2.5

mSv

2
1.5
1

1997

1995

1993

1991

1989

1987

1985

1983

1981

1979

1977

1975

1974

1972

1970

1968

1966

1964

1962

1960

1958

1956

0

1947-1954

0.5

Year

Tables 1 and 2 (Appendix 2) list the results of external radiation monitoring for the
periods 1947-1974 and 1974-1997. As a point of reference, members of the general U.S.
population receive an average annual effective dose equivalent of 3.6 mSv (0.36 rem)

11

Mitchell TJ, Istriycgiv G, Frime EL, Kerr GD. A method for estimating occupational
radiation dose to individuals, using weekly dosimetry data. Oak Ridge National Laboratory
Report ORNL-6778, December 1993.

-4-

 from natural, enhanced natural and man-made sources of ionizing radiation. The table
below summarizes the sources of these exposures.12
Annual Effective Dose Equivalent in the US population
Source

Average Annual Dose
(mSv)

Natural Sources
Cosmic
Cosmogenic (e.g., carbon-14)
Terrestial
In the body
Radon
Occupational
Nuclear Fuel Cycle Facilities
Consumer Products
Tobacco*
Other**
Miscellaneous Environmental Sources
Medical
Diagnostic x-rays
Nuclear medicine
Rounded Total
*
**

III.

0.27
0.01
0.28
0.39
2.00
0.009
0.0005
-0.05 to 0.13
0.0006
0.39
0.14
3.6

effective dose equivalent for tobacco is difficult to determine; dose to a
segment of the bronchial epithelium is estimated to be 0.16 Sv/y )16 rem/y)
includes uranium and thorium-containing building materials and supplies,
ophthalmic glass, and domestic water supplies.

Chemical Exposures

It has been estimated that more than 40,000 different chemicals are present
throughout the DOE complex, and some, such as solvents and degreasers, are used in vast
quantities. Most of these chemicals are not unique to DOE sites and are found in other
industries. However, little is known about the actual levels of worker exposure to these
materials. DOE does not maintain a centralized repository of industrial hygiene
information on exposures to individual chemicals. To further complicate matters,
exposures are often to mixtures of substances making a risk assessment based on the
known toxicological profiles of these materials nearly impossible.

12

National Committee on Radiation Protection and Measurements Report 93, “Ionizing
Radiation Exposure of the Population of the United States,” 1987.

-5-

 While chemical hazards have not been either well documented or studied at DOE,
a number of reports suggest, either directly or indirectly, that chemical hazards pose a
significant health risk to both current and former DOE workers.13, 14, 15 These risks may
exceed those posed by radionuclides. An example of a non-radiogenic exposure is
beryllium, a hazard that is specifically excluded from this report (since it is already
covered under separate legislation proposed by the Administration and introduced in
Congress as S.1954 and H.R. 3418). Exposure by DOE contractor workers and the
resulting health conditions associated with beryllium exposure16 served as a basis for the
Presidential Memorandum of July 15, 1999, and as the origin of this examination.

IV.

Findings
A.

Summary of Major Findings From DOE Epidemiologic Studies
1.

Background

Mortality studies of DOE workers began in 1964 and have continued through the
present. The patterns of mortality have been the primary focus of these studies,
particularly cancers from ionizing radiation exposure. More than 40 studies of DOE
contractor workers have been completed to date; there are more than 20 additional
studies underway. The studies cover fourteen of the nineteen principal DOE facilities
excluding most of the private facilities that supplied DOE. When excess mortality was
noted or a trend identified for a specific cause of death, special in-depth studies were
often undertaken.
The studies concentrated primarily on production workers. At those sites where
construction workers were employed as part of a prime contract, they would have been
included in the site’s study, but not analyzed as a separate group. Construction workers
employed by the Zia Company at the Los Alamos National Laboratory were the one
exception where a separate analysis of their mortality experience is reported. The
studies include workers employed from 1944 to 1986 with results emphasizing those
employed during the period of greatest production activity across the DOE weapons
complex between 1944 and 1979. Due to changes in the DOE’s mission with the
13

Hazards Ahead: Managing Cleanup Worker Health and Safety at the Nuclear Weapons
Complex. US Congress. Office of Technology Assessment. OTA-BP-O-85. Washington, D.C.:
U.S. Government Printing Office, February 1993.
14

Comparative Carcinogenicity of Ionizing Radiation and Chemicals. National Council on
Radiation Protection and Measurements. NCRP Report No 96. Bethesda, MD. March 1, 1989.
15

Radiation Protection in the Mineral Extraction Industry. National Council on Radiation
Protection and Measurements. NCRP Report No 118. Bethesda, MD November 30, 1993.
16

Beryllium Biomarkers: Application of Immunologic, Inflammatory, and Genetic Tools.
Lee S. Newman. Pages 285-300 in Biomarkers: Medical and Workplace Applications. Joseph
Henry Press. 1998, Washington D.C.

-6-

 cessation of the nuclear arms race and various international arms limitations agreements,
results of these historical studies no longer reflect current workplace conditions.
Types of ionizing radiation exposures that have been studied include those
exposures from external sources as well as exposures from internal depositions of
plutonium and polonium, tritium and uranium dust. In addition, exposures to metallic
mercury, nickel and nickel oxides, phosgene, and epoxy resins have also been studied.
The nature and degree of exposures varied greatly from site to site depending on the
operations and production at a given site. Historically, white males were the primary
subjects of these studies. More recent studies and most new studies examine the impact
on exposures to both non-white and female workers as well.
Human data from non-DOE cohorts on cancer induction by radiation are
extensive. The most comprehensive studies involve the survivors of the atomic
bombings of Hiroshima and Nagasaki, X-rayed tuberculosis patients, and persons
exposed during treatment for ankylosing spondilitis, cervical cancer, and tinea capitis.
Cancers either frequently or occasionally associated with radiation include leukemia,
thyroid, female breast, lung, stomach, colon, esophagus, bladder, ovary and myeloma.
Lifestyle factors (e.g., smoking, diet, alcohol) and occupational exposures (e.g.,
benzene, dyes) may contribute to some of these radiation-induced cancers. Age at
exposure, dose, dose rate and other factors may also influence the results of a particular
population-based study as well as modify an individual’s risk for disease.
2.

Findings

•

Statistically significantly elevated mortality rates were reported for some cancer
types at some facilities, among specific subgroups of workers, and for specific
time periods of employment (see table on next page).

•

Overall, DOE production workers had significantly lower age-adjusted death
rates compared to the U.S. general population for all causes of death combined;
there were two exceptions (Appendix 5 references LIND87, ORK96).

•

The relationship between mortality and exposure to ionizing radiation has been
investigated for some but not all of the DOE cohorts. An increase in the risk of
dying from specific conditions has been associated with increased exposure to
external radiation exposure in seven cohort studies and to internal exposure in
two studies. When these positive trends for mortality by level of ionizing
radiation were observed, they were based on small numbers of deaths (less than
five) among workers with the highest lifetime radiation doses. (Appendix 5
references HAN89, HAN93a, LANL94, MCW98, MND91b, ORX 91, ORC 97a,
RAI97, SRS94.)

•

Special studies of workers with brain cancer, multiple myeloma, malignant
melanoma, non-malignant respiratory diseases, and malignant respiratory

-7-

 diseases were pursued. Except for non-malignant respiratory disease among
Fernald workers, the special studies did not identify specific occupational
exposures associated with the conditions.
A review of studies and findings by site is found in Appendix 3. Appendix 4
contains a listing of the Standardized Mortality Ratios (SMRs) for all causes of death for
DOE workers (Table 1), summaries of statistically significant elevated SMRs for cancer
and non-cancer causes of death by DOE site (Tables 2-1, 2-2 respectively), and a
summary of statistically significant SMRs both increased and decreased for each cause
of death among DOE workers (Table 3).
A list of the peer-reviewed and other publications relating to epidemiologic
studies of DOE workers used to generate these summaries and tables is found in
Appendix 5.

-8-

 T

Savannah River Site

Rocketdyne/Atomics
International

S

Rocky Flats Plant

Oak Ridge K-25

Oak Ridge Y-12

Oak Ridge National
Laboratory (X-10)

Oak Ridge Combined
(All facilities)

Mound Plant

Mallinckrodt
Chemical Works

Los Alamos
National Laboratory

Linde Air Products
Ceramics Division

Lawrence Livermore
National Laboratory

Hanford Site

Type of Cancer*

Fernald Plant

SUMMARY OF STATISTICALLY SIGNIFICANT ELEVATED FINDINGS FOR
CANCER AT DEPARTMENT OF ENERGY (DOE) SITES

I

Salivary gland

T

Esophagus
S

Stomach

I

Rectum

S

T

Liver

S,T

Pancreas

S

Larynx

S

Trachea, bronchus & lung

S

S

S

S

Bone
I

Skin – malignant melanoma
Genital cancer

T
S

Prostate

S
I

Bladder
Kidney

T

Brain & other CNS

T

T
T

Lympho- & hemato-poietic
T

Leukemia - all types

S

S,T

T

Leukemia – lymphocytic
Leukemia – chronic
lymphocytic
Hodgkin's lymphoma

T

Multiple myeloma

T

S
T
T

Upper aero-digestive tract

Legend:

T

S – SMR study with statistically significant finding for specific organ site cancer
T – Statistically significant trend analysis for radiation versus indicated cancer
I – Incidence study with statistically significant finding for specific organ site cancer

Note: A full description of the associations and definitions contained in the table can be found in the text under "Major Findings,"
Appendix 3.
* - Listed in order of appearance in the International Classification of Diseases (ICD) 8th revision

-9-

 B.

Summary Of Findings Related To Chemical Hazards At DOE Sites
1.

Background

Appendix 6 lists those chemical hazards most commonly cited in either
environmental studies around DOE sites and/or in health studies of DOE workers. These
chemical are only a small fraction of the estimated 40,000 chemicals that have been used
at DOE facilities. Appendix 1 outlines the major steps in the production of nuclear
weapons and the radiation and non-radiation hazards associated with each step of the
process. Appendix 7 summarizes the principal weapons production processes by site.
Only a few of the chemicals used at DOE facilities have been examined in epidemiologic
health studies of its workers.
2.

Findings

•

Mercury Workers: Studies of exposure to metallic mercury were significantly
associated with clinical neurologic abnormalities in the most highly exposed
group (ORY88a, ORY97).

•

Centrifuge Workers: An increased incidence of bladder cancer was observed
among gas centrifuge manufacturing workers. Although epoxy resins and
solvents were commonly used in the gas centrifuge manufacturing process, the
observed higher incidence of bladder cancer among gas centrifuge workers was
not associated with exposure to these substances.

•

Welders: The most recent study of welders revealed higher risk of death from
lung cancer, prostate cancer, and stomach ulcers. The risk for lung cancer was
not related to nickel exposure. The potential contribution of thorium exposure to
the observed increased risk was not evaluated in the welders studies.

C.

Summary of Findings From Special Radiation Workers Monitoring
Programs
1.

Background

DOE supports three specialized monitoring programs or studies of a relatively
small number of workers with the highest exposures to ionizing radiation from
radionuclides and/or external sources. These special programs include a tissue registry
for post-mortem analyses of workers with known occupational exposure levels to
radionuclides, periodic medical follow-up for plutonium-exposed workers (average dose
1,250 mSv [125 rem]), and a program of cancer screening for workers with the highest
doses of external radiation (dose greater than 200 mSv [20 rem]). These specialized
programs are described in Appendix 8.
2.

Findings

-10-

 •

Specialized radiation worker studies have generally not shown unusual numbers
or types of illnesses commonly associated with radiation exposure, even among
workers with known high body burdens of radionuclides.

•

One case each of osteosarcoma and lung fibrosis have been diagnosed among
workers exposed to plutonium. Osteosarcoma is a rare cancer and is of interest
because plutonium is known to deposit in the bone.

•

Among the 244 causes of death in the tissue registries, cancer deaths from causes
potentially or known to be associated with radiation exposure were identified
(Appendix 8, Table 1).

•

In addition, six confirmed cases of mesothelioma among DOE workers exposed to
asbestos have been documented among the USTUR registrants.
D.

Summary of Findings From Other Surveillance Programs
1.

Background

DOE supports two injury and illness surveillance programs. The Epidemiologic
Surveillance Program collects illness information from occupational medicine programs.
The Computerized Accident/Incident Reporting System (CAIRS) is a centralized
database that collects all contractor reports of injuries, illnesses, and other accidents. It is
based on Department of Labor requirements for reporting these events. Data from DOE
investigations of these reports are used to generate performance indicators used by the
DOE to manage its safety and health programs, and to provide estimates of dollar loses
due to work-related injuries, illnesses, and accidental property damage. Recent
summaries of epidemiologic surveillance and CAIRS data are presented in Appendix 9.
2.

Findings

•

The Epidemiologic Surveillance Program reported cases of occupational illnesses
among DOE workers that are consistent with the definition of a “Sentinel Health
Event of Occupational origin [SHE(O)]” described in the medical literature.17 In
1997, data summarizing these SHE(O)s from 8 DOE sites included 13 cancer and
7 respiratory disease diagnoses (Appendix 9, Table 1).

•

CAIRS data from 1998 reported 659 cases of non-injury occupational health
events among contractor workers at all DOE sites (Appendix 9, Table 2).

17

Rutstein DD, Mullan RJ, et al. Sentinel health events (occupational): A basis for
physician recognition and public health surveillance. Arch. Envir. Health 39: 159-168; 1984.

-11-

 •

Both of these DOE-maintained surveillance systems allow for the identification of
current illnesses and injuries in its workforce.

E.

Initial Results From The Former Workers Program
1.

Background

In response to a Congressional mandate, DOE recently initiated a medical
surveillance program tailored specifically to examine former DOE workers felt to be at
high risk for occupationally-related illnesses. Results from chest radiographic screening
are presented below. There were other results of the initial screening examinations
presented to the panel related to heavy metals, hearing loss, beryllium exposure and
exposures to solvents and mixed chemicals. The panel concluded that the results of these
examinations were too preliminary to include in the report. Preliminary results from the
chest X-ray screening are presented in Appendix 10.
2.
•

Findings

Initially medical screening has found a relatively high proportion of abnormalities
on chest X-ray among selected groups of former workers. Of the 882 individuals
screened as of December 1999, 148 (17%) have International Labor Organization
(ILO) category 1/0 or greater perfusion on their chest X-ray indicating the
presence of a pneumoconiosis.

F.

Input From The Public
1.

Background

Beginning in August 1999, the Department of Energy initiated a number of
outreach efforts to learn more about work-related health concerns from its current and
former contractor workforce. These efforts included: 1) a series of public meetings in the
communities surrounding its facilities to seek input from workers regarding their workrelated health concerns and their experiences with filing for workers’compensation for
these health problems; 2) establishing a toll-free “hotline” for workers to call in to ask
questions and to relay any health concerns; and 3) distributing a questionnaire asking
DOE employees about health concerns and their experience with workers’compensation
systems (Appendix 11).
A summary of the nature of the health problems reported to the hotline and in the
questionnaires is provided in Appendix 11, and a bibliography of media reports of
illnesses among DOE workers both from these public meetings and independent of these
sessions is also included in Appendix 11.
2.

Findings

-12-

 •

The panel recognizes the importance of these reports in formulating policy
regarding compensation for these illnesses. They clearly reflect the strong
feelings among many workers that they have been made ill by workplace
exposures at DOE. The panel did not independently review nor verify these
reports. They may represent work-related illnesses that may not be reflected in
the study data reviewed by the panel.

-13-

 APPENDIX 1

PRODUCTION PATHWAY FOR NUCLEAR WEAPONS

Radiation and non-radiation hazards by process step

1

 Production Pathway for Nuclear Weapons

How Nuclear?Weapons are Made

Nuclear Weapon!
Manulncturtng Process

Functiond Precu-

Redlallon Hairdo

Non hall-do

 

 

     
 

      
 

      
 

 

     

 

 

 

 

 

 

 

 

  

 

 

 

    
    
     
   
 

 

    
 

 

 

Uranium Concentrates Uranium
Mining 8. Refining
Enrichment 3
Li?5 3 Uranium
Enrichment Enrichment
HEU
020 Target Assemblies DU
- 
Fuel Assemblies

_r

G)

3
3
n:
maimed 
Targets SNF U0 Rem'w} 
Li6 Tritium p?
l?
HEU DU
Part5
Tritium Recpyded
Loading 
Recycled Pans
Tritium 
Parts

 

 

Assembly



 

1

 

Urmium is refined from are and gaseous teed then

Internal deposition ol uranium and its decay

EMF Iduble uranium compounds;
oxide-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mining. unwed into meld product: throuyi mhdetion; utemd whole ammonia. nitrogen
Milling. body exposure to ionizing radiation. hydro?uoric acid fluoride.
and and welding lumen.
Flelining
Internal exposure to gaseous uranium
2 Natural inanium is enriched in the uranium?235 compound. during aampling. cyl'ndcr EMF. ?uoride. fumes lrom wetting
isotope Ioadng and unloadi oading. and maintenance and waking atainlael steel piping.
Separation operations; Internal deposition ct uranium exposure to nickel when
(Enrichment) Natural lithium is enriched in the lithium-6 isotope and its decay predicts; externat exposure marruiactuing dflusion barriers,
to ionizing radiation lrorn cylinder handing. eilluric Hid nitric etude. and
Manual water is e?mhad in the hydrogerrz isotope tritium and ltansuranlcs uranium chloride; hydrogen sulfide.

3 Uranium gas and metal is convened into metal lust

and target element: [or promotion reactors.
Fuel and Inhalation ol uranium-235, 238 and its EMF soluble uranium and lithium
Target Targets Include uraruum?Zat! a lithium-6 decay prornnte. and trit'IAm. 
Fabrlcation
Scrap metal recycled

4 3
l? Uraiium-238 slugs are irradiated to create
plutoni mmotai Inhalation oi products. activation
act promote. external whole body ionizing EMF
Ream.? Lithium targets Ire Irradiated to produce tnlium radiation.

Operations on

3
2
l1:

5 EMF. soluble uranium. nitric mid,
f; Irradated fuels and targets are cissolved Enema! Miole body ionizing radation kerosene enedm Ii?dodormne
Chemical toriium. urmium and other iinion products are Inhalation oi fission products md 

Separations n: extracted trmsinaiic element. fluoride. cdc?ium meld. oodum
hydroxide.
Chemicals are recycled


Nuclear-

6 Muiutmlinirig. inspection. bericli EMF. soluble In'ariium. beryiium.
teen rig. inid verificd?ron 01 nuclear component: and Extem alMiole body Ionizing redation nitric acid kerorene. noodecmo
major Iimnrernbliee 'nlidaemlion ot radiomtive materials (primuily 

lrmsinmics). U- 233. fluoride. cdcium meld oodum

Chemical processing to recover purify, lid recycle hmidde.
phtonium uranium tritium. and lithium from retired

Component warhead: aria reeimel

Fabrication
Nennuclnr EMF, him exploelvea, miventn,
Manufmlin'nig. assembly inspection. and External whole body ion'zing ruiation. beryllium Itu'ileu elect. heavy
benchteel?nig high exploeivea. tum. detorralon 'rihdatt'on ol radiomtive materials. molds. and malariale tiled in

brim batterie- etc electron'm lubrication.

7
humbly, maintenance and diamannement oi Enema! whole body ionizing rmalion AI at me me.

Weapons will" Wm
Operations

 

Sources

The Nuclear Weapon: Complex, Management lor health, lately, and the environment. Washingnn, Nam my Prone, 1968

(Appendxee 
thiologic
PNL ?as usun-oa ioez.

a health aspects of commercial uranium conversion. enrichment. md luet lubrication United States Uranium Report

Linking legacies: Connec?ng the cold NI nuclear weapon: production procure: to their environmental consequences Washington. DC

USDOE Report 1997

The 0.5 nuclear weapons complex, Internet reference WW November 1999,

 

APPENDIX 2

IONIZING RADIATION DOSES TO DOE EMPLOYEES

1947 -1997

Table 1
Deep Dose Equivalent - Number of Individuals Receiving Radiation Doses in Each Dose Range
1947-1974

[Dose

(Rem)]

1-5

5-10

10-15

>15

5,311
3,157
2,312
2,424
6,271
3,912
4,629
5,174
5,707
5,472
6,157
6,671
6,242
5,767
4,776
4,288
4,464
3,661
3,373
2,903
2,318

284
285
100
83
159
66
41
40
113
80
86
175
167
108
4
4
12
12
10
3
3

32
41
4
5
10
2
2
3

6
1
3
1
12
1
1
8
8
1

Year
0-1

1947-1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974

Note:

130,128
56,708
38,225
45,510
59,455
71,600
77,552
90,651
122,437
107,786
122,711
128,360
131,522
102,510
103,206
98,625
92,185
90,640
86,077
89,071
73,845

11
8
2
1
1
1

1

Total
Monitored

135,761
60,192
40,644
48,023
65,907
75,581
82,225
95,876
128,265
113,339
128,965
135,214
137,933
108,386
107,986
102,918
96,661
94,315
89,460
91,977
76,166

Coll. DDE
(person-rem)

Avg. DDE
per
Monitored

20,717
11,026
6,961
7,706
13,937
11,835
13,092
15,112
19,219
17,221
19,594
21,147
20,900
17,156
15,595
14,610
14,190
13,178
12,369
12,116
9,950

Prior to 1974 annual doses of less than 1 rem were not required to be reported. Collective dose
was not calculated or reported as well. Thus, to estimate collective doses for 1947-1974, a dose
was assigned to each dose range as follows: 0-1=0.1; 1-5=1.1; 5-10=5.1; 10-15=10.1; and
>15=15.1.

5

0.153
0.183
0.171
0.160
0.211
0.157
0.159
0.158
0.150
0.152
0.152
0.156
0.152
0.158
0.144
0.142
0.147
0.140
0.138
0.132
0.131

 Table 2
Deep Dose Equivalent - Number of Individuals Receiving Radiation Doses in Each Dose Range
1974-1997

[Dose
Year

1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997

Less
Than
Meas.

Meas.
-1

1-2

29,735
41,390
38,408
41,572
43,317
48,529
43,663
43,775
47,420
48,340
46,056
54,582
53,586
45,241
48,704
56,363
76,798
92,526
98,900
103,905
92,245
104,793
101,529
89,805

1,531
36,795
41,321
44,730
51,444
48,553
35,385
33,251
30,988
32,842
38,821
34,317
33,671
28,995
27,492
28,925
31,110
27,149
24,769
23,050
24,189
22,330
21,720
17,331

652
1,437
1,296
1,499
1,311
1,281
1,113
967
990
1,225
1,223
1,362
1,279
1,210
502
428
140
95
42
86
77
153
74
45

(rem)]
2-3

3-4

149
541
387
540
439
416
387
263
313
294
312
356
349
283
34
21
17

40
122
70
103
53
33
16
29
56
49
31
51
35
36

4-5

>5

4
28
6
23
11
10
5
28
31
11
8
1

1

1

Note: Dose ranges lower for this table compared to Table 1.

6

1
1
5
3

1
2

Total
Monitored

69,171
80,314
81,489
88,472
96,575
98,825
80,564
78,290
79,795
82,781
86,454
90,677
88,923
75,765
76,732
85,737
108,065
119,770
123,711
127,042
116,511
127,276
123,324
107,181

No.
with
Meas.
DDE
32,111
38,924
43,081
46,900
53,258
50,296
36,901
34,515
32,375
34,441
40,398
36,095
35,337
30,524
28,028
29,374
31,267
27,244
24,811
23,137
24,266
22,483
21,795
17,376

Coll.
DDE
(personrem)

Avg.
Meas.
DDE

Avg. DDE
per
monitored

10,202
9,202
8,938
10,199
9,390
8,691
7,760
7,223
7,538
7,720
8,113
8,340
8,095
6,056
3,735
3,151
2,230
1,762
1,504
1,534
1,600
1,809
1,598
1,285

0.318
0.236
0.207
0.217
0.176
0.173
0.21
0.209
0.233
0.224
0.201
0.231
0.229
0.198
0.133
0.107
0.071
0.065
0.061
0.066
0.066
0.08
0.073
0.074

0.147
0.115
0.110
0.115
0.097
0.088
0.096
0.092
0.094
0.093
0.094
0.092
0.091
0.080
0.049
0.037
0.021
0.015
0.012
0.012
0.014
0.014
0.013
0.012

 APPENDIX 3
SUMMARY OF EPIDEMIOLOGIC STUDIES
Background
Epidemiology is the study of the distribution and determinants of illness and injury
in human populations. This distribution is considered in relation to time, place, and
person. Relevant population characteristics include the age, race, and sex distribution
of a population, as well as other characteristics related to health, such as social
characteristics (e.g., income and education), occupation, susceptibility to disease,
and exposure to specific agents. Determinants of disease include the causes of
disease, as well as factors that influence the risk of disease. There are three major
study designs that are used in studies of workers and communities.
Study Designs
Cohort Studies. The cohort study design is a type of epidemiologic study frequently
used to examine occupational exposures within a defined workforce. A cohort study
requires a defined population that can be classified as being exposed or not exposed
to an agent of interest, such as radiation or chemicals that influence the probability
of occurrence of a given disease. Characterization of the exposure may be qualitative
(e.g., high, low, or no exposure) or very quantitative (e.g., radiation measured in
Sieverts (Sv), chemicals in parts per million [ppm]). Surrogates for exposure, such as
job titles, are frequently used in the absence of quantitative exposure data.
Individuals enumerated in the study population are tracked for a period of time, their
vital status (dead or alive) is determined at the time of the study, and cause of death
is sought for the deceased member of the study population. In general, overall rates
of death and cause-specific rates of death have been assessed for workers at DOE
sites. Death rates for the exposed worker population are compared with death rates
of workers who did not have the exposure (internal comparison), or compared with
expected death rates based on the U.S. population or state death rates (external
comparison) using a standardized mortality ratio (SMR).
The SMR is the ratio of the number of deaths observed in the study population to the
number of expected deaths. An SMR of 100 indicates the same risk of disease in the
study population compared with the reference population. An SMR greater than 100
indicates a higher risk of disease in the study population compared with the
reference group, and an SMR less than 100 indicates a deficit of disease. If the rates
of death differ from what is expected, an explanation is sought to account for the
differences such as exposure to a carcinogen at work. In cohorts where the exposure
has not been characterized, excess mortality can be identified, but these deaths
cannot be attributed to a specific exposure, and additional studies may be warranted.

7

 More recent studies have looked at disease endpoints other than death, such as
overall and cause-specific cancer incidence (newly diagnosed) rates.
In situations where the total worker population at risk has not been identified,
mortality rates cannot be calculated and risk cannot be estimated. When only deaths
or illnesses are known an alternative approach is the proportionate morality study.
This approach examines the proportional distribution of deaths from specific
conditions in the study group relative to the same condition in the U.S. general or
regional population. The resulting index is the Proportional Mortality Ratio (PMR).
This approach is not powerful although it is useful in rapidly screening worker
populations to identify conditions that may reflect occupational exposures.
Most cohort studies at DOE sites have been historical cohort studies, that is, the
exposure occurred some time in the distant past. These studies rely on past records to
document exposure. This type of study can be problematic if exposure records are
incomplete or were destroyed. Cohort studies require populations that have been
followed for many (20 to 30) years. They are generally difficult to conduct and are
very expensive. These studies are not well suited to studying diseases that are rare.
Cohort studies do, however, provide a direct estimate of the risk of death from a
specific disease, and allow an investigator to look at many disease end points.
Case-Control Studies. The case-control study design starts with the identification of
persons with the disease of interest (case) and a suitable comparison (control)
population of persons without the disease. Controls must be persons who are at risk
for the disease and are representative of the population that generated the cases. The
selection of an appropriate control group is often quite problematic. Cases and
controls are then compared with respect to the proportion of individuals exposed to
the agent of interest. Case-control studies require fewer persons than cohort studies,
and therefore, are usually less costly and less time consuming, but are limited to the
study of one disease (or cause of death). These types of studies are well suited for
the study of rare diseases and are generally used to examine the relationship between
a specific disease and exposure.
Cross-Sectional Studies. In cohort studies, detailed knowledge of the time
sequence of exposures relative to health outcomes is critical in “confirming”
associations. Cohort studies are complicated, expensive and require considerable
time to complete. A useful alternative to a cohort study that can provide evidence
“suggesting” associations is a cross-sectional study. This type of study does not
consider the time sequence of events leading up to an illness or injury. A typical
cross-sectional study is the health survey where at a single point in time information
about workers current health status and working conditions is collected. This
approach is useful in rapidly screening worker populations to identify conditions that
may reflect occupational exposures.

8

 MAJOR FINDINGS
Because of the large number of studies and the many comparisons involved, only
statistically significant higher rates and positive dose-response trends are reported.
They are shown below in italics. Statistical significance reflects estimates that are
based on a sufficient number of deaths to be judged reliable. Statistical significance
by itself is not proof that the condition is due partly or in entirely to workplace
exposures. Special studies were identified with a bold type face.

Fernald “Feed Materials Production Center” (Reference prefix - FMPC)
From 1951 to 1989 Fernald processed uranium and thorium into fabricated metal
products for use in the defense programs. There were 4,014 white male employees
included in the single cohort mortality study.
A. Cancer Causes of Death -- For deaths through 1989, the death rate for stomach
cancer among salaried white males was higher than the rate for the U.S.
population. Hourly males had higher rates for all cancer combined and lung
cancer.
B. Non Cancer Causes of Death --For all males there was a positive association
between chronic respiratory disease mortality, excluding respiratory cancers,
and internal dose equivalent. An independent study of the same population
reported positive trends for both acute and chronic respiratory disease illness.
Acute respiratory illness includes influenza and pneumonia; chronic illnesses
include emphysema and bronchitis. Hourly males had higher rates for motor
vehicle accidents.
The Fernald study will be updated with new deaths through 1997. It will also
include additional workers as well as an in-depth assessment of radiation, chemical
exposures, and cigarette smoking.

Hanford Site (Reference prefix - HAN)
The Hanford Site produced reactor fuel, operated nine reactors and five chemical
separation facilities, and fabricated plutonium components for the weapons program.
Hanford site workers have been the subjects of more than 15 mortality studies
beginning in 1964. The first study compared longevity of workers with that of their
brothers and sisters. No differences were seen among radiation exposed and nonexposed workers in the average age at death.
A. Cancer Causes of Death -- Within Washington state for the period 1950-1971,
atomic workers, presumed to be Hanford site workers, were reported to have
higher proportions of death due to multiple myeloma, cancer of the pancreas,

9

 and cancer of the colon than were seen in the general population of
Washington. A similar proportional analysis that included the average lifetime
occupational dose of ionizing radiation found that the dose was higher than
expected for multiple myeloma, cancer of the pancreas, cancer of the brain and
central nervous system, kidney cancer, lung cancer, colon cancer, myeloid
leukemia and lymphoma. In addition to the specific cancers, three broad
categories: “all cancer combined,” “bone marrow cancers,” and
“reticuloendothelial cancers” were identified as radiation sensitive cancers.
This method of analysis was questioned because it included only deceased
workers in the comparison group. Several independent reviewers of the average
lifetime dose methodology concluded that the method was inappropriate
although the data did support a conclusion that radiation was associated with
cancer of the pancreas and multiple myeloma.
The earliest cohort studies reported on about 13,000 white males who were
employed two or more years at Hanford with deaths through 1974, 1977 and
1978. Gradually the study population increased to include all workers without
regard to length of employment at Hanford, about 44,000 employees with deaths
through 1981 and 1986. Unmonitored (for radiation) males had higher death
rates compared to the U.S. general population rates through 1986 for cancer of
the pancreas and miscellaneous solid tumors.
In the early 1980s white males with a lifetime occupational dose of 20 mSv or
more were known to have a small excess risk of lung cancer. A study of tobacco
use in this group determined that the excess could not explained by smoking
cigarettes.
Positive trends in the death rate with increasing exposure have been reported for
white males and for white males and females combined. These trends were for
deaths due to cancer of the liver, cancer of the pancreas, Hodgkin's disease, and
multiple myeloma. In one study a positive trend for female genital cancers was
noted.
Estimates of the increased risk of death per unit radiation exposure were
made to test whether or not the radiation protection standards of the past
adequately protected workers. One approach was to look at the upper limit of
the risk per unit radiation and compare it to that for other populations. The
absolute excess risk for leukemia per million person-years per 10 mSv, based on
atomic bomb survivor data, as calculated by ICRP and BEIR committees, is
approximately 1-2 deaths. For Hanford, the 95% upper confidence limit is about
4-5 deaths.
Age-at-exposure effect. The idea of sensitive age-at -exposure groups first
appeared in 1977. Examination of the average lifetime dose equivalent for
specific cancers compared to non-cancer deaths supported two sensitive age-atexposure groups; under age 25 years and over age 45 years. Three subsequent

10

 analyses by the same research team reported this age sensitivity. It was variously
reported as over age 58 years, over age 62 years, and age 55-65 years. A recent
analysis reported a significant positive trend for all cancer combined by level of
cumulative dose equivalent for monitored workers age 75 years and older who
were born before 1905. A special case-control study of multiple myeloma at
four DOE facilities reported that the most sensitive age-at-exposure group was
age 45 years and older.
From 1981 through 1993 a number of models were proposed to estimate the
proportion of cancers among Hanford workers that could be attributed to
ionizing radiation. The attributable proportions for all cancers combined ranged
from 5% to 50% depending on the statistical model used.

B. Non Cancer Causes of Death --- The earliest cohort studies reported on about
13,000 white males who were employed two or more years at Hanford with
deaths through 1974, 1977 and 1978. Gradually the study population increased
to include all workers without regard to length of employment at Hanford, about
44,000 employees with deaths through 1981 and 1986. Among female workers
not monitored for external radiation, the rates for accidents, poisonings, and
violence are greater than expected. Radiation-monitored females had a higher
rate of death from diseases of the musculoskeletal system and connective tissues
than expected.
Analyses included occasional search for positive trends among the non cancer
causes of death. For deaths through 1986 no positive trends were detected for all
noncancers combined, circulatory diseases, respiratory diseases excluding
pneumonia, and external causes of death.

Lawrence Livermore National Laboratory

(Reference prefix - LLNL)

Lawrence Livermore National Laboratory (LLNL) is a multi-purpose laboratory that
conducts research and development for the weapons program and for stockpile
stewardship.
A. Cancer Causes of Death --The incidence rate of malignant melanoma was higher
for 5,100 LLNL employees than for the population of the region based on 19
cases diagnosed from 1972-77. Work involving exposure to ionizing radiation
was not associated with a diagnosis of melanoma; working as a chemist was. In
1984, based on a review of records for persons with and without melanoma,
occupational factors were reaffirmed as being associated with melanoma risk.
Later, when the incidence rates for LLNL workers were recalculated for the
period 1969-80, higher rates were found for some cancers in addition to
malignant melanoma. The incidence rates for salivary gland cancer and rectal
cancer, among female Laboratory workers, were above the rates for the region.

11

 For male laboratory workers, other nervous system tumors, excluding brain
tumors, were higher than expected.
Thirty one laboratory workers with malignant melanoma and a control group
were interviewed about personal and occupational factors that might be
associated with the disease. Five factors were more common than expected
among persons with malignant melanoma. These were judged to contribute
independently to a persons risk of melanoma. They were exposure to radioactive
materials, work at Site 300, exposure to volatile photographic chemicals,
participant at the Pacific Test Site, and chemist duties. The most recent
interview study of 69 cases and an equal number of controls found that
differences in personal factors, genetics, and recreational use of the outdoors
were consistent with what is known about malignant melanoma of the skin.
Only occupational exposure to alcohols, out of 39 industrial exposures examined,
was more common among persons with melanoma.
Several special studies of the microscopic features of the melanoma tumors
indicated that the tumor thickness among laboratory workers was significantly
less than for individuals that did not work at LLNL, at least up to the time when
the concern became public in 1977. These data on microscopic features were
taken as evidence of medical over diagnosis of tumors at LLNL. A greater
proportion of workers hired before 1962, who were engineers, particularly
electrical engineers, had dark moles or pigmented nevi that are associated with a
high risk of malignant melanoma.
B. Non Cancer Illness -- The studies did not consider non-cancers.

Linde Air Products

(Reference prefix - LIND)

Linde Air Products in Buffalo, New York processed the highest grade Belgian
Congo pitchblende and domestic uranium ores into uranium compounds from 1943
through 1949. Of the 995 employees studied, 699 worked in the facility for less than
two years. Mortality rates through 1979 for the 995 white males studied were
compared to U.S. rates and regional mortality rates. The results for the U.S. and
region were similar.
A. Cancer Causes of Death -- a statistically significantly elevated laryngeal cancer
rate was observed. Although smoking and alcohol use are known risk factors for
laryngeal cancer, insufficient information on these factors was available to assess
their potential contribution to these five deaths.
B. Non Cancer Causes of Death -- studies on former worker limited to white males
to 1979 found an elevated SMR for diseases of the circulatory system, the
primary contributor was arteriosclerotic heart disease; diseases of the respiratory
system were elevated with pneumonia being the primary contributor. Smoking

12

 history was not available to further study disease risks for the cardiovascular and
respiratory systems.

Los Alamos National Laboratory

(Reference prefix - LANL)

Los Alamos National Laboratory (LANL) is a multi-purpose laboratory where
nuclear weapons were designed, developed and tested; and small quantities of
plutonium metal were produced. The first and longest running study at LANL was
for two groups of workers with the highest exposures to plutonium. The two groups
are 224 white males within the Manhattan Project and 26 workers with plutonium
depositions in 1944-45. Deaths rates have been analyzed at various points in time.
The study of 224 males reported that no death rate was greater than expected for
deaths through 1980. For the 26 workers, the overall mortality rate and all causes of
cancer rate were below what was expected based on the U.S. general population
through 1987. In the most recent LANL study, based on 15,727 white males, no
cause of death was higher than the U.S. rates through 1990.
A. Cancer Causes of Death -- Within the most recent LANL study, positive trends
have been reported for external ionizing radiation and cancers of the brain and
central nervous system, cancer of the esophagus, and Hodgkin's disease. Among
workers not exposed to plutonium two additional positive trends were detected
for kidney cancer and lymphocytic leukemia.
B. Non Cancer Causes of Death -- Among 6,970 LANL females, those classified as
radiation workers had a high death rate for suicide through 1981. This was not
related to duration of employment, plutonium exposure, or marital status.
C. Cancer Illness -- A special study of malignant melanoma cases between 1969
and 1978 revealed that the rate of newly diagnosed melanomas was similar to
that for New Mexico in general. Detailed review of work histories for 15 cases
did not reveal any important characteristics of workplace exposures that differed
from a comparison group.
The Los Alamos Zia Company was the construction contractor at LANL. The Zia
study included 5,424 workers who were monitored for exposure to either plutonium
or external ionizing radiation.
A. Cancer Causes of Death -- For all Zia workers combined, the mortality rates
through 1984 were greater than the U.S. rates for stomach cancer. Non-Hispanic
males had higher rates for deaths from all cancers and lung cancer. No cause of
death was reported with a positive trend for radiation exposure in the Zia
Company study group.
B. Non Cancer Causes of Death -- For all Zia workers combined, senility and illdefined conditions, all injuries, all accidents, and in particular, motor vehicle

13

 accidents were elevated. Non-Hispanic males had higher rates for deaths from all
causes, all circulatory diseases, and non cancerous respiratory diseases.
Hispanic males did not share the high rate for senility and ill-defined conditions

Mallinckrodt Chemical Works

(Reference prefix - MCW)

The Uranium Division of Mallinckrodt Chemical Works (MCW) processed uranium
ore and concentrate to pure uranium oxide and uranium metal from 1942 to 1966.
The MCW study included deaths through 1993 for 2,514 white male employees.
A. Cancer Causes of Death -- No cancer causes of death were elevated relative to
the U.S. general population and a positive trend was found for kidney cancer by
level of exposure to cumulative external radiation.
B. Non Cancer Causes of Death -- There were no elevated death rates relative to the
U.S. general population.

Mound Facility (Reference prefix - MND)
Mound was the site for the development of non-nuclear and nuclear components for
weapons using polonium and beryllium, and for recycling tritium. Mound also
produced plutonium-238 electric generators for spacecraft. Three mortality studies
of white males have been conducted at Mound.
A. Cancer Causes of Death -- A preliminary analysis of mortality for 4,697 white
male employees of the Mound Facility through 1979 found that among men first
hired between 1943 and 1945, the rate for all cancers combined was elevated
primarily due to cancers of the rectum and lung. The highest rate for lung cancer
was for men who worked less than two years at Mound. Among men hired
between 1943 and 1959, a period during which polonium-210 was processed,
cancer of the prostate was elevated among men who worked more than 5 years.
Reanalysis of the cohort using deaths through 1983, for 4,402 white males,
confirmed that the rates for all cancers combined, cancer of the lung, and cancer
of the rectum were elevated only among workers hired in the period 1944
through 1945 (World War II hires). The higher death rates in World War II hires
did not appear to be due to radiation exposure.
Workers monitored for external exposure to ionizing radiation had a positive
trend for cancer of the lymphopoietic and hematopoietic system due primarily to
the individual positive trends for all leukemia combined, particularly for
lymphatic and myeloid leukemia. Males monitored for polonium-210 exposure
did not reveal any positive trends for cancer.

14

 B. Non Cancer Causes of Death -- Among men first hired between 1943 and 1945,
the rates for all respiratory diseases and all injuries were higher than expected
for deaths occurring through 1979.

Oak Ridge Reservation - Combined (Reference prefix - ORC)
Oak Ridge Reservation (ORR combined). There have been several studies that
considered Oak Ridge workers as a single entity. The first study looked at the
mortality experience of 28,008 white male World War II workers employed at three
ORR facilities.
A. Cancer Causes of Death -- Compared to the rates for the U.S. population through
1980, the workers had a higher rate for lung cancer. When the study was
updated with deaths through 1984, lung cancer was not elevated. The authors
reported that there were substantial differences in death rates among workers at
the various Oak Ridge facilities, particularly the rates for lung cancer, leukemia
and other lymphatic cancer that are discussed below.
In the updated study, data for 28,374 workers who were employed only at X-10
and Y-12 were analyzed for trends. Positive trends were reported with
increasing external radiation dose for all cancers combined.
There have been three published studies of brain cancer across the four ORR
facilities. Of 26 chemicals included in the exposure analysis, none were
positively associated with brain cancer. There were no positive trends for brain
cancer with increasing external radiation dose and internal dose as measured by
the lung dose. Although workers with brain cancer were more likely than other
workers to have worked at ORR more than 20 years, there was no trend with
years worked. A medical history of epilepsy or head injury was not associated
with brain cancer.
Mortality data through 1974 and through 1989 were analyzed for about 1,059
white male welders at the Oak Ridge Reservation. When deaths through 1989
were considered, welders had elevated rates for lung cancer and cancer of the
prostate. The risk of each cause was different among the facilities. The risk of
lung cancer among welders exposed to nickel oxides did not differ from nonexposed welders.

B. Non Cancer Causes of Death -- Compared to the rates for the U.S. population
through 1980, the workers had higher rates for tuberculosis; mental,
psychoneurotic, and personality disorders; cerebrovascular disease; diseases of
the respiratory system, particularly emphysema; and all accidents, particularly
motor vehicle accidents. Because these workers were not engaged in military
service during wartime, it is not possible to know whether or not these conditions

15

 reflect occupational exposures or underlying health conditions that would have
excluded them from military service.
Special studies of 1,059 Oak Ridge welders examined their mortality through
1989. Male welders had an elevated mortality rate for gastric ulcers.

Oak Ridge National Laboratory (Reference prefix - ORX).
The Oak Ridge National Laboratory (ORNL) is a multi-purpose laboratory that was
involved in reactor operations, chemical separations, and research.
A. Cancer Causes of Death -- The first cohort study of ORNL considered 8,375
white males and deaths through 1977. No cancer cause of death was greater than
expected based on the U.S. general population. A follow up study reported that
the death rate from leukemia was greater than the U.S. rate through 1984,
particularly among workers monitored for internal radiation contamination. In
the most recent update with death rates through 1990, none of the three
categories of cancer deaths reported -- all cancers combined, lung cancer, and
leukemia, were elevated.
Although the leukemia rate through 1984 was elevated, there was no positive
trend in the death rate by level of cumulative external ionizing radiation dose. A
positive trend was reported for all cancers combined by level of cumulative
external dose. The most recent update, with deaths through 1990, did not find a
trend for all cancers combined but did report that radiation doses received after
age 45 years predicts the all cancers combined mortality rate.
B. Non Cancer Causes of Death -- There were no elevated rates for non cancer
causes of death.

Oak Ridge Y-12 Plant (Reference prefix - ORY).
Y-12 was involved in uranium enrichment and fabrication of nuclear weapons
components. The original Y-12 mortality study was updated twice. The first study
included 18,869 white males who ever worked at the plant and mortality through
1974. The second study was restricted to 6,781 men who worked at least 30 days
with mortality through 1979. The most recent study was expanded to include 10,597
nonwhite workers and females with deaths through 1990.
A. Cancer Causes of Death -- The death rate for lung cancer was higher than the
U.S. rate in the two most recent studies with deaths through 1979 and 1990. An
elevated lung cancer death rate was first evident for deaths occurring between
1955 and 1964. The rate continued to increase for deaths occurring between
1975 and 1979 followed by a declining rate.

16

 Analysis of deaths through 1979 did not reveal positive trends for any cause of
death with either external or internal exposure to ionizing radiation. The most
recent study did not include radiation measurements.
Between 1953 and 1963 the Y-12 Plant used metallic mercury in a process to
produce large quantities of enriched lithium. There were 5,663 workers
categorized by exposure based on results of urinalysis data. Analysis of deaths
through 1978 revealed no differences in the cancer mortality patterns for
mercury exposed workers as a whole, workers with the highest mercury
exposures, and workers employed more than a year in a mercury process.
During the early operation of the Y-12 plant from 1942-1947, a group of 694
male workers was exposed to phosgene gas on a chronic basis and 106 males
received acute exposures along with 91 females. A control group of 9,280
workers who also worked at Y-12 during the same era, but who did not have
phosgene exposure, was also described. All groups were followed through the
end of 1978 with particular interest in respiratory diseases and lung cancer.
There was no evidence for increased mortality from lung cancer in this group.
B. Non Cancer Causes of Death -- Studies of mercury exposed workers did not
detect elevated mortality rates for non cancer causes of death. Studies of
workers exposed to phosgene did not find elevated rates for non cancer
respiratory disease.
C. Non Cancer Illness -- Between 1953 and 1963 the Y-12 Plant used metallic
mercury in a process to produce large quantities of enriched lithium. There were
5,663 workers categorized by exposure based on results of urinalysis data. There
were 502 mercury workers involved in a clinical study. Clinical measurements
revealed some deficiencies in neurological function particularly among those
workers with the highest exposures, but not with the duration of exposure. A
follow up study of 219 of the original subjects in the 1990s revealed that some
neurologic effects were still detectable.

Oak Ridge K-25 Gaseous Diffusion Plant (Reference prefix - ORK).
The K-25 plant was a center for uranium enrichment for nuclear weapons and
commercial uranium fuel. The death rates through 1989 for 35,712 workers were
the focus of the study.
A. Cancer Causes of Death -- White male workers had high rates relative to U.S.
general population rates for cancer of the respiratory system, particularly lung
cancer and bone cancer.
Powdered nickel was used at the Oak Ridge K-25 gaseous diffusion plant in the

17

 production of the barrier material used to separate and enrich uranium. Death
rates for 814 nickel workers who fabricated the barriers were compared to 1,600
controls. There were no differences in the death rates for the exposed and non
exposed workers by cause of death through 1972. A later study compared the
mortality through 1977 of the nickel workers and 7,552 non exposed workers.
There was no cancer cause of death with a rate higher than the U.S. rate and no
differences in the rates for exposed and non exposed workers.

B. Non Cancer Causes of Death -- White male workers had high rates relative to
U.S. general population for: mental disorders, all respiratory diseases,
particularly pneumonia; symptoms, senility, and ill-defined conditions; all
external causes of death, particularly accidents and specifically motor vehicle
accidents. White females had high rates for symptoms, senility, and ill-defined
conditions. Nickel exposed workers did not have elevated rates for non cancer
causes of death.
C. Cancer Illness -- Epoxy resins and solvents were common exposures among K25 gas centrifuge workers. A total of 263 workers with the most exposure were
compared with 271 employees with no exposure at the plant during the same
time period. The centrifuge workers reported five incident bladder cancers
versus none reported by the non-centrifuge group. One of the epoxy resins was a
potential bladder carcinogen. None of the workers with bladder cancer had jobs
that required routine, hands-on work with that material.

Pantex Plant (Reference prefix - PTX)
Pantex is the center for high-explosives component fabrication for nuclear weapons
and for nuclear weapons disassembly and storage. The cohort mortality study of the
Pantex Plant included mortality through 1978 among 3,564 white male employees.
There were no cancer or non cancer causes of death with rates greater than those
seen in the U.S. general population.

Portsmouth Gaseous Diffusion Plant (Reference prefix - PTS)
The Portsmouth Gaseous Diffusion Plant is dedicated to enriching natural uranium
in the uranium-235 isotope for nuclear reactors and weapons uses. The activities and
processes are similar to those at the Paducah Gaseous Diffusion Plant in Kentucky.
A. Cancer Causes of Death -- Mortality among 5,733 white male employees at the
Portsmouth Gaseous Diffusion Plant was studied through 1982. This study was
expanded to include all 8,877 workers employed through 1991. No cancer death
rate was greater than expected based on the U.S. general population rates for
either study.

18

 Among the 6,827 workers exposed to uranium hexafluoride, special emphasis
was on the death rates for all cancers combined, stomach cancer, hematopoietic
cancer, and lung cancer. The rate for each of these was no larger than the
comparable U.S. rate. There were no positive trends for these four cause of
death groups by increasing urine counts. Among 1,446 workers exposed to
fluorine or fluoride, and 465 exposed to nickel; the rate for all cancers combined
did not exceed the U.S. rates.
B. Non Cancer Causes of Death -- No non cancer cause of death had a rate higher
than the U.S. general population rate.
Rocketdyne/Atomics International (Reference prefix - RAI)
Rocketdyne/Atomics International was involved in small experimental reactor
design, construction, operation and decommissioning. The Rocketdyne/Atomics
International Radiation Study included 4,563 employees in the health physics
monitoring program from 1950 through 1993 with records. The mortality study
considered external exposure to ionizing radiation and internal deposition of
radioactive materials.
A. Cancer Causes of Death -- Compared to U.S. general population through 1994,
no rate for a cancer cause of death was greater than expected rate based on the
U.S. general population.
Positive trends in the rates by level of exposure to external radiation were
reported for three of the four cancer categories examined: all cancers combined,
cancers of the blood and blood forming tissues, and lung cancer. In the
Rocketdyne/Atomics International Chemical Study no relationship was seen
between asbestos exposure and lung cancer mortality among the radiationmonitored workers.
Positive trends in the rates by level of internal radiation dose were reported for
cancers of the blood and blood forming tissues, and cancers of the upperaerodigestive-tract (oral cavity, pharynx, esophagus, and stomach).
B. Non Cancer Causes of Death -- There were no reported elevated non cancer
mortality rates for this cohort.

Rocky Flats (Reference prefix - RFP)
Rocky Flats Plant was established in 1952 to produce plutonium parts for nuclear
weapons as well as other uranium, beryllium, and steel weapons components.

19

 A. Cancer Causes of Death -- There were no cancer causes of death that were higher
than the U.S. general population rates through 1979. Workers with a higher
body burden (internal deposition) of plutonium had a higher rate for all
lymphopoietic cancers combined when compared to those with a smaller body
burden.
There were no positive trends for any cancer cause of death by level of external
or internal radiation exposure.
B. Non Cancer Causes of Death -- For the 7,112 white males who ever worked at
Rocky Flats, only the death rate for benign and unspecified neoplasm of the
brain was greater than the corresponding U.S. general population rate. Among
the 5,413 Rocky Flats white males who worked at the site for at least 2 years,
there was a higher rate of benign tumors and tumors of unspecified nature when
comparing them with the U.S. general population through 1979; these were brain
tumors. A study of 16 of the 22 known brain tumor cases through 1977 found no
associations with exposure to internally deposited plutonium, external ionizing
radiation or occupation. Independent review of occupational dosimetry records
and pathologic examination of tissues from six of these workers led to the
conclusion that none were radiation-related.
A subsequent reanalysis of the data for the 5,413 Rocky Flats workers found a
positive trend for all non-cancers across external exposure groups due to a strong
positive trend for circulatory diseases.

Savannah River Site (Reference prefix - SRS)
The Savannah River Site produced, purified and processed plutonium, tritium, and
other radioisotopes for the nuclear weapons program.
A. Cancer Causes of Death -- The first complete mortality study included 9,860
white male Savannah River workers. A higher rate of leukemia than the U.S.
general population through 1980 was reported. This was concentrated among
hourly workers employed before 1955 who worked from 5 to 15 years. Review
of the plant records and job duties of all workers who died from leukemia
indicated that seven, half of the leukemia deaths, had the potential for some
exposure to industrial solvents. The leukemia death rate through 1986 was
higher than expected only for those deaths occurring from 1965 through 1969.
Preliminary findings from the most recent study of a larger group of workers
reported that the leukemia mortality rate was not higher than the U.S. rate
through 1995.
A positive trend was seen for leukemia mortality and external dose for deaths
through 1986.

20

 B. Non Cancer Causes of Death -- There were no non cancer causes of death rates
higher than the U.S. general population rates.

C. Cancer Illness -- Three cancer incidence studies were conducted among active
workers beginning with new cancer cases diagnosed in 1956 and ending in 1974,
1980, and 1983 respectively. There were no overall cancer incidence rates or
rates by radiation exposure group that were higher than U.S. rates. Special
investigations were conducted for (1) leukemia, and later for (2) leukemia,
prostate cancer, and lung cancer. Preliminary results from the later study
indicate that radiation monitored workers in the higher exposed group had a
higher death rate for chronic lymphocytic leukemia than expected.

Multi-Site study: All Department of Energy facilities (Greater than 5 rem Study)
(Reference - MULTI96)
This is a study of 1,404 DOE and DOE contractor employees who received 50 mSv
(5 rem) or more external radiation dose in any calendar year during employment at
the facilities.
A. Cancer Causes of Death -- Within this special group of workers, rates for cancer
causes of death were not higher than the corresponding U.S. general population
rates.
B. Non Cancer Causes of Death -- Within this special group of workers, rates for
non cancer causes of death were not higher than the corresponding U.S. general
population rates.

Multi-Site study: Multiple Myeloma (Reference - MULTI98b)
The study included 98 cases of multiple myeloma and 391 controls from the
populations of the Hanford Site, Los Alamos National Laboratory, Oak Ridge
National Laboratory, and the Savannah River Plant. The risk of multiple myeloma
was linked to external ionizing radiation exposure after age 45 years.

Multi-Site study: Uranium dust study (Reference - MULTI95b)
This special study of uranium dust exposure and lung cancer among workers
employed between 1943 and 1947 was conducted at the Tennessee Eastman, Y-12,
Fernald, and Mallinckrodt facilities. There were 787 cases of lung cancer in the
study. The risk of lung cancer did not increase with increasing radiation dose. The
authors did suggest that there was a trend in risk for worker exposure after age 45

21

 years. Analysis by external radiation dose and exposure to thorium, radium, and
radon were uninformative.

Multi-Site study: Uranium Millers (Reference prefix - MULTI83)
The front end of the uranium fuel cycle includes the milling of uranium ore. The
most recent National Institute for Occupational Safety and Health study of uranium
millers included 2,002 males from seven plants on the Colorado Plateau. These men
worked at least one year since 1940 and had never worked in uranium mining.
A. Cancer Causes of Death -- There were no cancer causes of death with rates
higher than the U.S. general population rates through 1977.
B. Non Cancer Causes of Death -- Compared to the U.S. population through 1977,
there were two causes of death that had higher rates: non malignant respiratory
diseases, particularly the chronic respiratory conditions, and miscellaneous
accidents.
________________

22

 APPENDIX 4

TABLES OF

STANDARDIZED MORTALITY RATIOS

FROM EPIDEMOLOGIC STUDIES

23

60

70

54

87

58

49

86

54

36

86
86

86

56

0

86
85
84

104
91
90
56
52
35
32
29
4
4
1
0
0

121
99
91
85
85
78

410
292
278
236
200
196
182
148
144
140
132
115
113
109
108
106
99
97
94
93
87
87
82
82
82
81
80
79
79
79
79
76
75
74
73
73
72

55
49
48
48
48
45
44
43
40
32
23
23
22
21
13
1
0
0
0
0
0

163
131
126
123
119
112
107
106
104
104
102
98
98
96
92
91
90
89
88
88
87
87
86
85
85
84
83
83
83
83
82
82
81
81
81
81
80

74
74
74
73
73
73
72
71
68
68
67
67
66
65
65
64
63
63
62
62
62
60
60
58
58
57
55
53
49
43
37

61 82
59 78
58 68
57
56
54
48
47
46
44
40
30
2
1
0

204
173
128
124
117
116
116
111
106
101
98
96
95
95
92
90
89
89
88
87
87
86
84
84
84
84
82
82
81
78
78
78
74
73
73
71
71

63
62
57
56
53
51
2
1
1
1
0

250
150
139
130
109
108
103
103
101
98
91
90
85
74
72
72
68
67
66
66
61
59
58
55
54
53
53
52
47
46
43
43
43
42
41
40
39

25
1
1
0
0
0

403
387
347
211
193
171
164
156
149
145
145
139
128
123
112
110
110
109
105
103
101
101
97
94
92
91
91
86
85
82
78
75
71
69
68
68
64

51
44
35
16
0
0
0
0
0
0
0
0
0

378
277
238
190
169
157
143
136
132
130
128
127
124
118
115
109
108
107
106
106
104
103
101
100
97
97
97
96
96
95
95
93
92
91
91
89
89

307
175
146
140
138
130
125
123
115
115
104
101
100
96
95
94
94
93
93
92
89
84
84
83
82
80
80
79
74
69
67
60
58
56
50
49
41

366
281
234
180
169
165
165
149
128
126
118
118
107
104
94
93
92
91
90
86
84
84
83
82
82
80
79
78
78
77
75
73
72
72
70
69
68

80

0

68

70

38

64

88

88

69

80

0

66

69

34

64

85

88

66

79

0

64

67

33

61

84

84

28

63

76

0

63

64

33

61

82

83

3

56

75

0

62

63

30

53

81

83

Respiratory system

•
Peritoneum and unspecified
digestive

•
Pancreas

•
Liver and gall bladder

•
Rectum

••
Colon

•
Small intestines and colon

•
Stomach

•
Esophagus

Digestive organs and peritoneum

Buccal cavity and pharynx

87

136
122
97
91
90
86
84
80
78
77
72
71
67
65
63
60
60
49
40
40
39
38
38
37
36
35
30
29
28
28
27
27
25
23
22
12
2

•

All cancer excluding leukemia
86
86
86
85
85
85
85
85
84
83
82
82
81
81
80
80
79
79
78
78
78
78
76
75
75
75
75
75
71
71
70
70
69
69
64
64
64

82
82
82
81
80
79
79
75
74
74
74
74
73
73
72
72
72
72
71
71
71
69
68
68
68
68
68
67
67
65
64
63
63
63
62
62
60

•

ALL CANCERS
112
110
110
106
105
104
103
103
103
102
102
101
100
100
100
99
99
98
98
96
96
95
95
94
94
94
92
91
91
91
90
90
89
88
88
88
88

133
121
118
109
106
104
103
102
102
101
101
101
100
98
97
97
96
95
95
95
95
93
92
92
92
92
91
90
90
90
89
89
88
88
87
86
86

83

•
Tuberculosis

INFECTIOUS AND PARASITIC
DISEASES

ALL CAUSES OF DEATH

Table 1. Rank Ordered Cause-Specific Standardized Mortality Ratios* (SMRs) for US Nuclear
Weapons Workers

71 31 161 81
70 22 144 80
68
139 76
66
136 76
65
136 75
65
132 73
61
131 66
59
129 65
59
127 65
125 62
56
125 59
55
123 59
50
119 57
43
117 56
38
116 56
26
25
116 50
14
115 46
2
115 45
1
113 36
1
113 20
0
112
110
108
108
107
104
103
102
101
98
98
97
97
94
93
93
92

SMR values greater than 100 indicate mortality rates above the general population rate; values below 100 indicate rates
below the general population rates. Bold italicized SMRs indicate those that are statistically significant or “truly” greater
than or less than the general population rate.
The symbols •
\•
•
\•
•
•
denote sub categories of the preceding cause of death category.

 •

SMR values greater than 100 indicate mortality rates above the general population rate; values below 100 indicate rates
below the general population rates. Bold italicized SMRs indicate those that are statistically significant or “truly” greater
than or less than the general population rate.
The symbols •
\•
•
\•
•
•
denote sub categories of the preceding cause of death category.

•

314
170
228
184
162
161
144
132
128
126
125
125
122
121
117
116
107
106
103
102
99
97
97
96
95
95
94
92
90
86
86
86
84
84
80
77
76
75
66
65
48
40

36
28
24
1
0
0
0
0

202 60 173 144
195 3 112 82
186 0 93 71
152
91 71
142
90 64
140
86 63
135
73
133
72
132
70
131
58
127
23
120
0
118
0
116
0
112
109
106
105
104
104
102
101
100
100
100
100
99
96
95
94
92
92
90
83
79
73
71
69
68
67
67
66
64

169
116
100
0

233
187
134
130
124
113
104
100
98
93
89
86
85
84
82
76
76
75
72
72
69
68
67
67
65
62
60
60
59
59
59
57
56
56
55
52
43
43
42
36
1
1

1
0
0
0

269
205
166
165
150
139
134
131
130
128
126
122
122
121
120
114
112
108
103
101
100
99
97
95
95
95
94
93
92
89
84
72
72
70
67
63
63
62
60
59
56
51

Other and unspecified sites

•••
Kidney

••
Other and unspecified urinary
organs

••
Bladder

•
Bladder and other urinary organs

••
Testis and other male genital
organs
•••
Testis

190
166
161
152
150
142
138
137
136
136
136
135
134
134
130
127
127
126
125
124
122
120
119
119
119
118
118
117
113
113
113
111
109
108
108
108
103
101
100
99
97
97
97

260 1812 0
54 307 0
191 0
182 0
168 0
162 0
119 0
117 0
115 0
113 0
109 0
108 0
106 0
105 0
104 0
94
0
89
0
87
0
78
77
74
73
62
51
44
32
31
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0

79 27
89 19
102
89
78
75
64
38

••
Prostate

447
236
199
169
166
164
161
161
155
136
134
131
119
106
106
100
97
96
88
86
82
75
74
70
69
68
67
63
60
52
32
0
0
0
0

96
94
92
92
92
89
88
85
84
84
83
83
81
80
78
78
78
77
75
75
75
72
67
65
65
64
62
62
61
60
60
58
58
57
55
49
45
39
14
1
1
0

127 161 87 100 110 95
121 63 70 99 88 80
121
36 95 0
0
118
36 80
104
64
95
63
92
34
91
33
89
0
88
86
85
55

••
Ovary and other female genital
organs
•
All male genital organs

•••
Other uterus

•••
Cervix uteri

••
All uterus

•
All female genital organs

Genitourinary organs

•
Female breast

•
Skin

•
Bone

Bone, connective tissue, skin and
breast

•
Trachea, bronchus and lung

•
Larynx

Table 1. Rank Ordered Cause-Specific Standardized Mortality Ratios* (SMRs) for US Nuclear
Weapons Workers

40 104 94
39 100 69
31
89
0
71
0
0
0
0
0
0

 1317
428
412
370
236
196
174
157
134
119
83
75
61
52
49
47
44
39
33
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

237
156
146
146
142
141
125
125
123
123
121
120
119
112
111
110
106
106
105
102
101
100
99
98
98
96
95
94
93
93
92
91
90
90
89
87
87
86
85
85
84
83

83 182 571 27
82 101 321 25
80 83 170 21
79
165 2
79
163 1
77
157 0
77
148
76
137
73
129
71
115
71
112
69
106
69
106
66
105
64
105
59
104
56
98
51
95
30
94
93
92
91
87
85
82
80
78
77
76
71
69
62
62
55
54
53
50
45
43
39
38
37

1286 56 116
231 41 41
200 31 36
191 0 19
154 0
145
143
138
138
128
126
123
110
103
103
98
94
94
93
91
91
90
90
87
86
86
84
83
83
78
77
74
74
72
69
62
62
62
60
60
59
57

133
129
93
91
83
55
4

223
163
163
160
159
155
148
146
135
134
132
129
129
128
124
121
118
117
116
115
113
112
111
110
108
107
107
106
105
101
101
98
94
91
91
87
84
84
84
83
83
82

82 125 221 150 133
79
213 118
77
186 102
77
146 99
76
141 98
75
136 97
75
134 92
74
133 91
72
132 87
71
132 85
71
129 83
65
128 78
60
126 70
60
123 64
58
118 59
57
113 49
56
110
54
110
50
106
46
105
41
98
20
98
1
97
0
95
0
90
0
84
0
84
83
81
77
77
71
68
57
53
2
0

134
81
43
41

600
405
390
376
371
263
250
201
190
135
133
122
110
102
100
98
92
92
90
87
87
84
79
75
74
74
66
58
56
55
55
54
54
52
49
40
39
37
32
25
1
0

230
209
188
182
180
165
160
157
154
149
147
136
131
129
128
122
122
119
119
119
117
116
114
114
112
111
109
109
108
106
104
102
96
96
96
95
93
87
86
80
78
78

•

SMR values greater than 100 indicate mortality rates above the general population rate; values below 100 indicate rates
below the general population rates. Bold italicized SMRs indicate those that are statistically significant or “truly” greater
than or less than the general population rate.
The symbols •
\•
•
\•
•
•
denote sub categories of the preceding cause of death category.

BLOOD AND BLOOD-FORMING
ORGANS

•
Diabetes mellitus

ENDOCRINE, METABOLIC,
NUTRITIONAL

BENIGN AND UNSPECIFIED
NEOPLASMS

Other unspecified cancer

•
Other hematopoietic and lymphatic

•
Other Iymphatic and hematopoietic

•
Other Iymphatic and hematopoietic

••
Lymphatic leukemia

•
Leukemia and aleukemia

•
Multiple myeloma

•
Other lymphoid tissue

•
Hodgkin disease

•
Lymphosarcoma and
reticulosarcoma

•
Lymphopoietic cancer

All Iymphatic and hematopoietic
cancer

All other solid tumors
156
147
107
104
103
102
100
90
81
80
53

244
193
180
170
143
114
99
97
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

•

75
74
72
69
69
68
68
66
60
59
55
53
52
45
37
36
34
25
23
1
0
0
0
0

Thyroid

Brain and other nervous system

Eye

Table 1. Rank Ordered Cause-Specific Standardized Mortality Ratios* (SMRs) for US Nuclear
Weapons Workers

0 213 250 285
0 124 196 148
0 98 106 123
0 94 76 119
0 91 69 116
0 88 67 103
86 66 99
85 63 99
84 62 94
83 61 90
76 58 88
69 55 85
67 55 84
65 55 79
64 52 76
62 38 76
62 24 75
56
1 69
52
1 65
52
1 63
52
59
51
56
52
19
1
53
49
42
41
34
0
0
0

 1232
384
306
180
164
159
148
147
143
141
131
121
116
113
113
102
95
89
82
82
80
76
71
70
67
56
44
42
3
2
2
2
0
0

•
•

570
155
108
102
93
90
86
86
84
84
82
82
81
81
74
73
73
72
70
68
66
62
61
55
52
50
47
44
43
40
37
36
26
22
1
1
0
0
0
0
0

118
106
102
100
99
98
97
96
95
93
93
92
92
90
90
90
89
89
88
88
88
88
87
87
86
86
85
84
84
83
83
83
83
82
82
81
80
80
78
78
78
78

SYMPTOMS AND ILL-DEFINED
CONDITIONS

SKIN AND SUBCUTANEOUS
TISSUE
MUSCULOSKETAL AND
CONNECTIVE TISSUE

••
Chronic nephritis

•
Nephritis and nephrosis

GENITOURINARY SYSTEM

•
Cirrhosis

•
Ulcer of stomach

DIGESTIVE SYSTEM

•
Asthma

•
Emphysema

•
Pneumonia

RESPIRATORY SYSTEM

•
Cerebrovascular disease

••
Ischemic heart disease

•
Ischemic and other heart disease

•
Chronic rheumatic heart disease

CIRCULATORY SYSTEM

MENTAL DISORDERS

NERVOUS SYSTEM AND SENSE
ORGANS

Table 1. Rank Ordered Cause-Specific Standardized Mortality Ratios* (SMRs) for US Nuclear
Weapons Workers

76 210 383 119 199 266 83 316 193 177 163 60 201 355 155 54 32 318 313 233 593
76 100 92 108 155 152 83 217 148 125 108 59 90 102 132 54 60 218 241 206 581
73 96 79 101 135 134 82 133 127 107 106 58 69 91 130 54
0 121 127 138 402
72 89 74 92 119 133 81 122 120 86 106 57 50 79 127 52
104 107 130 330
70 64 39 91 110 128 80 117 115 77 106 57 50 74 126 42
99 79 130 325
70 57
89 100 128 78 117 112
0 105 54 50 72 118 39
97 62 121 325
70 54
89 93 126 78 112 111
0 103 54
70 111 21
87 49 118 323
65 100 19
70 33
88 93 119 77 111 109
0 102 54
83 27 105 319
77 92 119 76 105 100
60 99 19
69 24
0 98 54
73 23 94 301
68 22
75 92 116 76 104 88
58 93 1
0 97 52
72 16 93 293
68 22
75 91 113 76 99 71
0 93 46
54 93 1
60
0 88 289
65
66 90 113 76 99 68
49 91 0
0 91 45
55
0 71 262
61 88 112 75 98 67
45 90 0
65
89 43
52
0 49 249
58 87 112 75 83 65
35 89 0
65
86 42
48
0 46 234
32 85 111 74 83 61
85 41
31 86 0
64
41
0 37 227
63
81 111 69 82 52
84 40
37
84
0 29 227
62
83 35
83
81 109 65 70 39
0
0 23 204
62
78 107 63 54 20
83 34
82
0
0
161
61
74 105 62 38
4
82 6
81
0
0
160
72 103 61 33
81 3
60
2
80
0
159
57
80 3
71 101 60 12
1
80
0
144
80 1
57
67 100 59
4
1
80
130
63 96 57
56
3
0
80
78
105
55
61 94 56
1
0
78
78
101
45
76
58 93 55
1
72
99
40
57 92 54
1
76
69
88
38
92 46
76
69
80
73
92 46
69
80
91 42
73
65
63
70
64
91 42
57
70
90 42
64
52
63
89 41
68
51
88 40
67
61
49
59
88 36
66
41
40
88 30
65
59
87 21
64
59
39
63
37
86 16
57
86 3
63
56
31
62
85
56
29
55
85
62
23
21
85
62
55
84
61
55
18

SMR values greater than 100 indicate mortality rates above the general population rate; values below 100 indicate rates
below the general population rates. Bold italicized SMRs indicate those that are statistically significant or “truly” greater
than or less than the general population rate.
The symbols •
\•
•
\•
•
•
denote sub categories of the preceding cause of death category.

1
0
0

 138
135
109
109
109
104
100
94
90
89
82
82
75
67
65
36

•
•

201
162
153
152
123
119
118
118
117
116
116
113
111
108
107
105
105
102
102
99
97
96
95
90
90
89
89
89
87
86
86
84
82
81
79
79
78
77
77
76
75
75

72
72
66
66
65
63
62
62
57
53
51
45
29
0

68 241
59 184
133
123
117
112
106
100
94
92
92
91
89
88
87
86
86
85
80
80
78
75
73
67
65
60
54
53
51
50
4
4
0

480
334
170
159
134
127
123
120
119
118
110
104
100
90
80
77
77
77
71
66
61
60
0

159
157
122
105
97
97
91
90
89
87
82
81
79
78
75
74
65
65
60
27
2
1
0

•
Violence

•
Suicide

••
Motor vehicle accidents

•
All accidents

••
Unintentional injuries

•
All external causes of death

ACCIDENTS POISONINGS, AND
VIOLENCE

Table 1. Rank Ordered Cause-Specific Standardized Mortality Ratios* (SMRs) for US Nuclear
Weapons Workers

44
41
36

SMR values greater than 100 indicate mortality rates above the general population rate; values below 100 indicate rates
below the general population rates. Bold italicized SMRs indicate those that are statistically significant or “truly” greater
than or less than the general population rate.
The symbols •
\•
•
\•
•
•
denote sub categories of the preceding cause of death category.

 Table 2-1. Statistically Significant Elevated Standardized Mortality Ratios (SMRs) by Type of Cancer and
Facility for US Nuclear Weapons Workers*

SMR (1)

DOE site

Minimu
m days
worked

Period of
employment

Deaths
Through

Race &
sex

Subgroup (exposure)

Reference
Numbe
and
r
Person- publicatio
n
of
Years
worker
year (2)
s

RESPIRATORY SYSTEM - All
125

Fernald

1

1951

1981

1989

W males

Hourly pay category

125

Oak Ridge

.

1943

1947

1979

W males

W males

4,014 121,038 FMPC96

116

Oak Ridge

.

1954

1985

1984

W males

W males

123

Oak Ridge K25

.

1945

1984

1989

W males

Hourly pay category

117

Oak Ridge K25

.

1945

1984

1989

W males

W males

35,712

ORK96

119

Oak Ridge Y12

.

1947

1974

1990

W males

W males

6,591

ORY96

995

27,740 LIND87

28,008

ORC90
ORC97a/c
ORK96

RESPIRATORY SYSTEM - Larynx
447

Linde Air Prod.

30

1943

1949

1979

W males

W males

125

Fernald

1

1951

1981

1989

W males

Hourly pay category

127

Oak Ridge

.

1943

1947

1979

W males

W males

118

Oak Ridge

.

1954

1985

1984

W males

W males

138

Oak Ridge

.

1943

1985

1989

W males

Welders

124

Oak Ridge K25

.

1945

1984

1989

W males

Hourly pay category

119

Oak Ridge K25

.

1945

1984

1989

W males

W males

134

Oak Ridge Y12

120

1953

1963

1978

W males

118

Oak Ridge Y12

2

1943

1945

1978

W males

136

Oak Ridge Y12

.

1947

1974

1979

120

Oak Ridge Y12

.

1947

1974

1990

RESPIRATORY SYSTEM - Lung
4,014 121,038 FMPC96
28,008

ORC90
ORC97a/c

1,211

ORC98
ORK96

35,712

ORK96

Comparison (no mercury exposure)

3,260

ORY84

9,280 266,027 ORY85

W males

Comparison (no phosgene
exposure)
W males

6,781

ORY88b

W males

W males

6,591

ORY96

DIGESTIVE SYSTEM - Stomach
281

Fernald

1

1951

1981

1989

W males

Salaried pay category

4,014 121,038 FMPC96

165

Los Alamos Zia

.

1946

1978

1984

W males

Monitored-external & Plutonium

4,942

169

Hanford

.

1944

1978

1981

All males

Not monitored-external

157

Hanford

.

1944

1978

1986

All males

Not monitored-external

LANL92

DIGESTIVE SYSTEM - Pancreas
HAN89
3,400

HAN93a

Bone
191

Oak Ridge K25

.

1945

1984

1989

W males

Hourly pay category

182

Oak Ridge K25

.

1945

1984

1989

W males

W males

ORK96
35,712

ORK96

Prostate
233

Oak Ridge K25

1943

1985

1989

W male

Welders K25

683

ORC98

195

Oak Ridge

1943

1985

1989

W male

Welders

1,211

ORC98

Leukemia
223

Oak Ridge X10

1

1943

1972

1984

W males

Monitored-internal

3,763

ORX91

163

Oak Ridge X10

1

1943

1972

1984

W males

Monitored-external

8,318

ORX91

121

Fernald

1

1951

1981

ALL CANCER (excluding leukemia)
1989

W males

Hourly pay category

4,014 121,038 FMPC96

* Source: Table derived from detailed listing of all statistically significant SMRs in Appendix 1 (Table 1). (1) SMR is
the abbreviation for “Standardized Mortality Ratio.” In this table, SMR values greater than 100 indicate a mortality
rate “truly” greater than the general population rate. Column headings used here are an expanded version of the

 shorthand headings used in the detailed SMR tables. When no subgroups were given, the race and sex group is given
for clarity. (2) References are listed in Appendix 2.

 Table 2-2. Statistically Significant Elevated Standardized Mortality Ratios (SMRs) for Non-Cancers by
Facility for US Nuclear Weapons Workers*

SMR(1)

DOE Site

Minimu
m days Period of
Deaths
Race &
worked employmen through
Sex
Subgroup (exposure)
t
BENIGN & UNSPECIFIED TUMORS

600

Rocky Flats

730

1951 1977

1977

W males

Monitored-external (1+ rem)

405

Rocky Flats

730

1951 1977

1977

W males

Employed 2+ years

376

Rocky Flats

730

1952 1979

1979

W males

Employed 2+ years

Reference
Numbe
and
r of
Person- publicatio
worker
years
n year (2)
s
RFP83b
RFP83b
5,413

RFP87

MENTAL DISORDERS
164

Oak Ridge K25

1945 1984

1989

W males

Hourly pay category

159

Oak Ridge K25

1945 1984

1989

W males

W males

141

Oak Ridge Y12

2

1943 1945

1973

W males

Comparison workers (no phosgene)

118

Linde Air Prod.

30

1943 1949

1979

ORK96
35,712

0RK96

9,352 240,494 ORY80

CIRCULATORY SYSTEM – All
W males

W males

995

27,740 LIND87

995

27,740 LIND87

CIRCULATORY SYSTEM - Ischemic heart disease
119

Linde Air Prod.

30

1943 1949

1979

W males

W males

CIRCULATORY SYSTEM - Cerebrovascular disease
110

Oak Ridge K25

1945 1984

1989

W males

Hourly pay category

ORK96

RESPIRATORY SYSTEM – All
152

Linde Air Prod.

1943 1949

1979

W males

W males

126

Oak Ridge K25

30

1945 1984

1989

W males

Hourly pay category

119

Oak Ridge K25

1945 1984

1989

W males

W males

112

Oak Ridge

1954 1985

1984

W males

W males

995

27,740 LIND87
ORK96

35,712

ORK96
ORC97

RESPIRATORY SYSTEM – Pneumonia
217

Linde Air Prod.

1943 1949

1979

W males

W males

122

Oak Ridge K25

30

1945 1984

1989

W males

Hourly pay category

117

Oak Ridge K25

1945 1984

1989

W males

W males

995

27,740 LIND87
ORK96

35,712

ORK96

RESPIRATORY SYSTEM – Emphysema
120

Oak Ridge K25

1945 1984

1989

W males

Hourly pay category

ORK96

DIGESTIVE SYSTEM – Ulcers
404

Oak Ridge K25

1943 1985

1989

W males

Welders at K25

683

ORC98

MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE
233

Hanford

1944 1978

1981

All females Monitored-external

206

Hanford

1944 1978

1986

All females Monitored-external

138

Hanford

1944 1978

1986

All workers All workers

HAN89
8,895

HAN93a

44,154

HAN93a

SYMPTOMS & ILL-DEFINED CONDITIONS
227

Los Alamos Zia

1946 1978

1984

W males

Monitored-external & Pu

4,942

LANL92

262

Oak Ridge

1943 1985

1989

W males

Welders

1,211

ORC98

593

Oak Ridge K25

1948 1953

1977

W males

Barrier workers (nickel)

814

ORK84

325

Oak Ridge K25

1948 1953

1977

W males

Comparison workers (no nickel)

7,552

ORK84

319

Oak Ridge K25

1945 1984

1989

W males

Hourly pay category

301

Oak Ridge K25

1945 1984

1989

W males

W males

249

Oak Ridge K25

1945 1984

1989

NW females NW females

227

Oak Ridge K25

1945 1984

1989

W females

W females

289

Oak Ridge X10

1943 1972

1984

W males

Monitored- internal

3,763

ORX91

234

Oak Ridge X10

1943 1972

1984

W males

8,318

ORX91

402

Oak Ridge Y12

2

1943 1945

1973

W males

699

18,825 ORY80

323

Oak Ridge Y12

2

1943 1945

1973

W males

W males
Chemical workers (chronic low
phosgene)
Comparison workers (no phosgene)

330

Oak Ridge Y12

2

1943 1945

1978

W males

Comparison workers (no phosgene)

9,280 266,027 ORY85

325

Oak Ridge Y12

2

1943 1945

1978

W males

Chemical workers (chronic low

ORK96
35,712

ORK96
ORK96
ORK96

9,352 240,494 ORY80
694

21,181 ORY85

 phosgene)
293

Oak Ridge Y12

1947 1974

1990

W males

271

Oak Ridge Y12

1947 1974

1990

All workers All workers

W males

6,591

ORY96

8,116

ORY96

ACCIDENTS, POISONINGS & VIOLENCE – All
138

Hanford

1944 1978

1981

All females Not monitored-external

HAN89

ACCIDENTS, POISONING & VIOLENCE – External
119

Los Alamos Zia

1946 1978

1984

W males

Monitored-external & Pu

105

Oak Ridge

1954 1985

1984

W males

W males

4,942

LANL92

116

Oak Ridge K25

1945 1984

1989

W males

Hourly pay category

111

Oak Ridge K25

1945 1984

1989

W males

W males

118

Oak Ridge Y12

2

1943 1945

1973

W males

Comparison workers (no phosgene)

9,352 240,494 ORY80

123

Oak Ridge Y12

2

1943 1945

1978

W males

Comparison workers (no phosgene)

9,280 266,027 ORY85

ORC97
ORK96
35,712

ORK96

ACCIDENTS, POISONING & VIOLENCE - All accidents
133

Los Alamos Zia

.

1946 1978

1984

W males

Monitored-external & Pu

117

Oak Ridge K25

.

1945 1984

1989

W males

Hourly pay category

112

Oak Ridge K25

.

1945 1984

1989

W males

W males

4,942

LANL92
ORK96

35,712

ORK96

4,942

LANL97

ACCIDENTS, POISONING & VIOLENCE - Motor vehicle acidents
170

Los Alamos Zia

.

1946 1978

1984

W males

Monitored-external & Pu

123

Oak Ridge K25

.

1945 1984

1989

W males

Hourly pay category

118

Oak Ridge K25

.

1945 1984

1989

W males

W males

ORK96
35,712

ORK96

 Table 3

1949 1979 W males

None

1945

1984 1989 W males

Hourly pay category

1943

1945 1973 W males

Comparison workers (no phosgene)

9,352 240,494 1980

1944

1972 1983 W males

None

4,402 104,326 1991

Mound

1944

1972 1983 W males

Monitored-internal (Polonium)

2,181

56,256 1991

91

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

89

Oak Ridge

1954

1985 1984 W females

None

89

Oak Ridge Y12

1953

1963 1978 W males

Nonmercury workers 4+ months

88

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

1996

86

All DOE sites

1943

1978 1984 W males

DOE contractor

1,412

35,000 1996

86

Oak Ridge Y12

120

1953

1963 1978 W males

Mercury workers 4+ months

2,133

1984

85

Savannah River

90

1952

1986 1986 W males

Hourly pay category

7,299

1995

83

Oak Ridge

1

1948

1953 1972 W males

Comparison workers (no nickel)

1,600

34,701 1979

80

Oak Ridge Y12

120

1953

1963 1978 W males

Mercury workers 1+ years

1,741

1984

79

Mound

1947

1979 1979 W males

Monitored-external

4,182

1991

77

Los Alamos Zia

1946

1978 1984 W males

Monitored-external & Pu

4,942

1992

77

Oak Ridge Y12

1953

1963 1978 W males

Mercury workers (>0.3 mg Hg/L)

858

1984

76

Oak Ridge

1954

1985 1984 NW females None

75

Oak Ridge K25

1948

1953 1972 W males

Barrier workers (nickel)

814

17,232 1979

75

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

74

Oak Ridge X10

1943

1972 1984 W males

None

8,318

1991

74

Rocky Flats

1952

1979 1977 W males

Monitored-external (<=100 mrem)

1,884

1983

73

Oak Ridge X10

1943

1972 1977 W males

None

8,375

1985

73

Portsmouth

1954

1991 1991 All workers Monitored-internal (uranium)

6,827 150,000 1999

72

Pantex

72

Portsmouth

72

Rocketdyne

72

Savannah River

71

Los Alamos

71

Rocky Flats

69

Portsmouth

68

Oak Ridge Y12

68

Portsmouth

68

Portsmouth

118

Linde Air Products

106

Oak Ridge K25

95

Oak Ridge Y12

93

Mound

92

2

120

120
1

1

995

Person-years

Employment period ends
(Year)

1943

Site

Race
&
sex
Subgroup (exposure)
ALL CAUSES OF DEATH COMBINED

Number of employees

Employment period begins
(Year)

30

Standardized
Mortality
Ratio (SMR)*

Deaths included through
(Year)

Minimum days worked

Year of publication or report

All Statistically Significant Standardized Mortality Ratios (SMR) for Each Cause of
Death Among DOE Contractor Employees

27,740 1987
1996

1997
3,260

1984

1997
1996

1951

1978 1978 W males

None

3,564

1

1954

1991 1991 All worker

None

8,877 200,000 1999

1985

1

1950

1993 1993 W males

Monitored-internal

90

1952

1975 1980 W males

Hourly pay category

6,687

1988

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

730

1951

1977 1977 W males

Monitored-internal (2+ nCi Pu)

7

1954

1982 1982 W males

Potential U exposure

4,876

87,896 1987

120

1953

1963 1978 W males

Mercury workers 4+ months

270

1984

7

1954

1982 1982 W males

None

5,773 107,698 1987

7

1954

1982 1982 W males

Greatest Potential U exposure

3,545

1997

1983

65,027 1987

 68

Rocketdyne

68

Savannah River

1

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

90

1952

1975 1980 W males

Salaried pay category

67

Oak Ridge Y12

2,745

1988

1947

1974 1990 NW males

None

449

1996

65

Rocky Flats

64

Rocky Flats

730

1951

1977 1977 W males

Monitored-external (1+ rem)

730

1951

1977 1977 W males

Employed 2+ years

63

Los Alamos

1943

1977 1990 W males

None

5,727 456,637 1994

63

Oak Ridge X10

1943

1972 1984 W males

Monitored- internal

3,763

1991

63

Oak Ridge Y12

1947

1974 1990 All females None

1,073

1996

62

Rocky Flats

1952

1979 1977 W males

Monitored-internal (<1 microCi/day)

4,982

1983

62

Rocky Flats

730

1952

1979 1979 W males

Employed 2+ years

5,413

1987

60

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

56

Los Alamos

1944

1974 1980 W males

Monitored-internal (>10 nCi Pu)

224

6,930 1985

54

Los Alamos

1944

1974 1976 W males

Monitored-internal (>10 nCi Pu)

224

1978

49

Rocky Flats

1952

1979 1977 W males

Monitored-external (100+ mrem)

5,228

1983

36

Pantex

1951

1978 1978 W males

Monitored-external (1+ rem)

252

1985

89

Oak Ridge Y12

1943

1945 1978 W males

Comparison workers (no phosgene)

86

Oak Ridge

1954

1985 1984 W females

None

86

Savannah River

90

1952

1986 1986 W males

Hourly pay category

7,299

85

Oak Ridge Y12

2

1943

1945 1973 W males

Comparison workers (no phosgene)

9,352 240,494 1980

82

Oak Ridge X10

1943

1972 1984 W males

Monitored- internal

3,763

82

Portsmouth

1954

1991 1991 All workers None

8,877 200,000 1999

79

Oak Ridge X10

1943

1972 1984 W males

None

8,318

79

Rocketdyne

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

78

Oak Ridge

1954

1985 1984 NW females None

78

Oak Ridge X10

1943

1972 1977 W males

None

8,375

1985

76

Rocky Flats

1952

1979 1977 W males

Monitored-internal (<1 microCi/day)

4,982

1983

75

Los Alamos Zia

1946

1978 1984 W males

Monitored-external & Pu

4,942

1992

75

None

1943

1971 1977 W males

None

2,002

43,252 1983

75

Rocky Flats

730

1951

1977 1977 W males

Employed 2+ years

71

Rocky Flats

730

1952

1979 1979 W males

Employed 2+ years

5,413

1987

71

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

70

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

69

Los Alamos

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

64

Los Alamos

1943

1977 1990 W males

None

60

Pantex

1951

1978 1978 W males

None

1983
1983

All cancers combined
2

1
1

9,280 266,027 1985
1997
1995
1991
1991
1997

1983

1996
15,727 456,637 1994
3,564

1985

All cancers (excluding leukemia)
121

Fernald

1

1951

1981 1989 W males

Hourly pay category

4,014 121,038 1996

Infections & parasitic diseases
40

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

38

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

1996

37

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

30

Savannah River

1952

1975 1980 W males

Hourly pay category

79

Oak Ridge

1954

1985 1984 W males

None

1997

55

Los Alamos

1943

1977 1990 W males

None

15,727 456,637 1994

23

Oak Ridge K25

1948

1953 1977 W males

Comparison workers (no nickel)

7,552

1984

23

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

21

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

1996

90

1996
6,687

1988

Cancer-buccal cavity & pharynx

 13

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

1996

Cancer-digestive organs & peritoneum
81

Oak Ridge K25

1945

1984 1989 W males

None

35,712

1996

80

Oak Ridge

1943

1947 1979 W males

None

28,008

1990

79

Oak Ridge

1954

1985 1984 W males

None

74

Los Alamos

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

74

Los Alamos

1943

1977 1990 W males

None

71

Oak Ridge

1954

1985 1984 W females

None

66

Oak Ridge Y12

1943

1945 1978 W males

Comparison workers (no phosgene)

65

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

64

Oak Ridge

1954

1985 1984 NW females None

63

Oak Ridge Y12

2

1943

1945 1973 W males

Comparison workers (no phosgene)

9,352 240,494 1980

62

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

58

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

1988

2

1997
15,727 456,637 1994
1997
9,280 266,027 1985
1996
1997

Cancer-esophagus
82

Oak Ridge

1954

1985 1984 W males

41

Oak Ridge Y12

1947

1974 1990 All workers None

None

1997
8,116

1996

Cancer-stomach
281

Fernald

1

1951

1981 1989 W males

Salaried pay category

4,014 121,038 1996
4,942

165

Los Alamos Zia

1946

1978 1984 W males

Monitored-external & Pu

73

Oak Ridge

1954

1985 1984 W males

None

1992
1997

70

Los Alamos

1943

1977 1990 W males

None

15,727 456,637 1994

Cancer-colon
81

Oak Ridge

1954

1985 1984 W males

None

78

Oak Ridge

1943

1947 1979 W males

None

28,008

1997

73

Los Alamos

1943

1977 1990 W males

None

15,727 456,637 1994

71

Oak Ridge

1954

1985 1984 W females

None

1997

57

Los Alamos

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

53

Los Alamos Zia

1946

1978 1984 W males

Monitored-external & Pu

4,942

1992

1990

Cancer-rectum
58

Los Alamos

1943

1977 1990 W males

None

15,727 456,637 1994

55

Oak Ridge

1954

1985 1984 W males

None

53

Oak Ridge

1943

1947 1979 W males

None

28,008

1990

42

Oak Ridge X10

1943

1972 1984 W males

None

8,318

1991

39

Oak Ridge

1954

1985 1984 W females

None

33

Los Alamos Zia

1946

1978 1984 W males

Monitored-external & Pu

1997

1997
4,942

1992

Cancer-Liver & gallbladder
78

Oak Ridge

1954

1985 1984 W males

None

1997

53

Oak Ridge

1954

1985 1984 W females

None

1997

169

Hanford**

1944

1978 1981 All males

Not monitored-external

157

Hanford**

1944

1978 1986 All males

Not monitored-external

14

Oak Ridge

1954

1985 1984 NW females None

125

Fernald

1951

1981 1989 W males

Hourly pay category

125

Oak Ridge

1943

1947 1979 W males

None

123

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

119

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

117

Oak Ridge K25

1945

1984 1989 W males

None

35,712

1996

Cancer-pancreas
1989
3,400

1993
1997

Cancer-respiratory system
1

4,014 121,038 1996
28,008

1990
1996

 116

Oak Ridge

1954

1985 1984 W males

None

73

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

1997

66

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

59

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

56

Los Alamos

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

447

Linde Air Products

1943

1949 1979 W males

None

995

27,740 1987

32

Los Alamos

1943

1977 1990 W males

None

1996
1988

Cancer-larynx
30

15,727 456,637 1994

Cancer-trachea, bronchus and lung
138

Oak Ridge

1943

1985 1989 W males

Welders

1,211

1998

136

Oak Ridge Y12

1947

1974 1979 W males

None

6,781

1985

134

Oak Ridge Y12

1953

1963 1978 W males

Nonmercury workers 4+ months

3,260

1984

127

Oak Ridge

1943

1947 1979 W males

None

28,008

1990

125

Fernald

1951

1981 1989 W males

Hourly pay category

4,014 121,038 1996

124

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

1996

120

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

119

Oak Ridge K25

1945

1984 1989 W males

None

35,712

1996

118

Oak Ridge

1954

1985 1984 W males

None

118

Oak Ridge Y12

2

1943

1945 1978 W males

Comparison workers (no phosgene)

78

Portsmouth

1

1954

1991 1991 All workers Monitored-internal (uranium)

77

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

75

Oak Ridge X10

1943

1972 1977 W males

None

8,375

75

Rocketdyne

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

72

Oak Ridge X10

1943

1972 1984 W males

Monitored- internal

3,763

1991

65

Oak Ridge X10

1943

1972 1984 W males

None

8,318

1991

64

Rocky Flats

730

1952

1979 1979 W males

Employed 2+ years

5,413

1987

62

Fernald

1

1951

1981 1989 W males

Salaried pay category

4,014 121,038 1996

62

Rocky Flats

730

1951

1977 1977 W males

Employed 2+ years

61

Los Alamos Zia

1946

1978 1984 W males

Monitored-external & Pu

4,942

1992

55

Los Alamos

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

49

Pantex

1951

1978 1978 W males

None

3,564

1985

45

Los Alamos

1943

1977 1990 W males

None

120
1

1

1997
9,280 266,027 1985
6,827 150,000 1999
1996
1985

1983

15,727 456,637 1994

Cancer-bone
191

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

182

Oak Ridge K25

1945

1984 1989 W males

None

35,712

1996
1996

1

Oak Ridge Y12

1947

1974 1990 NW males

None

449

1996

Cancer-breast (female)
86

Oak Ridge

1954

1985 1984 W females

None

1997

55

Oak Ridge

1954

1985 1984 NW females None

1997

87

Oak Ridge

1954

1985 1984 W females

None

1997

70

Oak Ridge

1954

1985 1984 NW females None

1997

Cancer-genitals (female)

Cancer-ovary
79

Oak Ridge

1954

1985 1984 W females

None

1997

38

Oak Ridge

1954

1985 1984 NW females None

1997

Cancer-prostate
195

Oak Ridge

1943

1985 1989 W males

X10/Y12/TEC welders

67

Los Alamos

1943

1977 1990 W males

None

Cancer-bladder

1,211

1998

15,727 456,637 1994

 76

Oak Ridge

1954

1985 1984 W males

None

1997

60

Los Alamos

1943

1977 1990 W males

None

15,727 456,637 1994

Cancer-leukemia
223

Oak Ridge X10

30

1944

1978 1981 W males

Monitored-internal

3,763

163

Oak Ridge X10

30

1944

1978 1986 W males

Monitored-external

3,400

20

Oak Ridge K25

30

1945

1984 1989 W males

Monthly pay category

3,287

1989
1991
1989

Benign & unspecified tumors
600

Rocky Flats

730

1951

1977 1977 W males

Monitored-external (1+ rem)

405

Rocky Flats

730

1951

1977 1977 W males

Employed 2+ years

376

Rocky Flats

730

1952

1979 1979 W males

Employed 2+ years

98

Oak Ridge Y12

1947

1974 1990 NW males

None

62

Oak Ridge Y12

1947

1974 1990 W males

56

Oak Ridge Y12

1947

1983
1983
5,413

1987

449

1996

None

6,591

1996

1974 1990 All workers None

8,116

1996

Endocrine, metabolic & nutritional

Diabetes
55

Mallinckrodt

24

Savannah River

90

1942

1966 1993 W males

Monitored-external

2,514

87,757 1998

1952

1975 1980 W males

Hourly pay category

6,687

1988

Blood & blood-forming organs
52

Oak Ridge

1954

1985 1984 W males

None

1997

164

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

159

Oak Ridge K25

1945

1984 1989 W males

None

141

Oak Ridge Y12

1943

1945 1973 W males

Comparison workers (no phosgene)

70

Oak Ridge

1954

1985 1984 W males

55

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

1996

44

Portsmouth

7

1954

1982 1982 W males

Potential U exposure

4,876

87,896 1987

40

Portsmouth

7

1954

1982 1982 W males

None

5,773 107,698 1987

37

Oak Ridge

1954

1985 1984 W females

None

26

Portsmouth

1954

1982 1982 W males

Greatest Potential U exposure

Mental disorders

2

1996
35,712

1996

9,352 240,494 1980

Nervous system & sense organs

7

None

1997

1997
3,545

65,027 1987

995

27,740 1987

Circulatory system
118

Linde Air Products

1943

1949 1979 W males

None

95

Oak Ridge

30

1954

1985 1984 W males

None

1997

90

Mound

1944

1972 1983 W males

None

4,402 104,326 1991

90

Oak Ridge Y12

2

1943

1945 1978 W males

Comparison workers (no phosgene)

9,280 266,027 1985

89

Savannah River

90

1952

1986 1986 W males

Hourly pay category

7,299

88

Fernald

1

1951

1981 1989 W males

Hourly pay category

4,014 121,038 1996

88

Mallinckrodt

1942

1966 1993 W males

Monitored-external

2,514

88

Oak Ridge

1954

1985 1984 NW males

None

87

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

86

Savannah River

1952

1975 1980 W males

Hourly pay category

6,687

1988

84

Oak Ridge

1954

1985 1984 W females

None

83

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

82

Mound

1947

1979 1979 W males

Monitored-external

4,182

1991

80

All DOE sites

1943

1978 1984 W males

DOE contractor

1,412

35,000 1996

78

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

76

Pantex

1951

1978 1978 W males

None

3,564

72

Portsmouth

1954

1982 1982 W males

None

5,773 107,698 1987

70

Oak Ridge

1954

1985 1984 NW females None

1997

90

7

1995
87,757 1998
1997

1997
1996

1996
1985

 70

Portsmouth

70

Savannah River

7

1954

1982 1982 W males

Potential U exposure

4,876

90

1952

1975 1980 W males

Salaried pay category

2,745

68

1988

Portsmouth

7

1954

1982 1982 W males

Greatest Potential U exposure

3,545

65,027 1987

68

Rocketdyne

1

1950

1993 1993 W males

Monitored-internal

65

Los Alamos

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

63

Rocketdyne

1

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

62

Fernald

1

1951

1981 1989 W males

Salaried pay category

4,014 121,038 1996

62

Savannah River

90

1952

1986 1986 W males

Salaried pay category

57

Los Alamos

1943

1977 1990 W males

None

55

Oak Ridge Y12

1947

1974 1990 NW males

None

449

1996

45

Los Alamos

1944

1974 1980 W males

Monitored-internal (>10 nCi Pu)

224

6,930 1985

40

Oak Ridge Y12

1947

1974 1990 All females None

1,073

1996

38

Los Alamos

1944

1974 1976 W males

224

1978

995

27,740 1987

Monitored-internal (>10 nCi Pu)

87,896 1987

1997

2,561

1995

15,727 456,637 1994

Ischemic heart disease
119

Linde Air Products

30

1943

1949 1979 W males

None

77

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

1988

75

Oak Ridge X10

1943

1972 1977 W males

None

8,375

1985

66

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

61

Rocketdyne

1

1950

1993 1993 W males

Monitored-internal

1997

58

Rocketdyne

1

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

32

Rocketdyne

1

1950

1993 1993 All females Monitored-external

1997

Cerebrovascular disease
110

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

61

Savannah River

57

Rocketdyne

152

Linde Air Products

126
119

1996

90

1952

1986 1986 W males

Salaried pay category

2,561

1

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

30

1943

1949 1979 W males

None

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

Oak Ridge K25

1945

1984 1989 W males

None

112

Oak Ridge

1954

1985 1984 W males

None

74

Oak Ridge

1943

1973 1973 W males

Welders

69

Los Alamos

1943

1977 1990 W males

None

63

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

61

Oak Ridge X10

1943

1972 1984 W males

None

57

Oak Ridge

1954

1985 1984 NW females None

56

Rocketdyne

55

Savannah River

46

1995

Respiratory system
995

27,740 1987
1996

35,712

1996

1,059

23,674 1981

1997
15,727 456,637 1994
1996
8,318

1991
1997

1

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

90

1952

1986 1986 W males

Hourly pay category

7,299

1995

Portsmouth

7

1954

1982 1982 W males

Potential U exposure

4,876

87,896 1987

42

Fernald

1

1951

1981 1989 W males

Salaried pay category

4,014 121,038 1996

42

Portsmouth

7

1954

1982 1982 W males

None

5,773 107,698 1987

42

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

41

Savannah River

90

1952

1975 1980 W males

Hourly pay category

6,687

1988

40

Portsmouth

7

1954

1982 1982 W males

Greatest Potential U exposure

3,545

65,027 1987

36

Oak Ridge X10

1943

1972 1977 W males

None

8,375

1985

30

Savannah River

1952

1975 1980 W males

Salaried pay category

2,745

1988

16

Oak Ridge Y12

1947

1974 1990 All females None

1,073

1996

995

27,740 1987

90

1995

Pneumonia
217

Linde Air Products

122

Oak Ridge K25

30

1943

1949 1979 W males

None

1945

1984 1989 W males

Hourly pay category

1996

 117

Oak Ridge K25

1945

1984 1989 W males

None

35,712

1996

33

Savannah River

90

1952

1975 1980 W males

Hourly pay category

6,687

1988

12

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

1988

120

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

1996

20

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

1996

Emphysema

Digestive system
85

Oak Ridge

1954

1985 1984 W females

None

84

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

1997

81

Oak Ridge K25

1945

1984 1989 W males

None

80

Oak Ridge

1954

1985 1984 W males

None

80

Oak Ridge Y12

2

1943

1945 1978 W males

Comparison workers (no phosgene)

9,280 266,027 1985

76

Oak Ridge Y12

2

1943

1945 1973 W males

Comparison workers (no phosgene)

9,352 240,494 1980

73

Oak Ridge

1954

1985 1984 NW males

None

1997

63

Los Alamos

1943

1977 1990 W males

None

15,727 456,637 1994

62

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

60

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

1996

59

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

57

Portsmouth

7

1954

1982 1982 W males

Potential U exposure

4,876

87,896 1987

57

Savannah River

90

1952

1986 1986 W males

Hourly pay category

7,299

1995

54

All DOE sites

1943

1978 1984 W males

DOE contractor

1,412

35,000 1996

54

Portsmouth

7

1954

1982 1982 W males

None

5,773 107,698 1987

54

Savannah River

90

1952

1975 1980 W males

Hourly pay category

6,687

52

Oak Ridge

1954

1985 1984 NW females None

46

Pantex

1951

1978 1978 W males

None

3,564

42

Rocketdyne

1

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

41

Rocketdyne

1

1950

1993 1993 W males

Monitored-internal

1997

40

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

34

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

1988

1996
35,712

1996
1997

1996

1988
1997
1985

Liver-cirrhosis
60

Savannah River

90

1952

1986 1986 W males

Hourly pay category

7,299

1995

58

Savannah River

90

1952

1975 1980 W males

Hourly pay category

6,687

1988

45

Rocketdyne

1

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

35

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

31

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

1988

83

Oak Ridge

1954

1985 1984 W males

None

1997

64

Oak Ridge

1954

1985 1984 W females

None

1997

63

Oak Ridge

1954

1985 1984 NW females None

1997

59

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

1996

55

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

54

Oak Ridge K25

1945

1984 1989 W females

None

39

Savannah River

90

1952

1975 1980 W males

Hourly pay category

32

Fernald

1

1951

1981 1989 W males

Genitourinary system

1996
6,687

1988

Nephritis & nephrosis
Hourly pay category

4,014 121,038 1996

Musculoskeletal system & connective tissue
233

Hanford**

1944

1978 1981 All females Monitored-external

206

Hanford**

1944

1978 1986 All females Monitored-external

138

Hanford**

1944

1978 1986 All workers None

1989
8,895

1993

44,154

1993

 Symptoms & ill-defined conditions
593

Oak Ridge K25

1948

1953 1977 W males

402

Oak Ridge Y12

330

Oak Ridge Y12

325

Oak Ridge K25

325

Oak Ridge Y12

323

Oak Ridge Y12

319
301

Barrier workers (nickel)
Chemical workers (chronic low
phosgene)
Comparison workers (no phosgene)

2

1943

1945 1973 W males

2

1943

1945 1978 W males

1948

1953 1977 W males

2

1943

1945 1978 W males

2

1943

1945 1973 W males

Comparison workers (no nickel)
Chemical workers (chronic low
phosgene)
Comparison workers (no phosgene)

Oak Ridge K25

1945

1984 1989 W males

Hourly pay category

Oak Ridge K25

1945

1984 1989 W males

None

35,712

1996

293

Oak Ridge Y12

1947

1974 1990 W males

None

6,591

1996

289

Oak Ridge X10

1943

1972 1984 W males

Monitored- internal

3,763

1991

271

Oak RidgeY12

1947

1974 1990 All workers None

8,116

1996

262

Oak Ridge

1943

1985 1989 W males

1,211

1998

249

Oak Ridge K25

1945

1984 1989 NW females None

234

Oak Ridge X10

1943

1972 1984 W males

None

8,318

1991

227

Los Alamos Zia

1946

1978 1984 W males

Monitored-external & Pu

4,942

1992

227

Oak Ridge K25

1945

1984 1989 W females

None

Welders

814

1984

699

18,825 1980

9,280 266,027 1985
7,552

1984

694

21,181 1985

9,352 240,494 1980
1996

1996

1996

Accidents, poisonings & violence
138

Hanford**

36

Portsmouth

7

1944

1978 1981 All females Not monitored-external

1954

1982 1982 W males

None

1989
5,773 107,698 1987

Accidents, poisoning & violence-External
123

Oak Ridge Y12

119

Los Alamos Zia

118

Oak Ridge Y12

116

Oak Ridge K25

111

2

1943

1945 1978 W males

Comparison workers (no phosgene)

9,280 266,027 1985

1946

1978 1984 W males

Monitored-external & Pu

4,942

1943

1945 1973 W males

Comparison workers (no phosgene)

9,352 240,494 1980

1945

1984 1989 W males

Hourly pay category

Oak Ridge K25

1945

1984 1989 W males

None

105

Oak Ridge

1954

1985 1984 W males

None

86

Oak Ridge Y12

1947

1974 1990 All workers None

8,116

82

Mound

1944

1972 1983 W males

None

4,402 104,326 1991

77

Los Alamos

1943

1977 1990 W males

None

15,727 456,637 1994

75

Oak Ridge X10

1943

1972 1984 W males

None

8,318

1991

72

Los Alamos

1943

1977 1990 W males

Hired before 1946

2,030

73,276 1994

72

Oak Ridge K25

1945

1984 1989 W males

Monthly pay category

66

Rocketdyne

1950

1993 1993 W males

Monitored-external

4,563 118,749 1997

63

Mound

1947

1979 1979 W males

Monitored-external

4,182

62

Rocketdyne

1

1950

1993 1993 W males

Monitored-internal

57

Fernald

1

1951

1981 1989 W males

Salaried pay category

4,014 121,038 1996

53

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

1988

51

Oak Ridge X10

1943

1972 1984 W males

Monitored- internal

3,763

1991

45

Savannah River

1952

1986 1986 W males

Salaried pay category

2,561

1995

2

.
1
.

.
90

1992
1996

35,712

1996
1997
1996

1996
1991
1997

Unintentional injuries
68

Los Alamos

.

1943

1977 1990 W males

None

59

Los Alamos

.

1943

1977 1990 W males

Hired before 1946

133

Los Alamos Zia

.

1946

1978 1984 W males

Monitored-external & Pu

117

Oak Ridge K25

.

1945

1984 1989 W males

Hourly pay category

112

Oak Ridge K25

.

1945

1984 1989 W males

None

73

Oak Ridge K25

.

1945

1984 1989 W males

Monthly pay category

15,727 456,637 1994
2,030

73,276 1994

4,942

1992

All accidents
1996
35,712

1996
1996

 60

Savannah River

90

1952

1975 1980 W males

Salaried pay category

2,745

1988

54

Portsmouth

7

1954

1982 1982 W males

Greatest Potential U exposure

3,545

65,027 1987

53

Portsmouth

7

1954

1982 1982 W males

Potential U exposure

4,876

87,896 1987

51

Savannah River

90

1952

1986 1986 W males

Salaried pay category

2,561

1995

4,942

1992

Motor vehicle acidents
170

Los Alamos Zia

.

1946

1978 1984 W males

Monitored-external & Pu

123

Oak Ridge K25

.

1945

1984 1989 W males

Hourly pay category

118

Oak Ridge K25

.

1945

1984 1989 W males

None

35,712

1996

60

Oak Ridge X10

.

1943

1972 1977 W males

None

8,375

1985

1996

 APPENDIX 5

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ORC88. Carpenter AV, Flanders WD, Frome EL, Tankersley WG, Fry SA. Chemical
exposures and central nervous system cancers: a case-control study among workers at two
nuclear facilities. American Journal of Industrial Medicine 1988; 13:351-362.
ORC90. Frome EL, Cragle DL, NcLain RW. Poisson regression analysis of the mortality
among a cohort of WWII nuclear Industry Workers. Radiation Research 1990; 123:138-152.
ORC97a. Frome EL, Cragle DL, Watkins JP, Wing S, Shy CM, Tankersley WG, West CM.
A mortality study of employees of the nuclear industry in Oak Ridge, Tennessee. Radiation
Research 1997; 148:64-80. [Published erratum appears in Radiat Res 1997; 148:297-298.]
ORC97b. Frome EL, Cragle DL, Watkins JP, Wing S, Shy CM, Tankersley WG, West CM.
A mortality study of employees of the nuclear industry in Oak Ridge, Tennessee. Final
Report to the U.S. Department of Energy under contract number DE-AC05-96OR22464.
Oak Ridge National Laboratory, Oak Ridge, Tennessee. Report number ORNL-6785, July
1997.
ORC97c. Watkins JP, Cragle DL, Frome EL, Reagan JL, West CM, Crawford-Brown D,
Tankersley WG. Collection, validation, and treatment of data for mortality study of nuclear
industry workers. Applied Occupational and Environmental Hygiene 1997; 12:195-205.
ORC98. Wells S, Cragle DL, Tankersley WG. Mortality update among welders at multiple
sites. Final Report. Oak Ridge Associated Universities Document 98-0790. National
Technical Information Service.
ORK79. Godbold JH Jr and Tompkins EA. A long-term mortality study of workers
occupationally exposed to metallic nickel at the Oak Ridge Gaseous Diffusion Plant. Journal
of Occupational Medicine 1979; 21:799-806.
ORK84. Cragle DL, Hollis DR, Newport TH, Shy CM. A retrospective cohort mortality
study among workers occupationally exposed to metallic nickel powder at the Oak Ridge
Gaseous Diffusion Plant. In: Nickel in the Human Environment, IARC Scientific
Publications No. 53, 1984; Lyon, International Agency for Research on Cancer:57-63.
ORK92. Cragle DL, Wells SM, Tankersley WG. An occupational morbidity study of a
population potentially exposed to epoxy resins, hardners and solvents. Applied Occupational
and Environmental Hygiene 1992; 7:826-834.

 ORK96. Dupree EA, Wells SM, Watkins JP, Wallace PW, Davis NC. Mortality among
workers employed between 1945 and 1984 at a uranium gaseous diffusion facility. Center for
Epidemiologic Research, Oak Ridge Institute for Science and Education, Oak Ridge,
Tennessee. Final Report to the National Institute for Occupational Safety and Health under
contract number DE-AC05-76ORO00033, February 1996.
ORX85. Checkoway H, Mathew RM, Shy CM, Watson JE Jr, Tankersley WG, Wolf SH,
Smith C, Fry SA. Radiation, work experience, and cause specific mortality among workers at
an energy research laboratory. British Journal of Industrial Medicine 1985;42(8):525-33.
ORX91. Wing S, Shy CM, Wood JL, Wolf S, Cragle DL, Frome EL. Mortality among
workers at Oak Ridge National Laboratory. Evidence of radiation effects in follow-up
through 1984. Journal of the American Medical Association 1991; 265:1397-1402.
[Published errata appear in JAMA 1991; 266:657.]
ORX93. Wing S, Shy CM, Wood JL, Wolf S, Cragle DL, Tankersley W, Frome EL. Job
factors, radiation and cancer mortality at Oak Ridge National Laboratory: follow-up through
1984. American Journal of Industrial Medicine 1993; 23:265-279. Published errata appear in
American Journal of Industrial Medicine 1993; 23:673.
ORX94. Shy CM, Wing S. Comprehensive epidemiology of DOE atomic workers. A report
on mortality among workers at Oak Ridge National Laboratory: Follow-up through 1990.
University of North Carolina. Final Report to the National Institute for Occupational Safety
and Health under Purchase Order number 3C-70837, March 31, 1994.
ORX97. Wing SB, Richardson, DB. Time-related factors in radiation-cancer dose response.
University of North Carolina. Final Report to the National Institute for Occupational Safety
and Health under grant number R03 OH03343, August 5, 1997.
ORX98. Richardson DB, Wing S. Methods for investigating age differences in the effects of
prolonged exposures. American Journal of Industrial Medicine 1998; 33:123-130.
ORX99. Richardson DB, Wing S. Radiation and mortality of workers at Oak Ridge National
Laboratory: Positive associations for doses received at older ages. Environmental Health
Perspectives 1999; 107:649-656.
ORY80. Polednak AP. Mortality among men occupationally exposed to phosgene in 19431945. Environmental Research 1980; 22:357-367.
ORY81. Polednak AP, Frome EL. Mortality among men employed between 1943 and 1947
at a uranium-processing plant. Journal of Occupational Medicine 1981; 23:169-178.
ORY83. Cookfair DL, Beck WL, Shy C, Lushbaugh CC, Sowder CL. Lung cancer among
workers at a uranium processing plant. In: Proceedings of the 16th Mid-Year Topical
Meeting: Epidemiology Applied to Health Physics, CONF-830101, pp 398-406, January 913, 1983, Albuquerque, New Mexico.
ORY84. Cragle DL, Hollis DR, Qualters JR, Tankersley WG, Fry SA. A mortality study of
men exposed to elemental mercury. Journal of Occupational Medicine 1984; 26:817-821.

 ORY85. Polednak AP and Hollis DR. Mortality and causes of death among workers exposed
to phosgene in 1943-45. Toxicology and Industrial Health 1985; 1:137-151
ORY88a. Albers JW, Kallenbach LR, Fine LJ, Langolf GD, Wolfe RA, Donofrio PD, Alessi
AG, Stolp-Smith KA, Bromberg MB. Neurological abnormalities associated with remote
occupational elemental mercury exposure. Annals of Neurology 1988; 24:651-659.
ORY88b. Checkoway H, Pearce N, Crawford-Brown DJ, Cragle DL. Radiation doses and
cause: specific mortality among workers at a nuclear materials fabrication plant. American
Journal of Epidemiology 1988; 127:255-366. Comment in: American Journal of
Epidemiology 1989; 129:639-640.
ORY96. Loomis DP, Wolf SH. Mortality of workers at a nuclear materials production plant
at Oak Ridge, Tennessee, 1947-1990. American Journal of Industrial Medicine 1996;
29:131-141. Comment in: American Journal of Industrial Medicine 1997; 31:121.
ORY97. Cragle D, Letz R. A study of the health effects of exposure to elemental mercury: A
follow-up of mercury exposed workers at the Y-12 Plant in Oak Ridge, Tennessee. Final
Report: NIOSH Contract No. 200-93-2629, 1997. Oak Ridge Associated Universities and
Emory University.
PTS87. Brown DP, Bloom T. Mortality among uranium enrichment workers. National
Institute for Occupational Safety and Health, January 1987. Report No. PB87-188991.
PTX85. Acquavella JF, Wiggs LD, Waxweiler RJ, Macdonell DG, Tietjen GL, Wilkinson
GS. Mortality among workers at the Pantex weapons facilityHealth Physics 1985; 48:735746.
RAI97. Morgenstern H, Froines J, Ritz B, Young B. Epidemiologic study to determine
possible adverse effects to Rocketdyne/Atomics International workers from Exposures to
Ionizing Radiation. University of California at Los Angeles. Final Report to the California
Public Health Institute under subcontract number 324A-8701-S0163, June 1997.
RAI99a. Ritz B, Morgenstern H, Froines J, Batts Young B. Effects of exposure to external
ionizing radiation on cancer mortality in nuclear workers monitored for radiation at
Rocketdyne/Atomics International. American Journal of Industrial Medicine 1999; 35:21-31.
RAI99b. Ritz B, Morgenstern H, Moncau J. Age at exposure modifies the effects of lowlevel ionizing radiation on cancer mortality in an occupational cohort. Epidemiology 1999;
10:135-140.
RFP83a. Voelz GL, Wilkinson GS, Acquavella JF, Tietjen GL, Brackbill RN, Reyes M,
Wiggs LD. An update of epidemiologic studies of plutonium workers. Health Physics 1983;
44(Suppl 1):493-503.
RFP83b. Wilkinson GS, Voelz GL, Acquavella JF, Tietjen GL, Brackbill RN, Reyes M,
Wiggs LD. Mortality among plutonium and other workers at a nuclear facility. . In:
Proceedings of the 16th Mid-Year Topical Meeting: Epidemiology Applied to Health
Physics, CONF-830101, pp 328-337, January 9-13, 1983, Albuquerque, New Mexico.

 RFP84. Reyes M, Wilkinson GL, Tietjen G. Brain tumors at a nuclear facility. Journal of
Occupational Medicine 1984; 26:721-724.
RFP87. Wilkinson GS, Tietjen GL, Wiggs LD, Galke WA, Acquavella JF, Reyes M,
Voelz GL, Waxweiler RJ. Mortality among plutonium and other radiation workers at a
plutonium weapons facility. American Journal of Epidemiology 1987; 125:231-250.
SRS88. Cragle DL, McLain RW, Qualters JR, Hickey JLS, Wilkinson GS, Tankersley WG,
Lushbaugh CC. Mortality among workers at a nuclear fuels production facility. American
Journal of Industrial Medicine 1988; 14:379-401.
SRS94. Cragle DL, Robertson-DeMers K, Watkins JP. Mortality among workers at a nuclear
fuels production facility: The Savannah River Site, 1952-1986. Center for Epidemiologic
Research, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee. Final
Report to the National Institute for Occupational Safety and Health under DOE contract DEAC05-76ORO00033, 1994.
USUR98. Gold B, Kathren RL. Causes of death in a cohort of 260 plutonium workers.
Health Physics 1998; 75:236-240.
________________

 APPENDIX 6
FREQUENTLY CITED DOE CHEMICAL & PHYSICAL CONTAMINANTS
METALS
Arsenic
Beryllium
Cadmium
Chromium
Copper
Lead
Mercury
Nickel (welding)
Zinc
RADIONUCLIDES
Cesium
Iodine
Plutonium
Polonium
Strontium
Tritium
Uranium
GASES/PARTICLES
Asbestos
Diesel emissions
Fiberglass
Freon
Metal machining fluids
Phosgene
Radon
Silica
CHLORINATED HYDROCARBONS
TCE
1,1,1-trichloroethane
1,2-dichloroethylene
Tetrachloroethylene
1,1-dichloroethane
Chloroform
PCBs
Methylene chloride
FUEL HYDROCARBONS
Benzene
Ethylbenzene
Toluene
Xylenes
KETONES
Acetone
Methyl ethyl ketone
PHTHALATES
Bis-2-ethylexylphthalate
OTHER HAZARDS
Acids
Epoxy resins
Fluorine compounds
Formaldehyde
Heat
Hydrazine
Mixed chemicals
Noise
Volatile organic compounds

Source: Chemical Contaminants on DOE Lands and Selection of Contaminants Mixtures for Subsurface
Science Research. DOE/ER-0547T. April 1992.

 Amchitka Island Test Site (AK)
Argonne National Laboratory*
Atlantic & Southern Pacific Test Sites
Fernald Feed Materials Production Center (OH)
Hanford Site (WA)
INEEL (ID)
Kansas City Plant (MO)
Lawrence Berkeley National Laboratory (CA)
Lawrence Livermore National Laboratory (CA)
Linde Air Products (NY)
Los Alamos National Laboratory (NM)
Mallinckrodt Chemical Works (MO)

•
•
•
•

•
•

• • •
•

•
•
•
•
•

•
•

•

•

Mound Facility (OH)
Nevada Test Site
Oak Ridge K-25 GDP (TN)
•
Oak Ridge X-10 (TN)
Oak Ridge Y-12 (TN)
• •
Paducah GDP (KY)
•
Pantex Plant (TX)
Pinellas Plant (FL)
Portsmouth GDP (OH)
•
Project Plowshare Test Sites (NV,NM,CO)
Rocky Flats Plant (CO)
Sandia National Laboratory (NM)
Savannah River Site (SC)
•
Tatum Dome/Vela Uniform Test Sites (AK,MS,NV)
Weldon Springs (MO)
•

• •
•
•
•

•
• •
• •
•
•

•

• •

•
•
•

*Italics indicates that no mortality study has been initiated. The Idaho National Engineering and
Environmental Laboratory in currently under study. Naval Nuclear facilities, by executive order, are a
separate and independent program.

Reference
most recent morbidity/mortality
study

Testing

Research & Development

Weapons assembly & modification

Non nuclear components

Nuclear components

Chemical separations

Production reactors

U Fuel rods & targets

U enrichment & isotope separation

U refining and metallurgy

APPENDIX 7
DOE Facilities and Sites by Role in the Nuclear Weapons Production

FMPC96
HAN93a
LLNL85a
LIND87
LANL94
MCW98
MND91a
ORK96
ORX91
ORY97b
PTX85
PTS87
RFP83
SRS94
VELA98
-

 APPENDIX 8
SUMMARY OF FINDINGS FROM SPECIAL RADIATION
STUDIES
1) Los Alamos Plutonium Workers:
• Twenty-six white male workers, who did the original plutonium research and
development work at the Los Alamos National Laboratory before 1946 and received
large internal deposition, volunteered for this medical monitoring program.
• They have been medically evaluated every five years for possible health effects.
• The average dose each worker received over the 50-year period since 1945 was 1,250
mSv (125 rem).
• The initial exposures were large- some 5 to 360 times the current annual limit on intake.
Results:
• To date there have been 7 worker deaths in this group.
• Three have died from cancers (lung, prostate, osteosarcoma).
• The one bone cancer (osteosarcoma) which a rare condition is of interest since plutonium
is known to deposit in the bone.
Reference: George L. Voelz, James N. P. Lawrence, and Emily R. Johnson. 1997. Fifty
Years of Plutonium Exposure to the Manhattan Project Plutonium Workers: an Update.
Health Physics 73(4):611-619.

2) Rocky Flats High RAD Workers Program:
In July 1992, a program was initiated that replaced a Rocky Flats Site Clinic program aimed
at former employees with internal depositions of radionuclides. The surveillance program is
aimed at any former worker with more than 200 mSv (20 rem) lifetime total effective dose
equivalent (TEDE) exposure to both internal and external radiation. In addition to providing
periodic medical surveillance, the program collects health histories of high dose workers and
develops doses models of internal depositions.
To date 860 individuals have been examined. More than 400 are eligible to continue
participation based on lifetime TEDEs greater than 200 mSv. A sentinel case of lung fibrosis
among plutonium-exposed worker has been diagnosed. Of 251 former worker records that
have been analyzed, 4.9% show chest X-ray changes consistent with asbestos exposure. A
complete analysis of other health outcomes is pending.

3) US Transuranium and Uranium Registries:
Background
The United States Transuranium and Uranium Registries (USTUR) are a unique DOE-

 sponsored research program that studies how plutonium, uranium and other heavy radioactive
metals (called actinides) distribute themselves within the human body and what biological
effects those metals have on body organs. Organ samples are acquired post-mortem from
volunteer donors who worked with the radioactive metals and who, at some time during their
work history, had an established intake of those metals into their bodies.
• During the past 30 years, the USTUR has received autopsy samples from about 360
donors. Of these, 24 have been whole body donations, providing a unique opportunity
for thorough investigation of the distribution of actinides in the human body. The
analyses of bones of entire skeletons from whole body donations, has enabled the
USTUR to determine the radiation dose to bone and its relationship to radiation-induced
bone tumors, which are one of the prime concerns of radiation protection regulations
governing intakes of the actinide elements.
• Approximately 5,000 organ samples have been collected and analyzed for isotopes of
uranium, plutonium, thorium, and americium resulting in more than 15,000 analytical
results for various organs of the body. These measurements have formed the basis for a
large number of scientific reports, and 133 of those reports have been published in the
peer-reviewed, scientific literature.
• The program continues to add to this unique set of data through the continued donation of
tissues from exposed workers with confirmed intakes. At present, there are about 230
living workers or former workers who are registered in the program.
Results:
A number of observations regarding the health effects of plutonium, americium, and other
elements in the body are possible based on USTUR data. Among them:
1. Table 1 summarizes the causes of death among 244 USTUR organ donors. The average
age at death of USTUR registrants is 63 years (range between 25 and 91 years). The
average age of USTUR registrants who are still living is 73 years (range between 30 and
93 years).
2. There were 28 cases of lung cancer among USTUR. There were also six cases of
mesothelioma, a type of cancer associated with asbestos exposure A records review
indicated asbestos handling in the work histories of all six of these cases.
3. There were seven brain cancers at Rocky Flats, a plutonium processing facility. Three of
the workers had very low body burdens of plutonium at death (less than 1% of the
regulatory limit, which was 40 nanocuries in the total body). The remaining four
individuals had depositions far below that amount.
4. Of the 244 registrants for whom cause of death is known, there were two cases in which
diseases found at death may be considered a result of intakes of plutonium or americium.
One individual was a Hanford worker who received a very high exposure to americium
from a chemical explosion of material that he was handling. Initial estimates were that he
had 4 – 5 times the regulatory limit in his lungs, liver, and skeleton with four times that
embedded in the skin of his face. This person had decreased numbers of certain blood
cells that began after the incident and continued until his death eleven years later from
heart disease. Another worker, who had been exposed to plutonium, died from bone

 cancer (osteosarcoma). Bone cancer is rare in someone of his age (66 years at death) and
it is one of the tumors associated with intakes of plutonium in experiments with animals.
5. The vast majority of USTUR organ sample donors had plutonium body burdens that were
less than 5% of the regulatory limit at the time that they worked with plutonium. It
would appear based on USTUR follow-up that, with exceptions mentioned above, they
suffered no health effects from plutonium. However, this appears not be the case with
Russian workers who have much larger plutonium exposures: on average, the Russian
workers had approximately 250 times as much plutonium in their bodies as did the
workers in the USTUR. While the studies of Russian workers are not yet complete, it
appears that they did have larger than usual numbers of lung cancers, liver cancers, bone
cancers, and cases of lung fibrosis. The average plutonium body burden of the Russian
workers was approximately 60 nanocuries or about 1.5 times the U. S. regulatory limit.

Table 1. Causes of death among 244 workers who donated organ samples to the USTUR
Cause of Death
Number
Diseases of blood
forming organs
Neurological diseases
Arteriosclerotic heart
disease
Other circulatory disease
Pulmonary embolism
Myocarditis
Cardiomyopathy
Diffuse arteriosclerosis
Cerebrovascular accidents
Vascular diseases
Pneumonia
Chronic obstructive
pulmonary disease
Intestinal diseases
Liver diseases
Aspiration
Sepsis
Accidents (auto)
Suicides

Number

1
7
80
2
4
1
9
1
8
3
5
10
1
4
1
2
7
7

Reference: Health Physics 75:236-240, 1998

Cause of Death

Esophageal cancer
Stomach cancer
Colon cancer
Rectal cancer
Liver cancer
Pancreatic cancer
Laryngeal cancer
Lung cancer
Mesothelioma
Bone cancer
Melanoma
Prostate cancer
Bladder cancer
Kidney cancer
Brain cancer
Lymphoma
Multiple myeloma
Leukemia

2
4
4
3
4
3
2
28
6
1
4
7
2
4
7
2
1
3

 APPENDIX 9
SUMMARY OF FINDINGS FROM OTHER SURVEILLANCE
PROGRAMS
1) The Epidemiologic Surveillance Program
Background
About 65,000 workers are covered under this program. Data from the most recent year where
complete information is available, 1997, are presented. The SHEO’s are identified from
return-to-work clearances that indicate illness and injury diagnoses among workers who have
been absent five or more consecutive workdays.
A sentinel health event for occupations (SHEOs) is a “disease, disability, or death which is
occupationally related and whose occurrence may serve as a warning signal that materials
substitution, engineering controls, personal protection, or medical care may be required.”
Sixty-four medical conditions associated with workplace exposures from studies of many
different industries were identified as sentinel health events. Although SHEOs may indicate
an occupational exposure, many may result from non-occupational exposures. Due to this
uncertainty, SHEOs are assessed in two categories: 1) definite sentinel health events –
diseases that are unlikely to occur in the absence of an occupational exposure, and 2) possible
sentinel health events – conditions that may or may not be related to occupation.
Results:
There were 516 SHEO’s (definite and possible) identified among workers at 8 DOE sites
participating in the Epidemiologic Surveillance program in 1997.
Injuries (n= 311) account for the majority, 60.3% of the SHEOs, followed by 80 (15.5%)
muscle and skeletal disorders, and 73 (14.1%) diagnoses related to the nervous system.
Thirteen (2.5%) cancers and 7 (1.4%) respiratory diagnoses were identified as SHEOs. The
breakdown by International Classification of Disease (ICD 9th revision) code for the latter
three categories is provided in Table 1.

Table 1
Breakout of Selected Sentinel Health Events for Occupations (SHEO)
Among DOE Sites Participating in Epidemiologic Surveillance, 1997

NERVOUS SYSTEM n =73
ICD Code Frequency

Description

354.1.1
354.2
366.9
369.60

carpal tunnel syndrome
mononeuritis of upper limb (lesion of ulnar nerve)
unspecified cataract
profound impairment one eye, unspecified

68
1
1
1

 372.40
386.50

1
1

pterygium, unspecified
labyrinthine dysfunction, unspecified

CANCER n = 13
ICD Code Frequency

Description

162.9
188.9
189.0

malignant neoplasm of bronchus and lung, unspecified
malignant neoplasm of bladder, part unspecified
malignant neoplasm of kidney, except pelvis

7
3
3

RESPIRATORY n = 2
ICD Code Frequency

Description

465.9
473.9
486
490
493.0
500

acute respiratory infection, NOS
sinusitis, NOS
pneumonia, organism unspecified
bronchitis, NOS
extrinsic asthma
coal workers’pneumoconiosis

1
1
1
2
1
1

Reference: Rutstein DD, Mullan RJ, et al. 1984. Sentinel health events (occupational): A
basis for physician recognition and public health surveillance. Arch. Envir. Health 39: 159168.

2) CAIRS
The Computerized Accident/Incident Reporting System (CAIRS) is a database used to collect
and analyze DOE and DOE contractor reports of injuries, illnesses, and other accidents that
occur during DOE operations. CAIRS data consist of DOE and DOE contractor reports of
injuries and illnesses, property damage, and vehicle accident events. The Occupational
Safety and Health Administration's guidelines for reportable cases are used to determine the
eligibility of injury/illness cases for reporting to CAIRS.
Most injuries have an immediate, specific cause, facilitating the determination of whether
they are occupational. Many other health effects may be less clearly associated with
occupational exposures or may develop over a substantial period of time. In general, the
CAIRS system best captures information on acute illnesses associated with an event that
results in lost time. The system tends to underreport illnesses that are not clearly associated
with work and/or chronic progressive illnesses that may not result in lost time.
An effort to summarize these less immediate health effects is presented in the table presented
below. They are based on CAIRS data reflecting these selection criteria:
1. All DOE sites included
2. Conditions other than injuries

 3. Contractor workers (not Federal employees)
4. Events occurred during calendar year 1998
The CAIRS data base does not include International Classification of Disease (ICD) codes,
using instead a health effect classification system containing a number of broad categories of
health effects. Where the CAIRS classification scheme uses these broad categories, no more
detailed coding of health effects was available for analysis.

Table 2
Non-Injury Occupational Health Effects among Contractor Workers at all DOE Sites, 1998
Non-Injury Occupational Health Effects among Contractor Workers at All DOE Sites, 1998
Health Effect

Number
of Events

Total Lost
Workdays

Effects of Environmental Conditions
27
7
Heat stroke, other
effects of high
temperatures
Other Poisonings and Toxic Effects
Chemical reactions
4
0
Other poisoning or
6
6
toxic effects**
Nervous System and Sensory Organ Diseases
Carpal tunnel
77
776
syndrome
Conjunctivitis
2
0
Central nervous
1
3
system disorders
Hearing
2
0
impairment
Hearing loss
7
0
Other nervous
75
99
system and
sensory organ
diseases**
Diseases of the Heart or Circulatory System
Other circulatory
1
0
system disorders**
Respiratory System Diseases
Asbestosis
1
0
Berylliosis
2
0
Upper respiratory
8
2
conditions
Other respiratory
25
42
diseases**
Digestive System Diseases and Disorders
Other digestive
1
0
system diseases**

Average*
Lost
Workdays
per Event

Total
Restricted
Workdays

Average*
Restricted
Workdays per
Event

<1

7

<1

0
1

398
4

100
1

10

912

12

0
3

0
21

0
21

0

0

0

0
1

0
473

0
6

0

0

0

0
0
<1

0
0
1

0
0
<1

2

49

2

0

2

2

 Musculoskeletal System and Connective Tissue Diseases and Disorders
Bursitis
1
0
0
Tendonitis
95
77
1
Tenosynovitis
7
18
3
Other
134
287
2
musculoskeletal
disorders**
Disorders of the Skin and Subcutaneous Tissue
Allergic dermatitis
4
0
0
Contact dermatitis
18
0
0
Dermatitis
12
0
0
Other skin
36
3
<1
conditions**
Other Systemic Diseases and Disorders
Other systemic
22
29
1
diseases and
disorders**
Infectious and Parasitic Diseases
Infections
3
14
5
Symptoms, Signs, and Ill-defined Conditions
Inflammation
10
22
2
Irritation
4
0
0
64
154
2
Other symptoms,
signs, and illdefined
conditions**
Other Diseases, Conditions, and Disorders
Mental disorders
5
313
63
2
40
20
Other diseases,
conditions, and
disorders**
Multiple Diseases, Conditions, and Disorders
3
0
0
Multiple diseases,
conditions, and
disorders
Total
659
1892
3

*Rounded to the nearest full day
**No finer category breakdown available within CAIRS
________________

0
574
42
1099

0
6
6
8

0
84
18
52

0
5
2
1

108

5

0

0

152
0
324

15
0
5

116
35

23
18

4

1

4475

7

 APPENDIX 10
SUMMARY OF INITIAL RESULTS FROM THE FORMER
WORKER PROGRAM
Background
The Former Workers Program was created at the Department of Energy in response to Public
Law 102-484, enacted in 1993. Section 3162 of this law directed DOE to evaluate the longterm health conditions of current and former employees who may be at significant risk of
adverse health effects as a result of their employment at DOE sites. To meet these
requirements, DOE established the Former Workers Program in October 1996.
The Former Workers Program is divided into two stages: Phase I and Phase II. In 1996, DOE
began to support Phase I activities consisting of needs assessments to identify groups of
former workers who may benefit from a medical surveillance program. In addition, Phase I
was designed to determine if enough information on current and former workers is available
to proceed with Phase II. During Phase II, current and former workers are contacted and
medical surveillance programs are implemented based on the exposures most likely to
produce adverse health effects. The projects are being conducted by cooperative agreements
with consortia of universities, unions, and other organizations.
As mandated by the law, the DOE Former Workers Program screens workers who are at high
risk. As of November, 1999, DOE supported 10 former workers projects at 9 DOE sites.
The table below presents a summary of chest X-ray screening conducted for 709 former
workers at three DOE sites. These X-rays are read by individuals (“B-readers”) with
specialty training in recognition of pneumoconioses. The International Labor Organization
(ILO) in Geneva, Switzerland, publishes criteria to allow for the standardization of reading
chest X-rays. The first number indicates the major category of profusion of abnormal
opacities on the film which is based on the concentration or number of small opacities per
unit area observed within the lung fields. The second number indicates whether the number
of opacities is judged to be less than, equal to, or more than the profusion level expected for
the major category.
Categories 0/-, 0/0, and 0/1 are generally regarded as exhibiting no evidence of
pneumoconiosis. Chest X-rays in profusion categories 1/0, 1/1, 1/2 or higher are generally
regarded as positive for pneumoconiosis.
Of the 882 individuals screened to date, 148 (17%) have category 1/0 or greater perfusion on
their chest X-ray.
In addition, 243 workers have been screened at the three DOE gaseous diffusion plants. Of
this number, 28 workers (11.5%) were found to have asbestos-related fibrosis. The results of
the ILO Perfusion scores were not available at the time of this report.

 Data regarding other disease endpoints such as hearing loss were presented to the panel and
are being accumulated as part of this program but were felt to be too preliminary for this
report.
Summary for Respiratory Findings for DOE Former Workers
ILO
Perfusion
0
0/0
0/1
1/0
1/1
1 /2
2/1
2/2
2/3
3/2+

Hanford
Construction

Hanford
Production

Nevada Test Site –
Tunnelers

Oak Ridge
Construction

TOTAL

5
29
12
8
3
3
0
1
0

175 [86%]
14 [7%]
8 [4%]
4 [2%]
2 [1%]

203 [37%]
255 [46%]
59 [11%]
19 [3%]
5 [1%]
5 [1%]
5 [1%]
2 [.4%]
3 [.5%]

53 [8%]
0
4 [6%]
3 [5%]
2 [3%]
0
0
0
0

436 [49%]
298 [34%]
83 [9%}
34 [4%]
12 [1%]
8 [1%]
5
3
3

Total
Number

61

203

556

62

882

[8%]
[47%]
[21%]
[13%]
[5%]
[5%]
[2%]

________________

 APPENDIX 11
SUMMARY OF PUBLIC INPUT AND
NEWSPAPER REPORTS
Input for Public Meetings
Beginning in August 1999, the Department of Energy initiated a number of outreach
efforts to learn more about work-related health concerns from its current and former
contractor workforce. DOE’s Assistant Secretary for Environment, Safety and Health,
Dr. David Michaels, held a series of public meetings in the communities surrounding
current and former DOE facilities. The purpose of these meetings was to seek direct
input from workers regarding their health concerns and experiences with filing for
workers’compensation for these health problems. At all sites, in addition to the public
meetings, several separate meetings were held with small groups of workers and their
families.
The following is a listing of the dates, location and attendance of these public meetings:
Date
8/1

Location

# Attended

# Testified

Secretary/Members of Congress

Paducah

200

20

9/16-17 Paducah

250

20

Secretary Richardson

10/29-30 Portsmouth

250

50

Senator Voinovich, Senator DeWine
Congressman Strickland

11/15

Los Alamos*

50

12/8-9

Oak Ridge

575

65

12/15-16 Rocky Flats

275

50

1/6

125

Burlington

Congressman Udall
Secretary Richardson
Senator Harkin

* - closed invitation only community meeting sponsored by unions and community groups.

Additional public meetings are planned for Hanford (February 2-4), Nevada (February)
and Los Alamos (March).meetings:

Toll-Free Hotline and Questionnaires

 In August 1999 the DOE established a toll-free “hotline” for workers to call in to ask
questions and to relay any health concerns. As of January 19, 2000, the hotline has
received 610 calls.
To assist in writing the Task 2 report, a questionnaire was distributed at the public
meetings mentioned above and by labor unions at these sites asking DOE employees
about health concerns and their experience with workers’compensation systems.
Workers were given the option of completing the questionnaire over the telephone using
the toll-free hotline. To date, 435 questionnaires have been completed: 368 over the
phone; 67 mailed in. Of these 435 completed questionnaires, 318 records have been
analyzed. Roughly 58% (183 of 318) have reported some type of illness or disease as
follows:
Type of Illness

# (%)

Cancer
Beryllium
Lung Disease
Asbestosis
Other
TOTAL

84 (46%)
10 (5%)
15 (8%)
6 (3%)
68 (37%)
183

 BIBLIOGRAPHY OF NEWSPAPER REPORTS – 1998-99

FERNALD
“Fernald Activist Hangs Tough,” Rachel Melcer, The Cincinnati Enquirer: Nov. 18,
1999.
“Fernald Workers Lack Data on Health: Agencies Won’t Pay for Analysis,” Tim
Bonfield, The Cincinnati Enquirer: June 27, 1999.
“Anecdotes at Fernald, or Evidence? Studies Seeking Hard Proof,” Rachel Melcer, The
Cincinnati Enquirer: June 27, 1999.
“Stories of Fernald Shock Health-Care Workers: Safety Rules Were Shunned in ‘50s,”
Rachel Melcer, The Cincinnati Enquirer: Nov. 8, 1998.
“Team Digs Up Tales of Fernald Exposure: Workers’Accounts Stun DOE Officials,”
Rachel Melcer, The Cincinnati Enquirer: May 11, 1998.
“Fernald Will Cause 85 Cancer Deaths: Risk Study Projects Illnesses,” Tim Bonfield,
The Cincinnati Enquirer: Mar. 19, 1998.

HANFORD
“‘Hot’Leak Contaminates Two Hanford Workers,” Associated Press, The Seattle Times:
Jan. 7, 2000.
“Second Beryllium Case at Hanford – Exposure Causes Sensitivity, Illnesses,”
Associated Press, The Seattle Times: Dec. 13, 1999.
“Working at Hanford May Have Been Hazardous to Workers’Health,” Linda Ashton,
Associated Press: Nov. 3, 1999.
“Nuke Site Workers Report Ailments,” Linda Ashton, Associated Press: Nov. 3, 1999.
“Reports: Lung, Hearing-Loss Problems Prevalent Among Hanford Workers,” Linda
Ashton, Associated Press: Nov. 3, 1999.
“Two Studies Find Disease High Among Former Hanford Workers,” Associated Press,
The Seattle Times: Nov. 2, 1999.
“Raising Hell at Hanford -- How Bad Were the Leaking Tanks and Did Anyone but a
Couple of Whistleblowers Really Want to Find Out?” Jim Lynch, The Seattle Times: Oct.
17, 1999.

 “Hanford Pipefitters Mistreated, Lawsuit Says: Whistleblowers Say They Were
Discharged in a Conspiracy to Cover Up Safety Concerns,” Karen Dorn Steele, The
Spokesman-Review: Aug. 6, 1999.
“Department of Energy Must Improve Environmental Compliance at Hanford,”
Hazardous Waste News: Mar. 1, 1999.
“Tests Show Hanford Workers at Risk of Lung Disease,” Associated Press: Nov. 6,
1998.

IOWA
“Former Ammunition Plant Worker Fights Cancer, Worries About Others,” Greg Smith,
Associated Press: Dec. 13, 1999, Nov. 27, 1999.
“Former Army Plant Workers Think Health Study Should Be Expanded,” Greg Smith,
Associated Press: Dec. 2, 1999.
“Army Official Challenges DOD Policy: DOE, Pentagon Differ Over Secrecy at Iowa
Plant,” John Donnelly, The Energy Daily: Nov. 1, 1999.
“Missing Munitions Records from Iowa Plant Apparently Found in Texas,” Associated
Press: Sept. 14, 1999.
“Harkin Says Records for Middletown Munitions Plant Vital for Worker Health,”
Associated Press: Sept. 14, 1999.
“Plant Kept Lid on its Nuclear Role: Now, Some Iowans Wonder Whether Munitions
Work Caused Illnesses,” Thomas R. O’Donnell, The Des Moines Register: Aug. 8, 1999.

LOS ALAMOS
“DOE Cites LANL for Not Protecting Workers From Radiation,” John Fleck,
Albuquerque Journal: Sept. 9, 1999.
“‘I Feel Betrayed,” Barbara Ferry, The Santa Fe New Mexican: July 31, 1999.
“Ex-LANL Workers to Be Tested,” The Santa Fe New Mexican: July 31, 1999.
“DOE Review Faults Los Alamos Worker Protection Program,” George Lobsenz, The
Energy Daily: July 26, 1999.
“Los Alamos Metallurgist Warns of Hazardous Metal Risks,” Lawrence Spohn,
Associated Press: July 24, 1999.

 “Beryllium Veteran Takes on the Role of Workers’Savior: Metallurgist at Los Alamos
Will Aid DOE,” Lawrence Spohn, The Albuquerque Tribune in The Denver Post: July
24, 1999.
“Government Says Thousands Became Sick in Making Nuclear Weapons,” H. Joseph
Hebert, Associated Press: July 15, 1999.
“Cancer Rates Still Up in Los Alamos County,” Barbara Ferry, The Santa Fe New
Mexican: July 15, 1999.
“Beryllium Screening Raises Ethical Issues: Chemist Reed Durham Finds Himself
Excluded From Work on Beryllium Because of Suspected Health Risks Caused by
Genetic Variation,” Eliot Marshall, Science: July 9, 1999.
“Accident Forces LANL to Close Chemistry Lab,” Ian Hoffman, Albuquerque Journal:
July 3, 1999.
“Independent Probe Launched Into Past Environmental Releases from Los Alamos,”
George Lobsenz, The Energy Daily: Mar. 3, 1999.
“Continuing Safety Problems Blasted at Los Alamos,” Associated Press: Sept. 25, 1998.

MOUND
“Advocate Says Government Could Apply Pro-Workers Settlement Elsewhere,” John
Nolan, Associated Press: June 16, 1999.
“Government Says No Plans to Apply Pro-Workers Settlement Elsewhere,” John Nolan,
Associated Press: June 16, 1999.
“Mound Bioassay Problems Prompt a DOE Crackdown at All Sites,” Nucleonics Week:
Nov. 26, 1998.

OAK RIDGE
“Oak Ridge Emissions Did Definite Harm to Health, Study Claims,” Frank Munger,
Knoxville News-Sentinel: Jan. 15, 2000.
“N-Plant Emissions Doubtless Hurt Neighbors, Experts Say,” Frank Munger, Scripps
Howard News Service: Jan. 14, 2000.
“Michaels Finds Weapons Workers’Stories ‘Powerful and Moving’,” Shawn Terry,
Inside Energy: Dec. 20, 1999.
“Y-12 Nuclear Plant Worker Sues: Beryllium Risk Known, Suit Says,” Laura Ayo,
Knoxville News-Sentinel: Dec. 15, 1999.

 “Compensation Can Be an Elusive Carrot,” Frank Munger, Knoxville News-Sentinel:
Dec. 15, 1999.
“500 Workers Show Up at Oak Ridge Health Meeting,” Weapons Complex Monitor:
Dec. 13, 1999.
“Overflow Crowd Tells Nuclear Illness Woes,” Frank Munger, Knoxville News-Sentinel:
Dec. 9, 1999.
“Nuclear Health Threat,” Bee News Services, The Sacremento Bee: Dec. 9, 1999.
“Workers Tell Oak Ridge Horror Stories: Official Hears How Safety Took Back Seat to
Cold War,” Laura Frank, The Tennessean: Dec. 9, 1999.
“Workers Relate Health Woes in Public Forum,” Larisa Brass, The Oak Ridger: Dec. 9,
1999.
“Plan to Help Ill Nuke Workers Not Applauded: Health Advocates Call It Grossly
Inadequate,” Frank Munger, Knoxville News-Sentinel: Dec. 1, 1999.
“Ex-Richardson Aide Warns of Potential for Nuclear Mishaps at DOE,” Inside Energy:
Nov. 29, 1999.
“Physicians Call Energy Department Sick Employee Compensation ‘Too Little, Too
Late’,” Physicians for Social Responsibility, U.S. Newswire: Nov. 19, 1999.
“Help Requested for All Ill Workers: Bill Serves Only Some at Nuclear Weapons Sites,”
Laura Frank, The Tennessean: Nov. 19, 1999.
“Oak Ridge Workers Say Compensation Plan Not Enough,” Duncan Mansfield,
Associated Press: Duncan Mansfield, Associated Press: Nov. 18, 1999.
“Plight of Oak Ridge Needs DOE’s Attention,” The Tennessean: Nov. 6, 1999.
“Testing No Longer Big Issue for Bomb Makers,” Frank Munger, Knoxville NewsSentinel: Oct. 27, 1999.
“Should Congress Increase Oversight of the Department of Energy? DOE Must Improve
Worker Safety Record,” Rep. Ron Klink, Roll Call: Oct. 25, 1999.
“Help Sought for Oak Ridge Workers: Gordon Asks Richardson to Authorize Treatment
Around Nuclear Facilities,” Laura Frank, The Tennessean: Oct. 20, 1999.
“Demolished Oak Ridge Building Called ‘Nastiest’of All: K-1131 Staff Had No Idea of
Radiation There,” Frank Munger, Knoxville News-Sentinel: Oct. 15, 1999.

 “DOE Admits Higher Amounts of Uranium Brought to Oak Ridge,” Associated Press:
Oct. 1, 1999.
“K-25 Uranium Contaminated: DOE Now Admits There Was Three Times as Much as
Earlier Estimated,” Frank Munger, Knoxville News-Sentinel: Sept. 30, 1999.
“DOE Plans Oak Ridge Probe in 2000: Health Official Expresses Concern about
Neptunium,” Laura Frank, The Tennessean: Sept. 30, 1999.
“Plutonium Was Dirty Word During Plants’Early Years,” Tennessee News Services in
The Tennessean: Sept. 26, 1999.
“Officials Silent on Reason for Piketon,Oak Ridge Exclusion,” Katherine Rizzon,
Associated Press: Sept. 23, 1999.
“Beryllium’s Toll,” Faye Flam, Philadelphia Inquirer in The Chicago Tribune: Sept. 20,
1999.
“Ill Workers Feel Left Out Again: Oak Ridgers Going to Washington,” Laura Frank, The
Tennessean: Sept. 17, 1999.
“Ill Workers Walk Out on Officials: Future of Oak Ridge Advisory Panel in Question,”
Laura Frank, The Tennessean: Sept. 10, 1999.
“A Metal’s Cost: Beryllium, a Lightweight Metal with High-Tech Uses, is Also the
Cause of a Lung Disease Affecting Those Who Worked with It,” Faye Flam, The
Philadelphia Inquirer: Sept. 7, 1999.
“DOE Study Ties Illnesses to Oak Ridge: Toxic Exposures Blamed for Weapons Plant
Ailments,” Associated Press in The Chattanooga Times/Chattanooga Free Press: Sept.
6, 1999.
“Workers’Illnesses Related to Nuclear Site,” Laura Frank, The Tennessean and Gannett
News Service: Sept.6, 1999.
“Doctors Hired by DOE Say Illnesses Linked to Workplace Toxins,” Associated Press:
Sept. 6, 1999.
“Doctors Back Fears of Workers: Illnesses Blamed on Nuclear Weapons Site,” Laura
Frank, The Cincinnati Enquirer: Sept. 5, 1999.
“Doctors Verify Poisons Harmed Workers: Study Backs Oak Ridge Employees’Long
Held Suspicions about Illness,” Laura Frank, The Tennessean: Sept. 5, 1999.
“ Steps Taken After Uranium ‘Uptake’ in DOE Workers,” Frank Munger, Knoxville
News-Sentinel: Aug. 19, 1999.

 “Government Agrees to Provide Medical Assistance to Some Federal Employees Who
Manufactured Nuclear Weapons and Contracted Beryllium Disease,” John Seigenthaler,
Soledad O’Brien, NBC News Transcripts, NBC Nightly News: Aug. 1, 1999.
“Victim Says Nuke Accident Ruined His Life,” Frank Munger, Knoxville News-Sentinel:
July 21, 1999.
“Richardson ‘Rights A Wrong’– DOE Admits Responsibility for Worker Injuries,”
George Lobsenz, Energy Daily: July 16, 1999.
“Ill Nuclear Workers Not Pleased with Proposal: Rep. Zach Wamp Booed During
Announcement,” Frank Munger, Knoxville News-Sentinel: July 16, 1999.
“Oak Ridge Spurs Aid Breakthrough: President’s Plan Limited to Lung Illness,” Laura
Frank and Susan Thomas, The Tennessean: July 16, 1999.
“Compensation for Nuclear Lab Workers Who Got Sick,” Lisa Stark and Peter Jennings,
ABC News, World News Tonight with Peter Jennings: July 15, 1999.
“Work on Weapons Affected Health, Government Admits,” Matthew L. Wald, The New
York Times: July 15, 1999.
“Former Oak Ridge Worker Awarded $600,000 in Medical Malpractice Lawsuit,”
Associated Press: April 7, 1999.
“HHS Agencies Won’t Assist Sick Oak Ridgers,” Laura Frank, The Tennessean: Mar. 30,
1999.
“Program for Ill Workers to Rise from Oak Ridge,” Laura Frank, The Tennessean: Feb.
4, 1999.
“New DOE Official Promises to Come Up with Options to Help Sick Workers,” Frank
Munger, Knoxville News-Sentinel: Dec. 21, 1998.
“Energy Official Vows to Aid Ill,” Associated Press: Dec. 17, 1999.
“Oak Ridge May Get Aid for Sick Soon: Health Official Ready to Help,” Laura Frank,
The Tennessean: Nov. 19, 1998.
“Groups Urge DOE Registry of Ill,” Laura Frank and Susan Thomas, The Tennessean:
Nov. 8, 1999.
“Frist: Probe Nuclear Site Illnesses,” Susan Thomas and Laura Frank, The Tennessean:
Nov. 5, 1999.

 “Former Y-12 Worker Feeling Betrayed,” Frank Munger, Knoxville News-Sentinel: Oct.
28, 1999.
“Couple Sues DOE, 8 Firms in Health Case,” Wesley Loy, Knoxville News-Sentinel: Oct.
23, 1999.
“Upcoming Report Criticizes DOE for Inattention to Worker Hazards,” Shawn Terry,
Inside Energy: Oct. 19, 1998.
“Sick Workers Want to Meet with Energy Chief: Cooperation Urged Rather Than Court
Fight,” Frank Munger, Knoxville News-Sentinel: Oct. 6, 1998.
“Newspaper Finds Hundreds Nationwide Suffering Mysterious Illnesses,” Associated
Press: Sept. 30, 1998.
“News Report Traces Pattern of Illnesses Near Nuclear Plants,” Kathryn Winiarski, USA
Today: Sept. 29, 1998.
“Sick People Across the Country Question Nuclear Neighbors (Ostracized by the
Community) – ‘People See Me and Turn the Other Way’,” Laura Frank, Susan Thomas,
Robert Sherborne, The Tennessean: Sept. 29, 1998.
“For the Ill, Help is Often Out of Reach: Specialized Medicine May Be Their Best
Chance,” Laura Frank, Susan Thomas, Robert Sherborne The Tennessean: Sept. 29,
1998.
“DOE Surveys and Programs Frustrate Sick,” Laura Frank, Susan Thomas, Robert
Sherborne The Tennessean: Sept. 29, 1998.
“Mystery Illnesses Found Nationwide: Sickness Surrounds Nation’s Nuclear Weapons
Complexes,” Laura Frank, Susan Thomas, Robert Sherborne, The Tennessean: Sept. 29,
1998.
“Lockheed Martin Sued, Accused of Tape-Recording Meeting with Doctors,” Wesley
Loy, Knoxville News-Sentinel: Sept. 4, 1998.
“Sick Workers Say Medical Evaluation Results Taking Too Long,” Associated Press:
July 29, 1998.
“Ill K-25 Workers Health Declines as Doctors Delay,” Frank Munger, Knoxville NewsSentinel: July 29, 1998.
“DOE Fined Over Waste Label: Ex-workers Say Cyanide Linked to Health Problems,”
Frank Munger, Knoxville News-Sentinel: July 8, 1998.

 “Cancer Risk Higher in Older Workers: Lab Staff Affected More by Radiation After Age
45,” Frank Munger, Knoxville News-Sentinel: June 10, 1998.
“Former Energy Chief Tells About Reprisals Against Whistleblowers,” Richard
Powelson, Knoxville News-Sentinel: May 18, 1998.
“Fired DOE Worker Cites Health Concern,” Frank Munger, Knoxville News-Sentinel:
April 1, 1998
“‘Oak Ridge’Movie in Works: Cher to Produce NBC Story of Unexplained Illnesses,”
Laura Frank, The Tennessean: Jan. 23, 1998.

PADUCAH
“Paducah Uranium Plant Tracked Cases of Employees with Cancer” Associated Press:
Dec.23, 1999.
“Paducah Plant Kept Cancer List: Secret File Tracked 13 with Disease,” James Malone,
Louisville Courier-Journal: Dec. 23, 1999.
“Plant Hid Risk From Workers: Paducah Bosses Knew Some Had High Radiation
Levels,” Joby Warrick, The Washington Post: Dec. 23, 1999.
“’92 Memo at Paducah Plant Told of Extra Radiation Peril: Risk to Workers Already
Existed,” James Malone, Louisville Courier-Journal: Nov. 21, 1999.
“Some Paducah Plant Workers Say They Never Saw Memo About ‘Transuranics’”
Associated Press: Nov. 21, 1999.
“Uranium Suit Exhumations Backed: 3 Plant Workers’Survivors Allow Radiation
Tests,” James Malone, Louisville Courier-Journal: Nov. 3, 1999.
“Some Ex-Uranium Workers Show Signs of Illnesses Linked to Plant: Tests Find Health
Problems, Patton Asks Senators for More Paducah Cleanup Money,” James R. Carroll,
Louisville Courier-Journal: Oct. 27, 1999.
“Paducah Revelation is Called Shocking: Bomb-Grade Uranium News to Union Chief,”
James Malone, Louisville Courier-Journal: Oct. 22, 1999.
“DOE May Fault Paducah :Oversight Report Assesses Why Problems Not Corrected,”
James Malone, Louisville Courier-Journal: Oct. 20, 1999.
“Paducah Whistleblower Proved Right,” Susan Vela, Cincinnati Enquirer in Gannett
News Service: Oct. 20, 1999.
“He’s Proven Right, Too Late: Family Carries on for Paducah Plant Whistleblower,”
Susan Vela, The Cincinnati Enquirer: Oct. 11, 1999.

 “Questions, Fears Part of Cold War’s Stateside Legacy,” Katherine Rizzo, Associated
Press: Sept. 27, 1999.
“A Culture of Indifference to Dangers at Paducah Plant, Environmentalist Charges,”
Associated Press: Sept. 26, 1999.
“Uranium Plant Workers Said Not Told of Radiation Dangers,” H. Joseph Hebert,
Associated Press: Sept. 23, 1999.
“Paducah Workers Told Uranium Powder Was ‘Safe Enough to Eat’,” H. Joseph Hebert,
Associated Press: Sept. 22, 1999.
“Workers Detail Lack of Precautions at Uranium-Processing Plant,” James Prichard,
Associated Press: Sept.21, 1999.
“Spokesman Says 1985 Recommendation for Worker Tests Never Followed,” Associated
Press: Sept. 18, 1999.
“Document Shows AEC Discussed Concern at Plant as Early as 1957,” Associated Press:
Sept. 16, 1999.
“DOE Team Criticizes Handling of Nuclear Waste, Radiation Exposure,” Associated
Press: Sept. 12-13, 1999.
“Federal Government Chose Not to Study Leukemia Concerns in Paducah,” Associated
Press: Sept. 6, 1999.
“U.S. Ignored Leukemia Concerns: Paducah Plant Not Investigated by Government,”
James Malone, Louisville Courier-Journal: Sept. 5, 1999.
“Memo Mentions Highly Toxic Metal at Plant,” Associated Press: Sept. 4, 1999.
“Paducah’s Silent Witness: Excessive Uranium Level Found in Worker’s Bones,” Joby
Warrick, The Washington Post: Aug. 22, 1999.
“Workers Wonder What Price They Paid for Jobs,” Associated Press: Aug. 16, 1999.
“Uranium Plant’s Past Raises Workers’Suspicion – and Support,” Bill Estep, Lexington
Herald-Leader: Aug. 15, 1999.
“Workers Unknowingly Exposed to Plutonium Contamination,” Associated Press: Aug.
8, 1999.
“Hearing Provides Widely Different Opinions on Contamination,” Associated Press:
Sept. 24, 1999.

 “Safety Lax: Congress Told Plant Problems,” James R. Carroll, Louisville CourierJournal: Sept. 23, 1999.
“Not Just Paducah’s Problem? Other Sites Possibly Handled Contaminated Material,
Panel Told,” Joby Warrick, The Washington Post: Sept. 23, 1999.
“Records Spotty on Radiation Contamination, Exposure,” James Malone, Louisville
Courier-Journal: Sept. 20, 1999.
“‘85 Report Urged Uranium Worker Tests: No Study Done on Processors at Paducah,”
James Malone, Louisville Courier-Journal: Sept. 18, 1999.
“Richardson: ‘The Buck Stops Here’,” James Prichard, Associated Press: Sept. 17, 1999.
“Energy Workers Get Apology; Energy Chief: Government Failed Them,” James Malone
and James R. Carroll, Louisville Courier-Journal: Sept. 17, 1999.
“Energy Secretary Makes Apology to Kentucky Nuclear Workers,” Guillermo X. Garcia,
USA Today: Sept. 17, 1999.
“Payback Sought for Nuclear Workers,” H. Joseph Hebert, Associated Press: Sept. 16,
1999.
“Document Shows AEC Discussed Concern at Plant as Early as 1957,” Associated Press:
Sept. 16, 1999.
“U.S. Will Propose Payments to Sick Paducah Workers: $20 Million Fund Eyed for
Radiation Cancers,” Joby Warrick, The Washington Post: Sept. 16, 1999.
“Safety Measures Ordered at Kentucky Uranium Plant: Investigation Uncovers Dozens of
Oversights in Radiation Safeguards,” Joby Warrick, The Washington Post: Sept. 15,
1999.
“Tests Planned on More Uranium Workers: Project Budget Could Grow to $4 Million,”
James R. Carroll, Louisville Courier-Journal: Sept. 11, 1999.
“Missing Documents Surface,” Associated Press: Aug. 12, 1999.
“Workers Claim Unwitting Exposures to Plutonium at Paducah Plant,” Wayne Barber,
Nucleonics Week: Aug. 12, 1999.
“Energy Department Trying to Determine if Nuclear Plant in Paducah, Kentucky, is
Safe,” Matt Lauer, Ann Curry, Fred Francis, NBC News Transcripts, TODAY: Aug. 10,
1999.

 “Washington Promises to Help Kentucky Uranium Workers,” Matthew L. Wald, The
New York Times: Aug. 10, 1999.
“In Harm’s Way, and in the Dark: Workers Exposed to Plutonium at U.S. Plant,” Joby
Warrick, The Washington Post: Aug. 8, 1999.

PORTSMOUTH
“Tsk, Tsk, Piketon Workers Suspicious, and Rightly So,” The Columbus Dispatch: Jan.
17, 2000.
“Healthy Move: Screenings Could Begin Righting Past Wrongs,” The Columbus
Dispatch: Dec. 30, 1999.
“DOE to Review Worker Claims: Workers Say That Illnesses Are Linked to Radiation
Exposure,” Associated Press in The Portsmouth Daily Times: Nov. 30, 1999.
“Investigator Hears Horrors of Piketon Plant: A-Plant Workers Relate Concerns to
DeWine, Voinovich, Strickland,” Mark Richard, The People’s Defender (Adams
County): Nov. 10, 1999.
“Compensate Fairly: Piketon Workers Were Injured in Cold War,” The Columbus
Dispatch: Nov. 7, 1999.
“A-Plant Employees Share Horrific Stories,” Mark Richard, The Pike County News
Watchman: Nov. 3, 1999.
“Piketon Workers Share Their Stories: Forty Plant Workers, Past and Present, Told
Lawmakers About Health Problems They Say the Facility Caused,” Frank Hinchey, The
Columbus Dispatch: Oct. 31, 1999.
“Workers Tell Their Stories: Panel Hears of Sickness, Death, Legal Fights,” Lori
McNelly, The Portsmouth Daily Times: Oct. 31, 1999.
“A-Plant Horror Stories Recalled,” Larry Di Giovanni, Chillicothe Gazette: Oct. 31,
1999.
“Senate Panel to Investigate Health Concerns at Ohio Uranium Plant,” The Plain Dealer:
Oct. 31, 1999.
“Ohio Workers’Radiation Fears Win Attention,” The Atlanta Journal-Constitution: Oct.
30, 1999.
“Plant Workers Might Get Compensation: Budget Officials Say Piketon Plan Could Set
Bad Precedent,” Darrel Rowland and Jonathan Riskind, The Columbus Dispatch: Oct. 30,
1999.

 “DOE Official Prepares for Investigation,” Terri Fowler, The Portsmouth Daily Times:
Oct. 30, 1999.
“Piketon’s Heavy Toll: Nuclear Plant Kept Risks of Contamination from Rank and File,”
Jonathan Riskind, The Columbus Dispatch: Oct. 29, 1999.
“U.S. Saw Region as Pushover,” The Columbus Dispatch: Oct. 29, 1999.”
“Compensate Workers, Ohio Legislators Say,” The Columbus Dispatch: Oct. 29, 1999.
“Strickland Vows Piketon Workers Will Share Compensation: Congress is Probing
Plutonium-Laced Uranium,” Jonathan Riskind, The Columbus Dispatch: Sept. 23, 1999.
“Richardson Wants Piketon Workers Compensated for Illnesses,” Katherine Rizzo,
Associated Press: Sept. 17, 1999.
“Plant Worker Still Concerned,” Mark Richard, The Pike County News Watchman: Aug.
29, 1999.
“Piketon Workers Handled Plutonium Unwittingly,” Jonathan Riskind, The Columbus
Dispatch: Aug. 12, 1999.
“Retiree Wonders if Job Caused His Cancer,” Bob Dreitzler, The Columbus Dispatch:
Aug. 12, 1999.

ROCKY FLATS
“Workers Object to Beryllium Plan at Flats: Dozens Lash Out at Feds in Emotional
Health Care Meeting,” Katy Human, The Boulder Daily Camera: Dec. 16, 1999.
“Flats Workers Seek Redress for Ailments: Energy Department Draws Crowd,” Berny
Morson, Denver Rocky Mountain News: Dec. 16, 1999.
“Beryllium-Afflicted Flats Workers Win Benefits,” Mike McPhee, The Denver Post:
Aug. 29, 1999.
“Leukemia Rate High in Kids of Nuclear Workers: But Highest Incidence is Among
Children of Those with Lowest Levels of Exposure, Study Says,” Berny Morson, The
Denver Rocky Mountain News: Dec. 21, 1997.

SAVANNAH RIVER
“SRS Operators Release Information on Radiation Treatment for Exposed Workers,”
Associated Press: Jan. 11, 2000.

 “Seven SRS Employees Exposed to Contamination,” Associated Press: Sept. 10, 1999.
“Study Detects Serious Illnesses in Four Savannah River Site Employees,” Associated
Press: Aug. 14, 1999.
“Little New Information is Expected in the Report on Cold War-Era Radiation and
Chemical Exposure at the Site,” The Post and Courier: Feb. 2, 1999.
“Hundreds Near Nuclear Plants Suffer Mysterious Illnesses,” The Herald: Sept. 30, 1998.
“N-Plant Towns Hit by Illnesses,” The Post and Courier: Sept. 30, 1998.
“Older Nuclear Plant Workers at Higher Risk for Rare Cancer,” The Post and Courier:
Jan. 30, 1998.
“Rare Cancer More Likely for Some Nuclear Workers,” Karin Schill, Augusta Chronicle:
Jan. 29, 1998.

 APPENDIX 12
LIST OF PANEL MEMBERS
Nuclear Regulatory Commission
Vincent Holahan
Department of Justice
Dianne Spellberg
Gerard Fischer
Environmental Protection Agency
Dr. Ana Maria Osorio
Department of Defense
CAPT Paul Blake
LtCol Issac Atkins
CAPT Richard Thomas
Department of Labor
Peter Turcic
Department of Health and Human Services
Roger Rosa
Council of Economic Affairs
Robin Lumsdaine
National Aeronautic and Space Administration
John W. Wilson
Department of Treasury
Robert McNary
Office of Management and Budget
John Pfeiffer
National Economic Council
William Dauster
Department of Energy
Paul Seligman
Heather Stockwell
Contributors to the report from the Department of Energy
Roger Anders, Barbara Brooks, Bonnie Richter, Donald Lentzen, Gerald Petersen, Cliff Strader,
Paul Wambach and Gwen Poffenberger.