Monday, March 22, 2010
By Steve Sternberg, USA TODAY
A Nuclear Regulatory Commission rule allowing hospitals to discharge radioactive thyroid cancer patients to their homes and hotels poses a public health threat, a congressional report says today.
The report (pdf), released by Rep. Edward Markey, D-Mass., chairman of the House Subcommittee on Energy and the Environment, which oversees the commission, also found that insurers routinely use the rule to deny hospital care even to patients whom doctors say may pose a radiation risk to others. Patients are often discharged to recover in self-imposed isolation.
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"The United States simply cannot play radioactive roulette and gamble with public health and safety," Markey says.
Radioactive iodine is a proven cancer fighter, with a five-year survival rate of 97%. The thyroid is the only body organ that uses iodine. Radioactive iodine kills any thyroid cancer cells that surgery might have missed. But radiation also poses a cancer risk, especially to children. Thyroid cancer patients give off radioactive iodine in urine, sweat and saliva for several days; traces may remain in the body for as long as two weeks.
In 1997, the NRC "weakened" its patient-release regulations from the global standard requiring hospitalization for patients whose bodies contain 30 millicuries or more of radioactive iodine to one that allows outpatient treatment, the report says. The report says the NRC repeatedly rebuffed efforts to get the agency to adopt stricter standards.
In August, the Ninth Circuit Court of Appeals rejected a petition by thyroid cancer survivor Peter Crane, a former NRC lawyer, to force a change. The court ruled that he "lacked standing to bring the case" because he is not undergoing treatment, the report says.
"I'm gratified that the committee is paying attention to this," Crane said. "Patients are going home in this country with 200 millicuries of radiation in their system. In Germany, they would be hospitalized with 8 millicuries. This isn't an academic matter, it's about exposing children to cancer-causing radiation."
Owen Hoffman, a radiation-risk expert at Senes Oak Ridge, says even though the risk is fairly low, about 1 in 1,000 for an infant boy and double that for an infant girl, "the right thing to do is to reduce unnecessary exposures."
The report cites a 2007 USA TODAY survey, carried out with the Thyroid Cancer Survivors Association, showing that 4% of the patients treated with radioactive iodine checked into hotels or other accommodations, 2% took public transportation, and 14% failed to go directly home, which gave patients "plenty of opportunity" to "unwittingly" expose others to radiation.
NRC spokesman Eliot Brenner says the agency will examine the report, but he added in an e-mail, "I don't want to set up false expectations about what we might do with the recommendations."