Article publication date
23 January 2023
Authored by
ABC News
Summary
The ABC published a news article on a potential cluster of nine non-Hodgkin’s lymphoma (NHL) cases identified in military officers who were stationed at the Malstrom Air Force Base, which is a nuclear missile base in Montana. The officers all served as missileers decades ago and their duties included being deep underground in a small operations bunker on standby to turn the missile launch keys if ordered. They were diagnosed with NHL between 1997 and 2007. The Malstrom Air Force Base had previously been investigated in 2001 when a suspected cancer cluster of 14 various types of cancer were reported amongst missileers. Two of these cases were NHL and it is unclear if these are also included in the group of nine NHL cases. However, the site was found to be environmentally safe following the investigation in 2001. In a statement to the Associated Press, an Air Force spokeswoman said “senior leaders are aware of the concerns raised about the possible association of cancer related to missile combat crew members at Malmstrom AFB. The information in this briefing has been shared with the Department of the Air Force Surgeon-General and our medical professionals are working to gather data and understand more.
Link to
Investigation underway after nine nuclear missileers develop non-Hodgkin's lymphoma
Commentary by ARPANSA
The incidence of NHL has been increasing worldwide in recent decades (Cai et al, 2021). In Australia NHL has increased from an incidence rate of 11.3 (per 100,000 persons) in 1982 to 20.4 in 2022, ranking the disease as the sixth most common cancer (AIHW, 2022). The causes of the rise in incidence are not clear and exposure to ionising radiation has been suggested as a possible factor.
As the suspected cluster reported by the ABC article occurred in the USA, we do not have specific information on the kinds of exposures occurring at the Malstrom Air Force Base. However, considering the suspected cluster occurred in a nuclear missile base, it is possible that personnel were occupationally exposed to ionising radiation. There have been a number of previous epidemiological studies that have investigated occupational exposure to ionising radiation and the risk of NHL including studies on individuals working in the nuclear industry, nuclear weapons testing programs, medical imaging or those working as airline crew; these have recently been reviewed by Harbron and Pasqual (2020). Results from the studies have generally been mixed and there are various methodological limitations that weaken the results including potential confounding and other biases. Another limitation in epidemiological studies is the uncertainty in the dose assessment. As described by Hasbron and Pasqual (2020), while most lymphomas are formed of mature lymphocytes, these cells do not necessarily represent the origin of the disease which means the appropriate organ for dose response analysis is unclear.
In Australia, ARPANSA has previously collaborated with various universities to investigate occupational exposure to ionising radiation and NHL in a population-based case control study (Karipidis et al. 2007). The study used overseas estimates of ionising radiation exposure and found no association with NHL. In an update to the study, Karipidis et al 2009, used occupational radiation estimates from ARPANSA’s Personal Radiation Monitoring Service and again found no association with NHL.
It is ARPANSA’s goal to ensure that the highest standard of protection is made available through the implementation of the relevant Codes and Safety Guides. The Code for Radiation Protection in Planned Exposure Situations (2020), RPS C-1 (Rev.1), sets out the requirements in Australia for the protection of occupationally exposed persons, the public and the environment in planned exposure situations. All Australian jurisdictions have uniform annual limits for public and occupational exposure to ionising radiation: 1 mSv for the public and 20 mSv for workers who are occupationally exposed. Compliance with the occupational dose limit protects occupationally exposed workers from the harmful effects of ionising radiation.
