0
August 2, 1995, Vol 274, No. 5 >
ARTICLE | August 2, 1995

Caring for Survivors of the Chernobyl Disaster: Title and subTitle BreakWhat the Clinician Should Know FREE

Armin D. Weinberg, PhD; Sunil Kripalani; Philip L. McCarthy, MD; W. Jack Schull, PhD
[+] Author Affiliations

Reprint requests to Center for Cancer Control Research, Baylor College of Medicine, One Baylor Plaza, ST924, Houston, TX 77030 (Dr Weinberg).


JAMA. 1995;274(5):408-412. doi:10.1001/jama.1995.03530050056032
Text Size: A A A
Published online
Article
References

The health status of approximately 1 million immigrants in the United States and Israel may have been adversely affected by radiation exposure as a result of the Chernobyl nuclear power plant disaster and cleanup efforts. Many of these immigrants suffer from significant psychological distress, fearing that they have a radiation-induced illness. Based on a review of the literature and our experience from the US National Chernobyl Registry Coordinating Center, we recommend that medical management of these immigrants include routine physical examination, with particular attention to the thyroid gland. Adults should receive regular cancer screening as well as routine blood chemistry tests, thyroid function tests, complete blood cell count, and urinalysis. Children should be examined regularly, with attention to the thyroid and overall body growth. It is reasonable for children to undergo thyroid studies, a complete blood cell count, or neuropsychiatric testing if there is clinical suspicion of a disorder. Given the long latency period for disease induction by radiation exposure, it is still too early to fully assess and draw conclusions concerning the possible health effects of the Chernobyl disaster, and long-term follow-up of all potentially affected individuals is important.

(JAMA. 1995;274:408-412)

REFERENCES

1 +
Nénot JC.  Overview of the radiological accidents in the world, updated December 1989. Int J Radiat Biol . 1990;;57:1073-1085.
2 +
Behar A, Cohen-Boulakia F, Othmani S.  Chernobyl three years later: radiobiologic evaluation of a radioactive contamination. J Environ Pathol Toxicol Oncol . 1990;;10:281-285.
3 +
Holowinsky IZ.  Chernobyl nuclear catastrophe and the high risk potential for mental retardation. Ment Retard . 1993;;31:35-40.
4 +
Bonte FJ.  Chernobyl retrospective. Semin Nucl Med . 1988;;18:16-24.
5 +
Mould RF.  After Chernobyl. Br J Radiol . 1987;; 60:B29-B34.
6 +
Souchkevitch G. Participants in the Clean-up Operations Following the Chernobyl Disaster: State of Health and Medical Monitoring in Belarus, Russia, and Ukraine . Geneva, Switzerland: World Health Organization; 1995;.
7 +
Gold SJ.  Soviet Jews in the United States.  In: Singer D, ed. American Jewish Year Book . New York, NY: American Jewish Committee; 1994;;94: 3-57.
8 +
Shimizu Y, Kato H, Schull WJ.  Life Span Study Report 11, II: cancer mortality in the years 1950-1985 based on the recently revised doses (DS86). Radiat Res . 1988;;121:120-141.
9 +
Kato H, Schull WJ.  Studies of the mortality of A-bomb survivors, 7: mortality, 1950-1978, I: cancer mortality. Radiat Res . 1982;;90:395-432.
10 +
Kato H, Brown CC, Hoel DG, Schull WJ.  Studies of the mortality of A-bomb survivors, report 7: mortality, 1950-1978, II: mortality from causes other than cancer and mortality in early entrants. Radiat Res . 1982;;91:243-264.
11 +
Neel JV, Schull WJ, eds. The Children of Atomic Bomb Survivors: A Genetic Study . Washington, DC: National Academy Press; 1991;.
12 +
Perry AR, Iglar AF.  The accident at Chernobyl: radiation doses and effects. Radiol Technol . 1990;;61:290-294.
13 +
Champlin RE, Kastenberg WE, Gale RP.  Radiation accidents and nuclear energy: medical consequences and therapy. Ann Intern Med . 1988;;109: 730-742.
14 +
Mettler FA, Upton AC, eds. The Medical Effects of Ionizing Radiation . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1995;.
15 +
United Nations Scientific Committee on the Effects of Atomic Radiation. Sources, Effects, and Risks of Ionizing Radiation: Report of the 37th Session With Annexes . Vienna, Austria: United Nations Scientific Committee on the Effects of Atomic Radiation; 1988;.
16 +
Committee on the Biological Effects of Ionizing Radiations. Health Effects of Exposure to Low Levels of Ionizing Radiation (BEIR V) . Washington, DC: National Academy Press; 1990;.
17 +
de Ruig WG, van der Struijs TD.  Radioactive contamination of food sampled in the areas of the USSR affected by the Chernobyl disaster. Analyst . 1992;;117:545-548.
18 +
Lie RT, Irgens LM, Skjaerven R, Reitan JB, Strand P, Strand T.  Birth defects in Norway by levels of external and food-based exposure to radiation from Chernobyl. Am J Epidemiol . 1992;; 136:377-388.
19 +
Geiger HJ.  The accident at Chernobyl and the medical response. JAMA . 1986;;256:609-612.
20 +
International Atomic Energy Agency (IAEA). The International Chernobyl Project: Technical Report . Vienna, Austria: International Atomic Energy Agency; 1991;.
21 +
Kampmann B.  Chromosomal abnormalities increased in Latvia. BMJ . 1994;;309:1299.
22 +
Ron E, Lobin J, Schneider AB.  Thyroid cancer incidence. Nature . 1992;;360:113.
23 +
Gale RP.  Immediate medical consequences of nuclear accidents: lessons from Chernobyl. JAMA . 1987;;258:625-628.
24 +
Linnemann RE.  Soviet medical response to the Chernobyl nuclear accident. JAMA . 1987;;258:637-643.
25 +
Champlin RE.  The role of bone marrow transplantation for nuclear accidents: implications of the Chernobyl disaster. Semin Hematol . 1987;;24( (3 suppl 2) ):1-4.
26 +
Baranov A, Gale RP, Guskova A, et al.  Bone marrow transplantation after the Chernobyl nuclear accident. N Engl J Med . 1989;;321:205-212.
27 +
Sjöberg L, Drottz BM.  Psychological reactions to cancer risks after the Chernobyl accident. Med Oncol Tumor Pharmacother . 1987;;4:259-271.
28 +
Ginzburg HM.  The psychological consequences of the Chernobyl accident: findings from the International Atomic Energy Agency Study. Public Health Rep . 1993;;108:184-192.
29 +
Trichopoulos D, Zavitsanos X, Koutis C, Drogari P, Proukakis C, Petridou E.  The victims of Chernobyl in Greece: induced abortions after the accident. BMJ . 1987;;295:1100.
30 +
Parazzini F, Repetto F, Formigaro M, Fasoli M, La Vecchia C.  Induced abortions after the Chernobyl accident. BMJ . 1988;;296:136.
31 +
Ericson A, Kallén B.  Pregnancy outcome in Sweden after the Chernobyl accident. Environ Res . 1994;;67:149-159.
32 +
Little J.  The Chernobyl accident, congenital anomalies, and other reproductive outcomes. Paediatr Perinat Epidemiol . 1993;;7:121-151.
33 +
Knudsen LB.  Legally induced abortions in Denmark after Chernobyl. Biomed Pharmacother . 1991;; 45:229-231.
34 +
Bertollini R, Di Lallo D, Mastroiacovo P, Perucci CA.  Reduction of births in Italy after the Chernobyl accident. Scand J Work Environ Health . 1990;;16:96-101.
35 +
The EUROCAT Working Group.  Preliminary evaluation of the impact of the Chernobyl radiological contamination on the frequency of central nervous system malformations in 18 regions of Europe. Paediatr Perinat Epidemiol . 1988;;2:253-264.
36 +
Sperling K, Pelz J, Wegner RD, Dörries A, Gröters A, Mikkelsen M.  Significant increase in trisomy 21 in Berlin nine months after the Chernobyl reactor accident: temporal correlation or causal relation? BMJ . 1994;;309:158-162.
37 +
Güvenc H, Uslu MA, Güvenc M, Ozekici U, Kocabay K, Bektas S.  Changing trend of neural tube defects in eastern Turkey. J Epidemiol Community Health . 1993;;47:40-41.
38 +
Harjulehto T, Aro T, Rita H, Rytömaa T, Saxén L.  The accident at Chernobyl and outcome of pregnancy in Finland. BMJ . 1989;;298:995-997.
39 +
Harjulehto-Mervaala T, Salonen R, Aro T, Saxén L.  The accident at Chernobyl and trisomy 21 in Finland. Mutat Res . 1992;;275:81-86.
40 +
Stoll C, Alembik Y, Dott B, Roth MP.  Epidemiology of Down syndrome in 118,265 consecutive births. Am J Med Genet Suppl . 1990;;7:79-83.
41 +
Haeusler MC, Berghold A, Schoell W, Hofer P, Schaffer M.  The influence of the post-Chernobyl fallout on birth defects and abortion rates in Austria. Am J Obstet Gynecol . 1992;;167:1025-1031.
42 +
De Wals P, Bertrand F, de la Mata I, Lechat MF.  Chromosomal anomalies and Chernobyl. Int J Epidemiol . 1988;;17:230-231.
43 +
Kuchuk AA.  Health problems of the population in different regions of the Ukraine. Toxicol Lett . 1994;;72:213-217.
44 +
Abelin T, Averkin JI, Egger M, et al.  Thyroid cancer in Belarus post-Chernobyl: improved detection or increased incidence? Soz Praventivmed . 1994;; 39:189-197.
45 +
Baverstock KF.  Thyroid cancer in children in Belarus after Chernobyl. World Health Stat Q . 1993;; 46:204-208.
46 +
Likhtarev IA, Sobolev BG, Kairo IA, et al.  Thyroid cancer in the Ukraine. Nature . 1995;;375:365.
47 +
Butturini A, Izzi GC, Benaglia G, Lloyd D, Pass B, Gale RP.  Fallout from Chernobyl: not all health problems seen close to Chernobyl can be attributed to radiation. BMJ . 1994;;309:1299-1300.
48 +
Boice J, Linet M.  Chernobyl, childhood cancer, and chromosome 21. BMJ . 1994;;309:139-140.
49 +
Nikiforov Y, Gnepp DR.  Pediatric thyroid cancer after the Chernobyl disaster: pathomorphologic study of 84 cases (1991-1992) from the republic of Belarus. Cancer . 1994;;74:748-766.
50 +
Furmanchuk AW, Averkin JI, Egloff B, et al.  Pathomorphological findings in thyroid cancers of children from the republic of Belarus: a study of 86 cases occurring between 1986 ('post-Chernobyl') and 1991. Histopathology . 1992;;21:401-408.
51 +
Tajtáková M, Langer P.  Retrospectively evaluated finding of larger thyroid volume in east Slovakian adolescents in 1987 than in 1992: effect of Chernobyl? Horm Metab Res . 1993;;25:644-645.
52 +
Castronovo FP Jr.  Iodine-131 thyroid uptake results in travelers returning from Europe after the Chernobyl accident. J Nucl Med . 1987;;28:535-541.
53 +
Likhtarev IA, Gulko GM, Sobolev BG, et al.  Thyroid dose assessment for the Chernigov region (Ukraine): estimation based on 1311 thyroid measurements and extrapolation of the results to districts without monitoring. Radiat Environ Biophys . 1994;;33:149-166.
54 +
Raymond L, Schubert H.  The 'post-Chernobyl' childhood leukemia study (ECLIS Study). Soz Praventivmed . 1991;;36:304-305.
55 +
Petridou E, Proukakis C, Tong D, et al.  Trends and geographical distribution of childhood leukemia in Greece in relation to the Chernobyl accident. Scand J Soc Med . 1994;;22:127-131.
56 +
Hjalmars U, Kulldorff M, Gustafsson G, Swedish Child Leukaemia Group.  Risk of acute childhood leukaemia in Sweden after the Chernobyl reactor accident. BMJ . 1994;;309:154-157.
57 +
Auvinen A, Hakama M, Arvela H, et al.  Fallout from Chernobyl and incidence of childhood leukaemia in Finland, 1976-92. BMJ . 1994;;309:151-154.
58 +
Parkin DM, Cardis E, Masuyer E, et al.  Childhood leukaemia following the Chernobyl accident: the European Childhood Leukaemia-Lymphoma Incidence Study (ECLIS). Eur J Cancer . 1992;;29A: 87-95.
59 +
Yarilin AA, Belyakov IM, Kusmenok OI, et al.  Late T cell deficiency in victims of the Chernobyl radiation accident: possible mechanisms of induction. Int J Radiat Biol . 1993;;63:519-528.
60 +
Emerit I, Levy A, Cernjavski L, et al.  Transferable clastogenic activity in plasma from persons exposed as salvage personnel of the Chernobyl reactor. J Cancer Res Clin Oncol . 1994;;120:558-561.
61 +
National Council for Radiation Protection and Measurements. Protection of the Thyroid Gland in the Event of Releases of Radioiodine . Washington, DC: National Council for Radiation Protection and Measurements; 1977;. Report 5.
62 +
United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Early Effects in Man of High Doses of Radiation: Proceedings of the 35th Session of UNSCEAR: Report to the United Nations . New York, NY: United Nations; 1985;.
63 +
Peter RU, Braun-Falco O, Birioukov A, et al.  Chronic cutaneous damage after accidental exposure to ionizing radiation: the Chernobyl experience. J Am Acad Dermatol . 1994;;30:719-723.
64 +
American Cancer Society. Cancer Facts and Figures—1995 . Atlanta, Ga: American Cancer Society; 1995;.
65 +
Nazarov AN, Gerasimov GA.  Status of endemic goiter in the USSR. Probl Endokrinol Mosk . 1992;; 38:58-61.
66 +
Bolshova EV, Tronko ND, Van Middlesworth L.  Iodine deficiency in Ukraine. Acta Endocrinol . 1993;;129:594.
67 +
Jensen RH, Langlois RG, Bigbee WL, et al.  Elevated frequency of glycophorin A mutations in erythrocytes from Chernobyl accident victims. Radiat Res . 1995;;141:129-135.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Nénot JC.  Overview of the radiological accidents in the world, updated December 1989. Int J Radiat Biol . 1990;;57:1073-1085.
2 +
Behar A, Cohen-Boulakia F, Othmani S.  Chernobyl three years later: radiobiologic evaluation of a radioactive contamination. J Environ Pathol Toxicol Oncol . 1990;;10:281-285.
3 +
Holowinsky IZ.  Chernobyl nuclear catastrophe and the high risk potential for mental retardation. Ment Retard . 1993;;31:35-40.
4 +
Bonte FJ.  Chernobyl retrospective. Semin Nucl Med . 1988;;18:16-24.
5 +
Mould RF.  After Chernobyl. Br J Radiol . 1987;; 60:B29-B34.
6 +
Souchkevitch G. Participants in the Clean-up Operations Following the Chernobyl Disaster: State of Health and Medical Monitoring in Belarus, Russia, and Ukraine . Geneva, Switzerland: World Health Organization; 1995;.
7 +
Gold SJ.  Soviet Jews in the United States.  In: Singer D, ed. American Jewish Year Book . New York, NY: American Jewish Committee; 1994;;94: 3-57.
8 +
Shimizu Y, Kato H, Schull WJ.  Life Span Study Report 11, II: cancer mortality in the years 1950-1985 based on the recently revised doses (DS86). Radiat Res . 1988;;121:120-141.
9 +
Kato H, Schull WJ.  Studies of the mortality of A-bomb survivors, 7: mortality, 1950-1978, I: cancer mortality. Radiat Res . 1982;;90:395-432.
10 +
Kato H, Brown CC, Hoel DG, Schull WJ.  Studies of the mortality of A-bomb survivors, report 7: mortality, 1950-1978, II: mortality from causes other than cancer and mortality in early entrants. Radiat Res . 1982;;91:243-264.
11 +
Neel JV, Schull WJ, eds. The Children of Atomic Bomb Survivors: A Genetic Study . Washington, DC: National Academy Press; 1991;.
12 +
Perry AR, Iglar AF.  The accident at Chernobyl: radiation doses and effects. Radiol Technol . 1990;;61:290-294.
13 +
Champlin RE, Kastenberg WE, Gale RP.  Radiation accidents and nuclear energy: medical consequences and therapy. Ann Intern Med . 1988;;109: 730-742.
14 +
Mettler FA, Upton AC, eds. The Medical Effects of Ionizing Radiation . 2nd ed. Philadelphia, Pa: WB Saunders Co; 1995;.
15 +
United Nations Scientific Committee on the Effects of Atomic Radiation. Sources, Effects, and Risks of Ionizing Radiation: Report of the 37th Session With Annexes . Vienna, Austria: United Nations Scientific Committee on the Effects of Atomic Radiation; 1988;.
16 +
Committee on the Biological Effects of Ionizing Radiations. Health Effects of Exposure to Low Levels of Ionizing Radiation (BEIR V) . Washington, DC: National Academy Press; 1990;.
17 +
de Ruig WG, van der Struijs TD.  Radioactive contamination of food sampled in the areas of the USSR affected by the Chernobyl disaster. Analyst . 1992;;117:545-548.
18 +
Lie RT, Irgens LM, Skjaerven R, Reitan JB, Strand P, Strand T.  Birth defects in Norway by levels of external and food-based exposure to radiation from Chernobyl. Am J Epidemiol . 1992;; 136:377-388.
19 +
Geiger HJ.  The accident at Chernobyl and the medical response. JAMA . 1986;;256:609-612.
20 +
International Atomic Energy Agency (IAEA). The International Chernobyl Project: Technical Report . Vienna, Austria: International Atomic Energy Agency; 1991;.
21 +
Kampmann B.  Chromosomal abnormalities increased in Latvia. BMJ . 1994;;309:1299.
22 +
Ron E, Lobin J, Schneider AB.  Thyroid cancer incidence. Nature . 1992;;360:113.
23 +
Gale RP.  Immediate medical consequences of nuclear accidents: lessons from Chernobyl. JAMA . 1987;;258:625-628.
24 +
Linnemann RE.  Soviet medical response to the Chernobyl nuclear accident. JAMA . 1987;;258:637-643.
25 +
Champlin RE.  The role of bone marrow transplantation for nuclear accidents: implications of the Chernobyl disaster. Semin Hematol . 1987;;24( (3 suppl 2) ):1-4.
26 +
Baranov A, Gale RP, Guskova A, et al.  Bone marrow transplantation after the Chernobyl nuclear accident. N Engl J Med . 1989;;321:205-212.
27 +
Sjöberg L, Drottz BM.  Psychological reactions to cancer risks after the Chernobyl accident. Med Oncol Tumor Pharmacother . 1987;;4:259-271.
28 +
Ginzburg HM.  The psychological consequences of the Chernobyl accident: findings from the International Atomic Energy Agency Study. Public Health Rep . 1993;;108:184-192.
29 +
Trichopoulos D, Zavitsanos X, Koutis C, Drogari P, Proukakis C, Petridou E.  The victims of Chernobyl in Greece: induced abortions after the accident. BMJ . 1987;;295:1100.
30 +
Parazzini F, Repetto F, Formigaro M, Fasoli M, La Vecchia C.  Induced abortions after the Chernobyl accident. BMJ . 1988;;296:136.
31 +
Ericson A, Kallén B.  Pregnancy outcome in Sweden after the Chernobyl accident. Environ Res . 1994;;67:149-159.
32 +
Little J.  The Chernobyl accident, congenital anomalies, and other reproductive outcomes. Paediatr Perinat Epidemiol . 1993;;7:121-151.
33 +
Knudsen LB.  Legally induced abortions in Denmark after Chernobyl. Biomed Pharmacother . 1991;; 45:229-231.
34 +
Bertollini R, Di Lallo D, Mastroiacovo P, Perucci CA.  Reduction of births in Italy after the Chernobyl accident. Scand J Work Environ Health . 1990;;16:96-101.
35 +
The EUROCAT Working Group.  Preliminary evaluation of the impact of the Chernobyl radiological contamination on the frequency of central nervous system malformations in 18 regions of Europe. Paediatr Perinat Epidemiol . 1988;;2:253-264.
36 +
Sperling K, Pelz J, Wegner RD, Dörries A, Gröters A, Mikkelsen M.  Significant increase in trisomy 21 in Berlin nine months after the Chernobyl reactor accident: temporal correlation or causal relation? BMJ . 1994;;309:158-162.
37 +
Güvenc H, Uslu MA, Güvenc M, Ozekici U, Kocabay K, Bektas S.  Changing trend of neural tube defects in eastern Turkey. J Epidemiol Community Health . 1993;;47:40-41.
38 +
Harjulehto T, Aro T, Rita H, Rytömaa T, Saxén L.  The accident at Chernobyl and outcome of pregnancy in Finland. BMJ . 1989;;298:995-997.
39 +
Harjulehto-Mervaala T, Salonen R, Aro T, Saxén L.  The accident at Chernobyl and trisomy 21 in Finland. Mutat Res . 1992;;275:81-86.
40 +
Stoll C, Alembik Y, Dott B, Roth MP.  Epidemiology of Down syndrome in 118,265 consecutive births. Am J Med Genet Suppl . 1990;;7:79-83.
41 +
Haeusler MC, Berghold A, Schoell W, Hofer P, Schaffer M.  The influence of the post-Chernobyl fallout on birth defects and abortion rates in Austria. Am J Obstet Gynecol . 1992;;167:1025-1031.
42 +
De Wals P, Bertrand F, de la Mata I, Lechat MF.  Chromosomal anomalies and Chernobyl. Int J Epidemiol . 1988;;17:230-231.
43 +
Kuchuk AA.  Health problems of the population in different regions of the Ukraine. Toxicol Lett . 1994;;72:213-217.
44 +
Abelin T, Averkin JI, Egger M, et al.  Thyroid cancer in Belarus post-Chernobyl: improved detection or increased incidence? Soz Praventivmed . 1994;; 39:189-197.
45 +
Baverstock KF.  Thyroid cancer in children in Belarus after Chernobyl. World Health Stat Q . 1993;; 46:204-208.
46 +
Likhtarev IA, Sobolev BG, Kairo IA, et al.  Thyroid cancer in the Ukraine. Nature . 1995;;375:365.
47 +
Butturini A, Izzi GC, Benaglia G, Lloyd D, Pass B, Gale RP.  Fallout from Chernobyl: not all health problems seen close to Chernobyl can be attributed to radiation. BMJ . 1994;;309:1299-1300.
48 +
Boice J, Linet M.  Chernobyl, childhood cancer, and chromosome 21. BMJ . 1994;;309:139-140.
49 +
Nikiforov Y, Gnepp DR.  Pediatric thyroid cancer after the Chernobyl disaster: pathomorphologic study of 84 cases (1991-1992) from the republic of Belarus. Cancer . 1994;;74:748-766.
50 +
Furmanchuk AW, Averkin JI, Egloff B, et al.  Pathomorphological findings in thyroid cancers of children from the republic of Belarus: a study of 86 cases occurring between 1986 ('post-Chernobyl') and 1991. Histopathology . 1992;;21:401-408.
51 +
Tajtáková M, Langer P.  Retrospectively evaluated finding of larger thyroid volume in east Slovakian adolescents in 1987 than in 1992: effect of Chernobyl? Horm Metab Res . 1993;;25:644-645.
52 +
Castronovo FP Jr.  Iodine-131 thyroid uptake results in travelers returning from Europe after the Chernobyl accident. J Nucl Med . 1987;;28:535-541.
53 +
Likhtarev IA, Gulko GM, Sobolev BG, et al.  Thyroid dose assessment for the Chernigov region (Ukraine): estimation based on 1311 thyroid measurements and extrapolation of the results to districts without monitoring. Radiat Environ Biophys . 1994;;33:149-166.
54 +
Raymond L, Schubert H.  The 'post-Chernobyl' childhood leukemia study (ECLIS Study). Soz Praventivmed . 1991;;36:304-305.
55 +
Petridou E, Proukakis C, Tong D, et al.  Trends and geographical distribution of childhood leukemia in Greece in relation to the Chernobyl accident. Scand J Soc Med . 1994;;22:127-131.
56 +
Hjalmars U, Kulldorff M, Gustafsson G, Swedish Child Leukaemia Group.  Risk of acute childhood leukaemia in Sweden after the Chernobyl reactor accident. BMJ . 1994;;309:154-157.
57 +
Auvinen A, Hakama M, Arvela H, et al.  Fallout from Chernobyl and incidence of childhood leukaemia in Finland, 1976-92. BMJ . 1994;;309:151-154.
58 +
Parkin DM, Cardis E, Masuyer E, et al.  Childhood leukaemia following the Chernobyl accident: the European Childhood Leukaemia-Lymphoma Incidence Study (ECLIS). Eur J Cancer . 1992;;29A: 87-95.
59 +
Yarilin AA, Belyakov IM, Kusmenok OI, et al.  Late T cell deficiency in victims of the Chernobyl radiation accident: possible mechanisms of induction. Int J Radiat Biol . 1993;;63:519-528.
60 +
Emerit I, Levy A, Cernjavski L, et al.  Transferable clastogenic activity in plasma from persons exposed as salvage personnel of the Chernobyl reactor. J Cancer Res Clin Oncol . 1994;;120:558-561.
61 +
National Council for Radiation Protection and Measurements. Protection of the Thyroid Gland in the Event of Releases of Radioiodine . Washington, DC: National Council for Radiation Protection and Measurements; 1977;. Report 5.
62 +
United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Early Effects in Man of High Doses of Radiation: Proceedings of the 35th Session of UNSCEAR: Report to the United Nations . New York, NY: United Nations; 1985;.
63 +
Peter RU, Braun-Falco O, Birioukov A, et al.  Chronic cutaneous damage after accidental exposure to ionizing radiation: the Chernobyl experience. J Am Acad Dermatol . 1994;;30:719-723.
64 +
American Cancer Society. Cancer Facts and Figures—1995 . Atlanta, Ga: American Cancer Society; 1995;.
65 +
Nazarov AN, Gerasimov GA.  Status of endemic goiter in the USSR. Probl Endokrinol Mosk . 1992;; 38:58-61.
66 +
Bolshova EV, Tronko ND, Van Middlesworth L.  Iodine deficiency in Ukraine. Acta Endocrinol . 1993;;129:594.
67 +
Jensen RH, Langlois RG, Bigbee WL, et al.  Elevated frequency of glycophorin A mutations in erythrocytes from Chernobyl accident victims. Radiat Res . 1995;;141:129-135.

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