Treatment for thyroid cancer poses radiation risk

Originally published Wednesday, October 20, 2010

WASHINGTON — Reports of thyroid-cancer patients setting off radiation alarms and contaminating hotel rooms are prompting the agency in charge of nuclear safety to consider tighter rules.

A congressional investigation made public Wednesday found that patients sent home after treatment with radioactive iodine have contaminated unsuspecting hotel guests and set off alarms on public transportation.

They've come into close contact with vulnerable people, including pregnant women and children, and trash from their homes has triggered radiation detectors at landfills.

The Nuclear Regulatory Commission (NRC) is considering new rules to address the problem, in particular curbs on sending patients to hotels after treatment, a spokesman said Wednesday.

"The assumption was that patients would be going home," said David McIntyre. "Now that we see there are some who are not, we are developing new guidance." It's unclear whether the radiation exposure occurs at levels high enough to cause harm.

The agency is also looking to make sure that risks of exposing pregnant women and children are more clearly communicated to patients, McIntyre said, after a commission meeting on the issue.

Rep. Edward Markey, D-Mass., says the problem stems from a decision years ago by the NRC to ease requirements that thyroid-cancer patients remain in the hospital a few days after swallowing doses of radioactive iodine to shrink their tumors.

"There is a strong likelihood that members of the public have been unwittingly exposed to radiation from patients," Markey wrote in a letter to the NRC that details findings by investigators on his staff. "This has occurred because of weak NRC regulations, ineffective oversight of those who administer these medical treatments and the absence of clear guidance to patients and to physicians."

Traditionally such patients were kept in the hospital, but treatment has now shifted to less costly outpatient facilities. Patients sent home are supposed to follow specific precautions, such as sleeping alone in their beds and not giving hugs and kisses to young children. Markey's investigation indicates that's where the breakdown is occurring.

In Seattle, Seattle Cancer Care Alliance and University of Washington experts said they carefully screen patients before allowing them to leave the hospital.

UW Medical Center radiation-safety specialist Jennifer Johnson said about 80 percent of cancer patients treated with radioactive materials remain in the hospital. Those who agree to the precautions designed to limit exposure to others can go home, Johnson said, but "we certainly do not allow them to go to hotels — that is never an option."

Johnson cautioned it's important to put the risks of exposure in perspective. A person exposed by a just-treated patient, if they were about a yard away for an hour, would get about the same radiation dose they'd get from two chest X-rays.

Terry Frazee, Western Regional Director for the Office of Radiation Protection for the Washington Department of Health, agreed the risk generally is small, but said the state's policy is to "keep all exposure as low as possible." Radiation is especially risky for infants or children.

He said the state also has been concerned that radiation detectors at landfills in Washington and other states were picking up radioactivity. It turned out to be caused by medical waste — not from hospitals but from cancer patients not realizing that their tissues, adult diapers and other personal hygiene products had become radioactive.

"It was setting off alarms, and causing us problems," he said. The radiation levels were low, he said, but set off detection equipment, which is set to pick up low levels.

Around the country, however, results from Markey's investigation were troubling. Staffers on the House Energy and Environment subcommittee that Markey chairs sent detailed questionnaires to states that enforce the NRC rules and conducted an online survey of more than 1,000 thyroid-cancer patients.

The investigation found that:

• In 2003, a patient who had received a dose of radioactive iodine boarded a bus in New York the same day, triggering radiation detectors as the bus passed through the Lincoln Tunnel heading for Atlantic City, N.J., a casino mecca. The patient had received medical instructions to avoid public transportation for two days, and ignored them.

• About 7 percent of outpatients said in the survey they had gone directly to a hotel after their treatment, most of them with their doctors' knowledge. In 2007, an Illinois hotel was contaminated after linens from a patient's room were washed together with other bedding.

• About one-fourth of outpatients said in the survey they never discussed with their doctors how to avoid exposing pregnant women and children to radiation. The survey found 56 cases in which a patient shared a bathroom or bedroom with a pregnant woman or a child, or had other close contact.

• At least two states — Maryland and Massachusetts — said they had encountered problems with household trash from the homes of patients treated with radioactive iodine. Garbage trucks set off radiation alarms at landfills.

Seattle Times health reporter Carol M. Ostrom contributed to this report.