On February 9, 2001, the Vancouver Sun published an article about Nancy Riva who lost her two brothers and was diagnosed with cancer as a result of thymus radiation treatment they received as children — in the belief that this would prevent sudden infant death.
Riva and her brothers were born in Vancouver General Hospital (VGH) in the late 1940s and underwent radiation treatment at the hospital as babies.
Radiation treatment for benign illnesses (that is not for treating cancer), like Riva’s inflamed thymus gland, was a standard medical practice worldwide during the 1940 and 1950s. The treatment was considered to be safe and effective for non-cancerous conditions such as acne and ringworm as well as deafness, birthmarks, infertility, enlargement of the thymus gland and more.
In the early 1970s, medical research confirmed the long-standing suspicion that children and young adults treated with radiation for benign diseases, during the 1940s and 1950s, showed an alarming tendency to develop thyroid cancer and other ailments as adults.
In our recent paper, published in the American Journal of Public Health, Shifra Shvarts and I have explored how health authorities in the United States responded to the discovery of the late health effects of radiation treatment.
Over two million people are estimated to have been treated with radiation in the U.S. for benign conditions. We show how an ethical decision at Michael Reese Hospital in Chicago in 1973 to locate and examine former patients, who had been treated with radiation in childhood, led to a nationwide campaign launched in July 1977 by the National Cancer Institute (NCI) — to warn the medical community and public about the late effects of radiation treatment in childhood for a variety of diseases.
U.S. campaign promotes thyroid checkups
Media coverage of the Chicago hospital’s campaign had a snowball effect that prompted more medical institutions to follow suit (first in the Chicago area and later in other parts of the U.S.), resulting in the NCI’s campaign.
Hundreds of thousands of pamphlets were distributed in shopping centres across the U.S., asking people who had undergone radiation treatment to go to their family doctor for a thyroid checkup. In addition, television presenters opened their programs with warnings; notices were published in newspapers.
Meanwhile in Canada, an unknown number of patients, like Riva and her brothers, were treated with radiation. Interviewed by the Vancouver Sun in 2001, Riva wanted to raise public awareness about this issue, encouraging people who might have been treated with radiation as children to have their thyroid checked.
According to VGH’s officials, quoted in the article, locating former patients was logistically impossible. Spokeswoman Tara Wilson told Vancouver Sun reporter Pamela Fayerman:
“Under the Hospital Act, records only have to be maintained for 10 years after a patient’s last hospital admission, so it’s unlikely we would have these birth records, although people can still phone the hospital to check.”
No systematic investigation in Canada
Riva’s story raises the question of why the Canadian health authorities did not launch a campaign to warn the public, as happened in the United States. Early detection of thyroid cancer saved lives.
The U.S. campaign was known in Canada. On July 14, 1977 a Globe and Mail article titled, “U.S. increasing efforts to warn million potential cancer victims,” described the national program to alert the public of the late health effects of radiation treatment.
Moreover, in an article published in Annals of Internal Medicine in February 1978, two University of Toronto professors of medicine, Paul Walfish and Robert Volpé, discussed the long-term risk of therapeutic radiation and described the efforts made by the U.S. Department of Health, Education and Welfare to educate the American public about the late effects of the treatment.
To date, there has been no known attempt to systematically investigate how many children underwent radiation treatment in Canada for benign conditions and what has been done to alert the public and the medical community of the risks. From Riva we learn that in 2001 patients were still looking for advice.
Had the Canadian health authorities effectively warned the public of the long-term risk of radiation treatment, illnesses and deaths may have been prevented.
Perhaps some still could?