What differentiates us from the other group will hopefully be all the additional crap

Abstract
The study compares the death from thyroid cancer in the US (population), with the
occurrence (or death?) of thyroid cancer in area affected by Nevadas nuclear tests (sample).
They use both mortality and incidence data.
Premise: People received radioactive iodine from Nevadas nuclear tests
Response variable: EER per Gy
Explanatory variable: Age (current and at exposure); Year; Gender; County location
No significant association overall. However, may have association for those exposed to the
tests before the age of one. No association found for older ages
Looking at mortality data only, increased ERR for those born in 1950-1959 of 12 units per
Gy
Conclusion: Risk of thyroid cancer from radioactive iodine from the atmosphere did not
generally increase with cumulative dose. There may be association for those below 1 year of
age, or born between 1950-1959. (What about the effects of tests after 1959? Why only 1950s
affected?)
There are limitations and biases inherent in ecologic studies, such as studying a mobile
population. What else affected this paper?
Nevada Test Site (NTS) was established on 11 January 1951. 100 atmospheric tests were
conducted (Find exact details?). Winds routinely carried the fallout of these tests directly
through St. George and southern Utah. The vast majority828 of the 928 total nuclear tests
were underground.
Fallout exposure in Rads (1 Rad = 0.01 Gray) :
https://en.wikipedia.org/wiki/Nevada_Test_Site#/media/File:US_fallout_exposure.png
What lawsuits have the public filed against the testing? The results?
Such side details can make our introduction?

Terms:
1. Excess Relative Risk
a. EER involves both difference and ratio operations, used in case-control studies
i. The current standard involves ratio only, because they provide a stable
measure of association
b. it is the excess risk per unit of exposure (difference operation here) divided by
the background risk (ratio operation here)
c. Using the theory of sufficient component cause model, the author shows that
when there is no mechanistic interaction (no synergism in the sufficient cause

sense) between the exposure under study and the stratifying variable, the ERR
index (but not the ratio-type indices) in a rare-disease case-control setting
should remain constant across strata and can therefore be regarded as a
common effect parameter.
i. Aka null hypothesis
d.

i. What are risk? IDK

e. From: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4412639/
2. Gray of radiation
a. The gray (symbol: Gy) is a derived unit of ionizing radiation dose in
the International System of Units (SI). It is defined as the absorption of
one joule of radiation energy per one kilogram of matter.[1]
b. It is used as a measure of absorbed dose, specific energy (imparted),
and kerma (an acronym for "kinetic energy released per unit mass"). It is a
physical quantity, and does not take into account any biological context
c. Gray is absorbed dose
i. Activity is measured in Becquerel (Bq)
ii. Dose equivalent is measured in Sievert (Sv)
iii. Absorbed does is used to assess the potential for biochemical changes
in specific tissues ; Equivalent dose is used to assess how much
biological damage is expected from the absorbed dose
Different types of radiation have different damaging properties
In diagnostic radiation, the radiation has the same low harm
potential so the absorbed and equivalent dose are usually the
same
iv. Effective does (also Sv) is used to assess the potential for long-term
effects that might occur in the future, taking three factors into account
The absorbed dose to all organs of the body
The relative harm level of the radiation
The sensitivities of each organ to radiation
v. From http://www.radiologyinfo.org/en/info.cfm?pg=safety-hiw_09
Introduction of paper
They used data from NCI that estimated radioactive iodine doses to the thyroid.
http://www.cancer.gov/about-cancer/causes-prevention/risk/radiation/i-131#thyroid . Data
can be downloaded from the link
Was the majority of iodine released in 1952, 1953, 1955, 1957?? From what tests?
Thyroid cancer risks and thyroid doses are larger for exposures in children than adults.
Reason: Still growing, and thyroid secretes hormones controlling growth (My bio

knowledge). Children also have smaller thyroids and consume from fresh milk (stated in
M&M section). Backup with other data/paper.
Is their data source they used the best data source to use? What are the sources of
inaccuracies?
Materials and Methods
Dosimetry data
What were the categories and assumptions listed in the NCI paper?
NCI says major source of contamination is from fresh cow milk containing radioactive
iodine. Find paper to support this idea?
They used 7 age at exposure categories because that is what NCI provides. They averaged
data for in utero, and below 1 year category. Is averaging the best (compared to choosing one,
or average 2 out of 4)? What consequences of averaging? (is lurking variables affected?)
They also used 7 time periods (Why?) and compared adult males against adult females
because of NCI data.
Does are based on assumption of average milk consumption scenarios. Can we attack this?
Their approach used for estimating thyroid doses used a lognormal distribution to account for
uncertainties. What is lognormal? Can we attack this?
Their analyses used means of these distributions. They also used median and found similar
results. Should the results be similar? (What are the implications of similar mean and
median?) Is mean the best?
Thyroid cancer mortality and incidence rates
They used data on deaths with thyroid cancer as the underlying cause from National Centre
for health statistics. What are the uncertainties associated with this data. Is this the best
source?
They did not use data from before 1957 and 0-4 years risk group, because radioactive induced
thyroid cancer have a minimal latent period of 4 or 5 years. Is this true?
They did not use data from those 55 years or older, to keep data manageable (Why?). This
affects those 13 years and above when the first significant event in 1952 occurred. What are
the implications of this age limit?
Thyroid cancer incidence data was from SSER tumour registries. Only data from 1973-1994,
for 194 counties. (Consequence of this limitation?) The average dose for these 194 counties
was 0.1 cGy higher than the US average. Significant? Implications?
Do we need to explain what counties are?
Statistical methods

Dose (county and sex specific) was calculated for every of the 7 tests, taking into account age
at exposure. What does the part about being born in the period of interest mean?
Entire does of 1961+ was added to 1962. Valid idea/ method?
Why would half of the (a to a +4) group be born in the year y a, and the other half y a 1?
Is y a really a good estimate of average time of birth?
The dose received at nuclear test abcd would include the age at exposure, and the dose when
they were born. Why?
They assume that the subject resides in the same county between the times of the survey
Why the data was collapsed into the cumulative dose categories? Would changing the
categories affect the result? Want to try?
If states data is so much better, why use counties?
Is Poisson regression method best? Whats AMFIT module?
What is linear relative risk model? What is likelihood ratio statistic?
What does it imply when lower confidence limits are less than zero?
They compared the dose-response analyses of counties with high dose, with those with low
dose. Weighted strata, with those with highest doses having greater weight. (Is my term
weighted strata right?)
Dose assignment method does not account for evidence that thyroid cancer risk decreases
with age.
How does their correction of dose assignment work? What is Cut points divided by 10?
Age dependence was also examined since uncertain how age-specific EER relates to
radioactive iodine exposure. How and Why?
Results
Table 1
What does person-years mean?
Why the jump between 0 and >0 to <1?
Table 2
How does the results provide little indication that thyroid cancer risk increases with
increasing exposure levels?
Why is their cGy range so big?
What does the double dagger mean?
Table 3

Data was heavily affected by 9 deaths with dose above 9 cGy. Without them, the result
changed greatly. Should these 9 deaths be included? Are they outliers?
Only state-specific doses did not contain outliers. Why still so high?
Comparing analysis B and C, does not support dose-response relationship.
Group D and E contains subjects that were affected twice. Why when older than 1, the ERR
is negative?
Table 4
Heterogeneity was found between birth cohorts. How was it found? Why was there
heterogeneity? Because they had subject age at exposure being under 1 year. What is the
consequences on the conclusion? Support the idea that under 1 is most dangerous? Other
papers support this conclusion?
Why is 1955 such an outlier? And only in mortality data? Because they had subject age at
exposure being under 1 year.
Why 1955 has positive ERR for multiple age groups?
They conclude that sex has little impact on mortality and incidence. Do other papers support
this?
Discussion
Limitation and biases
What are the ecologic approach limitations?
Do the uncertainties make the result inconclusive? Migration might be high for older peeps,
but not for newly born
Can the data be made to capture the variation in milk consumption?
How did the screening methods differ? Impact?
How much correction must be done to negate the conclusion? Are these correction rational?
Relevant literature
The dose-response relationship is unlikely to be linear.
Any new papers released that could affect this conclusion?
Findings and interpretation
Why is the exposure under one year of age is compatible with strong evidence of risk from
external exposure to radiation between one and 15 years?
Why is the papers EER lower than that of other papers on external radiation?