Worker Sickness a Legacy of the Arms Race

After a dozen years probing for work-related sickness among nuclear weapons workers, Lewis Pepper can say he’s made a difference. Prodded in part by his work, Congress a decade ago compensated more than 28,000 workers for a variety of illnesses. Now Pepper, a School of Public Health assistant professor of environmental health, is pushing to expand a Department of Energy (DOE) initiative providing CT scans to some workers in hopes of detecting lung cancer early.

The CT scan program has screened 10,000 workers already; Pepper would like to increase that number by half again. Meanwhile, he’s in the second year of a five-year, $6 million DOE grant to continue other testing of workers who were employed at a half dozen sites for possible illnesses. Many nuclear arms workers, especially during the Cold War, were exposed to various carcinogens, such as asbestos, radon, and beryllium, a commonplace metal in materials used to make nuclear weapons.

In addition to cancer, ailments that Pepper and his team have found include chronic beryllium disease (CBD), a lung affliction that is treatable, but can be fatal. They also look for beryllium sensitivity, a condition similar to an allergy that’s often a precursor to CBD.

Illness isn’t just the concern of a bygone era: in 2002, more than 5 percent of workers at a DOE office building in Las Vegas that was once a beryllium-machining site were found to have beryllium sensitivity.

Pepper’s current research focuses on workers who were employed at such places as the Nevada National Security Site, Lawrence Livermore National Laboratory, and Lawrence Berkeley National Laboratory. Researchers from SPH, the University of California at San Francisco, and the University of Nevada School of Medicine are collaborating on the testing. Pepper spoke with BU Today about his work and his advocacy for compensating workers.

BU Today: Why are you are pushing for CT scanning?
Pepper: For individuals who are at high risk of developing lung cancer, based upon their work history of exposure to a variety of carcinogenic agents, among them asbestos, beryllium, radon, and diesel exhaust. Chronic beryllium disease is associated with an increased risk of developing lung cancer in a series of studies. There’s a scientific basis to go forward, but one of the impediments is the uncertainty around the federal budget. I think they’re going to say it’s a great idea, but we’ve got to wait for the money. The program has incredible bipartisan support. There are facilities in many states.

Isn’t the scientific evidence that early detection of lung cancer can save lives in dispute?
In November, the National Cancer Institute released results of its national 10-year, 53,000-person randomized clinical trial of low-dose CT scanning for lung cancer screening. The study found a 20 percent lung cancer mortality reduction among the scanned group, compared to the group screened with a chest X-ray. Additional details are expected in the spring.

Who are the folks you’re still testing 20 years after the Cold War ended?
We continue to bring in people who worked during that era, people who are retiring. There are people who are maybe 70 now, people who worked in the ’60s and ’70s.

Aren’t you also testing people found to have beryllium sensitivity who worked for DOE in office buildings that had been rehabbed?
Yes. Beryllium was thought not to be a problem outside the machine shops where it was milled until then. And not to be alarmist, but the Department of Energy is very active in nanomaterials research. The department put in several oversight mechanisms to provide medical screening and surveillance to these individuals. It’s not entirely clear whether nanomaterials cause disease. There are recommendations from the National Institute for Occupational Safety that traditional medical screening and surveillance be used. It’s not unlikely, I think, that at some point, someone’s going to suggest CT scans. In 2007, the U.S. Air Force asked the National Academy of Sciences to look at beryllium exposure in their population and what should they be doing in terms of medical screening—not jet pilots, but people who work on the engines.

Since you’ve been doing this research, how many workers have you tested?
About 6,000, I think.

What got you interested in this?
I come out of the 1960s, so I guess that’s my problem. When I was in medical school, I heard a guest lecturer—at that time, I thought I was going to be a primary care internist—who said, “If you’re interested in social justice and making things better through your career as a physician, choose occupational medicine.”

Rich Barlow can be reached at barlowr@bu.edu.