X Rays in Utero
Though the X-ray industry and its medical proponents emphasize that the doses from diagnostic radiation are small, considerable evidence has surfaced indicating that the health effects can be devastating, particularly to the unborn fetus.24
In fact, one of the world’s first and biggest radiation surveys was conducted in the mid-1950s on the effects of X rays on unborn children, and it has had an important effect on all debate over safe radiation exposures since. The study began in 1955, when David Hewitt, a statistician at England’s Oxford University, noticed that in the preceding few years there had been more than a 50 percent increase in the number of British children dying of leukemia. His preliminary statistics convinced Dr. Alice Stewart of Oxford’s Department of Preventative Medicine to search for a reason. Trained as a pediatrician and epidemiologist, Stewart began crisscrossing Britain, persuading local health officials to interview the mothers of each of the 1,694 children who died of cancer the previous two years. An equal number of healthy mothers and children were used as controls.
As the interviews began to accumulate, a cause for the excess cancers emerged. Stewart and Hewitt sifted through the data and found that twice as many cancer deaths occurred before the age of ten among children whose mothers had received a series of pelvic X rays while pregnant.25 "It was quite by accident that we bumped into the radiation story," Stewart told us.26
The "accident" was not well received by either the medical community or the nuclear industry. An X-ray picture of a fetus in utero had been secured as early as February of 1896—two months after Roentgen’s discovery—and it had become common practice to use X rays to detect multiple births or abnormal conditions in the uterus, and to clarify the outlines of the mother’s pelvis to aid in delivery.27 Hewitt’s and Stewart’s findings jeopardized those practices and threw into doubt the entire foundation of the safety standards for radiation. Such doses from X rays were believed to be safe. At the time their study was issued, it was generally believed that the "threshold" below which radiation exposure was safe was roughly ten rads. The new findings indicated that a single rad of X-ray dosage to an infant in utero could lead to a higher chance of childhood leukemia.28
Dr. Stewart soon found herself under a barrage of criticism. She lost her staff and her funding for the Oxford survey. But she continued nonetheless. In 1958, with an expanded data base, she concluded that a fetus exposed in the first three months of development was ten times more likely to develop cancer than an unexposed fetus. The risk increased with the number of exposures, even a single X ray was found to contribute. Stewart also found that X rays to a woman who was not pregnant could also lead to damage in future offspring. Women carry their eggs from birth, and Stewart found the X rays would be particularly harmful if they affected the mothers’ ovaries.29
In 1962 Stewart’s embattled study received powerful confirmation from Dr. Brian MacMahon of the Harvard School of Public Health. A study of 700,000 children born between 1947 and 1964 was conducted in thirty-seven major maternity hospitals in the Northeast. MacMahon compared the children of seventy thousand mothers who had received pelvic X rays during pregnancy with the children of mothers who had not been X-rayed. He found that cancer mortality was 40 percent higher among the children with X-rayed mothers.30 It was a stunning confirmation of Stewart’s findings, a crucial turning point in the radiation controversy, and made essentially inescapable the conclusion that the human fetus was far more vulnerable to miscarriage, malformations, and cancer from X rays than anyone had previously believed possible. In 1963 MacMahon told a Joint Committee on Atomic Energy hearing on bomb fallout in southern Utah that "we must consider very seriously the possibility of cancer production by low doses of radiation such as encountered in x ray diagnosis and even fallout."31
Yet two decades after Stewart first published her findings, and fourteen years after MacMahon confirmed them, little had been done to warn the public. A 1976 telephone survey by the New York Public Interest Research Group indicated that women of childbearing age who underwent X-ray examinations were often not asked beforehand if they were pregnant.32 At 1980 hearings for radiation victims, held in Washington, Dr. Karl Z. Morgan remembered how he and others had "fought for years to pass a recommendation . . . that women in the childbearing age should not be given x rays in the pelvic and abdominal region except during emergency situations and except during the ten-day interval following the beginning of menstruation." The failure of the X-ray industry to comply was, he said, "one of the biggest problems in reducing the harmful effects of radiation."33
In 1970, the last year in which the federal government analyzed X-ray records on a national scale, it found that 23 percent of the 3.5 million pregnant women in the United States were exposed to medical X rays—some eight hundred thousand women. In 9 percent of these cases—involving more than seventy thousand individuals—the fetus was exposed to the X-ray beam. Five years later a study of sixty-eight thousand single deliveries in sixteen hospitals during 1969 and 1970 estimated that pelvic X rays were given in 6.9 percent of the cases. Current estimates indicate that pelvic X rays are still given in about 6 percent of all live births in the United States, though some facilities administer them at a far higher rate.34
Unfortunately the practice of X-raying pregnant women already has had tangible effects. In January of 1957 Emma Rita Mihal, an Ohio housewife, visited an obstetrician and told him she was pregnant. "But," she remembers, "he insisted that I was not pregnant" and then ordered month-long radiation treatments for endometritis, an inflammation of the lining of the womb. A few weeks after completion of the treatment Mrs. Mihal returned to the obstetrician. The doctor, she said, "took the stethoscope and he listened, and then . . . he turned to me and said, ‘Mrs. Mihal, you are pregnant.’ . . . It was the last thing that man ever told me." Worried about what the radiation treatment might have done to her unborn child, Mihal visited her radiologist. "He took me by the shoulder and he said, ‘I want you to go home, your baby will be fine.’" But when Kathleen Mihal was born on September 19, 1957, she came into the world with the undersized head of a microcephalic. Radiation burns scarred her back. Mihal recalled that her doctors "never told me I shouldn’t have another child. I did become pregnant again, and here again my other child is greatly damaged, because she has genetic damages. She was very sickly from the day she was born."35
Though the Mihals’ story was an extreme one, it and other cases ultimately could not be ignored. Additional studies have now linked X-ray doses to women even before pregnancy with significant rises among offspring in Down’s syndrome and fatal cancer before the age of fifteen.36 Finally, in April of 1980, the Bureau of Radiological Health and the American College of Obstetricians and Gynecologists launched a massive public education program warning of the damaging effects of radiation (as well as certain drugs) on pregnancies.37 The consumer education program is part of BRH’s nonpersonnel budget, which was cut in fiscal year 1981 from $6.3 million to $6.1 million. Projections for FY 1982 at the time of this writing put that budget at $5.9 million.38
24. DHEW, X-Ray Examinations A Guide to Good Practice (Washington, D.C.: Department of Health, Education and Welfare, 1970), p. 6. The unborn face greater risk of radiation damage than adults receiving the same amount of exposure. The stage of pregnancy determines, in large measure, the type of fetal damage. During the first trimester risks of accidental miscarriage, congenital malformation, and brain damage predominate. From the ninth day through the sixth week of pregnancy, organogenesis—the period of organ and limb development—occurs. The greatest radiation-induced deformities can be produced because of the specialized rapid development and division of cells and tissues. Ear, nose, eye, and structural brain deformities can result.
25. Griffiths and Ballantine, Silent Slaughter, p. 41.
26. Alice Stewart, interview, November 1980.
27. Brecher and Brecher, The Rays, p. 60.
28. Stewart, et al., "Survey of Childhood Malignancies," British Medical Journal (1958), p 1495.
29. Alice Stewart and George W. Kneale, "Radiation Dose Effects in Relation to Obstetrics, X Ray and Childhood Cancer," Lancet 1 (1970): 1185-1187.
30. Brian MacMahon, "Prenatal X-ray Exposure and Childhood Cancer," Journal of the National Cancer Institute 28 (1962): 1173.
31. Fallout, Radiation Standards and Countermeasures, U.S. Congress, Joint Committee on Atomic Energy, Subcommittee on Research, Development, and Radiation, August 20-22, 27, 1963, p. 595.
32. Deborah Van Brunt, Consumer Perspectives on X Rays (New York: New York Public Interest Research Group, November 15, 1976).
33. Citizens’ Hearings, p. 88.
34. "Considerations of Possible Pregnancy in the Use of Diagnostic X Rays," FDA Publication 75-8029, Health Physics in the Healing Arts, 7th Mid-year Topic Symposium, Health Physics Society (Washington, D.C.: DHEW, December 1972), p. 599; J. A. Campbell, "X-ray Pelvimetry: Useful Procedure or Medical Nonsense," Journal of National Medical Association 68 (November 1976): 514-520; K. M. Kelly, et al., "The Utilization and Efficacy of Pelvimetry," American Journal of Roentgenology 125, No. 1 (September 1975): 66-74.
35. Citizens’ Hearings, p. 35; Robert W. Gibson, et al., "Leukemia in Children Exposed to Multiple Risk Factors" New England Journal of Medicine 279, No. 17 (October 24, 1960): 906-909.
36. Griffiths and Ballantine, Silent Slaughter, p. 46; A. T. Sigler, et al., "Radiation Exposure in Parents of Children with Mongolism (Down’s Syndrome)," Johns Hopkins Hospital Bulletin 117 (December 1965): 374-399.
37. The FDA panel on X-ray pelvimetry approved the following statement on January 26, 1979:
"Pelvimetry is not usually necessary or helpful in making the decision to perform a cesarean section. Therefore, pelvimetry should be performed only when the physician caring for the patient feels that pelvimetry will contribute to the decisions concerning diagnosis or treatment. In those few instances, the reason for requesting the pelvimetry should be written on the patient’s chart. This statement does not apply to x-ray examinations for purposes other than measurement of the pelvis."
This statement was subsequently approved and adopted by the American College of Radiology in July 1980. The American College of Obstetricians and Gynecologists has approved the following statement in June 1980, which is comparable to the panel statement:
"X-ray pelvimetry provides limited additional information to physicians involved in the management of labor and delivery. It should not be a prerequisite to clinical decisions concerning obstetrical management. Reasons for requesting x-ray pelvimetry should be individually established." FDA’s public education campaign "X-Rays: Get the Picture on Protection" includes American College of Obstetricians and Gynecologists and FDAapproved materials on X rays and pregnancy. The information is available free from: X Rays, FDA, Rockville, MD 20857.
38. A revised FDA operating budget of $336 million for fiscal 1982 has been submitted to Congress by President Reagan. This is $16.9 million below the request submitted in January by the previous administration. The new proposed figures are:
Fiscal Year Budget Paid Staff Years
1981 $327 million 7,627
1982 $336 million 7,379
Source: FDA Talk Paper, March 10, 1981.