Republican Research and Practical Center for Radiation Medicine and Human Ecology. Ilya Veyalkin Head of Laboratory of Epidemiology Gomel, Belarus

Republican Research and Practical Center for Radiation Medicine and Human Ecology Ilya Veyalkin Head of Laboratory of Epidemiology Gomel, Belarus

The contaminated area in the Republic of Belarus consisted of 3600 settlements (including 27 cities), where 2.2 million people lived. Currently, there live about 1.5 million people related to the affected population.

Radiation affected population monitoring; Obtaining the reliable data on the medical and biological effects of the Chernobyl accident; Provision of information to support dispensary examination, planning and carrying out therapeutic measures.

Maintenance of a personalized automated records of persons affected by the accident; Dynamic replenishment of necessary information about the persons affected by the accident; Development of normative-legal acts for the medical monitoring of the various categories of the affected citizens.

1 GPR - persons who participated in the liquidation of the Chernobyl accident and its consequences, divided into two subgroups 2 GPR persons evacuated or who left the areas of evacuation on their own in 1986; 3 GPR people living or working in the areas of primary and subsequent resettlement, as well as those who were resettled or who left these areas after the accident on their own; 4 GPR - persons born from people of 1-3groups, except for children belonging to the 2 and 3 groups; 5 GPR - people living or working in areas with the right of resettlement and of periodic radiation monitoring, as well as residents of other settlements, where the average equivalent radiation dose exceeds 1 msv per year. 6 GPR - persons who participated in the liquidation or affected by the accidents and their consequences at other nuclear facilities of civil or military purposes, as well as the victims of these accidents or as a result of trials, tests or other work related to nuclear facilities, including nuclear weapons; 7 GPR disabled people due to the Chernobyl NPP accident from the number of people who have no status affected due to the Chernobyl NPP accident, as well as children and adolescents upon detection of diseases of blood-forming organs (acute leukemia), thyroid gland (adenoma, cancer) and malignant tumors if they are not assigned to other groups of primary accounting.

GPR Total number UnderObservation at 01.01.2015 Number of Cancer Cases (1986-2014) 1GPR (Liquidators) 99 693 55 425 11 431 2GPR (Evacuees) 13 101 4 310 828 3GPR (Residents) 139 470 56 593 6 731 4GPR (Offspring) 28 487 19 963 96

2500000 2000000 Total Children 1500000 1000000 500000 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Minsk Region Grodno Region Minsk city [ПРОЦЕНТ] Mogilev Region [ПРОЦЕНТ] [ПРОЦЕНТ] [ПРОЦЕНТ] Brest Region [ПРОЦЕНТ] Gomel Region [ПРОЦЕНТ]

n 90000 80000 70000 60000 50000 Residents Liquidators 40000 30000 20000 10000 0 Offspring Evacuees 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Median of Age, years 70 60 50 40 54 55 41 41 42 43 44 45 46 46 47 48 49 50 51 52 52 53 54 55 56 57 57 58 59 48 49 47 47 44 41 42 43 43 45 44 43 42 41 37 36 37 37 38 39 40 39 37 37 37 37 37 37 37 38 38 38 39 39 39.5 40 40 40 41 37 36 35 35 35 35 35 35 35 35 36 36 37 37 38 38 39 39 40 41 42 42 30 20 10 0 0 0 0 1 2 2 3 4 4 5 5 6 7 7 8 9 10 10 11 12 12 13 14 14 15 16 16 17 17 Liquidators Evacuees Residents Offspring

Per 100 000 16.00 14.00 14.3 13.4 13.2 12.8 12.00 11.50 12.20 12.50 12.50 10.00 8.00 6.00 14.7 13.63 13.56 13.44 13.11 4.00 8.15 8.51 8.66 8.74 8.89 2.00 0.00 2011 2012 2013 2014 2015 Birth Rate Mortality Rate Birth Rate Belarus Mortality Rate Belarus

Per 100 000 (World standard) 1000 950 900 850 800 750 700 650 600 550 500 2000 2005 2010 2011 2012 2013 2014 2015 Belarus 849.5 873.7 794.1 781.8 712.9 701.9 679.6 Liquidators 776.5 698.7 750 712.5 682.6 629 631.7 606.9 Evacuees 848.3 895.1 724.8 850.4 772 734.6 582.8 533.9 Residents 942.9 881.1 848.1 781.3 700.3 715.7 618.9 634.6

Affected Belarus 6.9% 8.0% 59.5% 8% 10% 56% 9.4% 12% 16.1% Cardiovascular diseases 14% Neoplasm Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Injury, poisoning and certain other consequences of external causes

Affected Diseases of the respiratory system Belarus 9.1% 26.9 % 49.8 % Cardiovascular diseases 10% 25% Diseases of the musculoskeletal system and connective tissue 52% 4.0% 5.9% 4.2% Diseases of the skin and subcutaneous tissue 5% 5% 3% Injury, poisoning and certain other consequences of external causes Other

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 From 1986 to 2014 the number of registered cases of cancer in Belarus increased from 23 200 to 46 467 (2 times) 50000 45000 46 467 40000 35000 30000 25000 20000 15000 23 200 10000 5000 0

In general there were many speculations, assumptions and predictions about the role of Chernobyl accident in cancer growth in Belarus. Most assumptions have been varying with the time. And till the present the question about role of Chernobyl accident has not been answered. But the growth of Thyroid cancer has been evident.

From 1978 to 2014 the number of registered cases of cancer in Belarus increased from 16 895 to 46 467 50000 45000 46 467 40000 35000 30000 25000 20000 15000 10000 16 895 GR=3,4% a year 23 200 GR=3,3% a year 5000 0 1978 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Rate per 100 000 population 70.00 9.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00 Rate per 100 000 population Stomach (males) Stomach (females) Lip (males) The left scale is for incidence rates of stomach cancer (males, females). The right scale is for incidence rates of lip cancer. Years

Rate per 100 000 population 6.00 5.00 Lip (females) 4.00 Esophageas (females) Larynx (females) 3.00 Lung (females) 2.00 Pancreatic (females) 1.00 Liver (females) Urinary bladder (females) 0.00 Years

Rate per 100 000 population 25.00 50.00 Colon (males) 45.00 Colon (females) Melanoma (males) 20.00 40.00 Melanoma (females) 15.00 10.00 5.00 35.00 30.00 25.00 20.00 15.00 10.00 Rate per 100 000 population Corpus uteri Kidney (females) Breast The right scale is for incidence rates of breast cancer. The left scale is for all presented sites. 5.00 0.00 0.00 Years

Rate per 100 000 population 18.00 80.00 Esophageas (males) 16.00 70.00 Rectal (males) Pancreatic (males) 14.00 12.00 10.00 8.00 6.00 4.00 2.00 60.00 50.00 40.00 30.00 20.00 10.00 Rate per 100 000 population Larynx (males) Thyroid (males) Ovaries Rectal (females) Urinary bladder (males) Lung (мужчины) The right scale is for incidence rates of lung cancer (males). The left scale is for all presented sites. 0.00 0.00 Years

Rate per 100 000 population 50.00 60.00 45.00 40.00 50.00 Skin (males) 35.00 30.00 25.00 20.00 15.00 40.00 30.00 20.00 Rate per 100 000 population Skin(females) Kidney (males) Prostate 10.00 10.00 5.00 0.00 0.00 Thyroid (females) Years

Leukaemia (С91-С95) Chronic myeloid leukaemia (C92.1, C93.1, C94.1) Chronic lymphatic leukaemia (C91.1) Acute myeloid leukaemia (C92.0, C93.0, C94.0, C94.2, C94.4-C94.5) Acute lymphatic leukaemia (C91.0) Non-Hodgkin lymphoma (C82.0-C85.9, C96) С00-С96 All malignant C90 Multiple myeloma C81 Hodgkin lymphoma C73 Thyroid C71 Brain C67 Bladder C64 Kidney C62 Testis C61 Prostate C56 Ovary C54 Corpus uteri C53 Cervix uteri C50 Breast (MALES) C50 Breast (FEMALES) C45 Mesothelioma C44 Other skin C43 Melanoma of skin C40-41 Bone C33-34 Trachea, bronchus and lung C32 Larynx C25 Pancreas C23-24 Gallbladder etc. C22 Liver C20 Rectum C19 Rectosigmoid junction C18 Colon C16 Stomach C15 Oesophagus C12-13 Hypopharynx C11 Nasopharynx C07-08 Salivary glands C03-06 Mouth C01-02 Tongue C00 Lip 0 0.5 1 1.5 2 2.5 3 3.5

Leukaemia (С91-С95) Chronic myeloid leukaemia (C92.1, C93.1, C94.1) Chronic lymphatic leukaemia (C91.1) cute myeloid leukaemia (C92.0, C93.0, C94.0, C94.2, C94.4-C94.5) Acute lymphatic leukaemia (C91.0) Non-Hodgkin lymphoma (C82.0-C85.9, C96) С00-С96 All malignant C90 Multiple myeloma C81 Hodgkin lymphoma C73 Thyroid C71 Brain C67 Bladder C64 Kidney C62 Testis C61 Prostate C56 Ovary C54 Corpus uteri C53 Cervix uteri C50 Breast (MALES) C50 Breast (FEMALES) C45 Mesothelioma C44 Other skin C43 Melanoma of skin C40-41 Bone C33-34 Trachea, bronchus and lung C32 Larynx C25 Pancreas C23-24 Gallbladder etc. C22 Liver C20 Rectum C19 Rectosigmoid junction C18 Colon C16 Stomach C15 Oesophagus C12-13 Hypopharynx C11 Nasopharynx C07-08 Salivary glands C03-06 Mouth C01-02 Tongue C00 Lip 0 0.5 1 1.5 2 2.5 3 3.5

Leukaemia (С91-С95) Chronic myeloid leukaemia (C92.1, C93.1, C94.1) Acute myeloid leukaemia (C92.0, C93.0, C94.0, C94.2, C94.4-C94.5) Acute lymphatic leukaemia (C91.0) Non-Hodgkin lymphoma (C82.0-C85.9, C96) С00-С96 All malignant C81 Hodgkin lymphoma C73 Thyroid C71 Brain C69 Eye C67 Bladder C64 Kidney C62 Testis C43 Melanoma of skin C22 Liver C20 Rectum C07-08 Salivary glands 0 1 2 3 4 5 6 7 8

PER 100 000 16 14 All 12 10 8 Adults (14+ years at diag.) 6 4 2 Children (0-14 years at diag.) 0 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 YEARS

1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 Incidence rates of thyroid cancer by age groups (0-19) female (per 100 000) 1.4 1.2 1 0.8 0.6 0.4 0.2 0 0-4

1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 16 Incidence rates of thyroid cancer by age groups (0-19) females (per 100 000) They were born in 1982-1986 14 12 10 8 6 4 2 0 0-4 5-9 10-14 15-19

Thyroid Cancer Incidence 1991 1994 1997 2000 2003 2006

The contamination of the territory of Belarus with iodine-131 (reconstruction) estimated 10 May, 1986

SIR 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 1986-1989 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014 1986-2014 Liquidators Evaquees Residents

Per 100 000 12 10 8 6 4 APC=0,3% в год 2 0 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Brest region Vitebsk region Gomel region Grodno region Minsk region Minsk city Mogilev region Belarus

8 7 6 5 4 3 2 1 0 1985-1989 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014 1991-2014 Liquidators Evacuees Residents Offspring

10 9 8 7 6 5 4 3 2 1 0 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014 1991-2014 Liquidators Evacuees Residents Offspring

10 9 8 7 6 5 4 3 2 1 0 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014 1991-2014 Liquidators Evacuees Residents

10 9 8 7 6 5 4 3 2 1 0 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014 1991-2014 Liqudators Evacuees Residents Offspring

10 9 8 7 6 5 4 3 2 1 0 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014 1991-2014 Liquidators Evacuees Residents Offspring

SIR 1.4 1.2 1 0.8 0.6 0.4 0.2 0 1986-1989 1990-1994 1995-1999 2000-2004 2005-2009 2010-2014 1986-2014 Liquidators Evacuees Residents

THANK YOU FOR YOUR ATTENTION