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The curious case of the radioactive ring
Editorials II II
I
The curious case of the radioactive ring It began as an act of love. A young professor was married in a double-ring ceremony in December, 1940, and the young couple wore their rings constantly. Recurring skin irritation developed under both rings, necessitating over twenty years of dermatologic treatment, including x-ray. Not believing conventional explanations of their condition, the professor fortuitously thought of radiation and confirmed the presence of radioactivity in each ring, He reported this to Drs. Simon and Hartley of the U. S. Atomic Energy Commission, who in turn reported the incident. 1 The rings proved to be contaminated with breakdown products from radon "seeds," orginially used to treat a variety of benign and malignant conditions. Two parallel cases were reported in the next year from western New York. 2':~Other cases were seen in the Buffalo, NY, area, but went unreported except for a case in 1973.4 Eventually, eight cases were known when a man with a deep, chronic ring finger ulceration came into my office in 1977. He triggered the interest and publicity that came through the media in 1981. Being the new dermatologist in town, this was all news to me, and I found it fascinating. Most of the other dermatologists had had a case or had seen one at a meeting, and we all agreed there were probably more rings out there. The case came out as a pictorial study in a small journal and attracted passing interest when presented at two meetings. ~ A brief symposium presentation at the meeting of the American Academy of Dermatology brought the case to the attention of Malcolm Manber of Medical World News. Their publisher put it on their medical news wire service and it reached the media. A Buffalo television station, alerted by a viewer's call, established a radioactivity testing center, soon copied throughout the western New York area. Thousands of pieces of jewelry have been examined, and at least 150 pieces of jewelry contaminated with radiation have been identified. So far, almost all known 696
pieces have come from New York or northwestern Pennsylvania, the overwhelming majority from two or three counties. It seems that discovery to date has been a function of knowledge and numbers. Existence of this phenomenon was common knowledge around Buffalo, Olean, and Rochester, NY, and was mentioned intermittently in meetings of the BuffaloRochester Dermatological Society. In that area, a reaction on the fourth finger makes one think of radioactivity exposure as much as a ring dermatitis or an erosio. The large number of items identified so far this year reflects local publicity and the large number of items tested. There seems to be a ratio of one radioactive piece per thousand checked. Testing programs in other locales might discover items if sufficient numbers of pieces were examined. Many aspects of the radioactive ring cases stir the imagination. This is a "natural experiment" of chronic, low-dose radiation exposure causing cancer, to be compared with those of uranium miners and radium dial painter's osteosarcoma. The emitted doses are miniscule; it is not surprising that earlier physicians considered them harmless. Nonetheless, the cancers are real and have necessitated excision, grafting, chemotherapy, and amputations. The magnitude of the problem is totally unknown. The Bureau of Radiological Health documented the existence of eighteen radon seed manufacturing plants in the United States but estimated that there were thirty or forty. ~ No records exist concerning the disposition of their "spent" radon seeds. These seeds were used widely throughout the country; many of them must still be around. However circumscribed this phenomenon has been, it is inconceivable that other pieces of radioactive gold will not surface in the Midwest, South, and West sooner or later. Soaring gold prices in the past two years bring old jewelry out of drawers and safe deposit boxes and back into 0190-9622/81 / 120696+02500.20/0 © 1981 Am Acad Dermatol
Volume 5 Number 6 December, 1981 circulation. Individual craftsmen rely on purchasing and recycling old gold. So far, all of the radioactive gold has been incorporated into jewelry and watches. I have heard of a case of a radioactive gold dental filling, but it was reportedly made in England, Radioactive gold dental restorations next to a mucous membrane might promote squamous cell carcinomas much more lethal than the cutaneous ones. Initially, it seemed that all significant pieces were manufactured in the 1930s and 1940s. The majority of them had either been custom-crafted or " s i z e d " with a small radioactive insert. Now a number of pieces manufactured in the 1950s and 1960s are turning up, and an Ohio gynecologist just discovered that his ring, purchased in Sarasota, FL in 1978, was radioactive. Evidently the problem is more widespread than imagined. Consider the feelings of a graduating class of a Buffalo high school when they found their graduation pins and rings were "hot"! T w o recent discoveries are significant. A child's gold-plated cross, found in Toronto, was radioactive. All previous pieces have been solid. If radioactive gold has been used in plating processes, a small amotmt would go a long way, and its distribution could be quite widespread. Veterinary sources reveal that gold seeds are used for many inflammatory and neoplastic conditions in horses. Presumably, the seeds are processed with the rest of the horse when rendered, ending up in pet foods, et cetera. Efforts were evidently made to decontaminate the gold from radon seeds before it was used in manufacturing. The Pb/Au ratio gives an indication of purity. Normal 24-K gold has one part impurities per ten thousand, but much of the recovered gold is pure to one part per million. Gold of this purity is normally used only for metallurgi-
Radioactive ring
697
cal research; the process by which it was produced (and who did it) remains unknown. We are left with many questions: "Where did the radon seeds come from? . . . . How much radioactive gold is in the hands of the public n o w ? " "Where is it? . . . . How did such low-dose radiation cause cancer? . . . . Is there danger for the many people who have retained radon seed implants?" In the long run, awareness of the phenomenon and a readiness to test suspicious pieces and biopsy suspicious lesions will be the first step in answering these questions. Report known cases to the Division of Medical Radiation Exposure, Bureau of Radiological Health, Rockville, MD 20851. In 1969, the Bureau of Radiological Health called a meeting of an Ad Hoc Committee on the Control of Spent Radon Seeds to review this problem and to make recommendations on future actions. They concluded that radioactive contm'nination of gold from spent radon seeds did not appear to be a widespread public health hazard. With the clarity of hindsight, we can no longer abide by their conclusion.
Frederic W. Stearns, M.D. Tulsa, OK REFERENCES
1. Simon N, Hartley J: Skin reactions from gold jewelry contaminated with radon deposit, lAMA 200:254-255, 1967. 2. Leone RA: Radiodermatitis caused by a radioactive gold ring. lAMA 206:2113-2114, 1968. 3. Gerwig T, Winer M: Radioactive jewelry as a cause of cutaneous neoplasm, lAMA 205:595-596, 1968. 4. Holubar K, et al: Hautkrebs durch radioaktiven Goldring. Hautarzt 24:489-491, 1973. 5. Steams F: Challenges in Dermatology 4:3-4, 1979. 6. Boggs RF, Schmidt GD, Williams KD: Radiological health aspects of spent radon seeds. Radiological Health Data and Reports 10:189, 1969.
I
The curious case of the radioactive ring It began as an act of love. A young professor was married in a double-ring ceremony in December, 1940, and the young couple wore their rings constantly. Recurring skin irritation developed under both rings, necessitating over twenty years of dermatologic treatment, including x-ray. Not believing conventional explanations of their condition, the professor fortuitously thought of radiation and confirmed the presence of radioactivity in each ring, He reported this to Drs. Simon and Hartley of the U. S. Atomic Energy Commission, who in turn reported the incident. 1 The rings proved to be contaminated with breakdown products from radon "seeds," orginially used to treat a variety of benign and malignant conditions. Two parallel cases were reported in the next year from western New York. 2':~Other cases were seen in the Buffalo, NY, area, but went unreported except for a case in 1973.4 Eventually, eight cases were known when a man with a deep, chronic ring finger ulceration came into my office in 1977. He triggered the interest and publicity that came through the media in 1981. Being the new dermatologist in town, this was all news to me, and I found it fascinating. Most of the other dermatologists had had a case or had seen one at a meeting, and we all agreed there were probably more rings out there. The case came out as a pictorial study in a small journal and attracted passing interest when presented at two meetings. ~ A brief symposium presentation at the meeting of the American Academy of Dermatology brought the case to the attention of Malcolm Manber of Medical World News. Their publisher put it on their medical news wire service and it reached the media. A Buffalo television station, alerted by a viewer's call, established a radioactivity testing center, soon copied throughout the western New York area. Thousands of pieces of jewelry have been examined, and at least 150 pieces of jewelry contaminated with radiation have been identified. So far, almost all known 696
pieces have come from New York or northwestern Pennsylvania, the overwhelming majority from two or three counties. It seems that discovery to date has been a function of knowledge and numbers. Existence of this phenomenon was common knowledge around Buffalo, Olean, and Rochester, NY, and was mentioned intermittently in meetings of the BuffaloRochester Dermatological Society. In that area, a reaction on the fourth finger makes one think of radioactivity exposure as much as a ring dermatitis or an erosio. The large number of items identified so far this year reflects local publicity and the large number of items tested. There seems to be a ratio of one radioactive piece per thousand checked. Testing programs in other locales might discover items if sufficient numbers of pieces were examined. Many aspects of the radioactive ring cases stir the imagination. This is a "natural experiment" of chronic, low-dose radiation exposure causing cancer, to be compared with those of uranium miners and radium dial painter's osteosarcoma. The emitted doses are miniscule; it is not surprising that earlier physicians considered them harmless. Nonetheless, the cancers are real and have necessitated excision, grafting, chemotherapy, and amputations. The magnitude of the problem is totally unknown. The Bureau of Radiological Health documented the existence of eighteen radon seed manufacturing plants in the United States but estimated that there were thirty or forty. ~ No records exist concerning the disposition of their "spent" radon seeds. These seeds were used widely throughout the country; many of them must still be around. However circumscribed this phenomenon has been, it is inconceivable that other pieces of radioactive gold will not surface in the Midwest, South, and West sooner or later. Soaring gold prices in the past two years bring old jewelry out of drawers and safe deposit boxes and back into 0190-9622/81 / 120696+02500.20/0 © 1981 Am Acad Dermatol
Volume 5 Number 6 December, 1981 circulation. Individual craftsmen rely on purchasing and recycling old gold. So far, all of the radioactive gold has been incorporated into jewelry and watches. I have heard of a case of a radioactive gold dental filling, but it was reportedly made in England, Radioactive gold dental restorations next to a mucous membrane might promote squamous cell carcinomas much more lethal than the cutaneous ones. Initially, it seemed that all significant pieces were manufactured in the 1930s and 1940s. The majority of them had either been custom-crafted or " s i z e d " with a small radioactive insert. Now a number of pieces manufactured in the 1950s and 1960s are turning up, and an Ohio gynecologist just discovered that his ring, purchased in Sarasota, FL in 1978, was radioactive. Evidently the problem is more widespread than imagined. Consider the feelings of a graduating class of a Buffalo high school when they found their graduation pins and rings were "hot"! T w o recent discoveries are significant. A child's gold-plated cross, found in Toronto, was radioactive. All previous pieces have been solid. If radioactive gold has been used in plating processes, a small amotmt would go a long way, and its distribution could be quite widespread. Veterinary sources reveal that gold seeds are used for many inflammatory and neoplastic conditions in horses. Presumably, the seeds are processed with the rest of the horse when rendered, ending up in pet foods, et cetera. Efforts were evidently made to decontaminate the gold from radon seeds before it was used in manufacturing. The Pb/Au ratio gives an indication of purity. Normal 24-K gold has one part impurities per ten thousand, but much of the recovered gold is pure to one part per million. Gold of this purity is normally used only for metallurgi-
Radioactive ring
697
cal research; the process by which it was produced (and who did it) remains unknown. We are left with many questions: "Where did the radon seeds come from? . . . . How much radioactive gold is in the hands of the public n o w ? " "Where is it? . . . . How did such low-dose radiation cause cancer? . . . . Is there danger for the many people who have retained radon seed implants?" In the long run, awareness of the phenomenon and a readiness to test suspicious pieces and biopsy suspicious lesions will be the first step in answering these questions. Report known cases to the Division of Medical Radiation Exposure, Bureau of Radiological Health, Rockville, MD 20851. In 1969, the Bureau of Radiological Health called a meeting of an Ad Hoc Committee on the Control of Spent Radon Seeds to review this problem and to make recommendations on future actions. They concluded that radioactive contm'nination of gold from spent radon seeds did not appear to be a widespread public health hazard. With the clarity of hindsight, we can no longer abide by their conclusion.
Frederic W. Stearns, M.D. Tulsa, OK REFERENCES
1. Simon N, Hartley J: Skin reactions from gold jewelry contaminated with radon deposit, lAMA 200:254-255, 1967. 2. Leone RA: Radiodermatitis caused by a radioactive gold ring. lAMA 206:2113-2114, 1968. 3. Gerwig T, Winer M: Radioactive jewelry as a cause of cutaneous neoplasm, lAMA 205:595-596, 1968. 4. Holubar K, et al: Hautkrebs durch radioaktiven Goldring. Hautarzt 24:489-491, 1973. 5. Steams F: Challenges in Dermatology 4:3-4, 1979. 6. Boggs RF, Schmidt GD, Williams KD: Radiological health aspects of spent radon seeds. Radiological Health Data and Reports 10:189, 1969.