Culpepper dies after 16 months of treatment for nasopharyngeal cancer

Radium Cure May Have Cancer Link: Patients Of Long-Ago Treatment Urged To Get Prompt Checkup

By Melissa B. Robinson, Associated Press
2 May 1999, The Arizona Republic, Final Chaser, Page A13
Copyright 1999 Phoenix Newspapers, Inc.

Steve Culpepper had endured blinding headaches, double vision, brain surgery and the violent nausea of chemotherapy. Then a doctor connected his cancer to nasal radium treatments he received as a boy.

Culpepper remembered that small amounts had been inserted through his nose to treat chronic ear infections, but he never worried about it as he grew older.

Culpepper , who rarely got so much as a cold, had not had a physical in years, much less a consultation about an obscure Cold War-era procedure no longer used.

"If someone had said anyone having these treatments in the '50s or '60s ought to immediately go see an ENT (ear, nose and throat) doctor, he would have gone," said Culpepper 's widow, Patti, of Newport Beach, Calif. "I know he would have gone."

Culpepper, 55, died in January after 16 months of treatment for nasopharyngeal cancer, which affects the nose and upper-throat area.

The government sees no need to warn former radium patients, a stand that enrages public health advocates.

"They're doing a great disservice to the population at risk and not meeting any of their responsibilities," says Stewart Farber, a Rhode Island public health scientist who has spent years researching the medical use of radium.

From the 1940s to the mid-1960s, it was common practice in civilian and military medicine to use nasal applicators containing 50 milligrams of radium to shrink tissues at the entrance of the eustachian tubes. Those tubes help drain and balance pressure in the ear.

A typical regimen involved three to four treatments, a few weeks apart. Over that course, the tissues closest to the radium capsules would have received a radiation dose about 100 times greater than that received by survivors of the bombings of Hiroshima and Nagasaki.

Nasal radium was given mostly to military pilots and submariners troubled by drastic changes in atmospheric pressure and to children who suffered from colds, tonsillitis, ear infections and sinus or adenoid problems.

The practice gradually was abandoned when the military started using pressurized aircraft cabins, effective new treatments such as antibiotics were developed, and questions were raised about radiation's health effects. Years later, radium patients are complaining of tumors, thyroid and immune disorders, brittle teeth and reproductive problems.

Public health advocates say the government should warn former radium patients that they could be at risk of contracting cancer or other diseases. They say notification could save lives by prompting people to get checkups or at least to discuss the matter with doctors.

But the Centers for Disease Control and Prevention said diagnostic tests are unnecessary for anyone who does not show symptoms of a problem.

"Current studies do not indicate substantial increases in risks for . . . disease among those who received radium treatments," the agency said in the March 29, 1996, edition of its Morbidity and Mortality Report.

Farber contends CDC specialists are ignoring important evidence of radium's health risks.

"It's severely impeachable science," he said.

By the CDC's own estimate, as many as 2 million people were treated with nasal radium.

The government has taken some steps to help.

Last year, Congress required the Department of Veterans Affairs to provide health care to veterans who had radium treatments and were suffering head or neck cancer. But little has been done for civilians.

The CDC has cited various studies, two of which dealt specifically with nasal radium.

One 1982 study in Maryland of hundreds of people who had nasal radium from 1943-60 found four cancer deaths - three of the brain and one of the soft palate - in the treated group, compared with none in people who were untreated as children. A follow-up study is awaiting agency review.

Dr. Anne Mellinger-Birdsong of CDC's National Center for Environmental Health said the findings were too small to draw broad conclusions.

Nevertheless, she said, "If necessary, we're going to revise our recommendations."

CDC's approach has not been completely hands-off. The CDC once urged patients who had nasal radium to tell their doctors and posted information about the treatment on the Internet.

But what about those who do not remember?

Mellinger-Birdsong said most people probably will recall such an uncomfortable treatment and can get a physical if they are worried. If they do not remember, "we don't feel it would be that harmful," she said.

The Culpeppers would disagree.

Before Culpepper died in January, he told his family he was glad his mother was not around to see him suffer. "He said, 'Thank God my mother died,' so she wouldn't have felt the guilt for taking him for those radium treatments," Patti Culpepper said.

Culpepper Ancestry: Steve was the son of Robert Cochran Culpepper of Louisiana, son of Dr. James Curran Culpepper. (Source: Steve's sister, Bobbye Culpepper Davis.)