No abstract

This study suggests that in patients with inflammatory breast cancer and nonmetastatic disease, an aggressive surgical approach may be justified with the goal of a negative surgical margin. Achievement of this local control is associated with a better overall outcome for this subset of patients. The ability to obtain negative margins may further identify a group of patients with a less aggressive tumor biology that may be more responsive to other modalities of therapy.

Detailed information concerning human food consumption patterns necessary for relating pollutant body burdens to environmental contamination levels was compiled to be used in lieu of site-specific data for calculating health impacts arising from the ingestion of food containing various levels of such pollutants as radionuclides, toxic heavy metals, insecticides and many others. Impact assessments for which food ingestion data is necessary may include pollutants from such diverse sources as mine tailings; construction and operation of power plants (coal, nuclear, gas, geothemol, etc.); recovery of uranium from phosphoric acid; decontamination and decommissioning of nuclear facilities; food additives; industrial and agricultural activities; and methods of disposal of various kinds of waste materials.This paper examines available data on human food consumption rates and estimates dietary intake rates by individuals of various ages. Ingestion parameters include intake rates of water and other beverages, milk, vegetables, fruits, meat, poultry, grain and fish. Information was analyzed from documented surveys of individuals within households and from interviews and personal communications. Although average intake rates are often the only data reported in the literature, ranges as well as averages are included in this paper whenever possible.Various results are tabulated including per capita food consumption in 1955 and 1965 and changes in per capita consumption as well as changes by urbanization. Details of milk consumption are presented by selected sex-age groups. Solid food intake is given by age group. Market basket quantities of foods consumed daily are also tabulated.

Since ingestion of foods is considered a major source of pollutant intake by man, the knowledge of detailed food consumption patterns is necessary to determine health risks and compliance with regulatory standards. As currently-available literature lacks data necessary for complete evaluation of aquatic foods via human consumption of fish and shellfish, a review of recent surveys of fish consumption in the U.S. was performed. The data in these surveys were subjected to statistical analysis to determine percentage distributions of individuals eating different quantities of marine and freshwater fish and shellfish. Included are surveys on consumption of sportfish from the Columbia River (Ho71) and Lake Michigan areas (Hu78) and a comprehensive study of fish consumption in the nine census regions of the U.S. . The results of these studies indicate that the quantity, as reported, of each type of fish eaten increases as a function of the age of consumers. Regional differences are most apparent in the use of shellfish and freshwater fish. About 94% of children and %lo% of adults eat some kind of fish with a per capifa average of 4.97 kglyr. Since this quantity is on an actual consumption basis. as opposed to "as purchased", the per capita consumption rate is lower than usually reported in the literature.

A hazard index methodology called CUMEX has been developed for limiting human exposure to environmental pollutants. Hazard index is defined as Q/Q. where Q is exposure or dose to total-body, organ or tissue from all environmental pathways and Q. is a limit which should not be exceeded because of health risk to humans. Mathematical formulations for hazard indices ire developed for each sampling medium corresponding to each effluent type. These hazard indices are accumulated into composite indices such that total human intake or dose would not exceed the health risk limit. Mathematical formulation for composite hazard indices or CUMEX indices for multiple pollutants are presented. An example CUMEX application to cadmium release from a smelter complex in East Helena, Montana demonstrates details of tne methodology for a single pollutant where human intake occurs through inhalation and ingestion. v TABLE OF CONTENTS PAGE LIST OF TABLES ix LIST OF FIGURES xi LIST OF APPENDICES xiii CONCLUSION APPENDIX t. MODIFICATIONS OF TERMOO APPENDIX II. CADMIUM REVIEW REFERENCES 59 vili LIST OF TABLES TABLE PAGE 3.4.1 Average cadmium concentrations 3.4.2 The average daily intake of cadmium as a function of diet for the U.S. and the study site in Helena, Montana .... 20 4.1.1.1 Source data for East Helena smelter area 22 4.1.2.1 Deposition of cadmium around Helena smelter area 24 4.1.2.2 Air concentrations of cadmium around Helena smelter area 25 4.1.2.3 Deposition of cadmium around Helena smelter area 39 4.1.3.1 Cadmium concentrations in area around East Helena .... 31 4.2.2.1 Equilibrium cadmium concentrations in various compartments 33 4.2.2.2 Equilibrium intakes by reference man S3 ix LIST OF FIGURES FIGURE PAGt 2.2.1 Block diagram of the terrestrial food pathways 4.1.2.1 Average deposition of cadmium (5i_) around East Helena smelter (mg/m 2 /month) 4.1.2.2 Average air concentration of cadmium (5") around East