Case-control study of leukaemia and non-Hodgkin's lymphoma in children in Caithness near the Dounreay nuclear installation

Case-control study of leukaemia and non-Hodgkin's lymphoma among children aged 0-4 years living in west Berkshire and north Hampshire health districts

OBJECTIVE

To investigate the relation between parental employment in the nuclear industry and childhood leukaemia and non-Hodgkin's lymphoma.

DESIGN

Case-control study. SETTING-West Berkshire and Basingstoke and North Hampshire District Health Authorities.

SUBJECTS

54 children aged 0-4 years who had leukaemia or non-Hodgkin's lymphoma diagnosed during 1972-89, who were born in the study area and were resident there when cancer was diagnosed. Six controls were selected for each case: four from hospital delivery registers and two from livebirth registers maintained by the NHS central register. Controls were matched for sex, date of birth (within six months), and area of residence at birth and time of diagnosis.

MAIN OUTCOME MEASURES

Parents' employment by the nuclear industry and exposure to ionising radiation at work.

RESULTS

Five (9%) of the 54 cases and 14 (4%) of the 324 controls had fathers or mothers, or both, who had been employed by the nuclear industry (relative risk 2.2, 95% confidence interval 0.6 to 6.9). Nuclear industry employees who work in areas where exposure to radiation is possible are given film badges to monitor their exposure to external penetrating ionising radiation. Three fathers of cases and two fathers of controls (and no mothers of either) had been monitored in this way before their child was conceived (relative risk 9.0, 95% confidence interval 1.0 to 107.8). No father (of a case or control) had accumulated a recorded dose of more than 5 mSv before his child was conceived, and no father had been monitored at any time in the four years before his child was conceived. A dose-response relation was not evident among fathers who had been monitored.

CONCLUSIONS

These results suggest that the children of fathers who had been monitored for exposure to external penetrating ionising radiation in the nuclear industry may be at increased risk of developing leukaemia before their fifth birthday. The finding is based on small numbers and could be due to chance. If the relationship is real the mechanisms are far from clear, except that the effect is unlikely to be due to external radiation; the possibility that it could be due to internal contamination by radioactive substances or some other exposure at work should be pursued. The above average rates of leukaemia in the study area cannot be accounted for by these findings.

Childhood cancer and paternal exposure to ionizing radiation: preliminary findings from the Oxford Survey of Childhood Cancers

Paternal occupational data already collected as part of the Oxford Survey of Childhood Cancers have been reviewed. Information on occupations during or before the relevant pregnancy was sought for 15,279 children dying from cancer in England, Wales, and Scotland in the period 1953-81, and for an equal number of matched controls. Estimates were made for paternal exposure to human-made external ionizing radiation in the six months before conception of the survey child--as judged from job histories and dates of birth. Assessments were also made for potential exposure to unsealed sources of radionuclides. Of the eight fathers placed in the highest dose group (> or = 10 mSv, external radiation), four were cases and four were controls. For the second dose group (5-9 mSv), the corresponding numbers were eight and four, and for the lowest exposed group (1-4 mSv), they were 55 and 42. There were 27 case fathers with potential exposure to radionuclides and only 10 control fathers. The independent effects of the two radiation variables were assessed by means of multiple logistic regression. Relative risks for estimated doses of external radiation were close to unity, but for radionuclide exposure the relative risk was 2.87 (95% CI = 1.15-7.13). These preliminary findings suggest that paternal exposure to radionuclides is a more likely risk factor for childhood cancer than exposure to external radiation.

Viruses, clusters and clustering of childhood leukaemia: a new perspective?

Clusters of childhood leukaemia have, during a lengthy and controversial history, focussed attention on two alternative putative aetiological agents: infections and localised environmental pollution. In the United Kingdom emphasis is currently placed on the latter because of reports of localised clusters in the vicinity of two nuclear reprocessing plants. Now the most recent studies of spatial clustering in the United Kingdom also support the hypothesis that a substantial population of cases of childhood acute lymphoblastic leukaemia (ALL) arise as a rare host response to certain patterns of exposure to common infectious agents--the aberrant response model. Relevant aspects of the epidemiology of ALL are reviewed from this perspective and the hypothesis shown to be capable of unifying reported associations with different types of risk factor. It is probable that specific agent(s) are involved though none have been identified and these may share many epidemiological characteristics of herpes viruses. The possible relevance of these results to associations with prenatal parental occupational exposures to dusts and ionising radiation is explored.

Childhood leukaemia and non-Hodgkins lymphoma in young people living close to nuclear reprocessing sites

An increased incidence of leukaemia and NHL has been recorded close to Britain's two nuclear reprocessing sites at Sellafield in West Cumbria and Dounreay in Northern Scotland. Two hypotheses have been advanced to explain the excesses - paternal preconceptional irradiation (PPI) and an infective basis promoted by population mixing. Subsequent studies have provided no support for the PPI hypothesis and have also shown that this was derived from the analysis of a sub-group. In contrast, support for the population mixing hypothesis has come from a series of studies of residential and occupational situations. One of these showed that the excess near Dounreay was part of a wider increase in rural areas of Scotland affected by the unusual mixing associated with away-from-home work in the North Sea oil industry, being more marked in areas of relatively high social class. It is probable that the excess in Seascale is due to related demographic factors, this parish being extreme in its high social class, geographic isolation and its proximity to Sellafield, the largest, most changing industrial site in rural Britain.

Incidence of leukaemia and other cancers in birth and schools cohorts in the Dounreay area

OBJECTIVE

To determine whether a raised incidence of leukaemia in the Dounreay area occurred in children born to local mothers (birth cohort) or in those who moved to the area after birth (schools cohort) and also whether any cases of cancer have occurred in children born near Dounreay who may have moved elsewhere.

DESIGN

Follow up study.

SETTING

Dounreay area of Caithness, Scotland.

SUBJECTS

4144 children born in the area in the period 1969-88 and 1641 children who attended local schools in the same period but who had been born elsewhere.

MAIN OUTCOME MEASURES

Cancer registration records linked to birth and school records with computerised probability matching methods.

RESULTS

Five cancer registrations were traced from the birth cohort compared with 5.8 expected on the basis of national rates (observed to expected ratio 0.9, 95% confidence interval 0.3 to 2.0). All five cases were of leukaemia (2.3, 0.7 to 5.4). In the schools cohort three cases were found (2.1, 0.4 to 6.2), all of which were of leukaemia (6.7, 1.4 to 19.5). All eight children were resident in the Dounreay area at the time of diagnosis; thus no cases were found in children who were born in or had attended school in the study area but who subsequently moved away.

CONCLUSION

The raised incidence of leukaemia in both the birth and schools cohorts suggests that place of birth is not a more important factor than place of residence in the series of cases of leukaemia observed near Dounreay area.

Major histocompatibility complex, t-complex, and leukemia

In experimental models, leukemia was the first disease shown to have an association with the major histocompatibility complex (MHC) genes. In humans, several allelic human-leukocyte antigen (HLA) associations also have been recognized. In addition to allelic associations, atypical HLA segregation patterns have been observed in leukemic families. These include a higher frequency of HLA-identical unaffected siblings, increased HLA homozygosity and increased maternal HLA-DR identity. These observations suggest preferential transmission of disease-associated haplotypes and a male transmission bias in leukemic families. The lack of disease-specific segregation, however, supports the idea that the HLA system is not directly relevant in leukemogenesis. Therefore, the existence of another genetic region linked to the MHC, causing segregation distortion, and containing recessive leukemia susceptibility genes may be postulated. The mouse t-complex would fit this model. This gene complex has recessive (semi-) lethal genes, is transmitted preferentially through fathers, and both the mouse t-complex and its rat homolog, growth and reproduction complex grc, confer susceptibility to carcinogenesis. This model could also explain the increased spontaneous abortion rate in mothers of leukemic patients, epidemiologic associations of leukemia with oral clefts and neuroectodermal tumors, and the transmission of a radiation-induced leukemia risk through fathers. Such segregation distortion might be the reason behind the maintenance of a gene(s) with a lethal effect in the population.

Incidence of childhood malignancies in the vicinity of west German nuclear power plants

The incidence of childhood malignancies in 20 areas surrounding major nuclear installations is compared with the incidence in matched control regions. The study is based on the registry of childhood malignancies in the Federal Republic of Germany and includes 1,610 cases which were diagnosed before 15 years of age from 1980 to 1990. The relative risk (RR) was 0.97 for all malignancies and 1.06 for acute leukemia in all regions within a 15 km radius of an installation. Increased RR was observed in subgroups for acute leukemia before five years of age and for lymphomas, especially in regions close to installations (less than 5 km) which started operation before 1970. Most of this increase was attributable to an unexpectedly low incidence in the control regions which could not be explained by analyzing possible confounding factors. Using the same control regions, a comparable and even more pronounced increase of RRs was observed in regions where nuclear power plants have been projected.

Environmental radiation: a cause for concern?

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Cancer risks related to electricity production

The International Agency for Research on Cancer has previously evaluated the cancer risks associated with fossil fuel-based industrial processes such as coal gastification and coke production, substances and mixtures such as coal tars, coal tar pitch and mineral oils, and a number of substances emitted from fossil-fuelled plants such as benzo[a]pyrene and other polycyclic aromatic hydrocarbons, arsenic, beryllium, cadmium, chromium, nickel, lead and formaldehyde. Based on these evaluations and other evidence from the literature, the carcinogenic risks to the general population and occupational groups from the fossil fuel cycle, the nuclear fuel cycle and renewable cycles are reviewed. Cancer risks from waste disposal, accidents and misuses, and electricity distribution are also considered. No cycle appears to be totally free from cancer risk, but the quantification of the effects of such exposures (in particular of those involving potential exposure to large amounts of carcinogens, such as coal, oil and nuclear) requires the application of methods which are subject to considerable margins of error. Uncertainties due to inadequate data and unconfirmed assumptions are discussed. Cancer risks related to the operation of renewable energy sources are negligible, although there may be some risks from construction of such installations. The elements of knowledge at our disposal do not encourage any attempt toward a quantitative comparative risk assessment. However, even in the absence of an accurate quantification of risk, qualitative indication of carcinogenic hazards should lead to preventive measures.

Parental employment at time of conception and risk of cancer in offspring

Studies on the possible association between exposures of parents at the time off conception and cancer in their offspring have provided no clear answer. In this large, population-based, record-linkage study, 1747 childhood cancer cases were identified in the Danish Cancer Registry and matched with 8630 population controls. Specific information on the employment held by each parent at the time of conception and during early pregnancy was obtained through record linkages. The most recent job titles of the parents were also supplied. Significantly increased risks for renal cancer (mainly Wilms' tumour) and for osteogenic and soft tissue sarcomas were observed in children in association with mothers' employment in medical and dental care, based on 15 observations and odds ratios (OR) of 2.5-4.0. The risk for cancers at all sites was significantly elevated in children of female nurses (OR = 1.4; n = 75) and of male and female physicians, dentists, dental assistants, veterinarians and pharmacists combined (OR = 1.4; n = 53). Handling of drugs, exposure to anaesthetics and infections during pregnancy are suggested to be potential risk factors. Significantly increased risks were also observed for children of fathers employed in the manufacture of iron and metal structures (OR = 2.2; n = 16), in machine repair workshops (OR = 2.8; n = 6), as machinists (OR = 1.6; n = 47) and as smiths (OR = 1.5; n = 28). The suggestion in earlier studies that exposures to hydrocarbons and lead are risk factors for childhood cancer could not be supported by our analysis. Overall, few associations were observed; it was therefore concluded that parental occupation is not likely to be a major risk factor for childhood cancer.