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Desbiolles A, Roudier C, Goria S, Stempfelet M, Kairo C, Quintin C, Bidondo M, Monnereau A, Vacquier B. Cancer incidence in adults living in the vicinity of nuclear power plants in France, based on data from the French Network of Cancer Registries. Int J Cancer 2017; 142:899-909. [DOI: 10.1002/ijc.31116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Alice Desbiolles
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
| | - Candice Roudier
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
| | - Sarah Goria
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
| | - Morgane Stempfelet
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
| | - Cécile Kairo
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
| | - Cécile Quintin
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
| | - Marie‐Laure Bidondo
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
| | - Alain Monnereau
- French Network of Cancer Registries (FRANCIM) and INSERM U1219 EPICENE Team, Bordeaux France
| | - Blandine Vacquier
- Santé publique France, French National Public Health AgencySaint‐MauriceF‐94415 France
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Spix C, Grosche B, Bleher M, Kaatsch P, Scholz-Kreisel P, Blettner M. Background gamma radiation and childhood cancer in Germany: an ecological study. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2017; 56:127-138. [PMID: 28337585 DOI: 10.1007/s00411-017-0689-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 03/11/2017] [Indexed: 06/06/2023]
Abstract
The relationship of low-dose background gamma radiation and childhood leukaemia was investigated in a number of studies. Results from these studies are inconclusive. Therefore, in the present study 25 years of German childhood cancer data were analyzed using interpolated background annual gamma dose rate per community in an ecological study. The main question was leukaemia; as exploratory questions we investigate central nervous system (CNS) tumours, thyroid carcinomas and diagnoses less likely to be related to radiation. A Poisson regression model was applied and a fractional polynomial model building procedure. As the main sensitivity analysis a community deprivation index was included as a potential confounder. It was found that outdoor background gamma annual dose rates in Germany range roughly from 0.5-1.5 mSv/a with an average of 0.817 mSv/a. No association of annual ambient gamma dose rates with leukaemia incidence was found. Amongst the exploratory analyses, a strong association was found with CNS tumour incidence [rate ratio for 1.5 vs 0.5 mSv/a: 1.35; 95% confidence interval (1.17, 1.57)]. The community level deprivation index was not a confounder. It is concluded that the present study did not confirm an association of annual outdoor ambient gamma dose rate and childhood leukaemia, corresponding to some studies and contrasting others. An association with CNS incidence was found in the exploratory analyses. As this is an ecological study no causal interpretation is possible.
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Affiliation(s)
- Claudia Spix
- German Childhood Cancer Registry at the Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany.
| | - Bernd Grosche
- Federal Office for Radiation Protection, 85764, Oberschleissheim, Germany
| | - Martin Bleher
- Federal Office for Radiation Protection, 85764, Oberschleissheim, Germany
| | - Peter Kaatsch
- German Childhood Cancer Registry at the Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
| | - Peter Scholz-Kreisel
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
| | - Maria Blettner
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical center of the Johannes Gutenberg-University Mainz, 55101, Mainz, Germany
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Mueller W, Gilham C. Childhood leukemia and proximity to nuclear power plants: A systematic review and meta-analysis. J Cancer Policy 2015. [DOI: 10.1016/j.jcpo.2015.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Fornalski KW, Cohen M, Cuttler JM, Dobrzyński L, Doss M, Esposito VJ, Feinendegen LE, Fellman A, Miller ML, Orient J, Pennington CW, Rithidech KN, Sacks B, Sanders CL, Scott BR, Siegel JA, Socol Y, Welsh J. French nuclear power plants and childhood leukemia. Dose Response 2015; 12:518-21. [PMID: 25552953 DOI: 10.2203/dose-response.14-048.fornalski] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jane Orient
- President of Doctors for Disaster Preparedness, USA
| | | | | | - Bill Sacks
- FDA's Center for Devices and Radiological Health (retired), USA
| | | | - Bobby R Scott
- Lovelace Respiratory Research Institute (retired), USA
| | | | | | - James Welsh
- Loyola University Chicago - Stritch School of Medicine, USA
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Thyroid cancer incidence around the Belgian nuclear sites: surrogate exposure modelling. Cancer Epidemiol 2014; 39:48-54. [PMID: 25475063 DOI: 10.1016/j.canep.2014.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 10/02/2014] [Accepted: 10/28/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND In a recent ecological study among residents living around Belgian nuclear sites (the NUCABEL study), significant increased incidences of thyroid cancer were observed around the two nuclear facilities with industrial and research activities (Mol-Dessel and Fleurus), prompting further research. METHODS The data from the NUCABEL study were reanalysed to test the hypothesis of a gradient in cancer incidence with increasing levels of exposure from these sites using three measures of surrogate exposure, being (i) residential proximity, (ii) prevailing wind directions and (iii) simulated dispersion of radioactive discharges. Single-site focussed hypothesis tests were complemented with Generalized Additive Models to estimate the exposure-response relationships. RESULTS For Mol-Dessel, the results of the focussed hypothesis tests were far from significant. For Fleurus, the p-values were much closer to significance with p=0.05 for Bithell's Linear Risk Score using radioactive discharge estimates as surrogate. CONCLUSIONS The re-analyses refute an association with the nuclear facilities for the site of Mol-Dessel. For the site of Fleurus, one of Europe's major production sites of radio-iodines, the results were less conclusive and further research suggests itself.
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Bollaerts K, Fierens S, Van Bladel L, Simons K, Sonck M, Poffijn A, Geraets D, Gosselin P, Van Oyen H, Francart J, Van Nieuwenhuyse A. Thyroid cancer incidence in the vicinity of nuclear sites in Belgium, 2000-2008. Thyroid 2014; 24:906-17. [PMID: 24624964 DOI: 10.1089/thy.2013.0227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Public health concern about nuclear activities have existed since the 1980s. Most studies on this subject investigated childhood leukemia. Thyroid cancer may be another health outcome of interest, because some nuclear installations are a potential source of radioactive iodine isotopes in the environment and because thyroid cancer is known to occur after exposure to these isotopes. METHODS This study describes an ecological study investigating whether there is excessive thyroid cancer incidence among residents living in the vicinity of nuclear sites. Single-site analyses using indirect standardization (standardized incidence ratios [SIRs]) and Poisson regression modeling (rate ratios [RRs]) were conducted. The proximity area is typically defined as a circular zone with a radius of 20 km centered on the site. However, the choice of the size of this area is somewhat arbitrary. Therefore, a sensitivity analysis was carried out to investigate whether the results vary with radii of increasing proximity. RESULTS No increased thyroid cancer incidence was found within the 20 km proximity area around the nuclear power plants of Doel (SIR=0.74 [95% confidence interval (CI)=0.64; 0.84] and RR=0.72 [95% CI=0.63; 0.83]) and Tihange (SIR=0.86 [95% CI=0.70; 1.01] and RR=0.85 [95% CI=0.70; 1.02]). For the sites of Mol-Dessel and Fleurus, where a combination of nuclear research and industrial activities are located, the incidences of thyroid cancer within the 20 km proximity area were higher than expected (Mol-Dessel: SIR=1.19 [95% CI=1.01; 1.36] and RR=1.19 [95% CI=1.02; 1.38]; Fleurus: SIR=1.15 [95% CI=1.02; 1.28] and RR=1.17 [95% CI=1.04; 1.33]). For Chooz, a French nuclear power plant close to the Belgian border, the results were unstable as a result of the small population denominator. For all Belgian nuclear sites, the results were generally insensitive to the choice of the proximity area. CONCLUSIONS No evidence for excessive thyroid cancer incidence around the Belgian nuclear power plants was found. On the other hand, an increased incidence of thyroid cancer was observed around the sites with other nuclear activities. Further research is recommended to verify whether the observed increases could be related to the site-specific nuclear activities.
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Affiliation(s)
- Kaatje Bollaerts
- 1 Scientific Institute of Public Health, Operational Direction Surveillance and Public Health , Brussels, Belgium
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Sermage-Faure C, Laurier D, Goujon-Bellec S, Chartier M, Guyot-Goubin A, Rudant J, Hémon D, Clavel J. Childhood leukemia around French nuclear power plants-The geocap study, 2002-2007. Int J Cancer 2012; 131:E769-80. [DOI: 10.1002/ijc.27425] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 12/20/2011] [Indexed: 11/09/2022]
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Roujeau JC. [Can drug-induced rashes constitute epidemics?]. Ann Dermatol Venereol 2012; 139:3-5. [PMID: 22225735 DOI: 10.1016/j.annder.2011.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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9
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Spycher BD, Feller M, Zwahlen M, Röösli M, von der Weid NX, Hengartner H, Egger M, Kuehni CE. Childhood cancer and nuclear power plants in Switzerland: a census-based cohort study. Int J Epidemiol 2011; 40:1247-60. [PMID: 21750009 PMCID: PMC3204210 DOI: 10.1093/ije/dyr115] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2011] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies on childhood cancer and nuclear power plants (NPPs) produced conflicting results. We used a cohort approach to examine whether residence near NPPs was associated with leukaemia or any childhood cancer in Switzerland. METHODS We computed person-years at risk for children aged 0-15 years born in Switzerland from 1985 to 2009, based on the Swiss censuses 1990 and 2000 and identified cancer cases from the Swiss Childhood Cancer Registry. We geo-coded place of residence at birth and calculated incidence rate ratios (IRRs) with 95% confidence intervals (CIs) comparing the risk of cancer in children born <5 km, 5-10 km and 10-15 km from the nearest NPP with children born >15 km away, using Poisson regression models. RESULTS We included 2925 children diagnosed with cancer during 21 117 524 person-years of follow-up; 953 (32.6%) had leukaemia. Eight and 12 children diagnosed with leukaemia at ages 0-4 and 0-15 years, and 18 and 31 children diagnosed with any cancer were born <5 km from a NPP. Compared with children born >15 km away, the IRRs (95% CI) for leukaemia in 0-4 and 0-15 year olds were 1.20 (0.60-2.41) and 1.05 (0.60-1.86), respectively. For any cancer, corresponding IRRs were 0.97 (0.61-1.54) and 0.89 (0.63-1.27). There was no evidence of a dose-response relationship with distance (P > 0.30). Results were similar for residence at diagnosis and at birth, and when adjusted for potential confounders. Results from sensitivity analyses were consistent with main results. CONCLUSIONS This nationwide cohort study found little evidence of an association between residence near NPPs and the risk of leukaemia or any childhood cancer.
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Affiliation(s)
- Ben D Spycher
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Martin Feller
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Marcel Zwahlen
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Martin Röösli
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Nicolas X von der Weid
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Heinz Hengartner
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Matthias Egger
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
| | - Claudia E Kuehni
- Division of International and Environmental Health, Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland, School of Social and Community Medicine, University of Bristol, Bristol, UK, Swiss Tropical and Public Health Institute, Basel, Switzerland, University of Basel, Switzerland, Paediatric Haematology-Oncology Unit, Centre Hospitalier Universitaire Vaudois, Service de Pédiatrie, Lausanne-CHUV, Switzerland and Ostschweizer Kinderspital, St Gallen, Switzerland
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Ma F, Lehnherr M, Fornoff J, Shen T. Childhood cancer incidence in proximity to nuclear power plants in Illinois. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2011; 66:87-94. [PMID: 24484365 DOI: 10.1080/19338244.2010.506497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objective of this study was to examine childhood cancer incidence in proximity to nuclear power plants in Illinois. Cancer cases diagnosed among Illinois children 0 to 14 years old from 1986 through 2005 were included in the study. Standardized incidence ratio (SIR) was calculated for the geographic zones defined by the proximity to nuclear power plants. The results show that children living within 10 miles of any nuclear power plant did not have significant increase in incidence for leukemia (period 1986-1995: SIR = 0.85 [95% confidence interval, CI: 0.54-1.26]; period 1996-2005: 1.23 [0.91-1.64]), lymphomas [period 1986-1995: 1.38 [0.77-2.27]; period 1996-2005: 0.77 [0.37-1.42]), or other cancer sites. Neither did the children living 10 to 20 miles or 20 to 30 miles from any nuclear power plants. This study did not find any significant childhood cancer excess among children living near nuclear plants and did not observe any dose-response patterns.
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Affiliation(s)
- Fangchao Ma
- a Division of Epidemiologic Studies,Illinois Department of Public Health , Springfield , Illinois , USA
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Abstract
The excess of childhood leukaemia (CL) in Seascale, near the Sellafield nuclear reprocessing site in rural NW England, suggested that an epidemic of an underlying infection, to which CL is a rare response, is promoted by marked population mixing (PM) in rural areas, in which the prevalence of susceptibles is higher than average. This hypothesis has been confirmed by 12 studies in non-radiation situations. Of the five established CL excesses near nuclear sites, four are associated with significant PM; in the fifth, the Krummel power station in Germany, the subject has not been thoroughly investigated.
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Affiliation(s)
- L Kinlen
- Cancer Epidemiology Unit, University of Oxford, Richard Doll Building, Headington, Oxford, OX3 7LF, UK.
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Dauer LT, Brooks AL, Hoel DG, Morgan WF, Stram D, Tran P. Review and evaluation of updated research on the health effects associated with low-dose ionising radiation. RADIATION PROTECTION DOSIMETRY 2010; 140:103-136. [PMID: 20413418 DOI: 10.1093/rpd/ncq141] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
While radiation health risks at low doses have traditionally been estimated from high-dose studies, we have reviewed recent literature and concluded that the mechanisms of action for many biological endpoints may be different at low doses from those observed at high doses; that acute doses <100 mSv may be too small to allow epidemiological detection of excess cancers given the background of naturally occurring cancers; that low-dose radiation research should use holistic approaches such as systems-based methods to develop models that define the shape of the dose-response relationship; and that these results should be combined with the latest epidemiology to produce a comprehensive understanding of radiation effects that addresses both damage, likely with a linear effect, and response, possibly with non-linear consequences. Continued research is needed to understand how radiobiology and epidemiology advances should be used to effectively model radiation worker risks.
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Affiliation(s)
- Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
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Abstract
Latency is associated with the time lag it takes for the health effects resulting from exposure to ionising radiation to show up. However, the term latency can also be applied to the time it takes for a policy to be implemented. This length of time has been suggested as broadly 40-year process. Given that radioactivity was identified and named in 1896, three paradigms are identified and examined from 1896 to 2016 and the criteria for a 4th paradigm suggested for the period 2017-2056. The review examines the changes that have taken place in scientific understanding and in public trust, a few key developments and the associated establishment of the related organisational infrastructure designed to collate and assess the evidence.
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Affiliation(s)
- Jill Sutcliffe
- Institute of Ecology and Environmental Management (IEEM), 43 Southgate Street, Winchester, Hampshire, SO23 9EH, United Kingdom.
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Fairlie I. Childhood cancer near German nuclear power stations. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART C, ENVIRONMENTAL CARCINOGENESIS & ECOTOXICOLOGY REVIEWS 2010; 28:1-21. [PMID: 20390965 DOI: 10.1080/10590500903585366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In 2008, the Kinderkrebs in der Umgebung von Kernkraftwerken (KiKK) study in Germany reported a 60% increase in solid cancers and a 120% increase in leukemias among children living within 5 km of all German nuclear power stations. The study has triggered debates as to the cause(s) of these increased cancers. This article reports on the findings of the KiKK study; discusses past and more recent epidemiological studies of leukemias near nuclear installations around the world, and outlines a possible biological mechanism to explain the increased cancers. This suggests that the observed high rates of infant leukemias may be a teratogenic effect from radionuclides incorporated by pregnant women living near nuclear reactors. Doses and risks from environmental emissions to embryos and fetuses may be larger than suspected. Hematopoietic tissues appear to be considerably more radiosensitive in embryos/fetuses than in newborn babies. Recommendations for advice to local residents and for further research are made.
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Fairlie I. Commentary: childhood cancer near nuclear power stations. Environ Health 2009; 8:43. [PMID: 19775438 PMCID: PMC2757021 DOI: 10.1186/1476-069x-8-43] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 09/23/2009] [Indexed: 05/28/2023]
Abstract
In 2008, the KiKK study in Germany reported a 1.6-fold increase in solid cancers and a 2.2-fold increase in leukemias among children living within 5 km of all German nuclear power stations. The study has triggered debates as to the cause(s) of these increased cancers. This article reports on the findings of the KiKK study; discusses past and more recent epidemiological studies of leukemias near nuclear installations around the world, and outlines a possible biological mechanism to explain the increased cancers. This suggests that the observed high rates of infant leukemias may be a teratogenic effect from incorporated radionuclides. Doses from environmental emissions from nuclear reactors to embryos and fetuses in pregnant women near nuclear power stations may be larger than suspected. Hematopoietic tissues appear to be considerably more radiosensitive in embryos/fetuses than in newborn babies. Recommendations for advice to local residents and for further research are made.
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Faure C, Mollié A, Bellec S, Guyot-Goubin A, Clavel J, Hémon D. Geographical variations in the incidence of childhood acute leukaemia in France over the period 1990–2004. Eur J Cancer Prev 2009; 18:267-79. [DOI: 10.1097/cej.0b013e32832bf43a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
This review considers recent studies regarding the role of environmental factors in the etiology of childhood leukemia and lymphoma. Potential environmental risk factors identified for childhood leukemia include exposure to magnetic fields of more than 0.4 micro Tessla, exposure to pesticides, solvents, benzene and other hydrocarbons, maternal alcohol consumption (but only for certain genotypes), contaminated drinking water, infections, and high birth weight. The finding of space-time clustering and seasonal variation also supports a role for infections. There is little evidence linking childhood leukemia with lifetime exposure to ionizing radiation although fetal exposures to X-rays are associated with increased risk. Breast-feeding, consumption of fresh fruit and vegetables and having allergies all appear to be protective. Burkitt lymphoma (BL) is confined to areas of the world where malaria is endemic, with the additional involvement of the Epstein-Barr virus (EBV) as a co-factor. Environmental risk factors suggested for other types of non-Hodgkin lymphoma (NHL) include exposure to ionizing radiation (both lifetime and antenatal), pesticides, and, in utero exposure to cigarette smoke, benzene and nitrogen dioxide (via the mother). Hodgkin lymphoma (HL) is especially associated with higher levels of socioeconomic deprivation, but breast-feeding seems to confer lower risk. This is consistent with an infection or immune-response mediated etiology for HL.
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Affiliation(s)
- Richard J Q McNally
- School of Clinical Medical Sciences, Child Health, University of Newcastle Upon Tyne, UK.
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Muirhead CR. Exposure assessment: implications for epidemiological studies of ionizing radiation. RADIATION PROTECTION DOSIMETRY 2008; 132:134-138. [PMID: 18922819 DOI: 10.1093/rpd/ncn267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Quantitative estimates of ionizing radiation exposure are often available for use in epidemiological studies. However, depending on the context, the quality of the exposure estimates can vary. For example, the estimates may be specific to individuals in the study or generic values averaged over populations; unavailable for some of the potential study subjects or vary in their form between individuals; based on contemporary measurements or assessed retrospectively; based on measurements alone, on surrogate measures of exposure, or on an exposure assessment model; or, as is often the case, cover one source of radiation exposure rather than all of them. Various ways in which ionizing radiation exposures have been assessed are illustrated through reference to some studies of childhood leukaemia, concerning environmental, medical, natural and parental occupational exposures. Based on this, implications for the interpretation of radiation epidemiological studies are discussed.
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Affiliation(s)
- Colin R Muirhead
- Health Protection Agency, Radiation Protection Division, Centre for Radiation, Chemical and Environmental Hazards, Chilton, Didcot, Oxon OX11 0RQ, UK.
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Laurier D, Hémon D, Clavel J. Childhood leukaemia incidence below the age of 5 years near French nuclear power plants. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2008; 28:401-3. [PMID: 18714138 PMCID: PMC2738848 DOI: 10.1088/0952-4746/28/3/n01] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
A recent study indicated an excess risk of leukaemia among children under the age of 5 years living in the vicinity of nuclear power plants in Germany. We present results relating to the incidence of childhood leukaemia in the vicinity of nuclear power plants in France for the same age range. These results do not indicate an excess risk of leukaemia in young children living near French nuclear power plants.
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Affiliation(s)
- D Laurier
- Institute for Radiation Protection and Nuclear Safety, IRSN/DRPH/SRBE, Fontenay aux Roses cedex, France.
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Case–control study on childhood cancer in the vicinity of nuclear power plants in Germany 1980–2003. Eur J Cancer 2008; 44:275-84. [DOI: 10.1016/j.ejca.2007.10.024] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/11/2007] [Accepted: 10/29/2007] [Indexed: 11/19/2022]
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Stewart BW. Banding carcinogenic risks in developed countries: A procedural basis for qualitative assessment. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2008; 658:124-151. [DOI: 10.1016/j.mrrev.2007.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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23
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Laurier D, Jacob S, Bernier MO, Leuraud K, Metz C, Samson E, Laloi P. Epidemiological studies of leukaemia in children and young adults around nuclear facilities: a critical review. RADIATION PROTECTION DOSIMETRY 2008; 132:182-90. [PMID: 18922823 DOI: 10.1093/rpd/ncn262] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The existence of an increased risk of childhood leukaemia near nuclear installations is a recurrent issue. A review of the related epidemiological literature is presented here. Results for 198 nuclear sites throughout 10 countries were included in the review. In addition to local studies, 25 multi-site studies have been published for eight countries. A large variability was noticed in the quality of the data as well as in the definition of the study population and in the methods of analysis. Many studies present important limits that make the results difficult to interpret. The review confirms that some clusters of childhood leukaemia cases exist locally. However, results based on multi-site studies around nuclear installations do not indicate an increased risk globally. Many studies were launched to investigate possible origins of the observed clusters around specific sites, but up to now, none of the proposed hypotheses have explained them.
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Affiliation(s)
- D Laurier
- Institute for Radiological Protection and Nuclear Safety, IRSN, DRPH/SRBE, BP17, F-92262 Fontenay-aux-Roses Cedex, France.
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Evrard AS, Hémon D, Morin A, Laurier D, Tirmarche M, Backe JC, Chartier M, Clavel J. Childhood leukaemia incidence around French nuclear installations using geographic zoning based on gaseous discharge dose estimates. Br J Cancer 2006; 94:1342-7. [PMID: 16622448 PMCID: PMC2292746 DOI: 10.1038/sj.bjc.6603111] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The present study investigated for the first time the incidence of childhood leukaemia (1990–2001) around French nuclear installations using a geographic zoning based on estimated doses to the red bone marrow due to gaseous radioactive discharges. The observed number of cases of acute leukaemia (O=750) in 40 km2 centred on 23 French nuclear installations between 1990 and 2001 was lower than expected (E=795.01), although not significantly so (standardised incidence ratio SIR=0.94, 95% confidence interval=(0.88–1.01)). In none of the five zones defined on the basis of the estimated doses was the SIR significantly >1. There was no evidence of a trend in SIR with the estimated doses for all the children or for any of the three age groups studied. This study confirmed that there was no evidence of an increased incidence of childhood leukaemia around the 23 French nuclear sites.
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Affiliation(s)
- A-S Evrard
- INSERM, U754, Villejuif, France
- Université Paris Sud, IFR69, Villejuif, France
| | - D Hémon
- INSERM, U754, Villejuif, France
- Université Paris Sud, IFR69, Villejuif, France
| | - A Morin
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN/DRPH/SER/UETP, Fontenay-aux-Roses, France
| | - D Laurier
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN/DRPH/SRBE/LEPID, Fontenay-aux-Roses, France
| | - M Tirmarche
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN/DRPH/SRBE/LEPID, Fontenay-aux-Roses, France
| | - J-C Backe
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN/DRPH/SER/UETP, Fontenay-aux-Roses, France
| | - M Chartier
- Institut de Radioprotection et de Sûreté Nucléaire, IRSN/DRPH/SER/UETP, Fontenay-aux-Roses, France
| | - J Clavel
- INSERM, U754, Villejuif, France
- Université Paris Sud, IFR69, Villejuif, France
- INSERM-U754, 16, avenue Paul Vaillant-Couturier, Villejuif cedex 94807, France. E-mail:
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25
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Bellec S, Hémon D, Rudant J, Goubin A, Clavel J. Spatial and space-time clustering of childhood acute leukaemia in France from 1990 to 2000: a nationwide study. Br J Cancer 2006; 94:763-70. [PMID: 16479258 PMCID: PMC2374236 DOI: 10.1038/sj.bjc.6602980] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the spatial and space–time distributions of cases of childhood acute leukaemia (CL) during 1990–2000 over the whole French territory. A global spatial heterogeneity and a spatial autocorrelation were first considered using the methods proposed by Potthoff and Whittinghill, Moran and Rogerson methods. The presence of space–time interaction between the places of residence and the dates of diagnosis was investigated with the Knox's test. Finally, the Kulldorff's statistic permitted to scan the whole territory in search for localised clusters. Two time periods were considered (1990–1994, 1995–2000). Overall, a statistically significant spatial heterogeneity of a very small magnitude was observed in the incidence of CL over 1990–1994, but neither over 1995–2000 nor over the whole time period. Moreover, a significant overdispersion of 5.5% was evidenced for 0–4 year children living in isolated areas with more than 50 inhabitants per km2. Cases older than 10 years living in the same area at diagnosis also tended to cluster within 6 months.
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Affiliation(s)
- S Bellec
- INSERM U754, Hôpital Paul Brousse, 94807 Villejuif cédex, France.
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26
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Bellec S, Hémon D, Clavel J. Answering cluster investigation requests: the value of simple simulations and statistical tools. Eur J Epidemiol 2006; 20:663-71. [PMID: 16151879 DOI: 10.1007/s10654-005-7924-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2005] [Indexed: 01/09/2023]
Abstract
Cluster investigations remain an important public health issue as the number of reported clusters and public concern increase. This study shows how statistical considerations and a simulation tool may be helpful in providing communities with proper answers to the questions usually raised in such situations: How surprising is an observed childhood cancer excess? What could be learned from a statistical test? What could be learned from a case-control study? Using real demographic and incidence-rate data together with simulations based on the hypothesis that incidence rates are homogeneous, the probabilities of observing given situations were estimated. A number of real situations have been used as examples. The results of the simulation study showed, in detail, that no reliable information on the reality of an observed excess could be obtained a posteriori from a statistical test. A cluster of the same size may or may not be surprising, depending on the spatial area and time window to which the cases are related (i.e., the expected number of cases), and depending on the size of the referential territory to which this area is associated. The lack of power of a case-control study if no particular unusual exposure is present is also addressed. The approach described in this paper can easily be reproduced and adapted to many situations. It may be of assistance to health departments conducting cluster investigations and communicating with the public.
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Affiliation(s)
- Stéphanie Bellec
- French Institute of Health and Medical Research, INSERM, U170, IFR69, Université Paris XI, 16, av. Paul Vaillant-Couturier, F-94807 cedex, Villejuif, France.
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Sommelet D, Clavel J, Lacour B. [Contribution of national paediatric cancer registries to survey and research]. Arch Pediatr 2005; 12:814-6. [PMID: 15904814 DOI: 10.1016/j.arcped.2005.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- D Sommelet
- Service d'oncohématologie pédiatrique, CHU, hôpital d'enfants, rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France.
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