Bouges S, Daurès J P, Hébrard M
Laboratoire d'Epidémiologie et de Biostatistiques-Institut Universitaire de Recherche Clinique de l'Université Montpellier I.
Rev Epidemiol Sante Publique. 1999 Jun;47(3):205-17.
The aim of this investigation was to report incidence of childhood leukemia, lymphoma and thyroid neoplasms in children under 15 years of age living in the vicinity of the French Marcoule nuclear reprocessing plant.
This exhaustive and retrospective survey was carried out between 1985 and 1995 in children aged under 14 at the time of diagnosis and living inside a 35 kilometer zone around the nuclear site. 656 practitioners, 109 medical analysis laboratories and 5 hospitals or cancer institutes were investigated. A panel of experts checked each case.
48 cases of acute leukemia (39 acute lymphoid leukemia and 9 acute myeloid leukemia), 15 cases of lymphoma (8 Hodgkin lymphomas--53%--and 7 non hodgkinian lymphomas including 5 Burkitt lymphomas), 1 case of chronic myeloid leukemia and 1 case of papillary thyroid cancer, appeared among the 1,116,442 children-years followed. The total incidences of leukemias and lymphomas were respectively 4.12 and 1.29.10(-5). Standardised Incidence Ratios, calculated according to Poisson methods and bayesian inference, with various reference rates did not show any excess of risk: 100.67 (95% confidence interval 72-131) for leukemia. Children under 5 years old and living in non exposed areas to dominant winds or downstream rhodanian water drawing presented a 3 or 4 fold decreased risk of leukemia than others (the latter still having an identical risk to that of the general population). This was not true for lymphomas, nor for the other age groups.
Over the entire zone, children do not have an increased risk of malignant hematology disease but health monitoring by a systematic collection of cases remains useful around Marcoule. The assumption of aquiferous or air contamination thus still remains questionable: further studies investigating models of contamination are needed to take into account all other nonionizing leucemogenic factors (benzene and viral injection in particular) or correlation studies between health indicators and dosimetry.
本调查旨在报告居住在法国马尔库勒核后处理厂附近15岁以下儿童患白血病、淋巴瘤和甲状腺肿瘤的发病率。
1985年至1995年间，对诊断时年龄在14岁以下、居住在核设施周围35公里区域内的儿童进行了全面回顾性调查。调查了656名从业者、109个医学分析实验室以及5家医院或癌症研究所。由专家小组检查每一个病例。
在随访的1,116,442儿童年中，出现了48例急性白血病（39例急性淋巴细胞白血病和9例急性髓细胞白血病）、15例淋巴瘤（8例霍奇金淋巴瘤——占53%——和7例非霍奇金淋巴瘤，其中包括5例伯基特淋巴瘤）、1例慢性髓细胞白血病和1例乳头状甲状腺癌。白血病和淋巴瘤的总发病率分别为4.12和1.29×10⁻⁵。根据泊松方法和贝叶斯推断计算的标准化发病率比，采用不同的参考率，均未显示出任何额外风险：白血病的标准化发病率比为100.67（95%置信区间72 - 131）。5岁以下且居住在不受主导风影响区域或罗讷河下游取水区域的儿童患白血病的风险比其他儿童降低了3倍或4倍（后者与一般人群的风险相同）。淋巴瘤以及其他年龄组的情况并非如此。
在整个区域内，儿童患恶性血液病的风险并未增加，但在马尔库勒周围通过系统收集病例进行健康监测仍然有用。因此，关于含水层或空气污染的假设仍然存在疑问：需要进一步研究污染模型，以考虑所有其他非电离致白血病因素（特别是苯和病毒感染），或者健康指标与剂量测定之间的相关性研究。
