Hatch M C, Wallenstein S, Beyea J, Nieves J W, Susser M
Division of Epidemiology, Columbia University, School of Public Health, New York, NY 10032.
Am J Public Health. 1991 Jun;81(6):719-24. doi: 10.2105/ajph.81.6.719.
In the light of a possible link between stress and cancer promotion or progression, and of previously reported distress in residents near the Three Mile Island (TMI) nuclear power plant, we attempted to evaluate the impact of the March 1979 accident on community cancer rates.
Proximity of residence to the plant, which related to distress in previous studies, was taken as a possible indicator of accident stress; the postaccident pattern in cancer rates was examined in 69 "study tracts" within a 10-mile radius of TMI, in relation to residential proximity.
A modest association was found between postaccident cancer rates and proximity (OR = 1.4; 95% CI = 1.3, 1.6). After adjusting for a gradient in cancer risk prior to the accident, the odds ratio contrasting those closest to the plant with those living farther out was 1.2 (95% CI = 1.0, 1.4). A postaccident increase in cancer rates near the Three Mile Island plant was notable in 1982, persisted for another year, and then declined. Radiation emissions, as modeled mathematically, did not account for the observed increase.
Interpretation in terms of accident stress is limited by the lack of an individual measure of stress and by uncertainty about whether stress has a biological effect on cancer in humans. An alternative mechanism for the cancer increase near the plant is through changes in care-seeking and diagnostic practice arising from postaccident concern.
鉴于压力与癌症发生或进展之间可能存在联系,以及此前报道的三里岛(TMI)核电站附近居民的困扰,我们试图评估1979年3月的事故对社区癌症发病率的影响。
居住距离核电站的远近在之前的研究中与困扰相关,被视为事故压力的一个可能指标;在TMI方圆10英里内的69个“研究区域”,根据居住距离,对事故后癌症发病率模式进行了研究。
事故后癌症发病率与居住距离之间存在适度关联(比值比=1.4;95%置信区间=1.3, 1.6)。在对事故前癌症风险梯度进行调整后,将最靠近核电站的人群与居住较远人群进行对比的比值比为1.2(95%置信区间=1.0, 1.4)。1982年,三里岛核电站附近癌症发病率在事故后出现上升,持续了一年,然后下降。通过数学建模的辐射排放量并不能解释观察到的上升情况。
由于缺乏个体压力测量方法,以及压力是否对人类癌症有生物学影响存在不确定性,因此从事故压力角度进行的解释受到限制。核电站附近癌症发病率上升的另一种机制是事故后担忧导致的就医和诊断行为的改变。