Strand Leif Aage, Martinsen Jan Ivar, Borud Einar Kristian
Norwegian Armed Forces Medical Services, N-2058 Sessvollmoen, Norway; Cancer Registry of Norway, Box 5313, N-0304 Oslo, Norway.
Cancer Registry of Norway, Box 5313, N-0304 Oslo, Norway.
Cancer Epidemiol. 2015 Aug;39(4):571-7. doi: 10.1016/j.canep.2015.04.011. Epub 2015 May 6.
We investigated cancer incidence and all-cause mortality among 21,582 Norwegian male military peacekeepers deployed to Lebanon during 1978-1998. We also looked at cancer risk according to duration of service in Lebanon, in the occupational groups of cooks and mechanics, and the risk of alcohol- and smoking-related cancers among those who served during high- or low-conflict periods.
The cohort was followed for cancer incidence and all-cause mortality from 1978 through 2012. Standardised incidence ratios (SIR) for cancer and mortality ratios (SMR) were calculated from national rates for the total cohort. SIRs were calculated according to duration of service; among cooks and mechanics; and according to high- and low-conflict exposure. Poisson regression, expressed as rate ratio (RR), was used to see the effect of duration of service, and of conflict exposure.
A decreased risk was found for cancer incidence overall (1050 cases, SIR=0.90, 95% confidence interval [CI] 0.84-0.95) and for cancers of the prostate (SIR=0.78) and skin (other than melanoma) (SIR=0.58). The incidence of rectal cancer was 73% higher in those who served for 1 year or more than in those with shorter-term service (RR=1.73, 95% CI 1.00-3.02). The cancer risk in cooks and mechanics was within expected values. The risk of lung cancer was higher in the high-conflict exposure group than in the low-conflict exposure group (RR=1.79; 95% CI 1.00-3.18). In the total cohort, all-cause mortality was lower than expected (SMR=0.83; 95% CI 0.78-0.88).
We found a "healthy soldier effect" for overall cancer incidence and all-cause mortality. Service during high-conflict periods was associated with a higher risk of lung cancer than service during low-conflict periods, but this risk was in line with that of the reference population.
我们调查了1978年至1998年期间被部署到黎巴嫩的21582名挪威男性军事维和人员的癌症发病率和全因死亡率。我们还根据在黎巴嫩的服役时长、厨师和机械师这两个职业群体，以及在高冲突或低冲突时期服役人员中与酒精和吸烟相关癌症的风险，研究了癌症风险。
对该队列从1978年至2012年进行癌症发病率和全因死亡率随访。根据全国总队列发病率计算癌症标准化发病率（SIR）和死亡率（SMR）。SIR根据服役时长、厨师和机械师群体以及高冲突和低冲突暴露情况进行计算。采用泊松回归，以率比（RR）表示，来观察服役时长和冲突暴露的影响。
总体癌症发病率（1050例，SIR = 0.90，95%置信区间[CI] 0.84 - 0.95）以及前列腺癌（SIR = 0.78）和皮肤癌（非黑色素瘤，SIR = 0.58）的风险有所降低。服役1年或更长时间的人员直肠癌发病率比服役时间较短的人员高73%（RR = 1.73，95% CI 1.00 - 3.02）。厨师和机械师的癌症风险在预期范围内。高冲突暴露组的肺癌风险高于低冲突暴露组（RR = 1.79；95% CI 1.00 - 3.18）。在整个队列中，全因死亡率低于预期（SMR = 0.83；95% CI 0.78 - 0.88）。
我们发现总体癌症发病率和全因死亡率存在“健康士兵效应”。高冲突时期服役比低冲突时期服役患肺癌的风险更高，但该风险与参考人群的风险一致。
