Gardner M J, Hall A J, Downes S, Terrell J D
MRC Environmental Epidemiology Unit (University of Southampton), Southampton General Hospital.
Br Med J (Clin Res Ed). 1987 Oct 3;295(6602):819-22. doi: 10.1136/bmj.295.6602.819.
Records on 1546 children who were identified as having attended schools in Seascale up to November 1984 and were born since 1950 but not in the civil parish were studied. These children lived in or near Seascale for a period of time while they were attending one or more of three local schools and are an additional group to the 1068 children who were identified as born to mothers resident in Seascale in an accompanying study. Even though some of the schoolchildren apparently remained in the village for a short period only all but 7% were followed up through the National Health Service Central Register. Mortality among these children to 30 June 1986 is comparable to that expected at national rates. From all causes there were 10 observed deaths compared with 12.69 expected--a ratio of 0.79 (95% confidence interval 0.38 to 1.45)--and from cancer one observed death compared with 2.04 expected--a ratio of 0.49 (95% CI 0.01 to 2.73). No deaths from leukaemia or lymphoma were reported, but only 0.83 was expected. Since 1971 (the year when cases of cancer were first notified to the NHS Central Register) three non-fatal cases of cancer were reported, including two lymphomas, compared with 2.04 expected and two cases of carcinoma in situ of the cervix compared with 1.79 expected. In addition, there was a case of leukaemia among the schoolchildren which was known previously and had been diagnosed in 1968. There is an interesting difference between the results of this study and the results of the study of children born to mothers who were resident in Seascale. In the latter study there was an excess of leukaemia and of other cancers, but a similar finding is not apparent among children who spent some time at schools in Seascale but were born elsewhere. This raises the question of whether one or more aetiological factors in childhood cancer were acting on a locality specific basis before birth or early in life. This cannot be answered from these cohort studies, but it is hoped that the case-control study that is under way in West Cumbria will provide relevant information.
对1546名儿童的记录进行了研究,这些儿童在1984年11月前被确认曾在西斯科尔的学校就读,他们出生于1950年以后,但并非来自该民政教区。这些儿童在就读当地三所学校中的一所或多所期间,曾在西斯科尔或其附近居住过一段时间,他们是在一项相关研究中被确认其母亲居住在西斯科尔的1068名儿童之外的另一组人群。尽管一些学童显然仅在村里短暂停留过,但除7%之外的所有儿童都通过国民保健服务中央登记处进行了随访。到1986年6月30日,这些儿童的死亡率与全国预期死亡率相当。所有原因导致的死亡中,观察到10例死亡,预期为12.69例——比例为0.79(95%置信区间0.38至1.45);癌症导致的死亡中,观察到1例死亡,预期为2.04例——比例为0.49(95%置信区间0.01至2.73)。未报告白血病或淋巴瘤死亡病例,但预期仅为0.83例。自1971年(癌症病例首次通报给国民保健服务中央登记处的年份)以来,报告了3例非致命癌症病例,包括2例淋巴瘤,预期为2.04例,以及2例宫颈原位癌,预期为1.79例。此外,学童中有1例白血病病例,该病例此前已知且于1968年被诊断。本研究结果与对母亲居住在西斯科尔的儿童的研究结果之间存在一个有趣的差异。在后一项研究中,白血病和其他癌症的发病率过高,但在曾在西斯科尔学校就读但出生在其他地方的儿童中,类似的发现并不明显。这就提出了一个问题,即儿童癌症的一种或多种病因是否在出生前或生命早期就以地区特异性的方式起作用。这些队列研究无法回答这个问题,但希望正在坎布里亚西部进行的病例对照研究将提供相关信息。