Forman D, Cook-Mozaffari P, Darby S, Davey G, Stratton I, Doll R, Pike M
Imperial Cancer Research Fund Cancer Epidemiology and Clincal Trials Unit, Radcliffe Infirmary, Oxford, UK.
Nature. 1987;329(6139):499-505. doi: 10.1038/329499a0.
The OPCS report on cancer incidence and mortality in the vicinity of nuclear installations in England and Wales provides a mass of information that is so large that it should be possible to detect quite small changes in disease levels with considerable confidence. The data on cancer mortality are less subject to selective bias than the registration data on which incidence rates are based, and they provide the firmest grounds on which evidence of any effect can be obtained. These data show conclusively that there has been no general increase in cancer mortality in the vicinity of nuclear installations in a 22-year period beginning several years after the opening of the installations that have released the largest amounts of radionuclides to the environment. On the contrary, the mortality from cancer has tended to be lower in the LAAs in the vicinity of nuclear installations than in control LAAs selected for their presumed comparability with the former. This is unlikely to be due to a protective effect of ionizing radiation and suggests that, despite the efforts that were made to choose comparable control areas, there were non-installation differences between the populations relevant to the risk of dying from one or other type of cancer. Detailed examination of the few types of cancer that were relatively more common in the installation areas suggest that several of the differences were most likely to be due to chance, diagnostic artefacts or social factors rather than to any hazard specifically related to the installations. One disease provides a possible exception: namely, leukaemia in the age group 0-24 years. Two other diseases need further investigation, multiple myeloma and Hodgkin's disease in the older age group 25-74 years. The excess mortality rates recorded from these cancers were not large, and it has yet to be established that they are not due to general confounding by other environmental or socio-economic factors.
英国国家统计局(OPCS)关于英格兰和威尔士核设施附近癌症发病率和死亡率的报告提供了大量信息,信息量如此之大,以至于应该能够相当有把握地检测到疾病水平的微小变化。癌症死亡率数据比发病率所基于的登记数据更不易受到选择性偏差的影响,并且它们为获得任何影响的证据提供了最确凿的依据。这些数据确凿地表明,在向环境释放了大量放射性核素的核设施开放数年之后开始的22年期间,核设施附近的癌症死亡率并没有普遍上升。相反,核设施附近的地方卫生当局区域(LAAs)的癌症死亡率往往低于为与前者进行假定比较而选择的对照LAAs。这不太可能是由于电离辐射的保护作用,这表明,尽管在选择可比对照区域方面做出了努力,但与死于一种或另一种癌症风险相关的人群之间存在与设施无关的差异。对在设施区域相对更常见的少数几种癌症类型进行的详细检查表明,其中一些差异很可能是由于偶然、诊断假象或社会因素,而不是与设施具体相关的任何危害。一种疾病可能是个例外:即0至24岁年龄组的白血病。另外两种疾病需要进一步调查,即25至74岁年龄组的多发性骨髓瘤和霍奇金病。这些癌症记录的超额死亡率并不高,而且尚未确定它们不是由其他环境或社会经济因素的一般混杂作用导致的。