Objective To determine cancer morbidity in members of the armed
forces who took part in tests of chemical warfare agents from 1941 to 1989.Design Historical cohort study, with cohort members followed up to
December 2004.Data source Archive of UK government research facility at Porton
Down, UK military personnel records, and national death and cancer records.Participants All veterans included in the cohort study of mortality,
excluding those known to have died or been lost to follow-up before 1 January
1971 when the UK cancer registration system commenced: 17 013 male members of
the UK armed forces who took part in tests (Porton Down veterans) and a similar
group of 16 520 men who did not (non-Porton Down veterans).Main outcome measures Cancer morbidity in each group of veterans;
rate ratios, with 95% confidence intervals, adjusted for age group and calendar
period.Results 3457 cancers were reported in the Porton Down veterans
compared with 3380 cancers in the non-Porton Down veterans. While overall cancer
morbidity was the same in both groups (rate ratio 1.00, 95% confidence interval
0.95 to 1.05), Porton Down veterans had higher rates of ill defined malignant
neoplasms (1.12, 1.02 to 1.22), in situ neoplasms (1.45, 1.06 to 2.00), and
those of uncertain or unknown behaviour (1.32, 1.01 to 1.73).Conclusion Overall cancer morbidity in Porton Down veterans was no
different from that in non-Porton Down veterans.
The cataract surgical coverage for women is less than that for men. The increased life expectancy in Cambodia and the fact that women constitute 60.6% of the population (aged ≥50 years) at Takeo Province could have had an impact on cataract workload and high prevalence of blindness. A repeated survey using the same methodology after 8-12 years might be helpful in proving genuine change over time.
Objective To investigate any long term effects on mortality in participants in experimental research related to chemical warfare agents from 1941 to 1989.Design Historical cohort study.Data sources Archive of UK government research facility at Porton Down, UK military personnel records, and national death and cancer records.Participants 18 276 male members of the UK armed forces who had spent one or more short periods (median 4 days between first and last test) at Porton Down and a comparison group of 17 600 non-Porton Down veterans followed to 31 December 2004.Main outcome measures Mortality rate ratio of Porton Down compared with non-Porton Down veterans and standardised mortality ratio of each veteran group compared with the general population. Both ratios adjusted for age group and calendar period.Results Porton Down veterans were similar to non-Porton Down veterans in year of enlistment (median 1951) but had longer military service (median 6.2 v 5.0 years). After a median follow-up of 43 years, 40% (7306) of Porton Down and 39% (6900) of non-Porton Down veterans had died. All cause mortality was slightly greater in Porton Down veterans (rate ratio 1.06, 95% confidence interval 1.03 to 1.10, P<0.001), more so for deaths outside the UK (1.26, 1.09 to 1.46). Of 12 cause specific groups examined, rate ratios in Porton Down veterans were increased for deaths attributed to infectious and parasitic (1.57, 1.07 to 2.29), genitourinary (1.46, 1.04 to 2.04), circulatory (1.07, 1.01 to 1.12), and external (non-medical) (1.17, 1.00 to 1.37) causes and decreased for deaths attributed to in situ, benign, and unspecified neoplasms (0.60, 0.37 to 0.99). There was no clear relation between type of chemical exposure and cause specific mortality. The mortality in both groups of veterans was lower than that in the general population (standardised mortality ratio 0.88, 0.85 to 0.90; 0.82, 0.80 to 0.84).Conclusions Mortality was slightly higher in Porton Down than non-Porton Down veterans. With lack of information on other important factors, such as smoking or service overseas, it is not possible to attribute the small excess mortality to chemical exposures at Porton Down.
The experimental archive at Porton Down has proved to be a rich source of data on tests conducted between 1941 and 1989. It has been possible to categorize most veterans according to date of test, chemical group, chemical, type of protection and, for certain chemicals, level of exposure and/or degree of acute toxicity. These categorizations have been used to assign veterans to exposure groups for epidemiological analysis.
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