The Seascale cluster: a probable explanation

Doll, Richard

doi:10.1038/sj.bjc.6690642

Cited by 48 publications

(26 citation statements)

References 24 publications

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“…They cannot, as suggested by Fear et al (1999), be attributed to social class as this was adjusted for in the analysis, though its effects on risk were slight. The findings therefore add to the evidence from many population mixing studies (reviewed in Kinlen, 1995;Doll, 1999), including a recent cohort study (Kinlen and Balkwill, 2001), that strongly support an infective basis in childhood leukaemia. Young children (aged 0-4 years) were of primary interest in the present study.…”

Section: Discussionsupporting

confidence: 68%

Paternal occupational contact level and childhood leukaemia in rural Scotland: a case–control study

Kinlen

Bramald

2001

Br J Cancer

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Significant increases of childhood leukaemia have repeatedly been recorded in situations of marked rural-urban population mixing, confirming the hypothesis that this disease has an underlying infective basis. For the increase in population density implicit in such mixing would increase the level of contacts between susceptible (more prevalent in rural areas) and infected individuals, thereby promoting an epidemic of the relevant infection. The infective agent in question is unknown, but the absence of marked space-time clustering of childhood leukaemia in the general population indicates that it must, as in known infection-based malignancies, be an uncommon response i.e. that the infection itself is largely immunizing. Adults as well as children appear to be involved in its transmission (Kinlen et al, 1993a;Kinlen, 1995).In the case of young (largely pre-school) children aged 0-4 years, an important contribution to their overall level of direct and indirect contacts will be made by fathers' contacts at work. 'High contact' occupations have already been associated with an increased incidence of childhood cytomegalovirus infection and paralytic poliomyelitis. Furthermore, in situations of extreme rural population mixing which had produced excesses of childhood leukaemia, risk was greater among the young children of those whose work involved many community contacts (Kinlen, 1997). No such increases have been found in mortality studies of the question in the (largely urban) general population of England and Wales (Kinlen, 1997;Fear et al, 1999). As an urban population would be expected to have the raised levels of immunity to infective agents often associated with high population density, we have considered the question still open as to whether high levels of paternal occupational contacts have effects on the incidence of childhood leukaemia in young children in a very rural area, where the prevalence of susceptible individuals would be unusually high.We have therefore investigated paternal occupational contact level in relation to childhood leukaemia in a national case-control study in Scotland in the period 1950-89, with particular reference to rural areas and the possible role of population mixing. METHODS Cases and controlsEligible cases consisted of children (aged 0-14) diagnosed in Scotland with leukaemia and non-Hodgkin's lymphoma (NHL) in the years 1950-89. For each child for whom a birth certificate was traced in Scotland that showed a parental occupation, 3 controls of the same age and sex were randomly chosen from the birth registers of the same county. A high proportion of the cases and controls had been included in an earlier investigation of paternal preconceptional occupational exposure to radiation (Kinlen et al, 1993b which gives further details of control selection). Young children (aged 0-4 years) were the main focus of our study, since in the case of older children, a change of paternal occupation is more likely between birth and diagnosis; nevertheless, older children were also investigated. So ...

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Section: Discussionsupporting

confidence: 68%

Paternal occupational contact level and childhood leukaemia in rural Scotland: a case–control study

Kinlen

Bramald

2001

Br J Cancer

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“…The most plausible explanation for these clusters is that childhood leukaemia is a rare response to a common infection and that population mixing between infected and susceptible individuals in these secluded areas produces localized epidemics of the relevant infection and a consequent increased risk of childhood leukaemia (Kinlen, 2000). Such an explanation would also account for the increased levels of childhood leukaemia that have been found after other instances of pronounced urban-rural population mixing in areas with no enhanced exposure to radiation (Doll, 1999;Kinlen, 2000).…”

Section: Introductionmentioning

confidence: 87%

The cancer epidemiology of radiation

2004

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“…The findings confirm those of a recent study in rural Scotland, and also suggest that unusual population mixing (as occurred in Scotland as a result of the North Sea oil industry) is not a necessary requirement for the effect, since comparable mixing has not been a feature of rural Sweden. Kinlen, 1995;Doll, 1999), most recently in a cohort study (Kinlen and Balkwill, 2001). Such rural 'mixing' situations would tend to promote epidemics of an underlying infection by increasing the level of contacts between susceptible and infected individuals, the former being more prevalent in rural areas.…”

mentioning

confidence: 99%

A case–control study of childhood leukaemia and paternal occupational contact level in rural Sweden

2002

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In a national case -control study in Sweden, we investigated whether in rural areas (where susceptible individuals are more prevalent than in urban areas) leukaemia risk was higher among the young children of fathers with many work contacts, as the infective hypothesis has predicted. A total of 1935 cases diagnosed in 1958 -1998 together with 7736 age-matched (within 1 year) population controls (of whom 970 and 3880 respectively were aged 0 -4) were linked to paternal occupational details as recorded in the census closest to the year of birth. Applying the two classifications of occupational contact level used in a study of rural Scotland, the odds ratios for children aged 0 -4 years in the highest contact category (which includes teachers) in the most rural Swedish counties were 3.47 (95% CI 1.54, 7.85) and 1.59 (1.07, 2.38) respectively, relative to the medium and low (reference) category; no such excess was found in urban or intermediate counties. There was also a significant positive trend at ages 0 -4 in the rural counties across the three levels of increasing occupational contact (P for trend 0.02 and 0.03, respectively), but again not in the urban or intermediate counties. No such effect or trend was found at ages 5 -14 in any of the three county groupings. The findings confirm those of a recent study in rural Scotland, and also suggest that unusual population mixing (as occurred in Scotland as a result of the North Sea oil industry) is not a necessary requirement for the effect, since comparable mixing has not been a feature of rural Sweden.

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The Seascale cluster: a probable explanation

Cited by 48 publications

References 24 publications

Paternal occupational contact level and childhood leukaemia in rural Scotland: a case–control study

Paternal occupational contact level and childhood leukaemia in rural Scotland: a case–control study

The cancer epidemiology of radiation

A case–control study of childhood leukaemia and paternal occupational contact level in rural Sweden

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