J7ournal of Epidemiology and Community Health 1993; 47: 109-115 Cancer in young people in the north of England, J Epidemiol Community Health: first published as 10.1136/jech.47.2.109 on 1 April 1993. Downloaded from 1968-85: analysis by census wards Alan W Craft, Louise Parker, Stan Openshaw, Martin Charlton, James Newell, Jill M Birch, Val Blair Abstract some villages, particularly Seascale, near to the Objective-To determine whether the seem- Sellafield nuclear installation, and that they could ing excess of childhood leukaemia and lym- find no biological explanation for this when known phoma identified in Seascale, Cumbria, UK, radiation exposures were taken into consideration. remains unusual when put into a wider The Black report made a number of recommen- context. dations for further study, the results ofwhich have Design-Analysis ofcancer incidence by geo- been published. These include a Seascale birth graphical area. cohort study,2 a Seascale school cohort study,3 Setting-The north ofEngland including the and a case-control study of leukaemia and lym- Northern and North Western Regional phoma in west Cumbria.4 The cohort studies have Health Authority regions and the Southport confirmed an increased risk of leukaemia in those and South Sefton districts of the Mersey children born in Seascale but not in those who Regional Health Authority. attended school in the district ofSeascale but were Subjects-Altogether 6686 cases ofmalignant born elsewhere. The case-control study of leukae- disease in people under 25 years old. mia and lymphoma has pointed to an increased Measurements and main results-Cases of risk for the children of workers employed at the cancer diagnosed before their 25th birthday nuclear installation at Sellafield who were exposed between January 1968 and December 1985 to relatively high doses of radiation. In addition identified from three regional cancer regis- recommendation 4 stated: tries were allocated to a census ward on the 'The Northern Children's Cancer Registry basis of'usual place ofresidence'. Population should be asked to analyse their data using 1961, data were derived from the 1971 and 1981 1971 and 1981 population census data where censuses, and the cancer incidence was cal- appropriate. Also stratification for age at diagnosis culated for each ward. Of the 6686 cases, and grouping by census ward at birth (as well as at there were 1035 cases ofacute lymphoblastic diagnosis) should be undertaken, to determine the leukaemia and 361 of non-Hodgkins lym- contribution these factors make to the incidence of phoma. Wards were ranked by cancer inci- leukaemia at Seascale.' dence and Poisson probability, using The data supplied to the Black enquiry from the different population bases. Seascale ward is Northern Children's Region Malignant Disease http://jech.bmj.com/ the most highly ranked ward for acute lym- Registry were those for 1968-82, using 1981 phoblastic leukaemia for the time periods census population data for children diagnosed 1968-85 or 1968-76. It is not the most highly before their 15th birthday. The purpose of ranked for non-Hodgkins lymphoma. How- recommendation 4 was to put the apparent excess Departments of Child ever, acute Health and Medical combining lymphoblastic leukae- of leukaemia in Seascale into a wider context and Statistics, University mia and non-Hodgkins lymphoma incidence in consultation with the Department of Health of Newcastle upon gives an even more extreme position for and Social Security it was decided to extend Tyne, The Medical Seascale. The most extreme on October 1, 2021 by guest. Protected copyright. School, Framlington Poisson proba- further the recommendation to include data from Place, Newcastle upon bility for any of the analyses was that for the Manchester Children's Tumor Registry and to Tyne. NE2 4HH brain tumours in the electoral ward ofAshton obtain information for all young people diagnosed A W Craft St Michael, Tameside (p=0*000009). L Parker as having cancer before their 25th birthday. It was J Newell Conclusion-The incidence of acute lym- also agreed to include the Southport and South Centre for Urban and phoblastic leukaemia and non-Hodgkins Sefton districts ofthe Mersey health region so that Rural Development lymphoma in the Seascale ward remains high the whole of the Studies, University of coastline from the Solway to the Newcastle upon Tyne. when put into a wider context. For other Mersey could be included. S Openshaw cancers there are wards with even more Seascale is an electoral ward and by analysing M Charlton extreme Poisson probability values. cancer incidence data Department of by electoral ward for the Epidemiology and whole of the Northern and North Western Social Oncology, J Epidemiol Community Health 1993; 47: 109-115 Regional Health Authorities plus the two Mersey University of health districts the relative Manchester. importance of the J M Birch apparent excess described in the Black report V Blair The seeming excess of cancer in young people on could be explored. the Cumbrian coast identified in 1983 by Correspondence to: Professor A Craft Yorkshire Television in a documentary entitled, Windscale: the nuclear laundry led the government Methods Accepted for publication to set up an independent inquiry under the CANCER August 1992 REGISTRATION DATA chairmanship of Sir Douglas Black. The report of Cases of cancer in young people diagnosed this advisory group' concluded that there did seem between January 1968 and December 1985 were to be an excess of leukaemia in young people in ascertained from existing cancer registries. The 110 Alatn W Craft, Louise Parker, Stan Openshaw, Martin Charlton, James Newell, Jill M Birch, Val Blair 0-14 year old children from the northern region all ages but is likely to be better for younger J Epidemiol Community Health: first published as 10.1136/jech.47.2.109 on 1 April 1993. Downloaded from were obtained from the Northern Region Child- people.7 All cases from 0-24 years for the two ren's Malignant Disease Registry which was estab- Mersey districts were ascertained from the Mersey lished in 19685 and for the north west region from Regional Cancer Registry. the Manchester Children's Tumour Registry, Patients included were all those with malignant established in 1953.6 Both registries have a high disease receiving their first treatment, or having level of case ascertainment, estimated at greater the diagnosis confirmed if no treatment given, than 98%, and there is extensive cross checking before their 25th birthday. Those with benign or with other data sources. All cases have central borderline intracranial or intraspinal neoplasms pathological review. The 15-24 year old cases were included but carcinoma in situ of the cervix from the northern and north western regions were was excluded. The National Health Service was obtained from the relevant regional cancer reorganised in 1974 and regional administrative registries. The registries contribute their data to borders changed. The geographical boundaries of the national cancer registration system. Ascer- this study were therefore taken as those areas tainment is thought to be in the region of 94% for common to the pre-1974 Newcastle and Man- Table I Number of cases by registry, agc group (y), and disease category, Age grouips (j) Age groiups (s) i.n New-castle i.n Alanichester r-egistry registry Diagniosis 0-14 15-24 0-14 15-24 Total Acute Ivmphoblastic leukaimia 359 81 459 136 1035 Acute myeloid leukemia 66 59 83 103 311 Chronic mycloid leukaemia 7 13 13 24 57 Other leukaemia 4 9 9 15 37 Northern Astrocytoma/glioma 156 108 192 122 578 Region Medulloblastoma 61 1:3 88 15 177 Ependymoma 30 14 48 16 108 Craniopharyngioma 19 17 19 12 67 Other brain 25 57 26 44 152 Osteosarcoma 40 40 44 61 185 North Ewing's sarcoma 22 26 27 34 109 Western Other bone 3 11 7 17 38 Non-Hodgkin's lymphoma 76 73 95 117 361 Region Hodgkin's lymphoma 56 285 72 353 766 Wilms' tumour 71 94 14 179 Neuroblastoma 71 4 100 6 181 Ganglioneuroblastoma 5 1 2 8 Retinoblastoma 48 41 - 89 Rhabdomyosarcoma 54 11 57 20 142 Other soft tissue sarcoma 20 51 21 71 163 Hepatoblastoma 7 3 10 1 21 Germ cell tumours 31 111 63 198 403 South port 440 191 784 1519 Miscellaneous 104 and c 6686 South Sefton Total 1335 1427 1761 2163 Districts of Mersey Region Table II Poissoni probability rankinlg: all canicers, 1981 census populationi data chester Regional Hospital Boards and the present http://jech.bmj.com/ Niumiibers Statistics Northern and North Westem Regional Health /-, n D I' - *' 1 - 1, ;I; Ward niamiie c Hate Ir(osmlty) Authorities plus the Southport and South Sefton Aged 0- 24 v,, 1968-85: districts of the Mersey region (fig 1). The local Kendal Fell, South Lakeland, Cumbria 526 7 5 8 *0002610 in the Central Bolton, Greater Manchester 4698 24 2 2 0003544 authority administrative counties included Prudhoe South, Tynedale, Northumberland 1374 11 3.5 0004430 study area were Greater Manchester, Tyne and John O'Gaunt, Lancaster, Lancashire 2347 15 2 8 *0004881 Lancashire, Beswick, Manchester, Greater Manchester 3492 19 2-4 *0006681 Wear, Cleveland, Cumbria, Durham, are on October 1, 2021 by guest. Protected copyright. Aged 0-14 sv, 1968-85: and Northumberland. The first three large 6 6-9 *0002804 Seascale, Copelaind, Cumbria 411 metropolitan urban areas with predominantly Easterside, Middlesbrough, Cleveland 1021 8 3.7 *0017235 No 6. Sedgefield, Durham 600 6 4.7 *0019432 heavy engineering and chemical industries while 4 7-1 *0026720 Kendall Fell, South Lakeland, Cumbria 267 the latter four are largely rural. All patients whose Prudhoe South, Tynedale, Northumberland 676 6 4 2 *0034776 'usual place of residence' at the time of diagnosis Aged 15-24 v, 1968-85: Central, Bolton, Greater Manchester 1914 15 2-6 *0009149 was within this area were included.