Residents of geothermal areas have higher incidence of non-Hodgkin's lymphoma, breast cancer, prostate cancer, and kidney cancers than others. These populations are exposed to chronic low-level ground gas emissions and various pollutants from geothermal water. The aim was to assess whether habitation in geothermal areas and utilisation of geothermal water is associated with risk of cancer according to duration of residence.
The cohort obtained from the census 1981 was followed to the end of 2013. Personal identifier was used in record linkage with nation-wide emigration, death, and cancer registries. The exposed population, defined by community codes, was located on young bedrock and had utilised geothermal water supply systems since 1972. Two reference populations were located by community codes on older bedrock or had not utilised geothermal water supply systems for as long a period as had the exposed population. Adjusted hazard ratio (HR), 95% confidence intervals (CI) non-stratified and stratified on cumulative years of residence were estimated in Cox-model.
The HR for all cancer was 1.21 (95% CI 1.12-1.30) as compared with the first reference area. The HR for pancreatic cancer was 1.93 (1.22-3.06), breast cancer, 1.48 (1.23-1.80), prostate cancer 1.47 (1.22-1.77), kidney cancer 1.46 (1.03-2.05), lymphoid and haematopoietic tissue 1.54 (1.21-1.97), non-Hodgkin´s lymphoma 2.08 (1.38-3.15) and basal cell carcinoma of the skin 1.62 (1.35-1.94). Positive dose-response relationship was observed between incidence of cancers and duration of residence, and between incidence of cancer and degree of geothermal/volcanic activity in the comparison areas.
The higher cancer incidence in geothermal areas than in reference areas is consistent with previous findings. As the dose-response relationships were positive between incidence of cancers and duration of residence, it is now more urgent than before to investigate the chemical and physical content of the geothermal water and of the ambient air of the areas to detect recognized or new carcinogens.
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University of Tampere, Faculty of Social Sciences, Epidemiology Group, Arvo, Arvo Ylpön katu 34, 33520 Tampere, Finland; Petrov National Research Medical Center of Oncology, Leningradskaya 68, Pesochny, Saint-Petersburg, 197758, Russia. Electronic address: firstname.lastname@example.org.
Breast and cervical cancer are among the leading causes of preventable cancer deaths in women in Russia. The aim of this study is to analyze changes in breast and cervical cancer incidence and mortality trends using data from the Russian State Cancer Registry.
The age-standardized rates of cervical cancer incidence (1993-2013) and mortality (1980-2013) were analyzed using piecewise linear regression. Age-period-cohort models were used to estimate the temporal effects and provide future predictions.
Breast and cervical cancer incidence rates uniformly increased over two decades from 33.0 to 47.0 per 100,000 and from 10.6 to 14.2 per 100,000, respectively. Breast cancer mortality rates however declined from 17.6 to 15.7 in 2013, while cervical cancer mortality increased steadily from 5.6 to 6.7. Breakpoints in the risk occurred in cohorts born 1937-1953, indicating a recent generational decrease in breast cancer mortality, but a concomitant increase in cervical cancer. Cervical cancer has already surpassed breast cancer in terms of years of life lost (YLL) (23.4 per death vs 18.5 in 2009-2013), while future projections suggest that the annual YLL could reach 1.2 million for cervical cancer and (decline to) 1.8 million for breast cancer by the year 2030.
The temporal patterns of breast cancer incidence and mortality in Russia are in line with other countries in Europe, although cervical cancer rates and the risk of occurrence in recent generations is rapidly increasing; these trends underscore the need to place immediate priority in national cervical vaccination and screening programs.
There is a four to fivefold variation in breast cancer incidence rates across different countries. The lowest rates are observed in Asia, and the highest rates are observed in western Europe and North America. The incidence of breast cancer has increased in all countries since 1960. We studied in detail (whenever possible) the changes in incidence and mortality between 1955 and 1990 in four age groups (35-44, 45-54, 55-64 and 65-74) for 11 "representative" countries (USA, England and Wales, Norway, Hungary, Yugoslavia, Spain, Colombia, Singapore, Japan, India and China). The largest increase in incidence took place in Japan and Singapore. The incidence rate for women aged 35-44 in Japan doubled between 1960 and 1985 and by 1985 was roughly two thirds the USA rate. There has been essentially no change in mortality rates in the USA, England and Wales or Norway, whereas there has been a 50-60% increase in Japan, Singapore and Hungary. Most of the observed increase in incidence rates in the USA, England and Wales and Norway may be "artefactual", that is, due to changes in screening patterns. Screening may also have contributed to the rate increase in other countries, but outside western Europe and North America the major part of the increase is likely to be due to changes in known and suspected breast cancer risk factors.
The age-standardized breast cancer mortality rate for Canadian females increased only slightly during the period 1941-1971. In contrast, the age-standardized breast cancer incidence rate for Saskatchewan females more than doubled during the same period. In the interval 1954-1973 there were significant increases in the age-specific mortality rates for females 50-64 years old and in the age-specific incidence rates for five of the six age groups in the 45 to 74 year range. Breast cancer mortality rates during 1970-1972 varied considerably by province. Age-specific rates in the 30-69 year range were significantly and negatively correlated with the proportions by province of married women first married at age 15-19. In Canada and Saskatchewan, respectively, the age-specific breast cancer mortality and incidence rates for females 40-59 years old were significantly and negatively correlated with cohort fertility rates at age 20-24. These data support the hypothesis that early pregnancy protects against breast cancer. The sharp decline in fertility rates since 1960 may result in an increased incidence of breast cancer in the future.
Breast cancer incidence is decisively influenced by life style, which probably to a large extent accounts for the more than fivefold international differences in incidence. Hence breast cancer is a potentially preventable disease. The lifetime risk of having a breast cancer diagnosed approaches 6% in the high-risk Nordic countries where the disease constitutes one-fourth of all malignant diseases in the female. A trend towards increasing incidence over several decades suggests a continuing addition of causative environmental agents affecting primarily the risk after the menopause. A constant mortality despite increasing incidence figures seems to be due to earlier diagnosis or a trend towards tumours with a lower malignancy potential rather than to therapeutic improvements. Breast cancer patients show an excess death rate also after 20 years of observation. Recent studies have, however, suggested the existence of a cured fraction constituting about 35% of all cases. The disease has also shown a more favourable prognosis in younger patients.
From 1958 to 1987, a total of 269 primary breast cancers were diagnosed in 261 women living in the Faroe Islands. The five-year survival was 46.7% (95% confidence interval 40.3-53.0%) and the median survival four years and three months. The incidence of breast cancer in the Faroe Islands remained constant from 1958 to 1972 after which an increase occurred. At present, one in 20 Faroe women will develop breast cancer before the age of 75 years. The time trend in breast cancer incidence is similar in the Faroe Islands and in Denmark, but the incidence is significantly lower in the Faroe Islands at a level corresponding to 2/3 of the Danish. This difference is presumed to be due to a different prevalence of risk factors for development breast cancer.