Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Leading Article
  • Published:

A record-based case–control study of natural background radiation and the incidence of childhood leukaemia and other cancers in Great Britain during 1980–2006

Abstract

We conducted a large record-based case–control study testing associations between childhood cancer and natural background radiation. Cases (27 447) born and diagnosed in Great Britain during 1980–2006 and matched cancer-free controls (36 793) were from the National Registry of Childhood Tumours. Radiation exposures were estimated for mother’s residence at the child’s birth from national databases, using the County District mean for gamma rays, and a predictive map based on domestic measurements grouped by geological boundaries for radon. There was 12% excess relative risk (ERR) (95% CI 3, 22; two-sided P=0.01) of childhood leukaemia per millisievert of cumulative red bone marrow dose from gamma radiation; the analogous association for radon was not significant, ERR 3% (95% CI −4, 11; P=0.35). Associations for other childhood cancers were not significant for either exposure. Excess risk was insensitive to adjustment for measures of socio-economic status. The statistically significant leukaemia risk reported in this reasonably powered study (power 50%) is consistent with high-dose rate predictions. Substantial bias is unlikely, and we cannot identify mechanisms by which confounding might plausibly account for the association, which we regard as likely to be causal. The study supports the extrapolation of high-dose rate risk models to protracted exposures at natural background exposure levels.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. UNSCEAR. United Nations Scientific Committee on the Effects of Atomic Radiation Report to the General Assembly, Vol. 1. Effects of Ionising Radiation with Scientific Annexes A and B. United Nations: New York, 2008.

  2. Belson M, Kingsley B, Holmes A . Risk factors for acute leukemia in children: a review. Environ Health Perspect 2007; 115: 138–145.

    Article  CAS  Google Scholar 

  3. NRPB. Estimates of late radiation risks to the United Kingdom population. NRPB 1993; Report No: NRPB-4, No.4.

  4. Wakeford R, Tawn EJ . The meaning of low dose and low dose-rate. J Radiol Prot 2010; 30: 1–3.

    Article  Google Scholar 

  5. Tubiana M, Feinendegen LE, Yang C, Kaminski JM . The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology 2009; 251: 13–22.

    Article  Google Scholar 

  6. Little MP, Wakeford R, Tawn EJ, Bouffler SD, Berrington de Gonzalez A . Risks associated with low doses and low dose rates of ionizing radiation: why linearity may be (almost) the best we can do. Radiology 2009; 251: 6–12.

    Article  Google Scholar 

  7. Wakeford R, Kendall GM, Little MP . The proportion of childhood leukaemia incidence in Great Britain that may be caused by natural background ionizing radiation. Leukemia 2009; 23: 770–776.

    Article  CAS  Google Scholar 

  8. Little MP, Wakeford R, Kendall GM . Updated estimates of the proportion of childhood leukaemia incidence in Great Britain that may be caused by natural background ionising radiation. J Radiol Prot 2009; 29: 467–482.

    Article  Google Scholar 

  9. Henshaw DL, Eatough JP, Richardson RB . Radon as a causative factor in induction of myeloid leukaemia and other cancers. Lancet 1990; 335: 1008–1012.

    Article  CAS  Google Scholar 

  10. Alexander FE, McKinney PA, Cartwright RA . Radon and leukaemia. Lancet 1990; 335: 1336–1337.

    Article  Google Scholar 

  11. Richardson S, Monfort C, Green M, Draper GJ, Muirhead C . Spatial variation of natural radiation and childhood leukaemia incidence in Great Britain. Stat Med 1995; 14: 2487–2501.

    Article  CAS  Google Scholar 

  12. UK Childhood Cancer Study Investigators. The United Kingdom Childhood Cancer Study of exposure to domestic sources of ionising radiation: 1: radon gas. Br J Cancer 2002; 86: 1721–1726.

    Article  Google Scholar 

  13. UK Childhood Cancer Study Investigators. The United Kingdom Childhood Cancer Study of exposure to domestic sources of ionising radiation: 2: gamma radiation. Br J Cancer 2002; 86: 1727–1731.

    Article  Google Scholar 

  14. Raaschou-Nielsen O, Andersen CE, Andersen HP, Gravesen P, Lind M, Schüz J et al. Domestic radon and childhood cancer in Denmark. Epidemiology 2008; 19: 536–543.

    PubMed  Google Scholar 

  15. Little MP, Wakeford R, Lubin JH, Kendall GM . The statistical power of epidemiological studies analyzing the relationship between exposure to ionizing radiation and cancer, with special reference to childhood leukemia and natural background radiation. Radiat Res 2010; 174: 387–402.

    Article  CAS  Google Scholar 

  16. UK Childhood Cancer Study Investigators. The United Kingdom childhood cancer study: objectives, materials and methods. Br J Cancer 2000; 82: 1073–1102.

    Article  Google Scholar 

  17. Stiller C, Stiller C (eds). Childhood Cancer in Britain: Incidence, Survival, Mortality. Oxford University Press: Oxford, 2007.

    Book  Google Scholar 

  18. Royal Mail. Postcode Atlas of Great Britain and Northern Ireland. Bartholomew: London, 1996.

  19. Martin D, Higgs G . Population georeferencing in England and Wales: basic spatial units reconsidered. Environ Plan A 1997; 29: 333–347.

    Article  Google Scholar 

  20. Wrixon AD, Green BMR, Lomas PR, Miles JCH, Cliff KD, Francis EA et al Natural Radiation Exposure in UK Dwellings. National Radiological Protection Board: Chilton, Didcot, Oxon, 1998; Report No: NRPB-R190.

    Google Scholar 

  21. Kendall GM, Hughes JS, Oatway WB, Jones AL . Variations in radiation exposures of adults and children in the UK. J Radiol Prot 2006; 26: 257–276.

    Article  CAS  Google Scholar 

  22. Miles JCH, Appleton JD . Mapping variation in radon potential both between and within geological units. J Radiol Prot 2005; 25: 257–276.

    Article  CAS  Google Scholar 

  23. Miles JCH, Appleton JD, Rees DM, Green BMR, Adlam KAM, Myers AH . Indicative Atlas of Radon in England and Wales. Health Protection Agency: Chilton, 2007; Report No: HPA-RPD-033.

    Google Scholar 

  24. Appleton JD, Miles JCH . A statistical evaluation of the geogenic controls on indoor radon concentrations and radon risk. J Environ Radioact 2010; 101: 799–803.

    Article  CAS  Google Scholar 

  25. Kroll ME, Stiller CA, Murphy MFG, Carpenter LM . Childhood leukaemia and socioeconomic status in England and Wales 1976–2005: evidence of higher incidence in relatively affluent communities persists over time. Br J Cancer 2011; 105: 1783–1787.

    Article  CAS  Google Scholar 

  26. Carstairs V, Morris R . Deprivation and Health in Scotland. Aberdeen University Press: Aberdeen, 1991.

    Google Scholar 

  27. Office of Population Censuses & Surveys. Classification of Occupations 1980. HMSO: London, 1980.

  28. ONS Classification and Harmonisation Unit. CO80 simplified 1980 occupation classification ONS factsheet. 1985. Crown Copyright.

  29. McCullagh P, Nelder JA . Generalised Linear Models 2nd edn, Chapman & Hall/CRC Texas, 1989.

    Book  Google Scholar 

  30. StataCorp. Stata Statistical Software: Release 11. StataCorp LP: College Station, Texas, 2009.

  31. Cox DR, Hinkley DV . Theoretical Statistics. Chapman & Hall: London, 1974.

    Book  Google Scholar 

  32. UNSCEAR. Sources and effects of ionising radiation. United Nations Scientific Committee on the Effects of Atomic Radiation. 2000 Report to the General Assembly with Scientific Annexes. United Nations: New York, 2000.

  33. Gunby JA, Darby SC, Miles JC, Green BM, Cox DR . Factors affecting indoor radon concentrations in the United Kingdom. Health Phys 1993; 64: 2–12.

    Article  CAS  Google Scholar 

  34. Committee on Medical Aspects of Radiation in the Environment (COMARE). Second Report. Investigation of the Possible Increased Incidence of Leukaemia in Young People Near the Dounreay Nuclear Establishment, Caithness, Scotland. HMSO: London, 1988; Report No: Second.

  35. Committee on Medical Aspects of Radiation in the Environment (COMARE). Fourth Report. The Incidence of Cancer and Leukaemia in Young People in the Vicinity of the Sellafield Site, West Cumbria: Further studies and an Update of the Situation Since the Publication of the Report of the Black Advisory Group in 1984. Department of Health: Wetherby, 1996; Report No: Fourth.

  36. Kroll ME, Stiller CA, Murphy MFG, Carpenter LM . Childhood leukaemia and socioeconomic status in England and Wales 1976–2005: evidence of higher incidence in relatively affluent communities persists over time. Br J Cancer 2011; 105: 1783–1787.

    Article  CAS  Google Scholar 

  37. National Research Council (NRC). Committee to Assess Health Risks from Exposure to Low Levels of Ionising Radiation. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. National Academies Press: Washington, DC, 2006.

  38. Wakeford R, Little MP . Risk coefficients for childhood cancer after intrauterine irradiation: a review. Int J Radiat Biol 2003; 79: 293–309.

    Article  CAS  Google Scholar 

  39. Raaschou-Nielsen O . Indoor radon and childhood leukaemia. Radiat Prot Dosimetry 2008; 132: 175–181.

    Article  CAS  Google Scholar 

  40. Laurier D, Valenty M, Tirmarche M . Radon exposure and the risk of leukemia: a review of epidemiological studies. Health Phys 2001; 81: 272–288.

    Article  CAS  Google Scholar 

  41. Carroll RC, Ruppert D, Stefanski LA, Crainiceanu CM . Measurement Error in Nonlinear Models: A Modern Perspective 2nd edn, Chapman and Hall/CRC: Boca Raton, 2006.

    Book  Google Scholar 

  42. Kinlen L . Childhood leukaemia, nuclear sites, and population mixing. Br J Cancer 2011; 104: 12–18.

    Article  CAS  Google Scholar 

  43. Greaves M . Infection, immune responses and the aetiology of childhood leukaemia. Nat Rev Cancer 2006; 6: 193–203.

    Article  CAS  Google Scholar 

  44. Pearce MS, Salotti JA, Little MP, McHugh K, Lee C, Kim KP et al. Radiation exposures from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 2012; e-pub ahead of print 7 June 2012; doi:10.1016/S0140-6736(12)60815-0.

    Article  Google Scholar 

Download references

Acknowledgements

We are grateful for the detailed and helpful comments of the two referees. This work was supported by the Department of Health for England and Wales, Scottish Government and CHILDREN with CANCER (UK), but these organisations had no role in study design, the collection, analysis, and interpretation of data, the writing of the article nor in the decision to submit it for publication. We thank the British Geological Survey for allowing the use of the HPA/BGS radon map and to Royal Mail and Ordnance Survey for making available ADDRESS-POINT data (Crown Copyright. All rights reserved). Colleagues at the Childhood Cancer Research Group undertook the geocoding of addresses and social class codings for occupations. We also thank Dr Gerald Draper and Mr Charles Stiller for advice and to Drs Ethel Gilbert, Colin Muirhead and Mark Pearce for commenting on a draft manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to G M Kendall.

Ethics declarations

Competing interests

Dr Wakeford undertakes work as a paid consultant. All other authors declare no conflict of interest.

Additional information

Supplementary Information accompanies the paper on the Leukemia website

Supplementary information

Supplementary Table S1 (DOC 85 kb)

Supplementary Table S2 (DOC 53 kb)

Supplementary Table S3 (DOC 79 kb)

Supplementary Table S4 (DOC 84 kb)

Supplementary Table S5 (DOC 56 kb)

Supplementary Table S6 (DOC 52 kb)

Supplementary Table S7 (DOC 103 kb)

Supplementary Table S8 (DOC 109 kb)

Supplementary Table S9 (DOC 61 kb)

Supplementary Table S10 (DOC 71 kb)

Supplementary Table S11 (DOC 46 kb)

Supplementary Table S12 (DOC 72 kb)

Supplementary Table S13 (DOC 48 kb)

Supplementary Table S14 (DOC 47 kb)

Supplementary Table S15 (DOC 55 kb)

Supplementary Table S16 (DOC 55 kb)

Supplementary Table S17 (DOC 62 kb)

Supplementary Table S18 (DOC 59 kb)

Supplementary Table S19 (DOC 72 kb)

Supplementary Table S20 (DOC 104 kb)

Supplementary Table S21 (DOC 117 kb)

Supplementary Table S22 (DOC 67 kb)

Supplementary Table S23 (DOC 43 kb)

Supplementary appendix 1 (DOC 125 kb)

Supplementary appendix 2 (DOC 37 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kendall, G., Little, M., Wakeford, R. et al. A record-based case–control study of natural background radiation and the incidence of childhood leukaemia and other cancers in Great Britain during 1980–2006. Leukemia 27, 3–9 (2013). https://doi.org/10.1038/leu.2012.151

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/leu.2012.151

Keywords

This article is cited by

Search

Quick links