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Biomedical subjects

R Doll

Publications and source records attributed to R Doll.

At least 127 records · Page 7Linked to original sources
PubMed1989

Incidence of AIDS and excess of mortality associated with HIV in haemophiliacs in the United Kingdom: report on behalf of the directors of haemophilia centres in the United Kingdom.

OBJECTIVE--To estimate the cumulative incidence of AIDS by time since seroconversion in haemophiliacs positive for HIV and to examine the evidence for excess mortality associated with HIV in those who had not yet been diagnosed as having AIDS. DESIGN--Analysis of data from ongoing national surveys. SETTING--Haemophilia centres in the United Kingdom. PATIENTS--A total of 1201 men with haemophilia who had lived in the United Kingdom during 1980-7 and were positive for HIV. INTERVENTION--None. END POINTS--Diagnosis of AIDS; death in those not diagnosed as having AIDS. MEASUREMENTS AND MAIN RESULTS--Estimation of cumulative incidence of AIDS and number of excess deaths in seropositive patients not diagnosed with AIDS. Median follow up after seroconversion was 5 years 2 months. Eight five patients developed AIDS. Cumulative incidence of AIDS five years after seroconversion was 4% among patients aged less than 25 at first test positive for HIV, 6% among those aged 25-44, and 19% among those aged greater than or equal to 45. There was little evidence that type or severity of haemophilia or type of factor VIII or IX that had caused HIV infection affected the rate of progression to AIDS. Mortality was increased among those who had not been diagnosed as having AIDS, especially among those with "AIDS related complex." Thirteen deaths were observed among 36 patients diagnosed as having AIDS related complex against 0.65 expected, and 34 deaths in 1080 other patients against 22.77 expected; both calculations were based on mortality rates observed in haemophiliacs in the United Kingdom in the late 1970s. CONCLUSIONS--Rate of progression to AIDS depended strongly on age. There is a substantial burden of fatal disease among patients positive for HIV who have not been formally diagnosed as having AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Geographical variation in mortality from leukaemia and other cancers in England and Wales in relation to proximity to nuclear installations, 1969-78.

The distribution of mortality from 11 causes of death (lymphoid leukaemia, other leukaemia, leukaemia of all types, Hodgkin's disease, other lymphomas, all lymphomas, multiple myeloma, lung cancer, other malignancies, all malignancies and all other causes) has been examined in three age groups throughout England and Wales over the period 1969-78. The reorganisation of local authority administration in 1974 meant that the smallest areas that could be examined were 400 county districts or (in some cases) approximate county districts formed by aggregating pre-1974 local authority areas. The variation in the numbers of deaths observed about the numbers expected was assessed using log-linear models to estimate the effect on the relative risk in each district associated with social class, rural status, population size, health authority region and proximity to one of 15 nuclear installations. Trends in risk with increasing proximity to an installation (as judged by the proportion of the population resident within 10 miles) were examined after adjustment for the other four variables. The results showed that in districts near to an installation there were significant excess mortalities in persons under 25 years of age from leukaemia (RR = 1.15, P = 0.01) and especially from lymphoid leukaemia (RR 1.21, P = 0.01) and from Hodgkin's disease (RR 1.24, P = 0.05) and a significant deficiency of mortality from lymphoid leukaemia in persons aged 25-64 years. No significant trends were observed with an increasing proportion of the population near to the installations and the greatest excess mortality from lymphoid leukaemia in young persons was observed in the districts with the intermediate proportion of the population (10.0-65.9%) near an installation.

Adolescent↗
PubMed1989

Progress against cancer: are we winning the war?

The conclusion of two biostatisticians that 'with respect to cancer as a whole we have lost ground' was based on the rise in the age-standardized mortality from cancer. Trends in mortality at all ages combined may be misleading, as the effect of recent progress may be obscured by the effect of changes in the distant past on the incidence of cancer in old age. Recent progress is best assessed by examining trends at young ages, which can be affected only by relatively recent changes in treatment, behaviour, and the environment. These trends are mostly encouraging, but a few indicate a need for preventive action or research.

Adolescent↗
PubMed1988

A summary of mortality and incidence of cancer in men from the United Kingdom who participated in the United Kingdom's atmospheric nuclear weapon tests and experimental programmes.

Altogether 22,347 men who participated in the United Kingdom's atmospheric nuclear weapon tests and experimental programmes in Australia and the Pacific Ocean between 1952 and 1967 were identified from the archives of the Ministry of Defence and followed up. Their mortality and incidence of cancer were compared with those in 22,326 matched controls selected from the same archives. The risk of mortality in the participants relative to that in the controls was 1.01 for all causes and 0.96 for all neoplasms. Thirty eight causes of death were examined separately. Significant differences in mortality were found for leukaemia, multiple myeloma, and other injury and poisoning, with higher rates in the participants, and for cancers of the prostate and kidney and chronic bronchitis, with higher rates in the controls. The mortality from leukaemia and multiple myeloma in the participants was slightly greater than would have been expected from national values (standardised mortality ratios of 113 and 111, respectively), but in the controls it was substantially lower (standardised mortality ratios of 32 and 0, respectively). Examination of the rates of leukaemia and multiple myeloma in groups of participants showed very little difference between groups characterised by recorded doses of external radiation or type of test participation and failed to indicate any specific hazard. Evidence obtained from participants who reported themselves voluntarily (or were reported by relatives or friends) suggested that 17% of participants may have been omitted from the main study group but that any resulting bias was small. Most of the differences observed between the participants and controls were interpreted as due to chance, but some may be due to differences in smoking habits. Participation in the test programme did not seem, in itself, to have caused any detectable effect on the participants' expectation of life, apart from possibly causing small risks of developing leukaemia and multiple myeloma.

Environmental Exposure↗
PubMed1988

Cancers of the respiratory tract in mustard gas workers.

In a study of a cohort of 2498 men and 1032 women employed in the manufacture of mustard gas in Cheshire during the second world war 3354 (95%) individuals were successfully traced for mortality to the end of 1984. Large and highly significant excesses were observed as compared with national death rates for deaths from cancer of the larynx (11 deaths observed, 4.04 expected, p = 0.003), pharynx (15 observed, 2.73 expected, p less than 0.001), and all other buccal cavity and upper respiratory sites combined (lip, tongue, salivary gland, mouth, nose) (12 observed, 4.29 expected, p = 0.002). For lung cancer, a highly significant but more moderate excess was observed (200 observed, 138.39 expected, p less than 0.001). Significant excesses were also observed for deaths from acute and chronic non-malignant respiratory disease (131 observed, 91.87 expected and 185 observed, 116.31 expected, respectively). The risks for cancers of the pharynx and lung were significantly related to duration of employment. None of these results is substantially altered when expected numbers are calculated from Cheshire urban areas rather than national rates, although the relative risks for lung cancer and non-malignant respiratory disease are substantially reduced if rates for Merseyside, the nearest large conurbation, are used. The results provide strong evidence that exposure to mustard gas can cause cancers of the upper respiratory tract and some evidence that it can cause lung cancer and non-malignant respiratory disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort Studies↗
PubMed1988

Estimated radiation doses to different organs among patients treated for ankylosing spondylitis with a single course of X rays.

A follow-up study of over 14,000 patients treated with a single course of X rays for ankylosing spondylitis demonstrated a substantial excess risk of developing cancer. Previously the excess risk of leukaemia has been related to the estimated mean radiation dose to the active bone marrow but detailed estimates were not made of the radiation doses to other organs. In the present work, data extracted from the original treatment records of a random sample of one in 15 patients have been used to make dose estimates, using Monte Carlo methods, for 30 specific organs or regions of the body and 12 bone marrow sites. Estimates of the mean and median organ doses, standard deviations and ranges have been tabulated. Detailed distributions are presented for six organs (lung, bronchi, stomach, oesophagus, active bone marrow and total body). Comparison with the earlier bone marrow estimates and more recent theoretical estimates shows good agreement.

Adult↗
PubMed1988

Effects of exposure to vinyl chloride. An assessment of the evidence.

This paper reviews the possible effects of vinyl chloride on the mortality of occupationally exposed men and the carcinogenic effects that might be observed in the general population as a result of environmental pollution with vinyl chloride. The results of four studies fulfilling the criteria of providing substantial numbers of observations more than 25 years after first exposure and covering a period long enough for more than 10% of the workers to have been expected to die constitute the basis for the assessment of the occupational hazards. Other studies provide only supplementary information. The data permit two conclusions. First, men occupationally exposed to vinyl chloride have experienced a specific hazard of angiosarcoma of the liver. Second, any other occupational hazards that may have existed have been small. No positive evidence of a hazard of any nonmalignant disease or any type of cancer other than angiosarcoma of the liver has been found except possibly for a small hazard of lung cancer when exposure was heavy. More definite conclusions might be reached if those who have studied exposed employees could present their results in appropriate and comparable ways. A very small risk of angiosarcoma may have occurred as a result of vinyl chloride escaping into the environment around plants handling vinyl chloride in the past, but the evidence indicates that the current risk to the general public (if any) must be negligible.

Canada↗
PubMed1987

Fallout, radiation doses near Dounreay, and childhood leukaemia.

Possible explanations for the recently reported increased incidence of childhood leukaemia around Dounreay were examined in the light of changes in the national incidence of leukaemia that occurred during the period of exposure to fallout from international testing of nuclear weapons in the atmosphere. It was concluded that the increase could not be accounted for by an underestimate of the risk of leukaemia per unit dose of radiation at low doses and low dose rates, nor by an underestimate of the relative biological efficiency of high as compared with low linear energy transfer radiation. One possible explanation was underestimation of doses to the red bone marrow due to the discharges at Dounreay relative to the dose from fallout, though investigation of ways in which this might have occurred did not suggest anything definite. Other possible explanations included a misconception of the site of origin of childhood leukaemia, outbreaks of an infectious disease, and exposure to some other, unidentified environmental agent. These findings weigh heavily against the hypothesis that the recent increase in childhood leukaemia near Dounreay might be accounted for by radioactive discharges from nuclear plants, unless the doses to the stem cells from which childhood leukaemia originates have been grossly underestimated.

Adolescent↗