COMARE Report (Hansard, 27 March 1996)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)

The Government are grateful to the committee for their thorough and comprehensive report, copies of which have been placed in the Library. Ministerial colleagues and I note the committee's concern about the continuing excess of leukaemia and lymphoma in young people in Seascale. We accept the recommendations made in the report, including the committee's recommendation that the incidence of leukaemia and other cancers in the area be kept under surveillance and reviewed periodically by the appropriate authorities. The Government also accept the committee's advice that there will be no benefit from continuing to investigate Seascale in isolation in the absence of new evidence of particular causative characteristics which could he relevant.

We welcome COMARE's advice on research priorities and will continue to fund the department's long-standing programme of research in the field of radiation protection, seeking advice as necessary from expert sources. The department will also maintain contact with other funding bodies to ensure priority is given to relevant, high quality research.

The Government's commitment to maintaining and updating effective radiation protection policies is demonstrated by the department's current spend of nearly £2 million a year on radiological protection research, together with support amounting to some £6.5 million a year for the National Radiological Protection Board (NRPB).

Following is COMARE's main conclusion:

"We conclude that there has been a continuing excess of leukaemia and other cancers in 0–24 year olds in Seascale Ward in the post—Black period 1984–1992, primarily due to an excess of acute lymphoblastic leukaemia and NHL. Taken together with the results for the earlier period 1955–62 (for which comparable statistical analysis is not possible) and 1963–1983 the data show that there has been a continued excess of leukaemia and NHL in Seascale for four decades. Such evidence as we have does not indicate any excess between 1900 and 1945. We have investigated possible causes of the excess in later decades and conclude that:

(i) On current knowledge, environmental radiation exposure from authorised or unplanned releases could not account for the excess. Much work WA 136 has been done to reduce the uncertainties present in the previous assessment although some uncertainties do still remain.
(ii) On current knowledge occupational exposure to radiation is very unlikely to account for the excess. Although there are uncertainties regarding internal radiation exposures it is not clear how these could affect the population of Seascale and not the other residents of small towns and villages nearby where workers from the Sellafield site also live.
(iii) Other possible hypotheses regarding chemicals and infectious aetiology have been considered. We conclude that environmental exposure to chemicals is unlikely to offer an explanation although admittedly the data are sparse. We do, however, believe that a mechanism involving infection may probably be a factor affecting the risk of leukaemia and NHL in young people in Seascale.

We conclude that the excess of leukaemia and NHL in young people in Seascale for the period 1963 to 1992 is highly unlikely to be due to chance alone. Various factors considered above could affect the incidence of leukaemia and NHL but no one factor alone could account for the increase. We cannot rule out interactions between different possible factors but, as yet, have no way of quantifying their effects nor of saying why the interaction would be unique to Seascale.

We have now produced four reports to Government on the incidence of childhood cancer and leukaemia around particular nuclear installations. The first and present reports have been concerned with the Sellafield site. Our work to investigate the cause has entailed one of the most intensive investigations of a local public health concern, due to a suspected environmental problem, ever undertaken in the UK. In addition to our efforts, the input from Government in sponsoring research, from the NRPB and many other independent research bodies and individuals, including industry, has been very substantial. Given this effort there exists a natural expectation of a clear and unambiguous answer to the key issues being addressed. Certainly, we are in no doubt of the raised incidence of leukaemia and NHL which has occurred in the young people of Seascale, and its persistence over several decades is probably unique in this country.

We have examined leading available current hypotheses and pathways by which the observed excess could have come about and have been unable to find any convincing explanation. We have, of course, been constrained by the fact that mechanisms involved in human leukaemogenesis are still not clearly understood. It is our view that current research efforts being undertaken in the UK and worldwide should eventually supply answers to these questions. However, until this research provides the required information we advise against further work specifically addressing the Seascale cluster until new insights into possible carcinogenic mechanisms suggest possible causes to test".

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COMARE have made five recommendations, as follows:

"Recommendation 1 (Chapters 2, 4, 6, 8)

We note that there are a number of epidemiological studies underway which will examine the various hypotheses which have been discussed in this report. The United Kingdom Childhood Cancer Study is testing both radiation and non-radiation hypotheses including infectious aetiology and possible predisposing features to carcinogenesis. We recommend that these should be supported to completion.

Recommendation 2 (Chapter 2)

We share the concern about the continuing excess of childhood and adolescent leukaemia and lymphoma and possible excess of other cancers in Seascale and we recommend that the incidence of leukaemia and other cancers in the area be kept under surveillance and reviewed periodically by the appropriate authorities and that any new cases of leukaemia or other cancer be fully characterised.

Recommendation 3 (Chapters 2 & 7)

We recommend that the mortality/incidence of both childhood and adult leukaemia and other cancers in Seascale for the years 1946–62 be examined as thoroughly as possible to connect the mortality study of 1900–45 with the incidence studies of 1963–92.

Recommendation 4

With regard to radiation specifically, our investigations have made us aware of several areas where an urgent need exists for improved knowledge. We consider that their investigation is both important for the scientific basis of radiation protection generally and for the evaluation of potential future problems in the field of radiation and public health. We therefore recommend support, wherever possible, for innovative research in the areas [set out in COMARE's report].

Recommendation 5 (Chapters 8 & 9)

We are aware that our inability to identify causative mechanisms to explain all the Seascale leukaemia and NHL excess reflects the present inadequate state of knowledge regarding the causes of childhood leukaemia. It is possible that this excess, and any others if they occur in future, will continue to elude explanation until underlying mechanisms are better understood. We expect such understanding to come from current and future initiatives in leukaemia and cancer research, whether related to radiation or not. We recommend that high quality innovative research, especially where it permits hypothesis testing, should be supported wherever possible, that this should be considered a necessary part of the remit of radiation protection, and that there should be continued liaison between funding bodies to ensure that essential research receives adequate priority for available funds."