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The distribution of cancers within individual countries can be very striking. Sometimes these distributions can attract a great deal of publicity. Perhaps the best known example in the United Kingdom is the relationship of childhood leukaemia, which is reported to be unusually high in the vicinity of nuclear power stations: the occurrence of childhood leukaemia around the nuclear processing plant at Sellafield has been reported to be as much as ten times the national average, whereas in the neighbourhood of other nuclear installations the incidence is about 20 per cent above the national average. The explanation for this is still not clear. The association with parental employment in the nuclear installations has been the cause of much discussion but is not yet settled. The arguments are usually based on very small numbers of cases which makes it difficult to draw firm conclusions.

Very detailed studies of the distribution of leukaemias and lymphomas in England and Wales have been carried out by the Leukaemia Research Fund Centre for Clinical Epidemiology run by our colleagues Ray Cartwright and Freda Alexander. One of the most striking features of their analysis is that many of these conditions have a relatively high incidence rate in the county of Somerset. The explanation for this is not forthcoming, but they have studied it in great detail and it appears that the high rates are real and call for further study to see if explanations can be found. It should be emphasized that these are relatively uncommon diseases and that while the higher incidence rates in Somerset are a source of concern and justify very detailed further work, in absolute terms the number of people affected is quite small and should not be a cause for general alarm in that part of the world.

What about commoner cancers? Lung cancer is the commonest cancer in men and careful studies of its geographic distribution in the United Kingdom have been performed for many years. The map is taken from a paper written by Dr Tony Swerdlow in the British Journal of Cancer in 1991 and shows the relative frequency of lung cancer in young men in the 1970s and 1980s, with the darker spots showing higher concentrations. The strikingly high concentrations of lung cancer in the north of England are obvious and this is a relatively new finding, having been less apparent in earlier decades in this century. We do not know why this distribution should occur, although we believe that it is likely to have something to do with the pattern of smoking. It certainly represents important information for those seeking to plan health care. Similar maps can be constructed for most cancer sites in countries like the United Kingdom and the European Community where accurate records are kept. For cancer of the breast in women the high concentration in the United Kingdom in general is apparent and for cancer of the oesophagus (gullet) in men the very high incidence in Dorthern France is clear (Figure to). The causes of the high incidence of cancer of the breast in the UK are not at all clear but the cause of cancer of the oesophagus in men in northern France is very likely to be associated with alcohol and tobacco use.



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