Biomedical subjects
Publications and source records attributed to R A Cartwright.
The problems associated with a diagnosis of non-Hodgkin's lymphoma are reviewed in the context of an apparent rise in incidence. It is concluded that a true rise exists and that further work is required to fully understand the significance of this.
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This review deals with the associations between exposure to ionising and non-ionising irradiation and the risks of leukaemia. A systematic approach is adopted to enable the reader to disentangle the different types of exposure and their resultant effects (if any) on leukaemogenesis.
A retrospective population-based case-control interview study has been conducted in three distinct areas in the north of England where local excesses of children with leukaemia have been reported. A total of 109 cases of childhood (0-14 years at diagnosis) leukaemia and non-Hodgkin's lymphoma who were born in one of the study areas and diagnosed there between 1974 and 1988 were included in the study. One control per case was matched on sex, date-of-birth and health district of birth. The objective was to compare residential histories of cases and controls and in particular to determine whether case children had lived in the same place at the same time more often than controls. The residential distance between two children was taken to be the smallest geographical distance between homes they had 'occupied' simultaneously for a period of at least 6 months between conception and diagnosis. Case children were more likely than expected to have other cases as their nearest neighbours by residential distance (observed = 69, expected = 54.5, P = 0.006). A detailed examination of the nearest neighbour pattern permits the generation of further specific hypotheses. These suggest that persistent infection established in utero or early infancy may be involved in the development of some cases of childhood leukaemia. Horizontal transmission of the agent(s) within small communities may occur but there is no evidence of direct contact between cases.
AIMS: A histopathological review of 43 cases of childhood non-Hodgkin's lymphoma (NHL) in an attempt to identify histological variables of prognostic importance. METHOD: Each case was reclassified according to the Working Formulation and an attempt made to allocate an immunophenotype using a panel of monoclonal antibodies. Results were correlated with clinical data on site and survival. RESULTS: Of the 43 cases, 30 were males and 13 females. There were 17 cases of lymphoblastic lymphoma, 15 cases of small non-cleaved cell lymphoma (SNCC), and four cases of large cell lymphoma. The SNCC group was subdivided into 10 cases of Burkitt's lymphoma and five cases of non-Burkitt's lymphoma. An immunophenotype was allocated in 65.1% of cases (23 B, 5 T). The SNCC cases were spread throughout the 0-16 year age range while the lymphoblastic lymphoma cases tended to occur in older children. Most mediastinal tumours were lymphoblastic lymphoma and most abdominal tumours were SNCC. Statistical analysis failed to show a significant difference in survival among histological subgroups or immunophenotypes. CONCLUSION: No histological variables of prognostic importance were identified partly due to the great variation in treatment regimens, standard of supportive care, and prognosis over the period of the study (1972 to 1988).
Data from a specialist registry of haematopoietic malignancies in England and Wales (1984-1988) have been analysed to investigate variations of incidence by age and diagnostic subtype of lymphoid malignancies in young people (aged 0-24 years). Attention has been focussed on the role of community lifestyle indicators for small areas, derived from routine sources, in an ecological analysis. The predominant conditions were acute lymphoblastic leukaemia (ALL)--42.4%, and Hodgkin's disease (HD)--37.5%. Lowest overall incidence at approximately 8 years of age corresponded to the termination of the childhood peak for ALL. Opposite trends of incidence rates with distance from urban centres (urban distance) were observed for the two age groups: odds ratios (OR) for areas greater than 20 km from towns and cities were 1.46 (95% confidence interval 1.01-2.12) for ages 0-7 and 0.75 (95% confidence interval 0.56-0.99) for ages 8-24. For the younger group this was entirely attributable to ALL. HD, which was dominant in the older group, had highest incidence in connurbations but the gradient of risk for older onset ALL followed the overall pattern for this age group. A positive relationship with socioeconomic status was evident for both age groups but this was considerably stronger for the older cases (OR = 1.16, 95% confidence interval 1.01-1.33) than for the younger for whom it was not independent of urban distance. These results display an association between expression of lymphoid malignancies in young people and urban distance which is not attributable to socioeconomic status; for urban distances the distribution is shifted towards ALL and towards younger age at onset.
This study relates to 1803 newly diagnosed cases of Hodgkin's Disease (HD) registered between 1984 and 1988 by a specialist leukaemia-lymphoma registry covering approximately half of England and Wales. In addition to registration data the analyses use routine census data. Rye classification is available for the majority of cases with only 7% being unclassified. The data confirm that the young adult peak in HD occurrence is attributable to the nodular sclerosing subtype (NS), and there is some evidence that NS has a different geographical distribution by county to the other Rye subtypes. Because of possible geographical biases in the classification, subsequent spatial analyses are disaggregated by age at diagnosis with particular emphasis being placed on the two age groups 0-34 and 50-79 years. For these, trends of risk by areal socioeconomic status are in opposite directions and the effects of urban-rural status while in the same direction also differ significantly. Allowance for these does not, however, explain the significant difference between the county distributions of the two groups. Patterns of spatial clustering are quite distinct with evidence for local spatial aggregation amongst younger cases.
A study of childhood malignancies in North Humberside for 1974-1986 has revealed significant spatial aggregations. Though no specific reason was found, certain geographical areas, tumour groups and putative risks were identified for further study. One possible risk was a tin smelter to the west of Hull. A new method of analysis (Stone's conditional Poisson maximum) was used and showed some evidence of increased risk close to the smelter. This was accounted for by the solid tumours (primarily central nervous system malignancies) and was not apparent for the leukaemias. The Poisson maximum method is a special case of isotonic regression; a more general isotonic regression method, also due to Stone, Maximum Likelihood Ratio (MLR), is also available, and for reasons described elsewhere we prefer the more general method. The present study begins by applying this to the childhood data and then to data for corresponding adult disease (leukemias and central nervous system tumours) in the same area and time period. In both children and adults the results are negative for the leukaemias. For the remaining tumour categories, there is a significant increase in risk close to the smelter, but it is not possible to identify any aspect of the smelter or feature in its vicinity as causative.
High rates of leukaemia in children and young people have been associated with features of community isolation and population growth. Incidence data collected by two specialist registries were used to compare incidence rates at ward level with relevant ward characteristics derived from routine census and Ordnance Survey data for England and Wales. An excess risk of childhood acute lymphoblastic leukaemia (ALL) was found for wards which are farthest from large urban centres. The excess was greatest for wards of higher socioeconomic status and for children aged 1-7 years (the childhood peak), for which a two-fold excess was seen. These findings in general support the hypothesis that childhood leukaemia has an infectious aetiology.
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A series of 101 cases of transitional cell carcinoma (TCC) was contrasted with a control series for several genetic parameters. Three genetic associations were demonstrated with the TCC patients having A gene frequencies, HLA B5 and HLA CW4 genes all higher than might be expected by chance. A classification of the natural history of the disease is used to show that the HLA frequencies vary with the more or the less severe forms of the disease.
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Results are reported for the Esterase D polymorphism in a sample of the general population from the Durham area. Gene frequencies agree well with those previously reported from the north of England. No differences are revealed when the sample is subdivided on the basis of age. No significant differences are observed between this sample and two disease series from the same region, one with diabetes, the other with carcinoma of the bladder. This holds true when the disease groups are considered with regard to current age, age at diagnosis, and in the case of the diabetic, current treatment.
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