[ RadSafe ] Fwd: [abolition-caucus] Horror of DU not limited to Iraq

[Franta, Jaroslav]

-----Original Message-----
From: Norm Cohen [mailto:ncohen12 at comcast.net]
Sent: Friday April 29, 2005 8:55 AM

<SNIP>

     The speaker is not some alarmist doom-sayer. He is Dr. Chris Busby,  
the British radiation expert, Fellow of the University of Liverpool in the  
Faculty of Medicine and UK representative on the European Committee on  
Radiation Risk, 

<SNIP>
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Regarding Dr. Busby, see for example the case below :

Jaro 
^^^^^^^^^^^^^^^

COMARE: Further Statement on the Incidence of Childhood Cancer in Wales

Background

In March 1999 the Welsh Office asked COMARE to examine two unpublished
studies. The first by Busby et al1 of "Green Audit" concluded that there was
a significant excess of childhood leukaemia in North Wales associated with
residential proximity to the coast. The second study, carried out by Steward
et al2 of the Welsh Cancer Intelligence and Surveillance Unit (WCISU), did
not support this conclusion. We were asked to advise as to whether we
considered that there was a real raised incidence of childhood leukaemia
near the coast of North Wales and whether further study was required. 

To do this we initially organised a comparison of the figures quoted by both
the Green Audit and WCISU with the database held by the Childhood Cancer
Research Group (CCRG) in Oxford. This group maintains the National Registry
of Childhood Tumours (NRCT), data for which are supplied from a variety of
sources including cancer registries but also directly from medical cancer
specialists as well as from death certificates. As a consequence this
provides an independent check on much of the data on childhood cancer held
by cancer registries in Great Britain and is clinically validated. After
carrying out the independent check on the number of cases of childhood
leukaemia in these Welsh counties it was immediately apparent that the data
held by Green Audit, on which the analysis by Busby et al was based, were
incorrect. These data were received from the Welsh Cancer Registry (WCR) in
1995. A further data set was received from WCR in 1996 but was not used in
the analysis by Busby et al.

In June 1999 we issued a statement to the Welsh Office. In that statement we
noted that Dr Busby and his colleagues appeared to have used erroneous data
in their study. On the basis of the Steward et al data, COMARE also stated
that we found no evidence to support the contention that there is an
increased incidence of childhood leukaemia or other childhood cancers
amongst the Welsh population living close to the Irish Sea.

Further investigations

At that time we were unable to resolve the confusion in the data used by
Green Audit. We were unable to establish that WCR had kept a copy, either on
computer or on paper, of exactly what was released to Green Audit. Following
the general re-organisation of cancer registries in England and Wales, the
responsibility for maintaining such databases, in Wales, had been passed to
WCISU. 

COMARE said it would like to ascertain exactly how the erroneous data
presented by Green Audit arose. To this end the COMARE Chairman wrote to Dr
Busby to ask him to release to this Committee copies of the electronic files
which he received from the Welsh Cancer Registry, so that an attempt could
be made to establish the nature and cause of the error. Following a
considerable correspondence we have received only a limited amount of data
from Dr Busby. Though far from satisfactory, these limited data have allowed
us to make further data comparisons. 

The data sent to us by Dr Busby were printouts of WCR data for Gwynedd for
1984 and 1988. We focussed, therefore, on data for Gwynedd for the period
1984 to 1988, for which there were summarised WCR data published in 1994. We
compared these data with those held by WCISU, the Office for National
Statistics (ONS) formerly the Office of Population Censuses and Surveys
(OPCS), and NRCT. The ONS database is entirely dependent upon input from
cancer registries. The ONS informs cancer registries of death certificates
that have any mention of cancer and it relies on the registries using this
information in combination with other sources of data to create a set of
checked records, which are then sent to the ONS. 

The NRCT was found to have the most complete database. It receives
information from a variety of sources in addition to the cancer registries.
It receives totally independent data directly from the UK Children's Cancer
Study Group, which started in 1977 and has evolved so that its members now
see around 85% of all cases of childhood cancer in the UK. The NRCT also
receives data on all cases enrolled into clinical trials. Furthermore, the
NRCT receives details of any death certificate recording childhood cancer.
Because of these independent checks this database is considered to be as
complete as is practically possible.

A comparison of these databases revealed a number of discrepancies, which
are discussed in detail in the accompanying technical annex. The only major
discrepancy between the various data-sets held by WCR, WCISU, ONS and NRCT
arose through some adult cases being classified as children on the WCR,
WCISU and ONS data files but this has little effect on the leukaemia data.
The data on childhood leukaemia currently held by WCISU are similar to those
held by the NRCT and there are only relatively minor discrepancies with data
(a) published by WCR, (b) from WCR tapes "frozen" in 1994 and 1996, or (c)
sent to Green Audit in 1996. As detailed in the annex, however, the 1995 WCR
data analysed by Green Audit contain an erroneous category of `All
leukaemias'. This group, which was presumably intended to give a total count
of leukaemias in each area, does not in fact agree with the data on the same
file for the individual leukaemia sub-types and is not found in any other
data-set. If this group is excluded from the 1995 WCR data analysed by Green
Audit, the total for childhood leukaemias is essentially in agreement with
those in the other databases. In summary, it is clear that the inclusion of
the erroneous `All leukaemias' group has led to the incorrect analysis of
Busby et al. 

The situation regarding other childhood malignancies is more complex and is
also explained in the technical annex.

The Welsh Cancer Registry

Our enquiries have also allowed us to determine, to some extent, the
workings of the Welsh Cancer Registry before its replacement by WCISU in
1997. The picture has emerged of an under-resourced group trying to build a
satisfactory registration database on a shared mainframe computer. Cross
checking of data appeared to take a very long time and amendments might have
gone unrecorded in appropriate cross-referenced material. We have been
informed that OPCS became aware in 1987 of considerable inconsistencies in
some of the data it had obtained from WCR. Attempting to cross check these
data with WCR proved extremely difficult. Further discrepancies were found
to have occurred during the 1980s. We understand that in the early 1990s,
the existence of unacceptable resource pressures on the Registry and
consequent low morale were recognised. A new operating system was introduced
in the mid 1990s but this resulted in further delays in entering information
because of unavoidable testing and software checking. It is possible to
speculate that unchecked tabulations could have been sent to Green Audit in
1995 in view of the history of under-resourcing and consequent problems in
the operation of the Registry. These problems have now been all been
resolved with the formation of WCISU.

Improvements to cancer registration generally

Even at the time of publication of our Third Report in 1989, we were aware
that false conclusions could be drawn from the use of the cancer
registration data then available. In that report we recorded the fact that
OPCS researchers and our own enquiries had highlighted a number of problems
with the National Cancer Registration Scheme. In recommendation 3 of our
Third report we said that urgent consideration should be given to the
validity of cancer registration data, which was at that time of variable
quality. In addition we recommended specific improvements relating to
registration data in England and Wales to ensure that the database was
complete and accurate. Our current investigations have also revealed that
despite the considerable improvements that have taken place in the last ten
years many cancer registries have been unable to carry out the annual 2%
data audit required in their contracts with the funding authorities.

Conclusions

In examining possible errors in the data analysed by Busby et al we have
attempted to distinguish between the errors of cancer registration
generally, some problems known to have occurred at WCR and the very specific
tabulation error that exists in the data file on which the analyses by Busby
et al are based. That data file contains about twice the number of cases of
leukaemia as those recorded by WCR and WCISU for the relevant period and
because these are concentrated in certain geographical areas the report by
Busby et al includes an even greater excess of cases. Neither the general
problems of cancer registry data nor the specific problems experienced by
WCR can account for the excess reported by Busby et al. We note that Busby
et al chose not to use the dataset sent to them by WCR in 1996 which appears
to be free of the erroneous childhood leukaemia entries.

In summary, there are recognised errors in cancer registration arising from
failure to ascertain cases or remove duplicates, incorrect diagnoses and
incorrect location of cases. However, none of these errors can explain the
findings of Busby et al. At the WCR, during the relevant period, a large
number of adults were wrongly classified as children because of errors in
birth dates. However, because leukaemia accounts for about 3% of adult
cancer compared with about 33% of childhood cancer this error had only a
small effect on the total number of childhood leukaemia cases registered.
Furthermore, the various other childhood leukaemia datasets described in
this statement agree reasonably well, while that used in the Busby et al
analyses is totally different. Hence we conclude that the data used by Busby
et al are incorrect. 

Therefore, we reiterate our original conclusion that we have found no
evidence to support the contention that there was an increased incidence of
childhood leukaemia or other childhood cancers close to the North Wales
coast. This conclusion is supported by a more complete analysis by Steward
et al3.

We hope that Dr Busby will now make all the data he received from WCR
available to us for further checking and that he will withdraw the
conclusions of his earlier analyses, which have given rise to considerable
public concern in Wales. 

We have previously expressed concerns about Cancer Registry practices
generally and we are still concerned that, despite our previous
recommendations, some cancer registries may still lack sufficient resources
to carry out their duties efficiently. It would have been of benefit to us
if the information concerning registry resources in Wales had been made
available to us at an earlier date.
 
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