title: Investigation of a cluster of leukaemia in the Illawarra region of New South Wales, 1989-1996.
abstract: OBJECTIVE
  To investigate a cluster of leukaemia among young people and assess the plausibility of a disease-exposure relationship.
  
  
  METHODS
  Descriptive analysis of population-based leukaemia incidence data, review of evidence related to the causation of leukaemia, assessment of environmental exposures to known leukaemogens, and resulting risks of leukaemia.
  
  
  METHODS
  Illawarra region of New South Wales, Australia, focusing on suburbs between the Port Kembla industrial complex and Lake Illawarra (the Warrawong area).
  
  
  METHODS
  Standardised incidence ratios (SIRs) for leukaemia; current measured and past estimated ambient air benzene concentrations; and expected leukaemia cases attributable to estimates of ambient air benzene concentrations.
  
  
  RESULTS
  In 1989-1996, 12 leukaemia cases among Warrawong residents aged less than 50 years were observed, more than the 3.49 cases expected from the rate in the rest of the Illawarra region (SIR, 343.8; 99% CI, 141.6-691.7). These people lived in suburbs immediately to the south-southwest of a coke byproducts plant (a major industrial source of benzene, one of the few known leukaemogens). The greatest excess was among 15-24-year-olds (SIR, 1085.6; 99% CI, 234.1-3072.4). In 1996, ambient air concentrations of benzene averaged less than 1 part per billion (ppb). Since 1970, ambient air concentrations of benzene were estimated to have averaged up to 3 ppb, about one-thousandth of the level at which leukaemia risk has been identified in occupational epidemiological studies. Using the risk assessment model developed by the US Environmental Protection Agency, we estimate that past benzene levels in the Warrawong area could have resulted in 0.4 additional cases of leukaemia in 1989-1996.
  
  
  CONCLUSIONS
  The excess occurrence of leukaemia in the Warrawong area in 1989-1996 is highly unusual. Current environmental benzene exposure and the reconstructed past environmental benzene exposure level are too low to explain the large excess of leukaemia. The cause of the cluster is uncertain.
authors.affiliation: Illawarra Public Health Unit, Illawarra Area Health Service, Wollongong, NSW. vwest@doh.health.nsw.gov.au
authors.forename: V J
authors.initials: VJ
authors.lastname: Westley-Wise
authors.forename: B W
authors.initials: BW
authors.lastname: Stewart
authors.forename: I
authors.initials: I
authors.lastname: Kreis
authors.forename: P F
authors.initials: PF
authors.lastname: Ricci
authors.forename: A
authors.initials: A
authors.lastname: Hogan
authors.forename: C
authors.initials: C
authors.lastname: Darling
authors.forename: S
authors.initials: S
authors.lastname: Corbett
authors.forename: J
authors.initials: J
authors.lastname: Kaldor
authors.forename: N H
authors.initials: NH
authors.lastname: Stacey
authors.forename: P
authors.initials: P
authors.lastname: Warburton
mesh_terms: D000293:Adolescent; D000328:Adult; D000397:Air Pollution / Q000009:adverse effects*; D001554:Benzene / Q000009:adverse effects*; D016000:Cluster Analysis; D015986:Confounding Factors, Epidemiologic; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D005260:Female; D006801:Humans; D015994:Incidence; D019570:Inhalation Exposure / Q000009:adverse effects*; D007938:Leukemia / Q000453:epidemiology* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D012306:Risk
chemical_list: D001554:Benzene