title: Association of Cancer Incidence and Duration of Residence in Geothermal Heating Area in Iceland: An Extended Follow-Up.
abstract: Residents of geothermal areas have higher incidence of non-Hodgkin's lymphoma, breast cancer, prostate cancer, and kidney cancers than others. These populations are exposed to chronic low-level ground gas emissions and various pollutants from geothermal water. The aim was to assess whether habitation in geothermal areas and utilisation of geothermal water is associated with risk of cancer according to duration of residence.
  
  
  
  The cohort obtained from the census 1981 was followed to the end of 2013. Personal identifier was used in record linkage with nation-wide emigration, death, and cancer registries. The exposed population, defined by community codes, was located on young bedrock and had utilised geothermal water supply systems since 1972. Two reference populations were located by community codes on older bedrock or had not utilised geothermal water supply systems for as long a period as had the exposed population. Adjusted hazard ratio (HR), 95% confidence intervals (CI) non-stratified and stratified on cumulative years of residence were estimated in Cox-model.
  
  
  
  The HR for all cancer was 1.21 (95% CI 1.12-1.30) as compared with the first reference area. The HR for pancreatic cancer was 1.93 (1.22-3.06), breast cancer, 1.48 (1.23-1.80), prostate cancer 1.47 (1.22-1.77), kidney cancer 1.46 (1.03-2.05), lymphoid and haematopoietic tissue 1.54 (1.21-1.97), non-Hodgkin´s lymphoma 2.08 (1.38-3.15) and basal cell carcinoma of the skin 1.62 (1.35-1.94). Positive dose-response relationship was observed between incidence of cancers and duration of residence, and between incidence of cancer and degree of geothermal/volcanic activity in the comparison areas.
  
  
  
  The higher cancer incidence in geothermal areas than in reference areas is consistent with previous findings. As the dose-response relationships were positive between incidence of cancers and duration of residence, it is now more urgent than before to investigate the chemical and physical content of the geothermal water and of the ambient air of the areas to detect recognized or new carcinogens.
authors.affiliation: Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Adalbjorg
authors.initials: A
authors.lastname: Kristbjornsdottir
authors.affiliation: Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.affiliation: Department of Preventive Medicine, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors.forename: Vilhjalmur
authors.initials: V
authors.lastname: Rafnsson
mesh_terms: D000293:Adolescent; D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005843:Geography; D006361:Heating; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000821:virology*; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000401:mortality; D012307:Risk Factors; D055815:Young Adult