Cancer incidence in an Austrian alpine valley 1983-2012 : A descriptive study

Our plain-English summary of Cancer incidence in an Austrian alpine valley 1983-2012 : A descriptive study, by H.P. Hutter, T. Waldhoer, K. Müller, et al (Wiener Klinische Wochenschrift, 2019).

The study

• Authors: H.P. Hutter, T. Waldhoer, K. Müller, M. Hackl, L. Weitensfelder, H. Heinzl
• Journal: Wiener Klinische Wochenschrift
• Published: 2019;131(9-10):200-204
• Read it: PubMed · Publisher · Free full text

Abstract

After one of Austria's largest environmental scandals in 2014, which involved the release of hexachlorobenzene (HCB) in the Carinthian valley Görtschitztal, concerns about increased cancer rates have arísen in the affected local population. A descriptive study was conducted to examine the cancer incidence rates between 1983 and 2012. Data from the affected area (Görtschitztal, district St. Veit) were compared to data from the neighboring area within the same district and Carinthia excluding St. Veit, considering incidence rates of liver, lung, kidney, thyroid cancer and mesothelioma. Prostate cancer and carcinoma in situ were both included and excluded from overall cancer incidents in order to prevent potential bias due to screening programs. Considering the observed variability at an overall level, no conspicuous differences in cancer incidences could be found (Carinthia: 495, St. Veit West: 408, St. Veit East: 572 cases per 100,000 person-years in 2012). For some cancer types, e. g. liver, thyroid cancer and mesothelioma, the affected region showed a higher increase in rates than the neighboring area or Carinthia overall; however, these increased rates date back to a time prior to the HCB exposure, suggesting other carcinogenic influences, such as asbestos exposure from antecedent years.

In plain English

This descriptive study looked at 1983 to 2012 cancer registry data for the Görtschitztal in Carinthia, Austria. It followed a 2014 scandal in which a cement factory released hexachlorobenzene (HCB). The authors compared St. Veit East (roughly the Görtschitztal) with St. Veit West and the rest of Carinthia using age-standardized rates per 100,000 person-years, without statistical tests. In 2012, overall cancer rates, excluding prostate cancer, in situ cases and code C44, were 572 (95% confidence interval 500 to 652) in St. Veit East, 408 (320 to 514) in St. Veit West and 495 (476 to 515) elsewhere in Carinthia. In St. Veit East, mesothelioma rose from 2.79 (0.90 to 7.35) in 1988 to 1992 to 12.08 (7.63 to 18.18) in 2008 to 2012. In the rest of Carinthia the rates were 0.29 (0.10 to 0.66) and 1.38 (0.95 to 1.93). The authors concluded HCB could not explain rates up to 2012, as its release began in 2013. They suggested asbestos, processed by the cement factory until the end of the 1980s, could explain the mesothelioma increase. Asbestos exposure was not measured.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive epidemiological study of cancer registry data: direct age-standardized incidence rates with 95% confidence intervals, and no statistical testing
• Who was studied: Residents of the district St. Veit/Glan, Carinthia, Austria, 1983 to 2012, using data from Statistics Austria. The district was split into St. Veit East (11 communities, virtually equal to the Görtschitztal) and St. Veit West (9 communities). These were compared with Carinthia excluding St. Veit. Table 2 gives average populations per five-year period of 38,701 to 40,020 for St. Veit East, 17,981 to 19,213 for St. Veit West, and 483,230 to 501,302 for Carinthia excluding St. Veit.
• Exposure: The study was prompted by HCB released into the air by a cement factory burning contaminated lime sludge, likely from mid-2013. Exposure was not measured for individuals. For mesothelioma, the authors pointed to the cement factory's processing of asbestos until the end of the 1980s. No fiber type is given.
• Main results:
  • In 2012, age-standardized rates of all cancers (excluding in situ cases, C44 and prostate cancer) per 100,000 person-years were: Carinthia excluding St. Veit 495 (95% CI 476 to 515), St. Veit East 572 (500 to 652), St. Veit West 408 (320 to 514).
  • Over the 30 years, overall cancer incidence in St. Veit East was higher than in St. Veit West in 28 years and higher than in Carinthia in 23 years.
  • Mesothelioma (ICD-10 C45) in St. Veit East was 0 in 1983 to 1987. It was 2.79 (95% CI 0.90 to 7.35) in 1988 to 1992 and rose to 12.08 (7.63 to 18.18) in 2008 to 2012, per 100,000 person-years. The authors described this as a steady increase, from 2.8 to 12.1.
  • Mesothelioma in Carinthia excluding St. Veit rose from 0 in 1983 to 1987, to 0.29 (95% CI 0.10 to 0.66) in 1988 to 1992, and to 1.38 (0.95 to 1.93) in 2008 to 2012. In St. Veit West the rate was 0 in every period until 2008 to 2012, when it was 1.21 (0.03 to 6.74).
  • Liver cancer incidence was higher in St. Veit East than in St. Veit West and Carinthia in 5 of the 6 five-year intervals.
  • Thyroid cancer incidence was higher in St. Veit East than in St. Veit West and Carinthia overall. Kidney cancer rates in both parts of St. Veit were above the Carinthian average, with St. Veit West higher than St. Veit East.
• The authors' conclusion: The authors concluded that the study showed no remarkable overall differences in cancer incidence between the Görtschitztal, the rest of St. Veit/Glan and the rest of Carinthia. They concluded that HCB could not explain any increase up to 2012, because the release began in 2013. They suggested the strongly increased mesothelioma incidence in St. Veit East could be explained by asbestos-related exposure.
• Limitations the authors state:
  • The authors did no statistical tests for time trends or for differences between regions, because they had no hypotheses set in advance.
  • Prostate cancer and carcinoma in situ rates may be affected by local screening and by how completely cases are recorded.
  • The study ended in 2012 because later registry data were not yet complete.

Topics

Medical terms in this study, explained in our Lexicon: Incidence, Mesothelioma, Carcinoma, Carcinogenic, Asbestos Exposure.

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