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Epidemiological Studies Among Royal Norwegian Navy Servicemen: Cohort Establishment, Cancer Incidence and Cause-Specific Mortality
Norwegian University of Science and Technology, Faculty of Medicine, Department of Public Health and General Practice.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The thesis covers the establishment and quality controls of two cohorts of civilian and military personnel serving in the Royal Norwegian Navy (RNoN) after January 1, 1950, and two studies among male members of the military cohort.

For the civilian cohort, the criterion for inclusion was all civilians who have served at any time during 1950–2005 in the Navy, while the military cohort was limited to officers and enlisted personnel. All branches of the Navy were covered, hereunder the Fleet, the Coast Guard and the Coastal Artillery. By 1950, the Norwegian Fleet was either destroyed during the Second World War (WWII) or out-dated. The rebuilding of the Navy was yet to begin, and Norway had just become a member of the North Atlantic Treaty Organisation (NATO) at the Treaty foundation in 1949. With its border with the Soviet Union in the north Norway became of strategic importance, and the Cold War shaped the design of the Norwegian Defence.

The present work started in 2002 with establishment of the cohorts. The registration work resulted in a military cohort of 29 056 persons (2.5% women) with an average of 6.2 years service in the Navy. The cohort of 8 378 civilians (39% women) had an average of 11 years in the Navy. Both cohorts were regarded as virtually complete.

The first cohort study dealt with asbestos related cancers among Navy vessels crews. Asbestos has been commonly used in shipbuilding for heat and sound insulation, and for fireproofing. Until 1987, asbestos aboard the Navy vessels potentially caused exposure to 11 500 crew members. Engine room crews were considered to experience higher exposure intensity than other crews aboard. Asbestos is the only environmental factor known to cause malignant mesothelioma, and an elevated incidence of this disease served as an indicator of asbestos exposure. The incidence of other potentially asbestos related cancers (lung, laryngeal, pharyngeal, stomach and colorectal cancers) was evaluated according to duty station and mesothelioma incidence. Elevated incidence of mesothelioma was found among engine room crews only, and the time from first exposure to date of diagnosis ranged from 28 to 48 years (median 41). The mesothelioma incidence offered no consistent explanation to the variation in incidence of other potentially asbestos-related cancers.

The second cohort study examined the cause-specific mortality and cancer incidence compared to the national rates. Internal comparisons between vessel crews and land-based personnel were performed. A military career implies adaptation to a rigid disciplinary system, handling of weaponry, and a life at remote locations causing separation from family members. In foreign navies, a higher than average alcohol consumption with a negative impact on occupational efficiency and adverse health outcome, has been reported. Special attention was thus given towards deaths from violent causes, alcohol related diseases (mental and behavioural disorders due to use of alcohol, liver cirrhosis) and incidence of alcohol-related cancers (mouth, pharynx, larynx, oesophagus and liver cancer). For the cohort as a whole, the overall mortality was 16% lower than in the general Norwegian male population. The physical and psychological screenings for military service and the demand for “keeping up” during service imply that the Navy personnel were highly selected and expected to be healthier than the general population. This phenomenon has been termed “healthy soldier effect”. Overall cancer incidence was 6% higher, mostly due to excess prostate cancer and malignant melanoma and non-melanoma skin cancers. Death from violent causes (accidents and suicide) was 36% lower than expected. Both overall mortality and cancer were higher among sailors than among land-based personnel. No increased risk of alcohol related cancers or mortality was found for the cohort as a whole, but a higher risk was found among those serving aboard the vessels than for land based personnel.

 

Abstract [no]

Epidemiologiske studier blant offiserer og vervet personell i Sjøforsvaret. Kohortetablering, kreftforekomst og årsaksspesifikk dødelighet

Avhandlingen omhandler etablering og kvalitetskontroller av kohorter (studiegrupper) bestående av sivilt og militært personell som har tjenestegjort i Sjøforsvaret (Marinen, Kystvakta og Kystartilleriet) etter 1950, samt to epidemiologiske studier blant mannlige militære. Tidsperioden karakteriseres av gjenoppbygging etter den andre verdenskrig, hvor Sjøforsvaret tilpasses ”den kalde krigen” og designes for invasjonsforsvar i kyst-farvann, og Sovjetunionens fall i 1991 med påfølgende omorganisering og nedbygging.

Arbeidet startet i 2002 med etablering av kohorter. Kilde til personopplysninger var Forsvarets Personelldatabase og rulleblader på papir. Inkludert i den sivile kohorten var alle sivilt ansatte, mens den militære kohorten ble begrenset til offiserer og vervete. Registreringsarbeidet resulterte i en militær kohort bestående av 29 056 personer, hvorav 2,5% kvinner, med gjennomsnitt tjenestetid i Sjøforsvaret på 6 år. Den sivile kohorten bestod av 8341 personer (39% kvinner) med 11 års tjeneste i snitt. Kohortene ble vurdert å være nær komplette.

Observerte antall krefttilfeller og dødsfall blant Sjøforsvarspersonellet ble sammenlignet med tilsvarende tall for den mannlige norske befolkning. Det ble også foretatt interne sammenligninger mellom ulike avdelinger i Sjøforsvaret.

Den første kohortstudien omhandlet asbestrelatert kreft. Asbest har vært brukt i skipsbygging som varme- og støyisolasjon og som brannsikring, og ble fjernet ved utskifting og overhaling av fartøyene i løpet av 1980-tallet. Rundt 11 500 besetningsmedlemmer kan ha vært eksponerte. Asbest er den eneste kjente miljøfaktor som kan forårsake mesoteliom (brysthinnekreft), og andre asbestrelaterte kreftformer (kreft i lunge, svelg, strupe, mage, og i tykk- og endetarm) ble evaluert i lys av tjenestested og forekomst av mesoteliom. Økt risiko for mesoteliom ble kun funnet blant maskinromsbesetninger.

Den andre kohortstudien dreide seg om kreft og dødsårsaker. Militær karriere betyr tilpasning til et rigid disiplinært system, håndtering av våpen og potensielt farlig maskineri, samt tjeneste på fjerne steder, atskilt fra familie. Et stort potensiale for ulykker, samt rapporter om høyt alkoholforbruk i utenlandske mariner, medførte fokus på voldsomme dødsfall samt dødsfall grunnet alkoholrelaterte sykdommer som skrumplever og alkoholpsykoser, og forekomst av alkoholrelatert kreft. For kohorten under ett var dødeligheten 16% lavere enn i den generelle norske mannlige befolkning. Dette kan forklares med seleksjoner på fysisk og mental helse ved opptak til militærtjeneste (sesjon) og befalsutdanning, samt regelmessige fysiske tester og helsekontroller under tjenesten. Kreftforekomsten var 6% forhøyet, først og fremst grunnet økt forekomst av prostatakreft og hudkreft. Voldsomme dødsfall (ulykker, selvmord) var 36% lavere enn forventet. Generelt var dødelighet og kreftforekomst høyere blant fartøybesetninger enn landbasert personell. Ingen økt risiko for alkoholbetinget dødsfall eller kreft ble observert for kohorten under ett, men høyere risiko ble funnet for fartøybesetningene sammenliknet med landpersonell.

Place, publisher, year, edition, pages
NTNU, 2011.
Series
Doctoral theses at NTNU, ISSN 1503-8181 ; 2011:20Dissertations at the Faculty of Medicine, ISSN 0805-7680 ; 466
Identifiers
URN: urn:nbn:no:ntnu:diva-12398ISBN: 978-82-471-2557-1 (printed ver.)ISBN: 978-82-471-2558-8 (electronic ver.)OAI: oai:DiVA.org:ntnu-12398DiVA: diva2:408481
Public defence
2011-02-01, 00:00
Available from: 2011-04-06 Created: 2011-04-04 Last updated: 2011-04-06Bibliographically approved
List of papers
1. Establishment of the Royal Norwegian Navy personnel cohorts for cancer incidence and mortality studies.
Open this publication in new window or tab >>Establishment of the Royal Norwegian Navy personnel cohorts for cancer incidence and mortality studies.
2008 (English)In: Military medicine, ISSN 0026-4075, Vol. 173, no 8, 785-91 p.Article in journal (Refereed) Published
Abstract [en]

The military cohort consists of 29,056 officers and enlisted personnel (2.5% women) with an average of 6 years of service in the Navy. Year of birth spans 1883 to 1985; the median is 1954. The cohort of 8,378 civilians (39% women) has an average of 11 years in the Navy; the year of birth spans 1884 to 1988 with a median of 1942. Both cohorts are regarded as virtually complete.

Identifiers
urn:nbn:no:ntnu:diva-12399 (URN)18751598 (PubMedID)
Available from: 2011-04-04 Created: 2011-04-04 Last updated: 2012-09-07Bibliographically approved
2. Asbestos-related cancers among 28,300 military servicemen in the Royal Norwegian Navy.
Open this publication in new window or tab >>Asbestos-related cancers among 28,300 military servicemen in the Royal Norwegian Navy.
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2010 (English)In: American Journal of Industrial Medicine, ISSN 0271-3586, E-ISSN 1097-0274, Vol. 53, no 1, 64-71 p.Article in journal (Refereed) Published
Abstract [en]

The overall increase (65%) in mesotheliomas among military Navy servicemen was confined to marine engine crews only. The mesothelioma incidence can be taken as an indicator of the presence or absence of asbestos exposure, but it offered no consistent explanation to the variation in incidence of other asbestos-related cancers.

Identifiers
urn:nbn:no:ntnu:diva-12400 (URN)10.1002/ajim.20778 (DOI)19921706 (PubMedID)
Available from: 2011-04-04 Created: 2011-04-04 Last updated: 2012-09-07Bibliographically approved
3. Cause-specific mortality and cancer incidence among 28,300 Royal
Open this publication in new window or tab >>Cause-specific mortality and cancer incidence among 28,300 Royal
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(English)Manuscript (preprint) (Other academic)
Identifiers
urn:nbn:no:ntnu:diva-12397 (URN)10.5271/sjweh.3140 (DOI)
Note
The original article may be found at http://www.sjweh.fi/index.phpAvailable from: 2011-04-04 Created: 2011-04-04 Last updated: 2011-04-06Bibliographically approved

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