Adapted from the opening address to the meeting of the International Association of Cancer Registries, Hamburg, Germany, August 13, 1990.
Urban and rural factors in the aetiology of cancer†
Article first published online: 17 JUL 2006
Copyright © 1991 Wiley-Liss, Inc., A Wiley Company
International Journal of Cancer
Volume 47, Issue 6, pages 803–810, 1 April 1991
How to Cite
Doll, R. (1991), Urban and rural factors in the aetiology of cancer. Int. J. Cancer, 47: 803–810. doi: 10.1002/ijc.2910470602
- Issue published online: 17 JUL 2006
- Article first published online: 17 JUL 2006
- Manuscript Revised: 22 DEC 1990
- Manuscript Received: 1 NOV 1990
The incidence of cancer, or the mortality attributed to it, has been compared in urban and rural residents in 13 populations. In each case, the incidence (or mortality) has been higher in the urban areas in each sex, the ratios varying from a minimum of 1.03 to I in men in Japan to 1.63 to I in men in Denmark. Examination of 26 separate types of cancer showed that 23 tended to be more common in towns, I (myeloma) to be evenly distributed, and 2 (cancers of the lip and eye) to be more common in the countryside. The urban excess was greatest for cancers of the bladder, larynx, liver, lung, mouth and pharynx, and oesophagus, and least for leukaemia and non-Hodgkin's lymphoma. It is concluded that differences in personal behaviour (cigarette smoking, alcohol consumption, sexual promiscuity, exposure to ultraviolet light, type of diet, and family size) are the principal factors responsible for the urban excess. Other factors include general atmospheric pollution, occupational hazards, genetic differences in susceptibility, and artefacts of diagnosis and recording. The rural excess was marked for cancer of the lip in both sexes, but less marked and clearly evident only in men for cancer of the eye. Three-quarters of eye cancers are melanomas and the excess incidence in rural areas provides some weak support for the idea that exposure to sunlight contributes to the production of the disease.