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Abstract

Purpose
To investigate the associations between residential proximity to nuclear power plants and ZIP code–level cancer incidence among Massachusetts residents.

Methods
We assessed proximity of Massachusetts ZIP codes to nuclear power plants using an inverse-distance weighted metric. We obtained cancer incidence data (2000–2018) from the Massachusetts Cancer Registry. We applied two approaches: (1) longitudinal Generalized Estimating Equation (GEE) Poisson regression to evaluate yearly incidences for all cancers combined, and (2) cross-sectional log-linear Poisson regression for site-specific cancers. We adjusted models for PM2.5, demographic, socioeconomic, environmental, and healthcare covariates, and stratified analyses by sex and four age groups (45–54, 55–64, 65–74, 75 +).

Results
Proximity to plants significantly increased cancer incidence, with risk declining by distance. At 2 km, females showed RRs of 1.52 (95% CI: 1.20–1.94) for ages 55–64, 2.00 (1.59–2.52) for 65–74, and 2.53 (1.98–3.22) for 75 + . Males showed RRs of 1.97 (1.57–2.48), 1.75 (1.42–2.16), and 1.63 (1.29–2.06), respectively. Cancer site-specific analyses showed significant associations for lung, prostate, breast, colorectal, bladder, melanoma, leukemia, thyroid, uterine, kidney, laryngeal, pancreatic, oral, esophageal, and Hodgkin lymphoma, with variation by sex and age. We estimated 10,815 female and 9,803 male cancer cases attributable to proximity, corresponding to attributable fractions of 4.1% (95% CI: 2.4–5.7%) and 3.5% (95% CI: 1.8–5.2%).

Conclusions
Residential proximity to nuclear plants in Massachusetts is associated with elevated cancer risks, particularly among older adults, underscoring the need for continued epidemiologic monitoring amid renewed interest in nuclear energy.

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Notably, relative risks sharply declined with increasing distance, decreasing substantially at 5 km and becoming negligible beyond approximately 25 km from the nuclear facilities (Fig. 3). This suggests that elevated cancer risks are disproportionately concentrated in communities located within close proximity to nuclear power plants. Unlike health risks associated with coal power plants, which typically affect larger populations spread over broader geographic areas [19], the impacts of nuclear power plants appear to be highly localized, significantly affecting communities residing closest to the plants. Massachusetts, as one of the states with substantial populations residing in close proximity to multiple nuclear power facilities, underscores the importance of these findings.

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