Nuclear power generates approximately 9% of the world’s electricity from 440 reactors, with the United States leading production through 93 reactors. While promoted as low carbon energy source, nuclear plants emit small radioactive pollutants which can expose nearby populations to ionizing radiation, a known carcinogen. Research on the link between proximity to nuclear plants and cancer risk presents inconsistent result which was influenced by study design and methodologies. As the U.S. contemplates nuclear energy expansion, it is important to understand the long term health effects for public health.
The published study in Nature aimed to evaluate the link between long-term residential proximity to operational nuclear power plants and cancer mortality in the U.S. from 2000 to 2018. The study sought to determine whether countries located closer to nuclear power plants experienced higher cancer mortality rates and to estimate the number of cancer deaths potentially attributed to plant proximity. The analysis focused on adults aged 35 years and older and examined differences by sex and age group to better understand the potential vulnerability patterns and latency effects.
This research was reviewed by the Institutional Review Board of the Harvard T.H. Chan School of Public Health and determined not to involve human subjects research under U.S. federal regulations, as it relied exclusively on secondary aggregated data. Information on nuclear power plant locations and operational years was obtained from the U.S. Energy Information Administration, with additional verification from plant-specific sources. Facilities in Canada located within 200 km of U.S. County centroids were included. Cancer mortality data for 2000 to 2018 were obtained from the Centers for Disease Control and Prevention and included uncensored records for all deaths classified under ICD-10 codes beginning with “C” representing malignant neoplasms. Analyses were stratified by sex and 6 adult age groups (35 to 44, 45 to 54, 55 to 64, 65 to 74, 75 to 84, and 85 and above).
The study developed a continuous, inverse-distance weighted proximity metric to assess exposure. For each county, the inverse distance (1/d) to every operational nuclear plant within 200 km was calculated annually. These values were averaged over a 10-year window to account for cumulative exposure and cancer latency, then summed across plants to generate an annual county-level proximity estimate. This method captured cumulative contributions from multiple facilities rather than relying on fixed distance cutoffs. The association between nuclear plant proximity and cancer mortality was examined by using Generalized Estimating Equation (GEE) Poisson regression models, adjusting for numerous county-level covariates, including socioeconomic status, racial composition, smoking prevalence, body mass index, environmental conditions, healthcare access, and demographic structure. Relative risks and attributable fractions were calculated to estimate the number of cancer deaths associated with proximity during the study period. Sensitivity analyses were conducted by using alternative distance thresholds (100 to 200 km) and different averaging windows (2 to 20 years) to test robustness.
The results showed a positive link between nuclear power plant proximity and cancer mortality, with stronger effects observed in older age groups. The highest relative risks were identified in the 65 to 74 age group for both sexes, with relative risks approaching 1.19 to 1.20 at closer equivalent distances. Attributable cancer deaths increased with age, peaking in individuals aged 65 to 74, specifically among males. Among people aged 65 and older, proximity to nuclear plants was linked to an average of approximately 4266 cancer deaths per year between 2000 and 2018. Risk decreased progressively with greater distance from nuclear facilities. These findings remained consistent across multiple sensitivity analyses, suggesting that the results were not driven by specific modeling assumptions.
This nationwide ecological study found that U.S. states located closer to operational nuclear power plants experienced higher cancer mortality rates, specifically in older adults. The consistent spatial associations and estimated attributable burden highlight potentially important public health concern although the study design does not allow for causal inference and relies on geographic proximity instead of direct radiation measurements. The study’s continuous, cumulative proximity metric and national scope provide a more comprehensive assessment. These findings underscore the importance of carefully evaluating long-term health implications as nuclear energy continues to be considered a key component of low-carbon energy strategies. Further research incorporating individual-level exposure data and site-specific cancer analyses is needed.
Reference: Alwadi Y, Alahmad B, Vieira CLZ, et al. National analysis of cancer mortality and proximity to nuclear power plants in the United States. Nat Commun. 2026;17:1560. doi:10.1038/s41467-026-69285-4
