Elliott et al (see page 81) report the findings of a spatial analysis examining the risk of congenital anomalies in relation to the density of landfill sites within 2 km of birth locations across 5×5 km grid squares in England.1 They observe significantly raised risks for some anomalies (cardiovascular defects, hypospadias) in areas classified with a higher density of sites destined to receive special (hazardous) waste; no significant excess risks were found for non-special (mainly domestic) waste sites. The data used for this study are similar to those used in a previous nationwide landfill study published in 20012; the current publication does not include Scotland and Wales. The main difference between the two studies is that the current study uses “landfill density” as an exposure indicator to account for residence near more than one site, whereas the 2001 study merely evaluated residence within 2 km of any site. Results are similar: in neither study does a clear pattern of excess risk emerge …