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Mortality and cancer incidence among physicians of traditional Chinese medicine: a 20-year national follow-up study
  1. Shu-Hui Liu1,
  2. Yu-Feng Liu1,
  3. Saou-Hsing Liou2,
  4. Yun-Lian Lin3,
  5. Yuen-Chen Hsiao4,
  6. Chu-Chieh Chen5,
  7. Chung-Yi Li5,
  8. Trong-Neng Wu1,2,6
  1. 1Institute of Environmental and Occupational Health Sciences, National Yang Ming University, Taipei, Taiwan
  2. 2Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
  3. 3National Research Institute of Chinese Medicine, Ministry of Education, Taipei, Taiwan
  4. 4Department of Industrial Education, National Taiwan Normal University, Taipei, Taiwan
  5. 5Department of Health Care Management, National Taipei College of Nursing, Taipei, Taiwan
  6. 6Department of Public Health and Institute of Environmental Health, China Medical University and Hospital, Taichung, Taiwan
  1. Correspondence to Dr Trong-Neng Wu, Institute of Environmental Health, College of Public Health, China Medical University and Hospital, 91 Hseuh-Shih Road, Taichung 404, Taiwan; tnwu{at}


Objective To study the risks of mortality and cancer incidence in physicians of traditional Chinese medicine (TCM) who had frequent exposure to herbal medicine.

Methods A population-based cohort design was conducted in which a total of 7675 certified physicians of TCM who ever practised between 1985 and 2005 were compared with the age-, sex- and calendar year-specific mortalities and cancer incidence rates of the general population of Taiwan. The age-, sex- and calendar year-standardised mortality ratio (SMR) and standardised cancer incidence ratio (SIR) were calculated to estimate the relative risks of all causes and site-specific mortality and cancer incidence.

Results Over an up to 20-year observational period, 796 (10.4%) physicians of TCM died, and 279 (3.6%) developed cancer. The study cohort showed a significantly reduced SMR for all-causes mortality (68, 95% CI 63 to 73), and for deaths from infectious (SMR=64), circulatory (SMR=68), respiratory (SMR=64) and digestive (SMR=56) disease. The study cohort also had a significantly reduced SIR (80, 95% CI 71 to 90) for all cancers, and for neoplasm of rectum, rectosigmoid junction, and anus (SIR=45), female breast (SIR=30) and cervix uteri (SIR=10). On the other hand, we noted that physicians of TCM suffered from a significantly increased SIR for neoplasm of liver and intrahepatic bile ducts (SIR=151, 95% CI 116 to 192) and of bladder cancer (SIR=259, 95% CI 167 to 382).

Conclusion Like other healthcare workers, we noted that physicians of TCM had significantly reduced risks of all-causes mortality and cancer incidence. Nonetheless, reasons truly responsible for significantly increased risks of liver and bladder neoplasm among physicians of TCM warrant further investigations.

  • Cancer
  • epidemiology
  • herbal medicine
  • liver
  • liver neoplasms
  • mortality studies
  • physicians
  • traditional Chinese medicine
  • urinary bladder neoplasms

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  • C-YL and T-NW contributed equally to this study.

  • Funding This study was supported by a grant from National Scientific Council, Taiwan (NSC 95-2314-B-030-002).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Taiwan Chinese Medical Association and the Department of Health, Taiwan.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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