Levine, P H, Atherton, M, Fears, T et al. · Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 1994 · DOI
This study looked at whether people in Nevada who developed a CFS-like illness in the mid-1980s had higher rates of cancer, particularly brain tumors and lymphoma, in the years that followed. Researchers checked cancer registry records to see if there was a connection. They found a slight increase in brain tumors but no clear pattern for lymphoma, though they noted the brain tumor trend might reflect a nationwide pattern rather than something specific to CFS.
This study addresses a patient concern about potential links between ME/CFS and cancer, providing an early systematic examination of this question using objective cancer registry data. It also highlights the scientific and methodological complexities in cluster investigations, which has implications for how future associations are studied and interpreted.
This study does not prove that CFS causes cancer, nor does it establish that cancer rates are definitively elevated in CFS populations. The findings are descriptive and ecological in nature; they reflect trends in a specific outbreak region and cannot establish causation or confirm whether any observed increase is due to CFS rather than surveillance bias, demographic shifts, or national disease trends.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Levine, P H, Atherton, M, Fears, T, & Hoover, R (1994). An approach to studies of cancer subsequent to clusters of chronic fatigue syndrome: use of data from the Nevada State Cancer Registry.. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. https://doi.org/10.1093/clinids/18.supplement_1.s49
BibTeX
@article{mecfsatlas-levine-1994-approach-studies,
author = {Levine, P H and Atherton, M and Fears, T and Hoover, R},
title = {An approach to studies of cancer subsequent to clusters of chronic fatigue syndrome: use of data from the Nevada State Cancer Registry.},
journal = {Clinical infectious diseases : an official publication of the Infectious Diseases Society of America},
year = {1994},
doi = {10.1093/clinids/18.supplement_1.s49},
note = {PubMed: 8148453},
url = {https://www.mecfsatlas.com/evidence/levine-1994-approach-studies},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/levine-1994-approach-studies
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