Review of epidemiological studies of cancer risk among Gulf War and Balkans veterans

OBJECTIVE: Analysis of the available epidemiological evidence on cancer risk among Gulf war and Balkans veterans. DESIGN AND SETTING: Eligible for the review were all studies published in peer-reviewed journals indexed in MedLine by the end of 2007. The review includes twelve studies published between 1996 and 2006 All of them are retrospective cohort studies focused on different outcomes: mortality, hospitalizations or cancer incidence. The study populations are from US, UK, Sweden, Denmark and Italy. The description ofthe studies reviewed focusses on their main features (design, study population, health outcomes and ascertainment procedures, analytical methods). RESULTS: Results are summarized by cancer site: all cancers, neoplasms that may be a target of exposure to depleted uranium (lung cancer, leukemias, kidney cancer, bone cancer), and other neoplasms (lymphomas, brain cancer, and cancer of the testis) relatively frequent among young adults. The overall incidence of cancers is not increased in the cohort studies of Gulf war and Balkans veterans published to date, nor there is consistent evidence of excess risks of neoplasms possibly related to exposure to depleted uranium. However, in the Danish cohort of Balkans veterans an increased risk ofbone cancer has been observed, but the excess disappeared when a 1-year latency was considered. An increased brain cancer risk in relation to exposure to nerve-gas agents has been observed. Sporadic excesses of Hodgkin lymphoma and testicular cancer in deployed veterans have been reported. CONCLUSION: None of the studies reviewed could obiectively assess exposures to depleted uranium or to other potentially carcinogenic agents experienced in the theaters. The study cohorts are young and the follow-up periods are probably too short to capture excesses of long latency outcomes. The update of the follow-up of the cohorts and studies of other cohorts with a better assessment of exposure to depleted uranium and to other potentially relevant risk factors are warranted.