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Sania Nishtar
Lessons in tackling chronic disease
BMJ 2006; 333: 820 [Full text]
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[Read Rapid Response] The depleted uranium and cancer debate continues but overemphasising any association is unhelpful
Amit Patel   (25 October 2006)

The depleted uranium and cancer debate continues but overemphasising any association is unhelpful 25 October 2006
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Amit Patel,
Senior House Officer in Cardiology
The Heart Hospital, UCLH NHS Foundation Trust, 16-18 Westmoreland Street, London, W1G 8PH, UK

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Re: The depleted uranium and cancer debate continues but overemphasising any association is unhelpful

Nishtar[1] highlights some of challenges of chronic disease management in the Middle Eastern and Eastern Mediterranean region, providing a few choice examples of possible positives solutions. I read with interest the comments on the increased incidence of cancer from exposure to depleted uranium (DU), particularly in light of the 1991 and 2003 wars.

This is often a controversial and emotive subject. The cited reference in the current editorial[1] is a cohort study which in fact did not find an excess risk of cancer associated with DU exposure, and included adjustments for confounding lifestyle factors such as alcohol and smoking.[2] The majority evidence and expert opinion on the lack of a clear association of DU with cancer are quite consistent, although a possible case for lung cancer has been suggested.[3] The last BMJ editorial on the public health effects of depleted uranium[4] and the two part report of The Royal Society Working Group both consistently uphold this view.[3]

The highest levels of DU exposure are on the battlefield and probably incur an added risk of lung cancer death of 1 in 1000, particularly for inhaled particles.[3] Soldiers who survive inside a vehicle hit by a DU shell may double their lifetime risk.[3] The added risk of leukaemias or other cancers caused by radiation from depleted uranium is less than 5 in a million for all possible levels of exposure.[3] A recent population- based retrospective study reiterates the lack of association of DU with leukaemia and testicular cancer.[5] Longer-term follow-up data are awaited but the current arguement is not in favour of a strong link.

References

[1] Nishtar S. Lessons in tackling chronic disease. BMJ 2006;333:820.

[2] Macfarlane GJ, Biggs AM, Maconochie N, Hotopf M, Doyle P, Lunt M. Incidence of cancer among UK Gulf war veterans: cohort study. BMJ 2003;327:1373.

[3] The Royal Society Working Group on the Health Hazards of Depleted Uranium Munitions. The health effects of depleted uranium munitions: a Summary. J Radiol Prot 2002;22:131–139.

[4] McDiarmid MA. Depleted uranium and public health. BMJ 2001;322:123-4.

[5] Storm HH, Jorgensen HO, Kejs AM, Engholm G. Depleted uranium and cancer in Danish Balkan veterans deployed 1992-2001. Eur J Cancer. 2006;42:2355-8.

Competing interests: None declared