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Incidence of cancer among UK Gulf war veterans: cohort study

BMJ 2003; 327 doi: (Published 11 December 2003) Cite this as: BMJ 2003;327:1373
  1. Gary J Macfarlane, professor of epidemiology (G.Macfarlane{at},
  2. Anne-Marie Biggs, research associate1,
  3. Noreen Maconochie, senior lecturer in epidemiology and statistics2,
  4. Matthew Hotopf, reader in psychological medicine3,
  5. Patricia Doyle, reader in epidemiology2,
  6. Mark Lunt, research fellow4
  1. 1Unit of Chronic Disease Epidemiology, School of Epidemiology and Health Sciences, University of Manchester, Manchester M13 9PT
  2. 2London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT
  3. 3Gulf War Illnesses Research Unit, Department of Psychological Medicine, Guy's, King's, and St Thomas's School of Medicine, London SE5 8AZ
  4. 4Arthritis Research Campaign Epidemiology Unit, School of Epidemiology and Health Sciences, University of Manchester
  1. Correspondence to: G J Macfarlane
  • Accepted 7 October 2003


Objectives To determine whether incidence rates of cancer are higher in UK service personnel who were deployed in the Gulf war than in those not deployed and whether any increased risk of cancer is related to self reported exposures to potentially hazardous material during the period of deployment.

Design A cohort study with follow up from 1 April 1991 (the end of the Gulf war) to 31 July 2002.

Participants 51 721 Gulf war veterans and 50 755 service personnel matched for age, sex, rank, service, and level of fitness who were not deployed in the Gulf (the Era cohort).

Main outcome measures Incident cancers, identified on the NHS central register.

Results There were 270 incident cancers among the Gulf cohort and 269 among the Era cohort (incidence rate ratio 0.99, 95% confidence interval 0.83 to 1.17). There was no excess in site specific cancers among the Gulf cohort. Adjustment for lifestyle factors (smoking and alcohol consumption) did not alter these results. In the Gulf cohort, risk of cancer was not related to multiple vaccinations or exposure to pesticides or depleted uranium during deployment.

Conclusion There is no current excess risk of cancer overall nor of site specific cancers in Gulf war veterans. Specific exposures during deployment have not resulted in a subsequent increased risk of cancer. The long latent period for cancer, however, necessitates the continued follow up of these cohorts.


  • Contributors GJM planned the study, and GJM, NM, PD, and MH were involved in the collection of data in the morbidity surveys. A-MB and ML conducted the data analysis. GJM drafted the manuscript, which was then revised by all authors. GJM, A-MB, and ML are guarantors

  • Funding Ministry of Defence

  • Competing interests None declared

  • Ethical approval University of Manchester Committee on the Ethics of Research on Human Beings

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