Lessons in tackling chronic diseaseBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39003.517731.BE (Published 19 October 2006) Cite this as: BMJ 2006;333:820
All rapid responses
Nishtar 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
This is often a controversial and emotive subject. The cited
reference in the current editorial 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. 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. The last BMJ
editorial on the public health effects of depleted uranium and the two
part report of The Royal Society Working Group both consistently uphold
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. Soldiers who survive inside a vehicle hit by a DU
shell may double their lifetime risk. 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. A recent population-
based retrospective study reiterates the lack of association of DU with
leukaemia and testicular cancer. Longer-term follow-up data are awaited
but the current arguement is not in favour of a strong link.
 Nishtar S. Lessons in tackling chronic disease. BMJ 2006;333:820.
 Macfarlane GJ, Biggs AM, Maconochie N, Hotopf M, Doyle P, Lunt M.
Incidence of cancer among UK Gulf war veterans: cohort study. BMJ
 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.
 McDiarmid MA. Depleted uranium and public health. BMJ
 Storm HH, Jorgensen HO, Kejs AM, Engholm G. Depleted uranium and
cancer in Danish Balkan veterans deployed 1992-2001. Eur J Cancer.
Competing interests: No competing interests