- Email: [email protected]
Mixed messages about depleted uranium
The leading edge
Mixed messages about depleted uranium Ten years ago this month the Gulf War was raging. Between January 17 and February 27 1991, the Allied forces bombarded southern Iraq and Kuwait with hundreds of thousands of rounds of depleted uranium (DU) shells. DU is used in bullets and shells because of its hardness and penetrating power. When DU ammunition hits its target, it explodes and burns, forming a chemically toxic and radioactive dust. The uranium oxide compounds in this dust can enter the body by ingestion and inhalation, or through wounds caused by shrapnel. In the Bosnian conflict (1992–95), American aircraft used 10 800 shells containing DU, and during the 1999 Kosovo campaign 31 000 rounds were fired. The Gulf War may have been a triumph against Saddam Hussein, but increased numbers of cases of cancer among war veterans and Iraqi civilians have been alleged ever since, and have been linked to the use of DU. Is a similar story going to unfold for the Balkan conflict over the next few years? The numerous articles in the newspapers in recent weeks seem to suggest so. Attention has focused almost exclusively on 17 cases of NATO servicemen who have developed leukaemia since serving in the Balkan war. All cases of leukaemia are distressing, but is this figure really in excess of the number of cases that would normally have been expected to develop in the general population? Of about 150 000 soldiers who served in Kosovo, 17 have been diagnosed with leukaemia – roughly 10 cases per 100 000 population. In the UK, the normal incidence rate of leukaemia in adult men is also about 10 per 100 000 population. Unfortunately, most of the reports fail to point out that it is very rare for cancer to develop within 2 years of exposure to this type of carcinogen. In seeking to show that DU is not carcinogenic, the UK Ministry of Defence quoted a study by the Department of Veteran Affairs, Baltimore, USA, which is following 33 American veterans, all of whom were exposed to DU, have shrapnel in their bodies, and have traces of uranium in their urine. After 2 years of follow up, none of the men in this study have developed cancer. Surely the word ‘yet’ has been missed off the end of this statement. While western reporting has concentrated on the possible effects on war veterans, very little attention has been paid to the possible risks to the civilian populations of Iraq and the Balkans, although the danger to them is much greater. The NATO military personnel have all gone home; they do not have to live near burnt-out tanks and are not continually exposed
THE LANCET Oncology Vol 2 February 2001
to contamination in the air and water around them. The main isotope in DU, U238, has a half-life of 4.5 billion years, so this problem is not going to go away soon. The Bosnian Health Minister said recently that cases of leukaemia in Bosnia have doubled in the last 2 years. In November 2000, a UN Environment Programme task force inspected 11 of the 112 known targets of ordnance containing DU and found evidence of contamination in eight of these. Final analysis of soil, water and vegetation samples from the inspected areas will be available in early March. We need to know more about this sort of radiation exposure. Radiotherapy-induced leukaemia does develop after a latency of only 2–3 years, but this is a high-dose, acute exposure. Evidence from Hiroshima showed the latency of leukaemia development to be an average of 10–15 years, but again the people were exposed to acute, high-radiation doses. In contrast, DU emits low-dose alpha-particle radiation over a long period of time. We should have accurate, comprehensive 10-year follow-up information from the Gulf War veterans and Iraqi civilians, but where is it? The newspapers tell the stories of particular individuals, which has greater emotional impact and makes harrowing reading, but does not provide definitive proof of cause and effect. One problem is that the studies so far have been poorly planned and on a small scale. Well-designed, large-scale, efficiently coordinated studies monitoring large numbers of exposed veterans and civilians are needed. With hindsight, as the safety of DU was in question before its use in military campaigns, the most scientific approach would have been to monitor servicemen from baseline, during combat, and for many years post-war. Politicians, scientists, and the military from all the countries involved need to cooperate. This may seem unrealistic, but would be of benefit to everybody in the long term. Why did it take so long for NATO to reveal where DU had been used? It would have done their public image and credibility good to have been open from the start – especially since it was fairly obvious that they would have to give in eventually. A Pentagon document from 1993 warned that ‘when soldiers inhale or ingest DU dust they incur a potential increase in cancer risk’, yet now they are publicly denying any health risk at all. The message is not consistent – is it any surprise that the reassurances fall on sceptical ears? The Lancet Oncology
65
For personal use only. Reproduce with permission from The Lancet Publishing Group.
Mixed messages about depleted uranium Ten years ago this month the Gulf War was raging. Between January 17 and February 27 1991, the Allied forces bombarded southern Iraq and Kuwait with hundreds of thousands of rounds of depleted uranium (DU) shells. DU is used in bullets and shells because of its hardness and penetrating power. When DU ammunition hits its target, it explodes and burns, forming a chemically toxic and radioactive dust. The uranium oxide compounds in this dust can enter the body by ingestion and inhalation, or through wounds caused by shrapnel. In the Bosnian conflict (1992–95), American aircraft used 10 800 shells containing DU, and during the 1999 Kosovo campaign 31 000 rounds were fired. The Gulf War may have been a triumph against Saddam Hussein, but increased numbers of cases of cancer among war veterans and Iraqi civilians have been alleged ever since, and have been linked to the use of DU. Is a similar story going to unfold for the Balkan conflict over the next few years? The numerous articles in the newspapers in recent weeks seem to suggest so. Attention has focused almost exclusively on 17 cases of NATO servicemen who have developed leukaemia since serving in the Balkan war. All cases of leukaemia are distressing, but is this figure really in excess of the number of cases that would normally have been expected to develop in the general population? Of about 150 000 soldiers who served in Kosovo, 17 have been diagnosed with leukaemia – roughly 10 cases per 100 000 population. In the UK, the normal incidence rate of leukaemia in adult men is also about 10 per 100 000 population. Unfortunately, most of the reports fail to point out that it is very rare for cancer to develop within 2 years of exposure to this type of carcinogen. In seeking to show that DU is not carcinogenic, the UK Ministry of Defence quoted a study by the Department of Veteran Affairs, Baltimore, USA, which is following 33 American veterans, all of whom were exposed to DU, have shrapnel in their bodies, and have traces of uranium in their urine. After 2 years of follow up, none of the men in this study have developed cancer. Surely the word ‘yet’ has been missed off the end of this statement. While western reporting has concentrated on the possible effects on war veterans, very little attention has been paid to the possible risks to the civilian populations of Iraq and the Balkans, although the danger to them is much greater. The NATO military personnel have all gone home; they do not have to live near burnt-out tanks and are not continually exposed
THE LANCET Oncology Vol 2 February 2001
to contamination in the air and water around them. The main isotope in DU, U238, has a half-life of 4.5 billion years, so this problem is not going to go away soon. The Bosnian Health Minister said recently that cases of leukaemia in Bosnia have doubled in the last 2 years. In November 2000, a UN Environment Programme task force inspected 11 of the 112 known targets of ordnance containing DU and found evidence of contamination in eight of these. Final analysis of soil, water and vegetation samples from the inspected areas will be available in early March. We need to know more about this sort of radiation exposure. Radiotherapy-induced leukaemia does develop after a latency of only 2–3 years, but this is a high-dose, acute exposure. Evidence from Hiroshima showed the latency of leukaemia development to be an average of 10–15 years, but again the people were exposed to acute, high-radiation doses. In contrast, DU emits low-dose alpha-particle radiation over a long period of time. We should have accurate, comprehensive 10-year follow-up information from the Gulf War veterans and Iraqi civilians, but where is it? The newspapers tell the stories of particular individuals, which has greater emotional impact and makes harrowing reading, but does not provide definitive proof of cause and effect. One problem is that the studies so far have been poorly planned and on a small scale. Well-designed, large-scale, efficiently coordinated studies monitoring large numbers of exposed veterans and civilians are needed. With hindsight, as the safety of DU was in question before its use in military campaigns, the most scientific approach would have been to monitor servicemen from baseline, during combat, and for many years post-war. Politicians, scientists, and the military from all the countries involved need to cooperate. This may seem unrealistic, but would be of benefit to everybody in the long term. Why did it take so long for NATO to reveal where DU had been used? It would have done their public image and credibility good to have been open from the start – especially since it was fairly obvious that they would have to give in eventually. A Pentagon document from 1993 warned that ‘when soldiers inhale or ingest DU dust they incur a potential increase in cancer risk’, yet now they are publicly denying any health risk at all. The message is not consistent – is it any surprise that the reassurances fall on sceptical ears? The Lancet Oncology
65
For personal use only. Reproduce with permission from The Lancet Publishing Group.