Health in the Middle East

Editor—In the editorial on lessons in tackling chronic disease in the Middle East Nishtar mentions the increased incidence of cancer from exposure to depleted uranium.¹ This is often a controversial and emotive subject. The reference cited in the editorial¹ is a cohort study that did not find an excess risk of cancer associated with exposure to depleted uranium 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 between depleted uranium and cancer are quite consistent, although a possible case for lung cancer has been suggested.³ Another editorial on the public health effects of depleted uranium⁴ and the two part report of the Royal Society Working Group both consistently uphold this view.³

The highest levels of 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 shell containing depleted uranium may double their lifetime risk.³ The added risk of leukaemias or other cancers caused by radiation from depleted uranium is less than five in a million for all possible levels of exposure.³ A recent population based retrospective study reiterates the lack of association between depleted uranium and leukaemia and testicular cancer.⁵ Longer term follow-up data are awaited, but the current argument is not in favour of a strong link.