Epidemiologic studies have yielded inadequate evidence of a risk of cancer or other chronic diseases after exposure of Gulf War soldiers to DU.
The epidemiologic data on workers exposed to uranium compounds are substantial (nearly 110,000 exposed, or potentially exposed, workers followed for long periods). Those data have weaknesses—such as little exposure-response information, inability to adjust for smoking habits, and no evidence on exposure of children or other presumptively susceptible populations—but the preponderance of the evidence indicates that there is not an appreciable risk of cancer in humans exposed to uranium.
Additional followup studies of exposed populations have the potential to improve knowledge of the health effects of DU. To permit an adequate assessment of the risks of cancer, renal toxicity, and other possible health effects faced by DU-exposed soldiers, a careful followup of the exposed groups should be continued, including the cohort of DU-exposed soldiers now being followed by the Department of Veterans Affairs. Furthermore, continued followup of the largest groups of workers and those who had the greatest highest exposure is recommended.
If sufficiently detailed records are still available, it would be valuable to reconstruct individual exposures in a few of the largest studies with the greatest range of exposures. That would permit the evaluation of exposure-response analyses that would help to solve the problems in evaluating health end points caused by the “healthy-worker effect.” More information is needed on other exposures sustained in the uranium-cohort workplaces, such as exposures to solvents, other metals, and asbestos.
A program of examination of subgroups of workers with high, medium, and low exposure to uranium, with appropriate matching on other risk factors, should be implemented for selected health-related end points and biomarkers, including renal function, genotoxicity, and bone enzymes and activity.