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Unlike many studies, the Baltimore VAMC study examined targeted health outcomes in the study group that might have resulted from continuous exposure from embedded depleted-uranium shrapnel. The study had a long-term and consistent followup, particularly in relation to uranium excretion, which allowed one to see the chronic health effects in this population. In the most recent study (McDiarmid et al., 2007), the use of measures of cumulative exposure and depleted uranium enhanced the specificity of exposure. However, the small and select sample and the absence of a control group limited its ability to detect effects in the various outcomes. In addition, the selection of the urinary-uranium cutpoint of 0.10 μg/g of creatinine was not based on a generally accepted standard for urinary uranium.

UK Gulf War Studies

All UK military personnel who were deployed to the gulf region from September 1990 to June 1991 were evaluated in a retrospective cohort study (Macfarlane et al., 2000, 2003). The cohort consisted of 53,462 service members and an age-, sex-, service-, and rank-matched comparison group of 53,462 service members who were not deployed to the gulf region in the same period. Personnel were linked to the NHSCR to determine cancer diagnosis and vital status, and deaths were coded according to ICD-9. After exclusion of those who had died before the end of the Gulf War, those who had emigrated from the UK during the study period, and those whose vital status could not be determined, the Gulf War–deployed group consisted of 51,721 participants, and the nondeployed group consisted of 50,755 participants.

Initial cancer diagnoses in the registry through July 2002 were included in the analysis, and person-years at risk were calculated from April 1, 1991, to the earliest of either the date of emigration from the UK, the date of death, the date of first diagnosis of cancer, or July 31, 2002. Of the 51,721 deployed to the gulf, 2,092 reported an exposure to depleted uranium.

No excess risk of cancer overall was observed in the Gulf War veterans: there were 270 incident cancers in the Gulf War–deployed and 269 in the nondeployed (incidence rate ratio, 0.99; 95% CI, 0.83-1.17). No excess risk of any site-specific cancers was found, and adjustment for lifestyle factors and other potential confounders did not change the results.

Balkans Studies

Gustavsson et al., 2004

Swedish military and civilian rescue personnel deployed to the Balkans in 1989-1999 were studied to determine whether they had a higher incidence of cancer (Gustavsson et al., 2004). Swedish Armed Forces and Swedish Rescue



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