title: Cancer incidence in Dutch Balkan veterans.
abstract: Suspicion has been raised about an increased cancer risk among Balkan veterans because of alleged exposure to depleted uranium. The authors conducted a historical cohort study to examine cancer incidence among Dutch Balkan veterans. Male military personnel (n=18,175, median follow-up 11 years) of the Army and Military Police who had been deployed to the Balkan region (1993-2001) was compared with their peers not deployed to the Balkans (n=135,355, median follow-up 15 years) and with the general Dutch population of comparable age and sex. The incidence of all cancers and 4 main cancer subgroups was studied in the period 1993-2008. The cancer incidence rate among Balkan deployed military men was 17% lower than among non-Balkan deployed military men (hazard ratio 0.83 (95% confidence interval 0.69, 1.00)). For the 4 main cancer subgroups, hazard ratios were statistically non-significantly below 1. Also compared to the general population cancer rates were lower in Balkan deployed personnel (standardised incidence rate ratio (SIR) 0.85 (0.73, 0.99). The SIR for leukaemia was 0.63 (0.20, 1.46). The authors conclude that earlier suggestions of increased cancer risks among veterans are not supported by empirical data. The lower risk of cancer might be explained by the 'healthy warrior effect'.
authors.affiliation: National Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands. rik.bogers@rivm.nl
authors.forename: Rik P
authors.initials: RP
authors.lastname: Bogers
authors.forename: Flora E
authors.initials: FE
authors.lastname: van Leeuwen
authors.forename: Linda
authors.initials: L
authors.lastname: Grievink
authors.forename: Leo J
authors.initials: LJ
authors.lastname: Schouten
authors.forename: Lambertus A L M
authors.initials: LA
authors.lastname: Kiemeney
authors.forename: Dieneke
authors.initials: D
authors.lastname: Schram-Bijkerk
mesh_terms: D000293:Adolescent; D000328:Adult; D063368:Balkan Peninsula; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D009381:Neoplasms, Radiation-Induced / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D016273:Occupational Exposure / Q000706:statistics & numerical data; D012042:Registries; D014501:Uranium / Q000506:poisoning; D014728:Veterans / Q000706:statistics & numerical data*; D014857:Warfare; D055815:Young Adult
chemical_list: D014501:Uranium
keywords: 95% CI; 95% confidence interval; Cohort studies; DU; HR; Historical; Incidence; Military personnel; NATO; Neoplasms; North Atlantic Treaty Organisation; Occupational exposure; SIR; depleted uranium; hazard ratio; n; number; standardised incidence rate ratio