title: Cancer risk and all-cause mortality among Norwegian military United Nations peacekeepers deployed to Kosovo between 1999 and 2011.
abstract: OBJECTIVE
  Media reports of leukaemia and other cancers among European United Nations (UN) peacekeepers who served in the Balkans, and a scientific finding of excess Hodgkin lymphoma among Italian UN peacekeepers who served in Bosnia, suggested a link between cancer incidence and depleted uranium (DU) exposure. This spurred several studies on cancer risk among UN peacekeepers who served in the Balkans. Although these studies turned out to be negative, the debate about possible cancers and other health risks caused by DU exposure continues. The aim of the present study was to investigate cancer incidence and all-cause mortality in a cohort of 6076 (4.4% women) Norwegian military UN peacekeepers deployed to Kosovo between 1999 and 2011.
  
  
  METHODS
  The cohort was followed for cancer incidence and mortality from 1999 to 2011. Standardised incidence ratios for cancer (SIR) and mortality ratios (SMR) were calculated from national rates.
  
  
  RESULTS
  Sixty-nine cancer cases and 38 deaths were observed during follow-up. Cancer incidence in the cohort was similar to that in the general Norwegian population. No cancers in the overall cohort significantly exceeded incidence rates in the general Norwegian population, but there was an elevated SIR for melanoma of skin in men of 1.90 (95% confidence interval [CI] 0.95-3.40). A fivefold increased incidence of bladder cancer was observed among men who served in Kosovo for ≥ 1 year, based on 2 excess cases (SIR=5.27; 95% CI 1.09-15.4). All-cause mortality was half the expected rate (SMR=0.49; 95% CI 0.35-0.67).
  
  
  CONCLUSIONS
  Our study did not support the suggestion that UN peacekeeping service in Kosovo is associated with increased cancer risk.
authors.affiliation: Norwegian Armed Forces Medical Services, N-2058 Sessvollmoen, Norway; Cancer Registry of Norway, Box 5313, N-0304 Oslo, Norway. Electronic address: laastrand@forsvaretshelseregister.no.
authors.forename: Leif Aage
authors.initials: LA
authors.lastname: Strand
authors.affiliation: Cancer Registry of Norway, Box 5313, N-0304 Oslo, Norway.
authors.forename: Jan Ivar
authors.initials: JI
authors.lastname: Martinsen
authors.affiliation: Norwegian Armed Forces Medical Services, N-2058 Sessvollmoen, Norway.
authors.forename: Einar Kristian
authors.initials: EK
authors.lastname: Borud
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D063826:Kosovo; D008297:Male; D008889:Military Personnel; D009369:Neoplasms / Q000453:epidemiology*; D009664:Norway / Q000453:epidemiology; D012306:Risk; D014480:United Nations; D014857:Warfare; D055815:Young Adult
keywords: All-cause mortality; Balkans; Cancer; Cohort study; Depleted uranium; Military