Lagorio Susanna, Grande Enrico, Martina Lucia
Istituto superiore di sanità, Centro nazionale di epidemiologia, sorveglianza e promozione della salute (CNESPS), viale Regina Elena 299, 00161 Roma.
Epidemiol Prev. 2008 May-Jun;32(3):145-55.
Analysis of the available epidemiological evidence on cancer risk among Gulf war and Balkans veterans.
Eligible for the review were all studies published in peer-reviewed journals indexed in MedLine by the end of 2007. The review includes twelve studies published between 1996 and 2006 All of them are retrospective cohort studies focused on different outcomes: mortality, hospitalizations or cancer incidence. The study populations are from US, UK, Sweden, Denmark and Italy. The description ofthe studies reviewed focusses on their main features (design, study population, health outcomes and ascertainment procedures, analytical methods).
Results are summarized by cancer site: all cancers, neoplasms that may be a target of exposure to depleted uranium (lung cancer, leukemias, kidney cancer, bone cancer), and other neoplasms (lymphomas, brain cancer, and cancer of the testis) relatively frequent among young adults. The overall incidence of cancers is not increased in the cohort studies of Gulf war and Balkans veterans published to date, nor there is consistent evidence of excess risks of neoplasms possibly related to exposure to depleted uranium. However, in the Danish cohort of Balkans veterans an increased risk ofbone cancer has been observed, but the excess disappeared when a 1-year latency was considered. An increased brain cancer risk in relation to exposure to nerve-gas agents has been observed. Sporadic excesses of Hodgkin lymphoma and testicular cancer in deployed veterans have been reported.
None of the studies reviewed could obiectively assess exposures to depleted uranium or to other potentially carcinogenic agents experienced in the theaters. The study cohorts are young and the follow-up periods are probably too short to capture excesses of long latency outcomes. The update of the follow-up of the cohorts and studies of other cohorts with a better assessment of exposure to depleted uranium and to other potentially relevant risk factors are warranted.
分析海湾战争和巴尔干地区退伍军人患癌风险的现有流行病学证据。
符合综述要求的是截至2007年底发表在被MedLine索引的同行评审期刊上的所有研究。该综述包括1996年至2006年间发表的12项研究。所有这些都是回顾性队列研究，关注不同的结果：死亡率、住院率或癌症发病率。研究人群来自美国、英国、瑞典、丹麦和意大利。所综述研究的描述重点在于其主要特征（设计、研究人群、健康结果和确定程序、分析方法）。
按癌症部位总结结果：所有癌症、可能是贫铀暴露目标的肿瘤（肺癌、白血病、肾癌、骨癌）以及在年轻人中相对常见的其他肿瘤（淋巴瘤、脑癌和睾丸癌）。在迄今发表的海湾战争和巴尔干地区退伍军人队列研究中，癌症总体发病率并未增加，也没有一致的证据表明与贫铀暴露可能相关的肿瘤存在额外风险。然而，在丹麦的巴尔干地区退伍军人队列中，观察到骨癌风险增加，但考虑1年潜伏期后，这种额外风险消失了。观察到与接触神经毒气剂相关的脑癌风险增加。有报告称部署的退伍军人中霍奇金淋巴瘤和睾丸癌偶尔出现超额病例。
所综述的研究均无法客观评估在战区接触贫铀或其他潜在致癌剂的情况。研究队列较为年轻，随访期可能太短，无法捕捉长期潜伏期结果的超额情况。有必要更新队列随访情况，并对其他队列进行研究，以更好地评估贫铀暴露及其他潜在相关风险因素。
