QUESTIONABLE INCREASE OF CHILDHOOD LEUKEMIA IN BASRAH, IRAQ

Abstract

The explosion of depleted uranium ammunition generates ultrafine uranium dust particles that may pose health hazards, especially an increased risk for cancer, for people living in combat zones. Hagopian et al.1 claims a more than doubling of childhood leukemia incidence in Basrah governorate over a period of 15 years (1993–2007), based on data of a hospital-based tumor registry, speculating about possible effects of chemical warfare agents, benzene, and exposure to depleted uranium dust. In our opinion this claim is as yet unsubstantiated, because no reliable population figures are available for the whole period. Besides, a hospital-based tumor registry usually cannot provide complete population coverage and lacks at least one indispensable data source of population-based cancer registries: death certificates. One of us (E. G.) was part of a group of World Health Organization (WHO) temporary advisors visiting Baghdad in September 1995 on request from the Iraqi Ministry of Health to advise on problems of cancer control. At that instance proportionate incidence data were presented by scientists from the Iraqi National Cancer Registry indicating higher rates of childhood leukemia for the governorate of Basrah than for the rest of Iraq. Exposure to depleted uranium ammunition in and around Basrah was discussed as a possible cause. In a subsequent WHO mission in December of 1995 we analyzed the National Cancer Registry and abstracted from ledgers data on childhood leukemia for the whole of Iraq. No population figures were available, but we were provided with projections of population data for all Iraqi governorates. Based on these data no increase of childhood leukemia could be detected for the governorate of Basrah. In our report to the WHO we raised the suspicion of gross underreporting for all Iraqi governorates except for Baghdad (report available from the authors). A diverse group of children at Kingsmead Primary School pay close attention during a school assembly. Most of the children live on the Kingsmead Estate in Homerton, Hackney, UK, close to the site of the 2012 Summer Olympic Games. Photograph by Gideon Mendell. Printed with permission of Corbis. Supported by the German Academic Exchange Service (Deutscher Akademischer Austauschdienst (DAAD) 2005, 2006) and the Norwegian Foreign Office (2009) we conducted postgraduate courses on epidemiologic methods for scientists from Basrah and Baghdad in Amman, Jordan (February 2005); Greifswald, Germany (February 2006); and Istanbul, Turkey (July 2009) to enable our colleagues from Iraq to establish a population-based cancer registry in Basrah and to prepare a design for a case-control study on childhood leukemia. This endeavor is still under way.