Dr. Muna Al Jubury - University of Baghdad
Health Consequences of D. U. weapons used by U.S. and
British Forces
Abstract:
A case control study of cancer cases in military troops
and its relation to Depleted Uranium used by U.S. and British
forces.
The study was a statistically and clinically descriptive
study of cancer cases in Iraq. These studies involved Iraqi military
personnel in the southern region of Iraq following the Gulf War.
1425 cases were selected retrospectively, which were
diagnosed with different types of cancer in military and civilian
hospitals. The study included cases of males who had participated in the
war in the southern region of Iraq. The cases included only males between
the ages of 19 and 50.
The study includes tabulation of cancer cases in this age
group to see whether there is a positive association or odds ratio between
those cases and D.U. used by the U.S. and British forces.
It is estimated that about 630,000 pounds of depleted
uranium contaminated huge areas including targets and the surrounding
environment.
The study shows increasing registration of different types of cancer cases and change in the epidemiological pattern of there occurrence with time among military personnel who were in the southern region of Iraq during the war. There is a significant correlation and association between these cases and D.U. exposure. This is illustrated by odds ratio of lymphomas and leukemias were 5.6 and 4.8 respectively.
Introduction:
In the war against Iraq in 1991 allied forces used 630,000
pounds of depleted uranium. Consequently, there are adverse health effects
on human beings and the environment in Iraq and probably in the
neighboring countries such as Kuwait and Saudi Arabia.
Military personnel and their families were exposed to
depleted uranium weapons, which have a radiological and chemically toxic
effect secondary to the their explosions. In addition, it is a source of
contamination of the environment.
The central committee that was established in Iraq did a
series of epidemiological investigations and field attachment surveys on
the ill effects of depleted uranium weapons on human beings and the
environment.
The result of this investigation is that both military
personnel and their families who have been exposed to depleted uranium
have experienced radiological and chemically toxic effects. Health
problems may also exist in Kuwait, as a result of the huge contaminated
area. It is estimated that approximately 14 acres, which are being used as
a collection point of contaminated and destroyed vehicles and tanks. In
addition, huge unknown quantities of D.U. munitions were buried in the
ground in this area. (Dan Fahey, 1998).
There is also a probability of pollution in Saudi Arabia.
Under the command of the New Jersey Company of American National Army,
King Khalid Military City and King Abdul Aziz Air Force Base were used as
collecting points for contaminated and destroyed vehicles and
tanks.
Objectives:
Material and Method:
A case control study of different types of cancer cases observed in military troops who participated in the war in the southern region of Iraq in 1991. To determine relative risk (odds ratio) of these cases, military personnel with cancer was compared to cases free from cancer in order to study the factor incriminated.
The sample of cancer cases selected includes lymphomas, leukemias, lung CA, bone CA, gastrointestinal cancers, brain CA, and liver CA.
The cases studied are those which are registered retrospectively from military and civilian hospitals in the age group (19-50 years) who were in service at that time. The cases were identified clearly from the case sheets and the addresses of their residence which were fixed since 1991 up to 1997. 1425 people, whose residences were known, were asked if they were exposed to an explosion.
Sample comparative groups were identified and selected from military patients free of cancer who were admitted to the military hospitals from the same age group and sex. Their addresses were fixed from the case sheets and they were asked whether they were exposed to an explosion while in field operation.
Method of selection of sample cases was done through study of all cancer cases that were diagnosed and registered from 1991-1997.
Size of sample: It includes all recorded cancer cases that were diagnosed and registered in the civilian and military hospitals.
Data collection: It included case history, clinical exam, laboratory investigation, radiological finding and results of histopathological findings through sample form attached in the appendix A.
Direct interviews were done with control group. Each were asked about exposure to explosion.
Analysis of sample forms was done manually.
Presentation of data in form of tables and histograms.
Results:
Table (1):
Different types of cancer cases that were registered from
1991 through 1997 of military participants exposed to depleted
uranium.
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| Lymphomas |
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| Leukemias |
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| Lung CA |
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| Brain CA |
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| Gastrointestinal CA |
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| Testicular CA |
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| Bone CA |
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| Pancreatic CA |
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| Salivary gland CA |
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| Liver CA |
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| Total |
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Shows an increase in registration of different types of cancer cases
from 1991 through 1997 in those who were exposed to explosions in the
battle field including lymphomas, leukemias, lung cancer, and brain
cancer.
Table (2):
Different cancer cases that were registered from 1991 through 1997 in
military participants not exposed to the causative agent under study
(D.U.)
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| Lung |
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| Gastrointestinal |
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| Leukemias |
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| Lymphomas |
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| Liver |
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| Bone |
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| Brain |
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| Total |
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Shows an increase in registration of different types of cancer cases
starting in the year 1992 for those military personnel who were not
exposed to an explosion in the field in comparison with 1991, especially
in relation to lung cancer, gastrointestinal cancer, leukemias, and
lymphomas.
Table (3):
Relative Risk is estimated by calculating odds ratio of different types
of cancer cases.
| Types of Cancer |
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| 1. Lymphomas |
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| 2. Leukemias |
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| 3. Brain CA |
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| 4. Liver CA |
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| 5. Bone CA |
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| 6. Gastrointestinal CA |
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| 7. Lung CA |
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| 10. Total cancer cases |
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Shows the odds ratio which is "the degree of association between the factor under study and cancer cases."
Statistically, it is significant in relation to lymphomas, leukemia,
lung , brain, gastrointestinal, bone, and liver cancers.
Discussion:
The tables and graphs indicate there is change in the pattern of different types of cancer cases in military personnel who were involved in the southern region of Iraq during the war with U.S. and British
forces in 1991.
The sample cases were from military personnel who
participated and were exposed to explosions of D.U. weapon in the south of
Iraq, Rumaila north, Rumaila south, strategic pipeline near pump station
(Border of Saudi Arabia), and the road between Safwan and Kuwait at which
attacks on tanks and vehicles continued 2 days after withdrawal of Iraqi
troops.
U.S. and British forces dropped about 630,000 pounds of
depleted uranium against Iraqi vehicles and tanks, and it is estimated
that approximately 5000-6000 rounds of 120 mm and about 940,000 bullets of
30mm.
From review of literature, these weapons have ill effect
on both human and environment.
It seems clear from tables and graphs that there is
increasing registration of different types of cancer cases from years 1993
and 1994, especially lymphomas, leukemias, in addition to lung CA, bone
CA, brain CA, Gastrointestinal cancers and liver CA.
The personnel under risk of exposure to an explosion
(population at risk) were tanks crews, armored vehicles, artillery, air
force defense, and those personnel who were engaged in administrative
support to the fighting troops.
Table (1):- There is relative decline in the percentage of
lymphoma in 1997 in comparison with 1991. It represents about 34.5% in the
year 1991, but represents 29.4% in 1997. Also, there is a decline in the
percentage of leukemias and bone cancer in 1997 in comparison with 1991.
This may be due to increase in registration of other types of
cancer.
Table (2):- Shows increase in the registration of
different types of cancer cases from the years 1993-1994 to those
participated, but not exposed, which is probably similar to the pattern in
the general population. Also there is a decline in the percentage of
registration in 1997 in comparison to 1991 concerning lung CA, leukemias
and probably this is due to the increase registration of other cancers
such as gastrointestinal cancer, leukemias, lymphomas, bone CA, and brain
CA, which were not registered in 1991.
The end result of the exploded weapon could be as dust, fumes, aerosol, or ashes that contain uranium oxide particles. These particles could be transmitted by air or carried with winds and can be airborne for miles before dropping to the ground (Dan Fahey 98).
This can raise the probability of different types of
cancer cases occurrences to those exposed to field explosion and front
units, in tank crews, armored vehicles, air force defense, artillery,
those personnel who were in administrative units, and in maintenance of
destroyed vehicles or evacuation.
Table (2) also shows increase in registration of cancer
cases in those who participated were but not exposed. This probably can be
due to environmental pollution, which might be similar to the pattern of
cases in the general population.
Dust of D.U., as a result of it's explosion, can fall on
the ground and personnel can inhale it or it enters the body through GIT.
In addition, some of the bullets that miss their targets fall on the
ground and could be considered as environmental pollutant that can
contaminate food and surface water sources and ground water.
Its effect on environment depends on the type of soil and
the degree of solubility of uranium oxide particles. (Dan Fahey
98).
Table (3):- shows statistically significant odds ratio of
different types of cancer cases to those involved and exposed to an
explosion in the battlefield. From an epidemiological point of view, it is
interpreted that there is a positive association between the explosion
(exposure to D.U.) and cancer cases.
Odds ratio was very high in lymphomas which was 5.6,
followed by 4.8 in cases of leukemias, and 4.5 in brain CA.
In fact, the odds ratios of other cancer cases in relation
to exposure to an explosion (the factor under study) also have
statistically significant values as shown by Table (3), but in a lesser
degree such as in cases of lung, gastrointestinal, liver, and bone
cancers.
The probability of this association as shown from odds
ratio could be related to the causative agent (D.U.).
D.U. contains alpha particles, the insoluble part of these
particles represent about 83.52%. This quantity, once entered the body of
the exposed person, will stay there and consequently ionize body organs
and tissues surrounding it, causing different types of cancer. (Dan Fahey
98).
The soluble part of alpha particles, which represent 48%,
is transmitted to the human body by absorption and through blood
circulation. Only about 60% will be excreted by urine and stool within a
few weeks. The residual 20% will be deposited in the bones and the other
10% will be distributed to the other body organs, especially the liver,
causing ionization of the tissues of the organs and disturbance of their
function. This, consequently, may cause different types of cancer cases
(Los Alamos National Laboratories 1996).
The soluble part of alpha particles inside the body of
human being has a chemically toxic effect on DNA of reproductive cells
which causes congenital anomalies and destructive effects on reproductive
mechanisms resulting in primary and secondary sterility (Dan Fahey
98).
The mechanism of cause and effect needs further laboratory
and experimental studies of those exposed to the causative agent through
examination of its effect on chromosomes.
It is stated by U.S. Army Environmental Institute Report
1995 and Department of Veterans Affairs 1997, that "D.U. has an effect on
changes of the shape of chromosomes in terms of increase in sister
chromatid exchange" and that was proven through lymphocyte culture of two
groups of people working in uranium manufacturing in U.S. The end result
of the study shows that the group of workers exposed to soluble type of
uranium have a statistically significant rise in chromosomal aberration
and sister chromatid exchange in comparison with group of workers exposed
to soluble and insoluble type of uranium.
The probability is that D.U. has a chemically toxic and
radiological effect due to the alpha particles it contains: consequently
causing infertility, congenital anomalies, low birth weight of babies of
fathers and mothers exposed to D.U.
This may explain the 222 cases of congenital anomalies and
stillbirths related to military personnel who were exposed to the
explosions in the southern region of Iraq as shown in Graph 15.
Graph (1):- represents subsequent rise in registration of
total cancer cases in those exposed and not exposed.
Graph (2):- shows subsequent rise in registration of
different types of cancer cases in those who participated and were exposed
to explosion from the years 1991 up to 1997.
Graph (3):- represents the total number of different types
of cancer cases in military personnel who participated but not exposed to
explosion,. Graph (3) also shows subsequent rise, but in a lesser degree,
probably due to environmental pollution.
Graphs (4-13):- show an increase in registration of
different types of cancer cases from the year 1992 forward of those
military personnel who were exposed to D.U. explosions including
lymphomas, leukemias, lung CA, brain CA, GIT CA, bone CA, testicular CA,
pancreatic CA, salivary and liver CA. In fact, the real rise was from the
year 1993-1994 forward which shows the effect of factor under study which
needs a lapse of years to show it's effect in terms of it's ionizing
radiation of alpha particles constituent.
Graph (14):- shows the percentage of different types of
cancer cases in military personnel who participated and were exposed to
the explosion. The most common type registered was lymphomas, leukemias,
lung CA, brain CA respectively. This might give a clue about the causative
agent and its pathogenesis.
Graph (15):- shows the percentage of still birth,
congenital anomalies, and secondary infertility in families of military
participants exposed to D.U. explosions.
Graphs (16-22):- show the pattern of total number of
different types of cancer cases in military personnel who participated,
but not exposed to D.U. explosion. These graphs also show an increase in
registration of cancer cases among them, but in a lesser degree, also
after a lapse of 3-4 years followed by subsequent rise.
Graph (23):- shows the registration of different types of
cancer cases among unexposed personnel who participated in the southern
region of Iraq during U.S. and British attacks. The common cancers
registered were lung CA, GIT, leukemias and lymphomas. It may be
interpreted in the following manner:
The dosage of exposure due to environmental pollution may
play a role in the pathogenesis of these diseases through inhalation and
ingestion of high doses of particles of the causative agent.
Further studies are required to isolate the causative
agent a principal cause for such problems, especially to determine the
effect of environmental pollution.
Conclusion:
The quantity of D.U. weapons used by U.S. and British
forces against Iraq in 1991 was estimated to be approximately 5000-6000
rounds of 120 mm and 940,000 bullets of 30 mm. Its weight was
approximately 630,000 pounds (Dan Fahey 98).
The effluent of this weapon is the dust of uranium oxide
resulted in pollution of thousands of targets hit by this sort of weapon
and surrounding areas in the southern region of Iraq, Kuwait, and Saudi
Arabia.
The study of tables and graphs shows the change in the pattern of different types of cancer cases in military personnel who participated in the southern region of Iraq (exposed or not exposed to an
explosion). They also show positive odds ratio of cancer
cases in relation to the explosion which indicates the association between
the factor under study (D.U.) and these cases.
From epidemiological criteria of effluent, the usage of
such weapons creates dust or aerosol as a result of explosion of D.U.
weapon in the field, and may be transmitted directly to the human body
through respiratory system or gastrointestinal system or contaminate
wounds directly or through contaminated shrapnel.
The indirect method of transmission is through pollution
of the environment in which the soluble part of alpha particles deposited
on the soil. In addition, the bullets that missed their targets and fell
on the ground can pollute food, surface water, and ground water. (U.S.
Army Chemical School, D.U. training 1995).
The significant odds ratio of lymphomas, leukemias, brain
CA, which were 5.6, 4.8 and 4.5 respectively in the exposed
personnel.
Proposals:
Provision of epidemiological and clinical studies to all health problems related to the use of D.U. weapons
The need for a prospective study to compare the exposed personnel to D.U. with group of personnel who were unexposed. Study should be followed for at least 2 years to directly determine the odds ratio.
Provision of training survey for doctors and allied personnel for such problems.
Studies should concentrate upon high risk groups and should be studied long term.
Utilize all the experiences of countries that were exposed to ionizing radiation weapons in the world.
Provisions of laboratory studies of chromosomes to confirm the chemically toxic effect of ionizing factors.
Clinical epidemiological screening of urinary tract system to those exposed to D.U. to identify the ill effects.
Identify the military troops which are at risk, and expose them for epidemiological and clinical studies.
Screening of all Iraqi cities as to the level of
contamination, not only the southern region.
REFERENCES:
1. Dan Fahey, case narrative, depleted uranium exposures, last update March 1998, p. 1-180.
2. Development of depleted uranium training support packages, Tier 1. General Audience, U.S. Army Chemical School, October 1995, B-5 to B-6.
3. Dietz L.A., Estimate of radiation dose from a depleted uranium oxide particle, 1991, reproduced in Appendix, Uranium Battlefields.
4. International Bone Seeking Radio Nuclides and Monocytes Counts, International prospective in public health, Dr. Rosalie Bertell, Vol. 9, 1993, p.21.
5. Kinetic Energy Penetrator Environmental and Health Considerations (Abridged). Science Application, International Corporation, July 1990, Vol. 1, 2-2.
6. Middle East trip provides useful information exchange,
Gulf Link, Jan. 28, 1998. Walid Al-Tawil interview conducted in Baghdad
Iraq, May 1995.
Prof. Mikdam M. Saleh, Ph.D. Ahmed J. Meqwar
Abstract
Weapons containing "Depleted Uranium" (DU) were used, for the first time during the "Mother of All Battles" (Operation Desert Storm) by the allied forces against military targets, industrial installations, and civilian populations. The long-term effects of DU on the Iraqi environment, especially in the southern region, were examined and analyzed.
The exposure rate to external gamma radiation was measured in six selected regions in the study area (Basra, Zubair, Safwan, Jabal Sanam, and north and south Rumaila), where (154) biological samples (plant and animal tissues), (128) soil and (60) water samples were collected from these regions.
Gamma spectrometric analysis of plant samples indicated the presence of some isotopes of the U-238 series in (36.4)% of the total samples, which were collected from the study area.
Some of the wild plant samples (Haloxylon salicornicum and Stippa capensis) tended to have high concentrations of Th-234 and Ra-226 (with several samples whose concentrations exceeded those taken from regions with natural background level). The minimum concentrations of Th-234 and Ra-226 were (28, 62) Bq.Kg-1, respectively, were found in the Haloxylon salicornicum samples, and the maximum (249, 275) Bq.Kg-1, were found in the Stippa capensis samples. Other samples concentrated Bi-214 and Pb-214, with concentration of (1-3) times the natural background level.
The "Transfer Coefficient" (TC) between soil and plant for U-238 and Ra-226 were measured, for the first time in Iraq (as far as can be ascertained). TC values for U-238 and Ra-226 were [0.17(54.2%), 0.37(79.6%)], respectively, and are in good agreement with corresponding values reported in the literature.
The internal and external doses that were delivered to the population in the study area have been calculated. The average doses over the period from (1991-1996) due to inhalation, ingestion of meat and milk, and external exposure, were (87.4, 0.25, 0.20, 0.13) mSv, respectively in each of Basra and Zubair, (173.5, 0.51, 0.39, 0.27) mSv, respectively, in Safwan. The result of these calculations showed that the dose delivered to infants and children (less than 15 years old) represent (70)% of the total dose delivered to the general population.
This study, also, predicted the fatality rate for the newly born (300) and for the general population (800) due to leukaemia, over the period from (1991-1996). The expected incidence (after 10 years latent period) for lung cancer was estimated at (44)% of the total population, while for fatal or non-fatal cancer and hereditary damages at (5)%.
The "Risk Coefficient" (RC) of mortality due to leukemia, from 1991-1994, was estimated at (2.67 Sv-1). This is in agreement with many values published in the literature.
Calculations showed that an estimated (845,100) tons of edible wild plant were contaminated with radioactive materials (U-238 series), and (31)% of the animal resources were exposed to internal radioactive contaminants that exceeds the natural background level. An estimated area of (1044800)m2 in which the soil organisms were exposed to radioactive contaminants, which exceeds the threshold level for damage.
Lastly, this study estimated the total damages incurred to the population and biosphere in the study area, at the sum of (372.2) billion dollars.
The effect of the war of the American and the
affiliated forces against Iraq on the distribution and elevation of cancer
diseases in Mosul.
Mohemid Maddadah Al-Jebouri, M.Sc. Ph.D. M.I. Biol.
Department of Microbiology, College of Medicine,
University of Tikrit, Tikrit Iraq
Ibraheem Abdul-Kareem Al-Ani, B.Sc., M.Sc.
Department of Biology, College of Science, University of
Al-Anbar, Ramadi, Iraq
Salih Abed Al-Joumaily, M.B., Ch.B., Ph.D.
Department of Pediatrics, College of Medicine, University
of Mosul, Mosul, Iraq
All correspondence to:
Prof. M.M. Al-Jebouri, Department of Microbiology, College of Medicine,
University of Tikrit, Tikrit, Iraq
Abstract:
A total of 1094 cancer cases were reported in four
hospitals and/or medical centers of Mosul city during 1974-1990 and
1997-1998. The present study showed that males were under risk of cancer
more than females. Deep x-ray as a treatment tool for tumour was the most
common. The frequency of incidence of cancer diseases elevated 5-fold
after the war in 1991. Lung, leukemia, breast, skin, lymphoma and liver
cancers elevated after the war. This elevation could be due to the
depleted uranium weapons used by the allied forces against Iraqi troops
and citizens. Other environmental contaminants with health hazards should
be not excluded.
Introduction:
Radiation can cause cancer. Highly energetic ionizing
radiation (capable of knocking electrons out of atoms and molecules) is
the most hazardous. But non-ionizing radiation such as ultra-violet light,
plays an important role in the genesis of human skin cancer. Survivors
from Hiroshima and Nagasaki showed a marked elevation in the incidence of
leukemia five years after the explosions in 1945. After a later period,
the incidence of breast, thyroid, lung, and bowel cancers were found to be
modestly elevated. (Currie and Currie, 1982) The effect of radiation on
man can be observed as weakness, age shortening, redness of the skin, and
the elevation of incidence with leukemia (Raymon, 1987). The effect of
radiation on human cells appears within 10-16 second, usually
called the direct physical effect of radiation. The biological effect of
radiation not only depends on the dose, but also depends on the relative
biological effect (R B E) which is consequently dependent on the type of
radiation used. This is defined as the quality factor. (Raymon, 1987.
Krane, 1987). The present study is an assessment of the effect of the
American and affiliated forces attacks using the depleted uranium
munitions and the rate of incidence of cancer diseases among the Iraqi
peoples by comparing the incidence of cancers before and after the war in
1991.
Patients and Methods:
The cancer diseases were recorded in four hospitals and/
or medical centers for cancer treatment and management in Mosul city from
August 1989 to March 1990. The same work was repeated in the same
hospitals and medical centers during August 1997 to March 1998. Type of
cancer, sex of patients, and type of therapy was studied. The two most
prevalent types of cancer diseases were also examined and statistically
analyzed (Al-Ani, 1990).
Results:
Table (1) shows that the rate of incidence of cancer was increased almost 3-fold after the attacks of the American and affiliated forces during 1991. Males were under risk of developing cancers more than females before and after the war.
Table (2) shows that most of the cancer patients were treated with deep x-ray. Cytotoxic drugs were also used for treatment of cancer patients either alone or in combination with deep x-ray.
Table (3) shows the distribution of various cancer diseases among the patients studied before and after the war. The lung cancer was prevalent with respect to other cancers, and the incidence frequency among males before and after was 20.5 and 25.7 percent, respectively. Lymphoma, leukemia, breast, and larynx cancers were also prevalent with different rate of incidence among males and females before and after the aggression.
Table (4) shows the prevalent cancer disease among males and females before and after the war. The present study shows that skin cancer was one of the common diseases disseminated among people, particularly males. This disease was more prevalent after the aggression against Iraq. Not one case was reported among females before the war. The incidence frequency of skin cancer among females after the war was almost 9%. The incidence of breast cancer was also elevated after the war.
Table (5) lists the cancer diseases which are elevated
after the war against Iraq. The lung cancer was elevated among males from
20.5% to 25.7%. There was no lung cancer cases reported among females from
before the war, but the frequency of incidence increased up to 3.6% of the
total cancer diseases reported after the war. The cancer of larynx, skin,
and liver among females was reported after the war only. Breast cancer was
also elevated from 21.8% to 27% after the war. Leukemia became prevalent
(9%) among males after the attacks of the affiliated forces. Thyroid
cancer was also elevated from 0.8% to 2% of the total cancer cases
reported in Mosul hospitals after the war.
Discussion:
The present study showed that males were under risk of
developing cancer diseases more than females, and the statistical
differences were significant (P< 0.05). The same conclusion was
reported by Ibraheem and Majeed (1987), Wilson and Patterson (1989) and
Al-Irhayim and Saleem (1990). The explanation for such difference might be
due to occupational, environmental, anatomical, and physiological
differences between males and females (Doll, 1977). Moreover, the elderly
peoples were under risk of cancer more than other age groups. This could
be due to the physiological and immunological change at this age.
Furthermore, the present study revealed that solid tumours were more
prevalent, and the same results were concluded by Elting (1986). However,
the distribution of the cancer diseases among males and females before and
after the war was different. This difference could be due to the change of
environmental conditions and contamination by declared and undeclared
weapons used by the allied forces against Iraq, e.g. the depleted uranium
weapons. The weapons used against the republican guard forces produced
ionizing radiation leading to possible biological effects on the Iraqis
(Al-Jomialy 1996). In 1996, Al-Jomialy found a remarkable increment in the
uranium concentration especially in Al-Muthanna and the Thee-Qar provinces
where the republican guard forces were concentrated. However, lung,
larynx, lymphoma, bladder, skin, stomach, breast, uterus, leukemia,
thyroid, and liver cancers were all showing and the incidence of the
diseases after the war were elevated.
References:
1. Al-Ani, I.A.K. (1990). Bacteriological studies on cancer patients in Mosul district. M.Sc. thesis, University of Mosul.
2. Al-Jomialy, F.M.A. (1996). Detection of depleted uranium in soils from UM - L - Maalrik battlefield by using CR.-39 detector. M.Sc. thesis. University of Mosul.
3. Al-Irhayim, B. and Saleem, S.H. (1990). Cancer in first two decades of life excluding leukemias - A pathological study of 300 cases in Mosul. 232-237.
4. Currie, G. and Currie, A (1982). Cancer - The Biology of Malignant Diseases. Edward Arnold. London.
5. Doll, R. (1977). Introduction. In II.II.Illatt. J.D. Watson and J.A. Winsten (ed s). Origin of human lab. Cold Spring Harbor, New York, pp. 309-330.
6. Elting, L.S.; Body, G.P.; Fainstein, V. (1986). Polymicrobial septicaemia in the cancer patient. Medicine, 65: 218-255.
7. Ibraheem, K.S. and Majeed, A.A. (1978). Cancer in the north part of Iraq (Ninerveh Province). Iraqi Medical journal, 35:63-66.
8. K.S. (1987). Introduction - Nuclear Physics. John & Sons, Inc. London.
9. Raymon, M. (1987). Nuclear Energy. second edition, Pergamon Press, London.
10. Wilson, R. and Patterson, B.A. (1989). Pattern of malignant tumours in King Fahad Hospital, Al-Baha, Saudi Arabia, Saudi Medical Journal, 10: 498-502.
Table 1. Distribution of cancer patients in the Mosul
Hospital.
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|
|
|
| |||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | |
| Institute of Deep X-Ray and Nuclear Medicine | 111 | 64 | 494 | 56.7 | 63 | 36 | 377 | 43.3 | 174 | 87 | 871 | 97.4 |
| Ibn-Sina | 9 | 45 | 3 | 30 | 11 | 55 | 7 | 70 | 20 | 10 | 10 | 10.1 |
| Al-Khansala Maternal Hospital | 2 | 33.3 | 4 | 30.8 | 4 | 66.7 | 9 | 69.2 | 6 | 3 | 13 | 1.5 |
| Total | 122 | 61 | 501 | 56 | 78 | 39 | 393 | 44 | 200 | 100 | 894 | 100 |
Table 2. Distribution of cancer patients according to the type of
therapy.
| Type of Therapy |
|
|
| |||||||||
|
|
|
|
|
|
| |||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | |
| Deep X-Ray | 51 | 63.8 | 317 | 65.1 | 29 | 36.2 | 170 | 34.9 | 80 | 40 | 487 | 54.5 |
| Cytotoxic Drugs | 44 | 50.1 | 67 | 43.2 | 4.3 | 49.9 | 88 | 56.8 | 87 | 43.5 | 155 | 17.3 |
| Deep X-Ray + Cytotoxic Drugs | 27 | 81.8 | 117 | 46.4 | 6 | 18.2 | 135 | 53.6 | 33 | 16.5 | 252 | 28.2 |
| Total | 122 | 61 | 501 | 56 | 78 | 39 | 393 | 44 | 200 | 100 | 894 | 100 |
Table 3. Distribution of different cancer diseases among patients in Mosul hospitals,
before and after the War 1991.
| Cancer Diseases |
|
|
| ||||||||||
| I.C.D. Code | 1989-1990 | 1997-1998 | 1989-1990 | 1997-1998 | 1989-1990 | 1997-1998 | |||||||
| No. | % | No. | % | No. | % | No. | % | No. | % | No. | % | ||
| Ca. Lung | 162.1 | 25 | 20.5 | 129 | 25.7 | 2 | 2.5 | 14 | 3.6 | 27 | 13.5 | 143 | 16 |
| Lymphoma | 200 | 14 | 11.4 | 52 | 10.4 | 8 | 10.2 | 43 | 11 | 22 | 11 | 95 | 10.6 |
| Leukemia | 204-206 | 9 | 704 | 45 | 9 | 12 | 15.3 | 17 | 4.3 | 21 | 10.5 | 38 | 4.2 |
| Ca. Larynx | 161 | 17 | 13.9 | 71 | 14.2 | 2 | 2.5 | 13 | 3.3 | 19 | 9.5 | 84 | 9.4 |
| Ca. Breast | 174 | - | - | 1 | 0.2 | 17 | 21.8 | 106 | 27 | 17 | 8.5 | 107 | 12 |
| Ca. Bladder | 188 | 6 | 4.9 | 27 | 5.4 | 2 | 2.5 | 6 | 1.5 | 8 | 4 | 33 | 3.7 |
| Ca. Stomach | 151 | 4 | 3.2 | 20 | 4 | 4 | 5.1 | 12 | 3 | 8 | 4 | 32 | 3.6 |
| Ca. Bone | 170 | 2 | 106 | 10 | 2 | 4 | 5.1 | 5 | 1.3 | 6 | 3 | 15 | 1.7 |
| Ca. Nasopharynx | 147 | 6 | 4.9 | - | - | - | - | - | - | 6 | 3 | - | - |
| Ca. Skin | 172 | 5 | 4.1 | 35 | 7 | 1 | 1.3 | 34 | 8.6 | 6 | 3 | 69 | 7.7 |
| Ca. Rectum | 154.1 | 3 | 2.4 | 14 | 2.8 | 2 | 2.5 | 13 | 3.3 | 5 | 2.5 | 27 | 3 |
| Testicular tumour | 186 | 4 | 3.2 | 9 | 1.8 | - | - | - | - | 4 | 2 | 9 | 1 |
| Ca. Mouth | 144-143 | 3 | 2.5 | - | - | 1 | 1.3 | - | 4 | 2 | - | - | |
| Hodgkin disease | 201 | 3 | 2.5 | - | - | 1 | 1.3 | - | - | 4 | 2 | - | - |
| Ca. Uterus | 182 | - | - | - | - | 3 | 3.8 | 29 | 7.4 | 3 | 1.5 | 29 | 3.2 |
| Ca. Oesophagus | 150 | 1 | 0.8 | 13 | 2.6 | 2 | 2.5 | 13 | 3.3 | 3 | 1.5 | 6 | 2.9 |
| Ca. Thyroid | 193 | 1 | 0.8 | 10 | 2 | 2 | 2.5 | 6 | 1.5 | 3 | 1.5 | 1.6 | 1.8 |
| Ca. Tonsil | 146.0 | 2 | 1.6 | - | - | 1 | 1.3 | - | - | 3 | 1.5 | - | - |
| Ewings sarc. | 170.9 | 1 | 0.8 | 10 | 2 | 2 | 2.5 | 5 | 1.3 | 3 | 1.5 | 15 | 1.7 |
| Peritoneal sarc. | 158 | 2 | 1.6 | - | - | 1 | 1.3 | - | - | 3 | 1.5 | - | - |
| Ca. Lip | 140 | 1 | 0.8 | - | - | 1 | 1.3 | - | - | 2 | 1 | - | - |
| Ca. Tongue | 141 | 2 | 1.6 | - | - | - | - | - | - | 2 | 1 | - | - |
| Ca. Colon | 153.2 | 1 | 0.8 | 7 | 1.4 | 1 | 1.3 | 5 | 1.3 | 2 | 1 | 12 | 1.3 |
| Malignant Myeloma | 191 | 1 | 0.8 | 18 | 3.6 | 1 | 1.3 | 15 | 3.8 | 2 | 1 | 33 | 3.7 |
| Hypernephroma | 189.0 | 1 | 0.8 | 9 | 1.8 | 1 | 1.3 | 5 | 1.3 | 2 | 1 | 14 | 1.6 |
| Rhabdomyo sarcoma | 171.9 | 2 | 1.6 | - | - | - | - | - | - | 2 | 1 | - | - |
| Ca. Salivary gland | 142 | 1 | 0.8 | - | - | 1 | 1.3 | - | - | 2 | 1 | - | - |
| Ca. Liver | 155 | 1 | 0.8 | 4 | 0.8 | - | - | 7 | 1.8 | 1 | 0.5 | 11 | 1.2 |
| Ca. Nose | 160.0 | - | - | - | - | 1 | 1.3 | - | - | 1 | 0.5 | - | - |
| Ca. Vagina | 184.0 | - | - | - | - | 1 | 1.3 | - | - | 1 | 0.5 | - | - |
| Ca. Ovary | 183.0 | - | - | - | - | 1 | 1.3 | 16 | 4.1 | 1 | 0.5 | 16 | 1.8 |
| Ca. Soft tissue | 171 | - | - | 15 | 3 | 1 | 1.3 | 17 | 4.3 | 1 | 0.5 | 32 | 3.6 |
| Neuruoblastouma | 192 | 1 | 0.8 | - | - | - | - | 1 | 0.3 | 1 | 0.5 | 1 | 0.1 |
| Malignant ascites | 153.9 | 1 | 0.8 | - | - | - | - | - | - | 1 | 0.5 | - | - |
| Perianal tumour | 154.2 | 1 | 0.8 | 10 | 2 | - | - | 10 | 2.5 | 1 | 0.5 | 20 | 2.2 |
| Ca. Yolk sac | 184.1 | - | - | - | - | 1 | 1.3 | - | - | 1 | 0.5 | - | - |
| Ca. Paranasal | 160.8 | - | - | - | - | 1 | 1.3 | - | - | 1 | 0.5 | - | - |
| Wilms tumour | 189.0 | 1 | 0.8 | - | - | - | - | - | - | 1 | 0.5 | - | - |
| Total | - | 122 | 61 | 501 | 56 | 78 | 39 | 393 | 44 | 200 | - | 894 | - |
Table 4. The distribution of the prevalent cancer diseases before
and after the war in 1991
| Cancer Diseases |
|
| ||||||
|
|
|
|
| |||||
| No. | % | No. | % | No. | % | No. | % | |
| Ca. Lung | 25 | 20.5 | 129 | 25.7 | - | - | 14 | 3.6 |
| Ca. Larynx | 17 | 13.9 | 71 | 14.2 | - | - | 13 | 3.3 |
| Lymphoma | 14 | 11.4 | 52 | 10.4 | 8 | 10.2 | 43 | 11 |
| Leukemia | 9 | 7.3 | 21 | 4.2 | 12 | 15.3 | 17 | 4.3 |
| Ca. Bladder | 6 | 4.9 | 27 | 5.4 | - | - | - | |
| Ca. Nasopharynx | 6 | 4.9 | - | - | - | - | - | - |
| Ca. Skin | 5 | 4.1 | 35 | 7 | - | - | 34 | 8.6 |
| Ca. Stomach | 4 | 3.2 | 20 | 4 | 4 | 5.1 | 12 | 3 |
| Ca. Testicular | 4 | 3.2 | - | - | - | - | - | - |
| Ca. Breast | - | - | - | - | 17 | 21.8 | 106 | 27 |
| Ca. Bone | - | - | - | - | 4 | 5.1 | - | - |
| Ca. Uterus | - | - | - | - | 3 | 3.8 | 29 | 7.4 |
Table 5. The cancer diseases with increased incidence after the war
in 1991.
| Cancer Diseases |
|
| ||||||
|
|
|
|
| |||||
| No. | % | No. | % | No. | % | No. | % | |
| Ca. Lung | 25/122 | 20.5 | 129/501 | 25.7 | - | - | 14/393 | 3.6 |
| Ca. Larynx | 17/122 | 13.9 | 71/501 | 14.2 | - | - | 13/393 | 3.3 |
| Lymphoma | - | - | - | - | 10.2 | 43/393 | 11 | |
| Ca. Bladder | 6/122 | 4.9 | 27/501 | 5.4 | - | - | - | - |
| Ca. Skin | 5/122 | 4.1 | 35/501 | 7 | - | - | 34/393 | 8.6 |
| Ca. Stomach | 4/122 | 3.2 | 20/501 | 4 | - | - | - | - |
| Ca. Breast | - | - | - | - | 17/78 | 21.8 | 106/393 | 27 |
| Ca. Uterus | - | - | - | - | 3/78 | 3.8 | 29/393 | 7.4 |
| Leukemia | 9/122 | 7.4 | 45/501 | 9 | - | - | - | - |
| Ca. Thyroid | 1/122 | 0.8 | 10/501 | 2 | - | - | - | - |
| Ca. Liver | - | - | - | - | - | - | 7/393 | 1.8 |