23 July 2002

Final Report by the Italian Mod Commission on the Incidence of Malignant Neoplasia among Military Personnel deployed in Bosnia And Kosovo AD HOC Committee on Depleted Uranium (AHCDU) Conclusions: The total number of cases of malignant neoplasia, both haematological and otherwise, falls below the estimated figure. This result may be due partly to the physical fitness criteria applied in selecting military personnel, and partly to the fact that estimates were calculated on the basis of Tumour Registers taken predominantly from northern Italy, where the overall incidence of tumours is higher than in southern Italy, the area from which most of the military personnel deployed in Bosnia and/or Kosovo originated. A statistically significant excess can be observed in Hodgkin's Lymphoma (HL) cases. This HL excess in the group of military personnel deployed in Bosnia and/or Kosovo is also apparent from a comparison with a group of Carabinieri who had never previously been sent on missions abroad. This latter group can be used as a basis for comparison with military personnel deployed in Bosnia and/or Kosovo as both involve military personnel. In addition, the Carabinieri's distribution by geographical origin is not greatly dissimilar to that of the military personnel deployed in Bosnia and/or Kosovo (see Appendix 2). However, pathological data for this group were obtained from the Carabinieri Coips Health Services, who are informed by patients affected by these pathologies on a voluntary basis; this could lead to the number of cases being underestimated, and in turn to an overestimation of the Standardised Incidence Ratio (SIR). By contrast, it is unlikely that the number of cases reported by the Tumour Registers should be underestimated. Indeed, these registers use several sources for recording cases, such as patient recovery charts, hospital discharge forms, histological and cytological report archives, as well as death certificates. On the other hand, the incomplete diagnosis verification for suspected HL cases in Carabinieri personnel, with only 5 diagnoses verified out of 14, could have caused the SIR for this pathology in military personnel sent to the Balkans to be underestimated. With regard to the incidence of HL, it is worth emphasising that there is no evidence in Italy of significant variations between various geographical areas. The results of the sample survey carried out on Italian military7 personnel deployed in Bosnia and Kosovo have not produced any evidence of depleted uranium contamination. This result is in line with the conclusions reached by other surveys conducted to date at national and international level, both on military personnel and on the environment. On the basis of the recorded data and of currently available information, it has been impossible to identify the cause of the excess in Hodgkin's Lymphoma highlighted by the epidemiological analysis. Recommendations The Commission recommends: a) that the group of individuals assigned to operations in Bosnia and/or Kosovo be monitored over time to observe the incidence of solid and haematological tumours and monitor the evolution of the epidemiological scenario emerged at this stage; b) that the military and non-military individuals, who may for various reasons have been exposed to depleted uranium, be identified and included in a long-term medical control programme; c) that monitoring campaigns be encouraged in the appropriate international fora for territories where depleted uranium munitions have been used, with a view to identifying the long-term effects on resident civilian populations as well as on the environment, e.g. the possible future presence of this pollutant in water and more generally in the food chain; d) research be promoted at national and international level on the effects of exposure to depleted uranium, as occurred in the Balkans and in other areas; e) that proposals be made in the appropriate international fora, e.g. UNEP, for the scope of studies on the possible dispersal of depleted uranium in the environment to be expanded to cover Bosnia, and in particular the Sarajevo area; f) that thorough research be conducted into other possible causes for the increase in the incidence oflymphomas, as in the present state of our knowledge no correlation has yet been established between Hodgkin's and non-Hodgkin's lymphomas on the one hand, and internal exposure to ionising radiation on the other.