بیماری های خون و سرطان در کودکان

Title: Persian Gulf War and rate of childhood malignancies in southern I.R.Iran.

Author: Dr Mahdi Shahriari, associate professor of pediatric hematology oncology, Shiraz University of Medical Sciences, Shiraz, Islamic Republic of Iran

I- Introduction

After attack of Iraq to Kuwait and Persian Gulf war in 1990-1991 and firing in oil wells of Kuwait and Iraq, wide environmental pollution have been distributed in the bordering provinces of south, west-south and west of Iran that caused wide effects on the health of residents.

Now, that about 20 years have passed from that war, a part of damages resulting from it, related to increment of the rate of neoplasms due to environmental pollution.

1- Provinces Exposed to the Danger in Iran:

Twelve provinces of Iran have been exposed to the pollution, among which Khuzestan, Boushehr, Ilam , Kermanshah, and also some regions ( southern cities) of Fars and Kohkiluieh have been most affected and collected data in some of them show the increasing rate of cancers related to the pollution.

2- Contaminating Chemical Materials Resulting from Persian Gulf War:

After firing in oil wells, air pollution (the route of smoke- cloud) has been distributed in the region. The chemical combination of smoke – cloud includes; Nitrogen, Sulfur dioxide (SO2), Carbon Mono-oxide (CO). Ozone (03), suspended particles (smoke), Sodium and Potassium salts (1).

Lead combinations, Zinc, Chromium and insignificant amounts of Cadmium, Enadium, non-methane Hydrocarbons and non oxidized cyclic aromatics have been detected in suspended particles (1). Percentage of the substances include: 30% of salts 8% of sulfates, 30% organic combinations and 10-15% smoke (1).

3- Rate of malignancies in south of Iran after Persian Gulf War:

According to the data from local cancer registry, the rate of Hematologic, Reticulo-endothelial, Breast, Stomach, Bladder, Lung, Lymph nodes and larynx malignancies has been increased significantly in the period of 1997 to 2002.

 A study on malignant diseases after Persian Gulf War in South west of Iran (5):

418 files of patients who suffered from malignancies have been studied retrospectively and its results were reported as follows:

In this study, frequency of hematopoietic malignancies such as Acute Lymphoblastic Leukemia (ALL),  Acute Myelogenous Leukemia (AML), Chronic Lymphocytic Leukemia (CLL), Chronic Myelogenous leukemia (CML), Hairy cell Leukemia, Myelodysplastic Syndrome (MDS), Multiple Myeloma and Lymphoid malignancies such as Non-Hodgkin's Lymphoma (NHL) and Hodgkin Disease (HD) as well as solid malignant neoplasm after Gulf War. The results is shown in the following diagrams and tables:

II- Role of Environmental Pollution, Resulting from Persian Gulf War, on frequency of cancers:

As it is mentioned in the introduction, there are 6 provinces placed in the exposed area from which studies performed in Khuzestan and Fars are mentioned in this document and show an increase in the rate of cancers after the war.

1- Khuzestan Province

Having long border with Iraq and Kuwait, Khuzestan is one of the most important provinces exposed to the pollution.

Due to usage of chemical weapons and Depleted Uranium in the Gulf War and also materials resulting from firing of oil wells, residents of this province have been exposed to contaminated soil, water, agricultural products especially wheat, fruits, milk, dairy products. On the other hand the sky of cities in some regions of Khouzestan especially in Ahwaz, Abadan, Shadegan, Mahshahr, Sousangerd  and also, Imam and Khoramshahr Port was contaminated by the smoke for several days, and black rain has fallen repeatedly. There has consequently been acid rain and black snow for several times (1).

Data collected by local Cancer Registry (Ahwaz Medical University),shows that malignancies related to the mentioned contaminating material has been increased in the years of 97 to 2002 (Table No.1).

In addition to the pollution Depleted Uranium was used in the Persian Gulf War.

4- Etiologic Role of Contaminating Materials Resulting from Persian Gulf War in Malignancies (Hygienic Effects of Contaminating Materials):

Role of some of the materials has been identified in malignant tumors (2) see the appendix).

Cadmium: Lung Cancer

Nickel: Nose & Lung Cancer

Iron & steel founing : Lung Cancer

Sulfuric Acid mist: Nose and Laryngeal Cancers

Aromatic Hydrocarbons and Benzene: Hematopoietic Cancers and Hodgkin Disease

Depleted Uranium (Radon): Lung (2), Stomach (3) and Breast Carcinoma (4).

Metal                                                                              Average (milligram/liter)

Cadmium                                                                                   0.113

Copper                                                                                       0.562

Lead                                                                                           0.511

Zinc                                                                                            1.248

Nickel                                                                                          69%

All amounts of tested heavy metals are more than the maximum determined in the free waters (by W.H.O) and there is strong possibility that increasing amounts is related to sediments of oil materials in Iran south-coasts and Black Rain after Gulf War.

• Concentration of smoke has been rated as76 to460 milligram/liter in rain water.

• Concentration of organic Carbon in the water of region's rivers, especially Karoon, previously had been recorded as 1.10 milligram/ liter, while, after the air pollution, dissolved organic Carbon measured as 8.4 milligram/liter.

• In one study, the amount of Cadmium measured in the body of fish in the Persian Gulf and Oman Sea was 0.032-0.075 milligram/Kilogram (Standard is 0.1 milligram). The amount of Cadmium in the body of shrimps had no significant difference to amounts in fish (1).

• The mean of Radium in the body of fish in Persian Gulf in 1993 has been reported as 0.001 milligram/Kg (1).

• After the pollution, first of all much amounts of SO2 was distributed in the air and secondly, induced formation of destructive H2SO4.

Amounts of Contaminating Materials in Water and Aquatics in the Regions Exposed to the Danger:

Concentration of some of the above elements have been measured in the sediments and water of Karoon river in Khuzestan Province, rain water as well as in the body of aqua in some of the regions exposed to the contaminating material and is reported as follow (1):

Concentration of Heavy metals in Water and Sediments of Karoon River

All of the above amounts (except zinc) are more than the amounts that had existed in previous investigations (before pollution) and are considered as pollution.

Amounts of heavy metals were measured in an ecological study performed by Environment Protection Organization in marine point of Khour Musa (1993) (1) is shown as follows:

The results from this study and routine data collected by Local Cancer Registry in Ahwaz University of Medical Science indicate an increase in the malignant diseases with a rate of 10% in the years after the war in comparison to the years before. This increment seems to be related to the smoke and contaminating rains and also, smelling of benzene gas and the other mentioned chemical materials.

2- Fars Province

Some area of Fars and all regions of Bushehr Provinces were exposed to the chemical pollution resulting from Persian Gulf War. Data from Fars Province including the capital Shiraz (most patients of Bushehr Province were referred to shiraz medical centers for tertiary care) indicates an increase in cancer rate.

Data from local Cancer Registry, Shiraz Medical University:

The date shows that, the rate of malignancies related to the mentioned contaminating materials has been increased considerably in the years of 1996 to 2002. ( Table No.4).

Table No.4: Distribution of malignancies related to the Gulf War in 1375-81 (1997-2002) in Fars province

Table No.4 shows, a significant increase in the cancers in 2002 compared to the year of 1996.

Effects of Some Environmental and prenatal factors in the rate of Acute Lymphoblastic Leukemia (ALL) in Children of Fars Province and neighboring Provinces"

This study is on 156 cases of ALL reported in a period of two years from 1996 to 1999 in Fars Province, Number of cases had increased in comparison to the number of cases (96) of ALL reported in a similar study in five years period (1979 to 84). On the other hand this study shows that being resident of the littoral area of Persian Gulf has association with the rate of ALL. According to the results, 46 cases (29%) are from cities of the littoral area, 64 cases (40%) from Shiraz, Marvdasht and Kavar cities and 24 affected cases (15%) are from Bushehr province.

III: Discussion

After attack of Iraq Kuwait and Persian Gulf War in the years of 1990-1991 and firing in Kuwait oil wells as well as, usage of Depleted Uranium , wide pollution of smoke- cloud includimg of Nitrogen Oxides, Sulfur Dioxide, Carbon Mono-Oxide as well as suspended particles such as lead, Chromium, Cadmium, Enadium , non-Methan Hydrocarbons, non-oxidized Cyclic Aromatics and Benzene have been distributed in the region. These materials caused contamination of air, water, sediments of river, aquatics, farms and their products and dairy productions. As a result, the residents of bordering regions of south, west-south and west of Iran including 6 provinces of Khouzestan, Fars, Boushehr, Ilam, Kermanshah and Kordestan have been widely and constantly exposed to the contaminating materials.

The carcinogenic role of the above mentioned chemical and environmental factors as well as Depleted Uranium is proved in some of malignancies such as hematopoietic, Lymph nodes as well as solid carcinoma (Stomatch, Lung, Breast, Bladder and Larynx).

The frequency of cancers related to the contaminating materials resulting from Persian Gulf War in two provinces of Khouzestan and Fars have been studied. Statistical data from Local Cancer Registey in Ahwaz and Shiraz Universities of Medical Science show the increment of rate of the above mentioned cancers in the years of 1996 to 2002.

On the other hand, separate researches in Ahwaz and Shiraz Medical Universities, also, show the increasing rate of these malignancies in the region and Boushehr province in the years after Persian Gulf War which is correlative to the data from Local Cancer Registery.

In general, regarding to the constant exposure of residents of the regions to the contaminating and carcinogenic substances and according to the data available, an association has been determing between the effects, resulting from Persian Gulf War and increasing rate of malignancies.

Appendix:

References:

1- Akbari H.: " Determination of health and death rates in the population resident in Zagros Southern Provinces which have been exposed to the environmental pollution resulting from Iraq and Kuwait War in the years of 1991 & 1992 and its comparison to the residents of Zagros Northern Provinces ; July 2003.

2- Devita V.T. et al, Cancer Principle & Practice of oncology , PP:243 & 1093; 2001

3- Cotran et al, Robbins’ Pathologic Basic of Disease, P: 242 & 1093; 1999

4- Tavassoli F. Pathology of the Breast, PP: 31-32; 1999

5- Pedram M.: Epidemiological study of increment of malignant diseases after Persian Gulf War in South West of Iran.

6- Shahriari M.: Influence of Some Environmental and prenatal factors in the prevalence of ALL in the Children of Fars and neighbouring Provinces; 1999