Cancer in Serbia After 1999: What the Registry Shows

the research described here comes from Srđan Aleksić, a lawyer and legal scholar who collaborates with Legal Smart and represents claimants in Serbian proceedings concerning depleted uranium. He had no editorial role in this article.

In 2006 the oncology dispensary in Vranje, which serves the Pčinja district in Serbia’s south, published a figure that its doctors could not explain away. In 2005 it had registered twelve times more malignant disease than in 1995. Pčinja lies next to the hills where depleted uranium rounds were fired in 1999. Srđan Aleksić’s 2024 study Projektili pravde begins its health chapter with that number.

The short answer is that, on the study’s reading of national registry data, cancer in Serbia rose modestly between 2002–2005 and 2006–2009. Leukaemia and lymphoma rose dramatically. New cases of all cancers increased by 6.6 per cent and deaths by 7.8 per cent. New cases of leukaemia and lymphoma increased by 74 per cent and deaths from them by 139 per cent. The study treats this as a signal that demands explanation, not yet as proof of a cause.

What the registry shows about cancer in Serbia

The figures come from the cancer registry of the Batut Institute of Public Health, as analysed in the study. Between 2002 and 2005, Serbia, a country of 7.2 million people, registered on average 32,130 new cancer cases a year. Between 2006 and 2009 the average was 34,254. That is 8,496 more cases across the second four-year period, an increase of 6.6 per cent, which the study reports as statistically significant (p < 0.01). Average annual cancer deaths rose from 18,144 to 19,566, an increase of 7.8 per cent.

The striking numbers are in the blood cancers. New leukaemias and lymphomas rose from an average of 796 a year to 1,384. Deaths rose from 452 a year to 1,069. In 2009, the study notes, the crude incidence of all cancers in central Serbia, 499 per 100,000, had moved close to Western European levels. Mortality in central Serbia rose by 2.3 per cent a year on average, while in Western and Northern Europe it had been falling by about one per cent a year for 15 to 20 years. On a longer scale, the study cites figures of about 10,000 people diagnosed with cancer in Serbia in 1981 and about 41,000 in 2011.

Laboratory scientist analysing blood samples for uranium and heavy metals in a biomonitoring study

What the doctors say

The study gathers the views of Serbian clinicians. The neurosurgeon Danica Grujičić is quoted on latency. Systemic malignancies such as leukaemia and lymphoma take five to ten years to appear after exposure; solid tumours of the lung or bowel take 15 to 20. The oncologist Slobodan Čikarić, president of the Serbian Society for the Fight Against Cancer, is cited as estimating that Serbia records about 7,000 more cancer cases and 5,000 more deaths a year than 15 to 20 years earlier. He links the rise to about 15 tonnes of uranium-238 turned to dust and carried into the food chain.

Those timelines fit the registry pattern. A blood-cancer rise would come first, within a decade of 1999, with solid tumours later. That is a hypothesis the timing supports, and a hypothesis is what it remains until it is tested.

What is in people’s blood

The study adds a second line of evidence: biomonitoring. It cites a human biomonitoring study that measured arsenic, cadmium, lead, thorium and uranium in the whole blood of adults in Serbia. On the study’s reading, thorium and uranium were up to a hundred times higher than in comparable studies elsewhere. It sets these results beside the Italian Istituto Superiore di Sanità‘s reference values for the Italian population from 1990 to 2009, and beside analyses of Italian soldiers who served in the Balkans. In both the Serbian population and the soldiers, the study reports, some elements were hundreds of times above the Italian reference, where they appeared in the reference sample at all.

What the figures cannot yet show

The study is candid about the limit. Its own conclusion on the evidence is that there are still no “well-structured, evidence-supported cases” (translated). It calls for contamination maps, a mapping of where cancers occur, and a statistical link between the two. The registry comparison of cancer in Serbia is a national count. It does not show who was exposed, where they lived in 1999, or whether those people are the ones falling ill. These are crude numbers, not adjusted for an ageing population or for improvements in registration. Both can raise counts on their own.

The size of the blood-cancer rise between two adjacent four-year periods is the finding that most deserves an independent, age-standardised re-analysis. So does the twelvefold figure from Pčinja. If the effect survives that test, cancer in Serbia after 1999 becomes a question of evidence for courts as well as doctors. If it does not, the families of Vranje deserve to know that too.

The tissue evidence in What the Tissue Shows is the next step in the chain. What a state owes people exposed to a risk it knew about is the argument of The Last Address of Responsibility.

Frequently asked questions

Which cancers rose most in Serbia after 1999?

Leukaemias and lymphomas. On the study’s reading of registry data, new cases rose from 796 to 1,384 a year and deaths from 452 to 1,069 a year between 2002–2005 and 2006–2009.

How long after exposure does cancer appear?

Doctors cited in the study put it at five to ten years for leukaemia and lymphoma and 15 to 20 years for solid tumours such as lung or bowel cancer.

What happened in Vranje and the Pčinja district?

The Vranje oncology dispensary reported in 2006 that it had registered twelve times more malignant disease in 2005 than in 1995.

Do the registry figures prove depleted uranium caused cancer?

No. They are national, crude counts not adjusted for age or registration changes. The study itself calls for contamination maps and case-level evidence.