Professor Rik Bryan, Director of the Bladder Cancer Research Centre at the University of Birmingham and a co-author of the study said:
“Despite the relatively small size of this initial study, the findings provide a strong signal that there is a considerably increased risk of bladder cancer amongst members of the ammunition technician profession who are exposed to certain explosives on a regular basis. This risk is significant enough to warrant urgent further investigation and a definitive study working with as many veterans as possible.
“Bladder cancer is a common cancer, but many people may not be aware that, beyond blood in the urine, there are other signs of the disease such as changes in urination and bladder irritation that mimic the symptoms of a urine infection or cystitis. The majority of patients with these symptoms do not have bladder cancer, but further investigation should be initiated, particularly in at-risk populations. With this study the signs point to a group of heroic individuals who have served our country being at a greater risk of developing bladder cancer, and we would recommend that healthcare professionals have a greater awareness of a potential risk amongst veterans.”
Personal experience
The research was inspired by the personal experience of Dr Collett, a retired British Army Brigadier, and former head of UK bomb disposal. After being diagnosed with bladder cancer in November 2023, Gareth shared his diagnosis in a private social media group for retired and serving ammunition technicians.
Within days, other members of that group reported similar diagnoses, leading Dr Collett and a team of urologists, epidemiologists, and scientists to investigate whether there is a higher incidence among the population as the lifetime incidence of bladder cancer in the general population is below 1per cent.
Dr Gareth Collett said:
“I was diagnosed with bladder cancer at the age of 56. I had been an ammunition technical officer for 33 years, seeing operational service in Northern Ireland, the Balkans, Iraq, Afghanistan and in less publicised operations globally. I was fortunate to survive when many of my friends and colleagues did not. However, I carry psychological scars and wasn’t expecting to deal with another unwanted consequence of military service. The diagnosis was somewhat of a shock and the treatment quite invasive.
“It affects your life and those around you. The impact of immunotherapy and transurethral resections of tumours is physical and psychological. It can prevent you from having intimate relationships with your partner, interfere with your sleep patterns, and change the way you need to pee - in the most severe cases, it may involve the removal of your bladder, prostate, lymph nodes and urethra.
“The immediate supposition by medical professionals was that it was a heavy smoker’s disease. This was not the case at all for me, leading to the possibility that it could be occupational related given my service history and frequent visits to the Regimental Medical Officer with bouts of overactive bladder for over a decade. Anecdotal evidence was already being amassed by the ammunition technical profession, raising concerns of the link between explosives and urological cancers. However, there was very little epidemiological evidence available for the MOD to consider this a matter of concern. As such I decided to gather factual and preliminary evidence, speaking with service charities, learned professors of urology and trade professionals to formulate an initial epidemiological survey. This survey led to the standard incidence ratios and confidence intervals reported in the paper, and the necessity for further action.
“The profession is epitomised by the ‘Lonely Walk,’ that approach you do on your own when dealing with unpredictable explosives. This research suggests that those who have hung up their bomb suits, or destroyed stockpiles of ammunition during their careers, may have one further lonely walk to take long after their service is over. Let’s make sure we have the support mechanisms in place to assist those who have given so much to their country.”
Implications for Veteran Health and Policy Change
Further investigation linked the exposure to the disposal of munitions containing nitro-explosives such as TNT, and their combustion products. Studies have long established that occupational exposure to certain chemicals increases the risk of bladder cancer, particularly among professions such as tyre and chemical industry workers but the team believe that this is the first study linking the disease to explosive ordnance disposal.
Since the research began, two more veterans have been diagnosed with bladder cancer, highlighting the immediate need for better screening and preventative measures for those at risk. Service charities have already implemented self-help guidance on early detection, potentially saving lives by enabling earlier diagnosis.
The study’s authors are calling for:
- Further large-scale research into the long-term health impacts of explosive exposure.
- Changes in military safety regulations regarding the disposal and handling of explosives.
- Regular screening programmes for at-risk individuals, using low-cost urinalysis tests for early detection of bladder cancer.
- Raised awareness amongst GP’s when dealing with veterans exposed to explosives during their careers, particularly if they are aged below 70 and are experiencing blood in their urine.
