US Army Chemical Corps Vietnam veterans health study: preliminary results.

The long-term health consequences of exposure to phenoxyherbicides used in Vietnam has been a great concern to the veterans. In addition to the Air Force Ranch Hand personnel, Army Chemical Corps personnel who served in Vietnam are thought to have had some of the highest herbicide exposures. The Department of Veterans Affairs commenced a study of veterans who served in Vietnam as members of the Army Chemical Corps and a comparison cohort of Army Chemical Corps personnel who served elsewhere. A total of 2872 Vietnam veterans and 2737 non-Vietnam veterans who served in the Army Chemical Corps were identified for inclusion in a telephone health interview survey with a random 20% sample of veterans receiving serum dioxin and other congeners assessments. In a feasibility study which included 284 Vietnam veterans and 281 non-Vietnam veterans, 100 serum assessments were conducted of which 95 were included in the analysis. Vietnam veterans with a history of spraying herbicides were found to have a statistically significant elevation in their current serum 2,3,7,8-TCDD concentrations compared to non-Vietnam veterans without a spray history (P = 0.05). Other 2,3,7,8-substituted dioxins levels were comparable to the levels found in the non-Vietnam veterans. This feasibility study demonstrated that serum dioxin concentrations from a sample of the study participants can be used to identify exposure variables in the health survey that can serve as a surrogate measure of phenoxyherbicide exposure.

Cancer mortality among the highest exposed US atmospheric nuclear test participants.

Of the estimated 205,000 military personnel who participated in the US atmospheric nuclear weapons testing program from 1945 to 1962, less than 1% had ionizing radiation doses that met or exceeded the current federal occupational guideline for dose of 5 rem (roentgen equivalents in humans) in a 12-month period. The objective of this study was to determine whether veterans who received the highest gamma radiation doses (n = 1010) have experienced increased cancer mortality compared with a group of Navy veterans who received a minimal radiation dose as participants of HARDTACK I (n = 2870). Mortality from all causes of death (relative risk, 1.22; 95% confidence interval, 1.04 to 1.44) and from all lymphopoietic cancers (relative risk, 3.72; 95% confidence interval, 1.28 to 10.83) was significantly elevated among the 5-rem cohort compared with the Navy controls. The lack of statistically significant excesses in deaths from many of the known radiogenic cancers suggests that the observed excess mortality may be the result of many factors, of which radiation exposure was only one.

The health status of Gulf War veterans: lessons learned from the Department of Veterans Affairs Health Registry.

OBJECTIVE: To describe the demographic characteristics and postwar health status of U.S. Gulf War veterans who participated in the Department of Veterans Affairs health examination registry program. DESIGN: Case records of 52,835 veterans who participated in a standardized health examination program were reviewed. SETTING: Participants volunteered for physical examinations at a Department of Veterans Affairs medical treatment facility from August 1992 to September 1996. SUBJECTS: U.S. Gulf War veterans deployed to southwest Asia between August 1990 and 1996. MAIN OUTCOME MEASURE: Demographic, military, symptom, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic categories. RESULTS: A wide variety of symptoms and diagnoses were reported without apparent internal variation by military characteristics (branch and service component). The frequency of symptoms (fatigue, skin rash, headache, muscle and joint pain, and memory loss) reported increased over time, whereas the proportion of individuals with physician-diagnosed illnesses remained fairly constant. No single category of disease increased or decreased substantially over time. CONCLUSIONS: Veterans have experienced a wide variety of health problems since their Gulf War service. These problems, in aggregate, are different from what has been seen in other armed conflicts. The Department of Veterans Affairs registry is a very large case series and has failed to identify a single, unique syndrome or new illness after Gulf War service. An epidemiologic study would better define the prevalence of specific symptoms and medical conditions among Gulf War veterans and to what extent any of the conditions identified are associated with Gulf War military service. The knowledge provided by such studies would be important to development of preventive measures and future deployment medical surveillance planning.

Mortality among Army Chemical Corps Vietnam veterans.

Army Chemical Corps personnel who served in Vietnam were among those service personnel with the greatest potential for exposure to herbicides. An earlier evaluation of the mortality experience of 894 Army Chemical Corps Vietnam veterans found a statistically significant excess risk of dying from digestive disease, primarily due to cirrhosis of the liver, and from motor vehicle accidents. That study was expanded to include 2,872 Vietnam veterans who served with the Army Chemical Corps and a comparison cohort of 2,737 veterans who never served in Southeast Asia but who did serve in the same occupational category. The results of the analysis comparing the Vietnam cohort to the non-Vietnam cohort support the earlier finding of a significant excess of deaths from digestive diseases (adjusted relative risk (RR) = 3.88, 95% C.I. = 1.12-13.45) primarily due to liver cirrhosis. Non-significant elevated relative risks were observed for all cancers combined, digestive and respiratory systems cancers, skin cancer, lymphopoietic cancers, and respiratory system diseases. Compared to the mortality rates in the general population, the non-Vietnam Army Chemical Corps veterans had a statistically significant deficit in mortality from all causes combined, which is consistent with a 'healthy selection bias' seen among military populations (SMR = 0.79, 95% C.I. = 0.66-0.94). For the Vietnam veterans, patterns of elevated but nonsignificant SMRs persisted for diseases of the digestive and respiratory systems and for selected cancer sites.

Hodgkin's disease and Vietnam service.

Earlier studies that showed an association between exposure to phenoxy herbicides and the risk of malignant lymphomas have sparked concerns among Vietnam veterans over Agent Orange exposure. The Department of Veterans Affairs (VA) undertook a hospital-based case-control study to examine the association between military service in Vietnam and several histologic types of malignant lymphomas. This is a report of 283 Vietnam-era veteran patients who were treated in one of 172 VA hospitals from 1969 to 1985 with a diagnosis of Hodgkin's Disease (HD). Four hundred and four Vietnam-era veteran patients with diagnosis other than malignant lymphoma served as a comparison group. Military service in Vietnam was not associated with any significant increase in the risk of HD (adjusted odds ratio = 1.28; 95% confidence interval = 0.94, 1.76). Surrogate measures of potential Agent Orange exposure such as service in a specific military branch, in a certain region within Vietnam, in a combat role, or extended Vietnam service time were not associated with any significant increased risk of HD.

Cancer mortality risk among military participants of a 1958 atmospheric nuclear weapons test.

OBJECTIVES: This study was undertaken to determine if Navy veterans who participated in an atmospheric nuclear test in 1958 were at increased risk of death from certain cancers. METHODS: Cancer mortality risk of 8554 Navy veterans who participated in an atmospheric nuclear test in the Pacific was compared with that of 14,625 Navy veterans who did not participate in any test. Radiation dosage information was obtained from film badges for 88% of the test participants. RESULTS: The median radiation dose for the test participants was 388 mrem (3.88 millisieverts [mSv]). Among participants who received the highest radiation dose (> 1000 mrem, or 10 mSv), an increased mortality risk for all causes (relative risk [RR] = 1.23; 95% confidence interval [CI] = 1.04, 1.45), all cancers (RR = 1.42; 95% CI = 1.03, 1.96), and liver cancer (RR = 6.42; 95% CI = 1.17, 35.3) was observed. The risk for cancer of the digestive organs was elevated among test participants (rate ratio = 1.47; 95% CI = 1.06, 2.04) but with no significant dose-response trend. Many of the cancers of a priori interest were not significantly elevated in the overall test participant group or in the group that received the highest radiation dose. CONCLUSIONS: Most of the cancers suspected of being radiogenic were not significantly elevated among the test participants. Nevertheless, increased risks for certain cancers cannot be ruled out at this time. Veterans who participated in the nuclear weapons tests should continue to be monitored.

Cancer mortality patterns among women who served in the military: the Vietnam experience.

In response to concerns of women veterans regarding the long-term health effects of military service in Vietnam, the Department of Veterans Affairs has been conducting a retrospective cohort mortality study of women Vietnam veterans. Military records were used to identify approximately 4600 women who served in Vietnam between July 4, 1965, and March 28, 1973, and a comparison cohort of nearly 5300 women who served during the same time frame but not in Southeast Asia or the Pacific theater. Current data include vital status determinations as of December 31, 1991, with a total of 532 deaths and an average follow-up of just over 20 years for both groups. Both the Vietnam and non-Vietnam women cohorts had a significant deficit of deaths from all causes compared to women in the US population. The two cohorts showed no difference in total mortality or in deaths from all cancers. A significant excess risk of pancreatic cancer was observed among Vietnam nurses compared to either non-Vietnam nurses (relative risk = 5.74) or women in the US population (standardized mortality ratio (SMR) = 2.78). Vietnam nurses also had an elevated risk of dying from cancer of the uterine corpus. Non-Vietnam nurses had a higher lung cancer mortality rate than women in the general population (SMR = 1.55) or nurses who served in Vietnam. Observed deficits of deaths from all causes and circulatory system diseases generally confirm a healthy selection bias for entry into and retention in the military that has been observed among men serving in the Armed Forces.

Mortality among women Vietnam veterans, 1973-1987.

A retrospective cohort mortality study was conducted to examine health effects of US military service in Vietnam on women veterans who served there between July 4, 1965 and March 28, 1973. About 4,600 women Vietnam veterans and 5,300 women veterans who had never served in Vietnam were identified from military records and followed for vital status on December 31, 1987. Mortality rates for all causes of death combined and for all cancers among Vietnam veterans were similar to those among non-Vietnam veterans (relative risk (RR) = 0.93). There was a slight excess of mortality from external causes among women Vietnam veterans compared with non-Vietnam veterans (RR = 1.33), primarily due to an excess of motor vehicle accidents (RR = 3.19). Suicide rates were nearly the same in both cohorts (RR = 0.96). Vietnam veterans had twofold increases in mortality from cancers of the pancreas and uterine corpus compared with non-Vietnam veterans. Women Vietnam veterans and non-Vietnam veterans had lower-than-expected mortality from all causes of death combined (standardized mortality ratio (SMR) = 0.82 and 0.88, respectively), based on rates for US women, due to significant deficits of deaths from circulatory diseases. Compared with rates for US women, mortality from cancers of the pancreas (five deaths, SMR = 3.27) and uterine corpus (four deaths, SMR = 4.05) was significantly elevated among Vietnam veteran nurses.

Non-Hodgkin's lymphoma among Vietnam veterans.

In light of findings suggesting an increase in the risk for non-Hodgkin's lymphoma among men exposed to phenoxyherbicides and concerns among veterans over Agent Orange exposure, a hospital-based case-control study was undertaken to examine the association between military service in Vietnam and non-Hodgkin's lymphoma. The cases consisted of 201 Vietnam-era veteran patients who were treated in one of 172 Department of Veterans Affairs hospitals from 1969 through 1985 with a diagnosis of non-Hodgkin's lymphoma. 358 Vietnam-era veteran patients with a diagnosis other than malignant lymphoma served as a comparison group. Military service information was obtained from a review of the veteran's military personnel records. Service in Vietnam did not increase the risk of non-Hodgkin's lymphoma either in general (branch adjusted odds ratio = 1.03, 95% confidence interval = 0.70-1.50) or with increased latency period as defined as the duration in years from first service in Vietnam to hospital discharge. Surrogate measures of potential Agent Orange exposure such as service in a specific military branch, in a certain region within Vietnam, or in a combat role as determined by military occupational speciality were not associated with any increased risk of non-Hodgkin's lymphoma.

The relation of passive smoking to lung cancer.

To evaluate the role of passive smoking in the development of lung cancer among nonsmokers, data were pooled from three large incident case-control interview studies. Ninety-nine lung cancer cases and 736 controls never used any form of tobacco. Overall the adjusted odds ratio for lung cancer among nonsmokers ever living with a smoker was 0.8 (95% confidence interval, 0.5-1.3) rising to 1.2 among those exposed for 40 or more years. Persons living with a spouse who smoked cigarettes were at increased risk (adjusted odds ratio, 1.5; 95% confidence interval, 0.8-2.8). When adjusted for age and gender, there was a significant trend in risk with increasing amounts smoked per week by the spouse (P = 0.05) and with cumulative pack-years of exposure (P = 0.03). This effect was limited to females, especially older women whose husbands were heavy smokers. The elevated risk associated with spouse smoking was restricted to squamous and small cell carcinomas (odds ratio, 2.9; 95% confidence interval, 0.9-9.3), which provides additional evidence linking passive smoking to lung cancer.

Lymphomas and leukemias in the relatives of patients with mycosis fungoides.

Of 526 consecutive patients with cutaneous T-cell lymphomas, 21 had first-degree relatives with lymphoproliferative or hematopoietic malignancies. Twenty-nine such tumors occurred in the 21 kindreds. Hodgkin's disease accounted for one-third of this total, with various leukemias (11 cases), non-Hodgkin's lymphoma (five cases), and multiple myeloma (three cases) comprising the remainder. These data suggest that genetically-determined immunoregulatory abnormalities may represent a shared pathway of oncogenesis in diverse lymphoproliferative and hematopoietic malignancies.

Cancer mortality among workers exposed to zinc chromate paints.

To evaluate the carcinogenicity of chromium compounds among user industries, the proportionate mortality experience of spray painters exposed to zinc chromate primer paints and electroplaters exposed to chromic acid in the aircraft maintenance industry was examined. Compared to the mortality patterns of U.S. white males, no excess of cancer was found in the 48 deaths among electroplaters. Analysis of the 202 deaths among spray painters revealed a significant excess of cancer, primarily of the respiratory tract. The relative increase of respiratory cancer showed a positive gradient with the length of estimated exposure time, and was confined to painters whose interval from first employment to death was at least 20 years. The findings consistent with occupational exposure to chromium compounds, previously shown to be carcinogenic in manufacturing processes, but the effect of other paint constituents, tobacco smoking, or methodologic limitations could not be discounted.

Mycosis fungoides: epidemiologic observations.

An analysis of cases from a multi-hospital, pathologically verified clinical series and of deaths from US mortality statistics available at the county level for 1950--1975 (excluding 1972) was made in order to obtain information on the etiology of mycosis fungoides (MF). Despite the absence of an appropriate comparison group, the cases seemed to have a high frequency of antecedent allergies, fungal and viral skin infections, sun sensitivity, familial aggregation of lymphoma and leukemia, and employment in a manufacturing occupation (especially petrochemical, textile, metal, and machinery industries). The mortality survey revealed a predominance among males, nonwhites, and residents of the northeastern US, the latter due partly to an association between MF mortality and population size. The influence of occupational exposures was suggested by the excessive MF mortality rates in counties where petroleum, rubber, primary and fabricated metal, machinery, and printing industries were located.