Veterans and Agent Orange : Update 1998

by Institute of Medicine (U. S.) Committee to Review

• ISBN13: 9780309063265
• ISBN10: 0309063264
• Edition: 1st
• Format: Hardcover
• Copyright: 1999-12-01
• Publisher: NATL ACADEMY OF SCIENCE

Summary

Third in a series of five congressionally mandated studies occurring biennially, this book is an updated review and evaluation of the available scientific evidence regarding the statistical association between exposure to herbicides used in Vietnam and various adverse health outcomes suspected to be linked with such exposures. As part of the review, the committee convened a workshop at which issues surrounding the reanalysis and the combination of existing data on the health effects of herbicide and dioxin exposure were addressed.This book builds upon the information developed by the IOM committees responsible for the 1994 original report, Veterans and Agent Orange, and Veterans and Agent Orange: Update 1996, but focuses on scientific studies and other information developed since the release of these reports. The two previous volumes have noted that sufficient evidence exists to link soft tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne with exposure. The books also noted that there is "limited or suggestive" evidence to show an association with exposure and a neurological disorder in veterans and with the congenital birth defect spina bifida in veterans' children. This volume will be critically important to both policymakers and physicians in the federal government, Vietnam veterans and their families, veterans organizations, researchers, and health professionals.

Table of Contents

Executive Summary	1	(17)
Veterans and Agent Orange: Previous Iom Reports	17	(15)
Background	17	(6)
Impact of the Reports	23	(2)
Federal Government's Response to Concerns over the Military Use of Herbicides in Vietnam	25	(7)
Toxicology	32	(92)
Summary	32	(4)
VAO and Update 1996 Overview	36	(1)
Update of the Scientific Literature---Overview	36	(7)
Toxicity Profile Updates	43	(65)
Issues in Evaluating the Evidence	108	(16)
Methodologic Considerations in Evaluating The Evidence	124	(11)
Questions to Be Addressed	124	(4)
Issues in Evaluating the Evidence	128	(4)
Summary of the Evidence	132	(3)
Exposure Assessment	135	(34)
Military Use of Herbicides in Vietnam	135	(6)
Occupational and Environmental Exposures to Herbicides and Dioxin	141	(1)
Exposure Assessment for Epidemiology	142	(4)
Exposure Assessment in Studies of Vietnam Veternas	146	(4)
Exposure Assessment in Occupational and Environmental Studies	150	(7)
Review of the Scientific Literature	157	(12)
Epidemiologic Studies	169	(96)
Occupational Studies	219	(13)
Environmental Studies	232	(4)
Vietnam Veterans Studies	236	(29)
Cancer	265	(142)
Introduction	265	(2)
Gastrointestinal Tract Tumors	267	(15)
Hepatobiliary Cancers	282	(6)
Nasal/Nasopharyngeal Cancer	288	(4)
Laryngeal Cancer	292	(3)
Lung Cancer	295	(7)
Bone Cancer	302	(2)
Soft-Tissue Sarcomas	304	(7)
Skin Cancers	311	(2)
Melanoma	313	(4)
Basal and Squamous Cell (Nonmelanoma) Skin Cancer	317	(5)
Breast Cancer	322	(7)
Cancers of the Female Reproductive System	329	(5)
Prostate Cancer	334	(9)
Testicular Cancer	343	(4)
Urinary Bladder Cancer	347	(4)
Renal Cancer	351	(5)
Brain Tumors	356	(6)
Non-Hodgkin's Lymphoma	362	(9)
Hodgkin's Disease	371	(6)
Multiple Myeloma	377	(6)
Leukemia	383	(7)
Summary	390	(17)
Latency and Cancer Risk	407	(27)
Analysis of Latency in Epidemiologic Studies	408	(4)
Four Questions Addressed by the Committee	412	(4)
Review of the Scientific Literature	416	(2)
Respiratory Cancer	418	(8)
Prostate Cancer	426	(2)
Non-Hodgkin's Lymphoma	428	(2)
Relevance of Latency in Assessing the Effect of Herbicides on Cancer Risk in Vietnam Veterans	430	(4)
Reproductive Effects	434	(32)
Introduction	434	(1)
Birth Defects	435	(9)
Fertility	444	(7)
Stillbirth, Neonatal Death, and Infant Death	451	(3)
Low Birthweight and Preterm Birth	454	(4)
Conclusions for Reproductive Effects	458	(8)
Neurobehavioral Disorders	466	(12)
Background	466	(2)
Cognitive and Neuropsychiatric Effects	468	(1)
Motor/Coordination Dysfunction	469	(1)
Chronic Persistent Peripheral Neuropathy	470	(3)
Acute and Subacute Transient Peripheral Neuropathy	473	(1)
Conclusions for Neurobehavioral Disorders	473	(5)
Other Health Effects	478	(53)
Introduction	478	(1)
Chlorance	478	(2)
Porphyria Cutanea Tarda	480	(2)
Respiratory Disorders	482	(5)
Immune System Disorders	487	(4)
Diabetes	491	(12)
Lipid and Lipoprotein Disorders	503	(5)
Gastrointestinal and Digestive Disease, Including Liver Toxicity	508	(6)
Circulatory Disorders	514	(4)
Summary	518	(13)
APPENDIXES	531	(16)
A Information Gathering	533	(4)
B ICD.9 Codes for Cancer Outcomes	537	(3)
C Committee and Staff Biographies	540	(7)
Index	547