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Veterans and Agent Orange: Update 2000 (2001)
Institute of Medicine (IOM)

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Veterans and Agent Orange: Update 2000

Index

A

Acquired immune deficiency syndrome. See AIDS/HIV

ACTH. See Adrenocorticotropic hormone

Acute lymphocytic leukemia (ALL). See Leukemia

Acute myelogenous leukemia (AML) See Leukemia

Acute myeloid leukemia (AML). See Leukemia

ADA. See American Diabetes Association Adipose tissue

TCDD distribution, I: 130, 131, 168–169, 259, 269, 280;

IV: 42, 43, 64, 116, 117

Adrenocorticotropic hormone (ACTH), IV: 59

Aerial spraying, I: 3, 24;

III: 135, 137, 139;

IV: 117, 120, 123, 150, 160, 303

military early research, I: 25–26;

III: 28;

IV: 150

records of, I: 84–85, 287

See also Herbicide application methods;

Herbicides

AFHS. See Air Force Health Study

Aflatoxin, I: 453;

IV: 267

Africa, sub-Saharan, II: 181;

III: 282;

IV: 267

Age and aging

acute lymphocytic leukemia incidence, data for selected age groups, III: 384;

IV: 9, 378

acute myeloid leukemia incidence, data for selected age groups, III: 384;

IV: 378

bone cancer incidence, data for selected age groups, III: 302;

IV: 288

brain cancer incidence, data for selected age groups, III: 356;

IV: 351

breast cancer incidence in US women, data for selected age groups, III: 324;

IV: 314

cancer age-specific incidence, I: 436–438

chronic lymphocytic leukemia incidence, data for selected age groups, III: 384;

IV: 378

chronic myeloid leukemia incidence, data for selected age groups, III: 384;

IV: 378

diabetes prevalence, data by age, III: 492

epidemiologic studies, control of aging effects, II: 261–262;

III: 409;

IV: 3, 13, 23

female reproductive system cancer

incidence, data by type, for selected age groups, III: 329, 330;

IV: 321

gastrointestinal tract cancer incidence, data by type for selected age groups, III: 267;

IV: 250

Hodgkin’s disease incidence, data for selected age groups, III: 372;

IV: 365

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Veterans and Agent Orange: Update 2000 Index A Acquired immune deficiency syndrome. See AIDS/HIV ACTH. See Adrenocorticotropic hormone Acute lymphocytic leukemia (ALL). See Leukemia Acute myelogenous leukemia (AML) See Leukemia Acute myeloid leukemia (AML). See Leukemia ADA. See American Diabetes Association Adipose tissue TCDD distribution, I: 130, 131, 168–169, 259, 269, 280; IV: 42, 43, 64, 116, 117 Adrenocorticotropic hormone (ACTH), IV: 59 Aerial spraying, I: 3, 24; III: 135, 137, 139; IV: 117, 120, 123, 150, 160, 303 military early research, I: 25–26; III: 28; IV: 150 records of, I: 84–85, 287 See also Herbicide application methods; Herbicides AFHS. See Air Force Health Study Aflatoxin, I: 453; IV: 267 Africa, sub-Saharan, II: 181; III: 282; IV: 267 Age and aging acute lymphocytic leukemia incidence, data for selected age groups, III: 384; IV: 9, 378 acute myeloid leukemia incidence, data for selected age groups, III: 384; IV: 378 bone cancer incidence, data for selected age groups, III: 302; IV: 288 brain cancer incidence, data for selected age groups, III: 356; IV: 351 breast cancer incidence in US women, data for selected age groups, III: 324; IV: 314 cancer age-specific incidence, I: 436–438 chronic lymphocytic leukemia incidence, data for selected age groups, III: 384; IV: 378 chronic myeloid leukemia incidence, data for selected age groups, III: 384; IV: 378 diabetes prevalence, data by age, III: 492 epidemiologic studies, control of aging effects, II: 261–262; III: 409; IV: 3, 13, 23 female reproductive system cancer incidence, data by type, for selected age groups, III: 329, 330; IV: 321 gastrointestinal tract cancer incidence, data by type for selected age groups, III: 267; IV: 250 Hodgkin’s disease incidence, data for selected age groups, III: 372; IV: 365

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Veterans and Agent Orange: Update 2000 immune system, IV: 31, 79 laryngeal cancer incidence, data for selected age groups, III: 292; IV: 277 latency and, II: 261–262, 273, 275; III: 409, 414–415, 425, 428, 430; IV: 254, 256, 264, 265 leukemia incidence, data by type, for selected age groups, III: 384; IV: 378 liver/intrahepatic bile duct cancers incidence, data for selected age groups, III: 282; IV: 267 lung cancer incidence, data for selected age groups, III: 296; IV: 281 melanoma incidence, data for selected age groups, III: 313; IV: 300 multiple myeloma incidence, data for selected age groups, III: 377 nasal/nasopharyngeal cancer incidence, data for selected age groups, III: 289; IV: 273 non-Hodgkin’s lymphoma age of onset, I: 436 non-Hodgkin’s lymphoma incidence, data for selected age groups, III: 362; IV: 356 prostate cancer incidence, data for selected age groups, III: 334; IV: 10, 327 renal cancers incidence, data for selected age groups, III: 352; IV: 346 reproductive disorders, IV: 51–52, 59, 63, 66, 71, 80, 200 soft-tissue sarcoma age of onset, I: 436 soft-tissue sarcoma incidence, data for selected age groups, III: 306; IV: 292 TCDD half-life, IV: 24, 28, 45 testicular cancer incidence, data for selected age groups, III: 343; IV: 33 urinary bladder cancer incidence, data for selected age groups, III: 347; IV: 340 See also Demographic data, Vietnam veterans Agent Blue, I: 27, 89–90, 93, 97, 100; III: 136, 137; IV: 118 volume used in Operation Ranch Hand, data, III: 136 Agent Green, I: 27, 90, 92, 114; III: 136, 137, 140, 146; IV: 118 volume used in Operation Ranch Hand, data, III: 136; IV: 123 Agent Orange, II: 308; III: 130, 159, 315, 344, 359, 389, 407, 444, 460, 462, 489, 491; IV: 117–118, 150, 156 Air Force research activities, II: 31–32; III: 28–29 birth defects association, II: 298, 300; III: 435; IV: 400 cancer latency issues, II: 260–276; III: 407–431; IV: 284 chemical composition, I: 27; II: 102; IV: 119 chloracne association, II: 317, 318; III: 479; IV: 138, 463 congressional hearings, II: 27–28; III: 25 defoliant effectiveness, I: 90 Department of Veterans Affairs activities, II: 29–31, 153, 156–157; III: 27–28; IV: 15 Environmental Protection Agency research activities, II: 32; III: 29–30 exposure opportunity index (EOI), II: 290–291; III: 146, 147, 148; IV: 124, 405 federal government action/research, I: 45–60; II: 27–32; III: 27–32; IV: 13 health effects of, concerns, I: 2; II: 19–23, 26–27; III: 19–20, 236, 237, 240, 242, 243 International Agency for Research on Cancer research activities, III: 30 legislation, I: 47–52; II: 28–29; III: 26–27; IV: 1, 15 Orange II formulation, I: 90; III: 137; IV: 119 product liability litigation, I: 34–35 spontaneous abortion, II: 283; IV: 399–400, 409–412 suspension of use, I: 92–93; II: 26 TCDD as contaminant of, I: 91, 114, 126–127; II: 102; III: 140; IV: 133–135 Vietnam amount used, I: 1, 27, 74, 90, 97–98, 106; II: 1, 26; III: 136; IV: 115, 118–119 Vietnam military application, I: 1, 3, 27, 74, 84–85, 90, 92–93, 97–107, 543–545; II: 1, 26–27; III: 1, 25, 136, 137, 138, 140; IV: 125–126 Vietnam surplus disposal, I: 93–94 Vietnam veterans’ concerns, I: 32–34; II: 26–27 Vietnam veterans’ increased disease risk, II: 22–23; III: 22–23, 272; IV: 8–9, 12, 256, 270, 275, 279, 284, 290, 296, 305, 311, 318, 323, 332, 338, 343, 348, 353, 359, 367, 374, 381, 388

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Veterans and Agent Orange: Update 2000 volume used in Operation Ranch Hand, data, II: 136; IV, 120, 123, 150 See also Herbicides; Incineration, of Agent Orange Agent Orange, the Deadly Fog, I: 33 Agent Orange Act of 1991. See Public Law 102–104 Agent Orange Briefs, I: 56; II: 31; III: 28 Agent Orange Registry (AOR), I: 20, 53, 56, 729; II: 29, 31, 153, 228; III: 28, 344 See also Department of Veterans Affairs (DVA) Agent Orange Review, I: 56; II: 31; III: 28 Agent Orange Scientific Task Force, I: 60–61 Agent Orange Study, I: 19, 57, 58–59, 63–64, 276–278; II: 102; III: 147, 148; IV: 124 Agent Orange Task Force, II: 24–26; III: 24–25, 148; IV: 124 See also Department of Veterans Affairs, U.S. (DVA) Agent Orange Validation Study, III: 240; IV: 156, 159, 160, 162, 283, 304, 327, 403 Agent Orange Victims International, I: 34 Agent Orange Working Group, I: 19, 46, 58, 277, 743 research methodology, I: 728 Agent Orange II. See Agent Orange Agent Pink, I: 27, 90, 92, 114; III: 136, 137, 140, 146; IV: 118, 122–123 volume used in Operation Ranch Hand, data, III: 136; IV: 123 Agent Purple, I: 27, 89, 92, 114; III: 136, 140, 146; IV: 118, 122–123 Operation Ranch Hand, IV: 123 TCDD in, I: 126; IV: 122 volume used in Operation Ranch Hand, data, III: 136 Agent White, I: 27, 90, 92–93, 97, 115, 189; III: 136, 137; IV: 118–119, volume used in Operation Ranch Hand, data, III: 136 Agricultural/forestry workers brain tumors, I: 320, 523; II: 136 Canadian Farmer Cohort, II: 135–136 cancers, I: 13, 37, 320–323, 443, 447, 454; II: 133–137, 179 case-control studies, I: 326–341, 486–488; II: 118–122, 138–140; III: 185–195, 228–232 cohort studies, I: 318–323; II: 118–120, 135– 137, 197–198; III: 178–185, 224–228; IV: 197–202 epidemiologic studies, I: 37, 318–323; II: 118–120, 135–137, 232–234, 238–239, 241–243; III: 178–195, 224–232, 284–285, 335, 364–365, 379–380, 387–388; IV: 134, 141–142, 145, 257, 260, 263, 265, 271, 285, 290, 296, 306, 312, 318, 324, 333, 338, 349, 353, 360, 368, 374, 381, 401 female reproductive and breast cancers, I: 510–511; IV: 324–325 hepatobiliary cancer, I: 454; II: 183–184; III: 284–285; IV: 271 herbicide exposure assessment, I: 265–266; III: 154–157; IV: 202 Hodgkin’s disease, I: 550–553; II: 135 Irish agricultural workers study, II: 136–137 kidney cancer, I: 515 leukemia, I: 332–335, 566–568; II: 136; III: 387–388 malignant lymphoma in, IV: 201 multiple myelomas, I: 11–12, 558–561; II: 138–139, 238–239, 241–243; III: 379–380 non-Hodgkin’s lymphoma, I: 9, 256–257, 530–540; II: 138, 139, 232–234; III: 364–365; IV: 359–361 prostate cancer, I: 11, 518, 519, 575; II: 8–9; III: 335; IV: 327–329 reproductive outcomes, I: 510–511, 598 respiratory cancer, I: 11, 466; II: 197–198 soft-tissue sarcomas, I: 37, 326–328, 479– 481, 486–488 sperm dysfunction, I: 632 suicide, I: 650 See also Forests; Professional pesticide/herbicide applicators Agricultural Health Study, IV: 142 See also Iowa Agricultural herbicides, I: 24, 35, 39, 174–175, 181; II: 137–139 See also Herbicides Agriculture. See Agricultural/forestry workers; Agricultural herbicides; Food crops; Forests Ah receptor (AhR), I: 3, 123, 134; II: 3–4, 51–53, 54–56, 57–62; III: 54–58, 129; IV: 25–26, 29–30, 42, 47, 50–58, 60, 68, 69, 70–73, 76, 80, 82, 84, 85, 86, 87, 90, 93, 94, 95, 99–100 animal studies and, I: 114, 123; II: 3–4, 51–53, 54–56, 57–62, 92–93; III: 33, 34, 35, 54–58, 62–63, 67–69, 129; IV: 48–49, 61–62, 64–67, 74–75

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Veterans and Agent Orange: Update 2000 anti-estrogenicity and, II: 62; III: 67–69 biological consequences of activation, II: 57; III: 62; IV: 56–60, 323 blood abnormalities, I: 125 cacodylic acid acute toxicity, I: 188 cacodylic acid carcinogenicity, I: 118, 119, 187; IV: 5, 387 cacodylic acid chronic exposure, I: 188–189 cacodylic acid developmental toxicity, I: 189 cacodylic acid genotoxicity, I: 187–188 cacodylic acid mechanism of action, I: 188–189 cacodylic acid and mechanism of toxicity, II: 50–51; IV: 24 cacodylic acid pharmokinetics, I: 186–187 cacodylic acid renal toxicity, II: 50–51 cacodylic acid reproductive toxicity, I: 189 cacodylic acid toxicity summary, II: 50; III: 48; IV: 38 cacodylic acid toxicokinetics, I: 188–189; IV: 24, 27, 38 combinatorial interactions, II: 57–58 DNA binding capability and transcription, activation of, II: 56–57; III: 58–61 free radicals and, II: 60; III: 64–65 growth/differentiation signaling, III: 62–63 growth factor and, II: 59 inconsistencies in, II: 57–62 ligand-independent activation, II: 58 multiple forms of, II: 57 nervous system and, I: 161 protein kinases and, II: 60–62; III: 65–67; IV: 69–71 redox signaling, III: 64–65; IV: 67–69 signaling interactions, II: 59–62; III: 62–69; IV: 60–61, 64, 71–74 structural and functional aspects of, II: 54–56; III: 54–58; IV: 54–56 TCDD biologic plausibility and, I: 3, 133–138, 452–453; IV: 4, 25–26, 29, 42, 47–53, 322, 386 TCDD carcinogenicity and, I: 118, 439 TCDD hepatotoxicity and, I: 151, 152, 457; II: 3–4 TCDD immunotoxicity and, I: 122, 150 TCDD reproductive toxicity and, I: 123 TCDD teratogenicity and, I: 159–160 transcriptional-independent responses, II: 58–59 See also ARNT AIDS/HIV, I: 338, 527, 541, 695; II: 326; IV: 144, 214, 356, 47, 476 Air Force. See U.S. Air Force Air Force Health Study (AFHS), I: 62–63, 260, 272, 622; II: 284, 293–295, 336; III: 23, 25, 29, 239, 438–439, 495, 505, 514; IV: 13, 232, 233, 234, 235 appropriation for, I: 51 autoimmune disease in, I: 698 basal/squamous cell skin cancer in, III: 318, 321, 322; IV: 309 baseline mortality studies, II: 151 birth defects in offspring, II: 286, 293–295; III: 436, 438, 439; IV: 402 bone cancer in, III: 303; IV: 289 cancer and latency in, III: 423, 424, 425, 427 circulatory disease in, I: 703–705, 706; II: 336; III: 514, 517; IV: 508–509 data sources, I: 385–386; II: 150–151 diabetes mellitus in, I: 684; II: 330; III: 495, 498–500, 502; IV: 485–487 epidemiological studies, II: 31, 32, 149, 150–152, 154–156, 293–295; III: 28–29, 206–207, 218, 237–240, 303, 309–310, 313–314, 318, 321, 322, 339, 340, 385, 436, 438, 439, 446–447, 449, 452–453, 457–458, 481, 486, 495, 498–500, 502, 505, 506, 507, 510, 513, 514, 517; IV: 291, 294–295, 298, 301, 305–306, 308–311, 313, 327, 329, 331, 334–36, 342, 345, 347, 350, 352, 355, 357, 362, 366, 370, 373, 376, 380, 383 exposure assessment in, I: 279–280, 281, 386; II: 4–5, 101, 103, 109; III: 6, 146–147, 157–158, 162; IV: 123–124 gastrointestinal ulcers in, I: 691; III: 510, 513 immune system disorders in, I: 696 infertility in, II: 280; III: 446–447, 449 lipid abnormalities in, I: 689; II: 333; III: 505, 506, 507; IV: 494 liver toxicity in, II: 332; III: 510, 513; IV: 502 low birthweight in, I: 626, 627; III: 457–458 melanoma in, III: 313–314; IV: 303–304 methodology, I: 230–231, 385–386, 445, 757–762 multiple myelomas in, I: 562; II: 244, 245; IV: 373

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Veterans and Agent Orange: Update 2000 neurological disorders in, I: 659; IV: 441–443, 445, 454–455, 459 non-Hodgkin’s lymphoma in, I: 541; IV: 362 participants, I: 722–723; II: 150–152 perinatal death in offspring, III: 452–453 peripheral nervous system disorders in, I: 665; IV: 454–455 porphyria cutanea tarda in, I: 681–682; II: 321–322; III: 481 recommendations for, I: 16–17, 722–724; II: 23, 24; IV: 13 reproductive outcomes in, I: 601, 612–613, 632, 633, 727; II: 293–295; III: 436, 438, 439, 446–447, 449, 452–453, 457–458; IV: 403 respiratory cancers in, I: 469; II: 201 respiratory disorders in, I: 711–712; III: 486 role of, I: 53 skin cancers in, II: 209; IV: 303 skin disorders in, I: 678 soft tissue sarcoma in, I: 492–493; III: 309–310; IV: 294–29 spina bifida in offspring, II: 9, 295–296; III: 7, 8, 9–10, 438 spontaneous abortions in, II: 283–284 status of, I: 53; II: 31–32 TCDD half-life estimates, I: 260–261; II: 104–105; III: 37, 50, 157–158 TCDD serum levels, I: 273, 281, 285, 656; II: 101, 103, 105, 109, 351, 356, 357; III: 146, 147 See also Operation Ranch Hand; U.S. Air Force; Vietnam veterans Aktiengesellschaft, Germany, IV: 137 Alanine aminotransferase (ALT), II: 331, 332; III: 45, 509, 510; IV: 37 Alaskan natives Inuit, III: 50–51 See also Race/ethnicity Alberta, Canada, II: 135–136, 232, 242, 246; III: 234–235, 319–320; IV: 149, 198, 229, 312–313 Alberta Cancer Registry, III: 235 Alberta Health Care Insurance Plan, III: 235 Alcohol consumption, I: 507 ALL. See Leukemia Allergies, II: 327, 329; III: 487–488; IV: 469–470 See also Immune system disorders Alsea, Oregon, I: 42–43, 372–373, 598 ALT. See Alanine aminotransferase AL-type primary amyloidosis See Amyloidosis American Association for the Advancement of Science, I: 29, 92 Herbicide Assessment Commission, I: 30–31 American Cancer Society, I: 334; II: 177, 181, 189, 191, 204, 205, 209, 211, 217, 223, 228, 231, 239, 245; III: 267, 282, 289, 292, 295, 296, 302, 304, 312, 322, 324, 329, 334, 343, 347, 351, 356, 362, 371, 377, 383; IV: 250, 267, 273, 277, 281, 287, 291, 299, 300, 314, 320, 326, 335, 339, 345, 350, 355, 364, 371, 377 Cancer Prevention Study, II: 239; III: 229 American College of Epidemiology, II: 25 American Diabetes Association (ADA), III: 492, 493, 502 American Industrial Hygiene Association, II: 25 American Journal of Epidemiology, II: 281 American Legion, I: 60, 278–279, 399, 601–602, 626, 633; II: 113, 157; IV: 133, 158 Vietnam veterans’ epidemiological studies, III: 212–213, 243 American Public Health Association, II: 25 American Thoracic Society Epidemiology Standardization Questionnaire, II: 136 d-Aminolevulinic acid synthetase, I: 153–154 Amitrole, I: 323 AML. See Leukemia Amyloidosis, IV: 2, 7, 11, 511–513 Anencephaly, IV: 404–405 Angina, I: 708; IV: 135 See also Circulatory disorders Animal studies; III: 394–396, 524; IV: 254, 256, 269, 275, 279, 290, 293–294, 296 2,4-D carcinogenicity, I: 118–119, 176–178; II: 48; III: 47, 396; IV: 37 2,4-D chronic exposure, I: 179–180; IV: 34 2,4-D developmental toxicity, I: 124, 180–181; III: 46 2,4-D disease outcomes and mechanisms of toxicity, II: 48–49; III: 38–39, 44–47; IV: 30–32, 35 2,4-D genotoxicity, I: 178–179; IV: 28, 33 2,4-D immunotoxicity, I: 122–123, 181; III: 46, 423; IV: 36 2,4-D lethality, III: 44–45; IV: 35

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Veterans and Agent Orange: Update 2000 2,4-D mechanism of action, II: 47–48; III: 44; IV: 33 2,4-D mechanism of toxicity, II: 48–49; IV; 28, 37 2,4-D neurotoxicity, II: 48; III: 45–46, 473; IV: 30, 35 2,4-D pharmacokinetics, I: 175 2,4-D reproductive toxicity, I: 124, 180, 181; III: 46; IV: 29, 36 2,4-D toxicity profile update summary, II: 46; IV: 33 2,4-D toxicokinetics, II: 46–47; III: 43–44; IV: 24, 27 2,4,5-T acute toxicity, I: 184 2,4,5-T carcinogenicity, I: 118, 119, 182–184; III: 396 2,4,5-T chronic exposure, I: 184 2,4,5-T developmental/reproductive toxicity, I: 124, 185; II: 49–50 2,4,5-T genotoxicity, I: 184 2,4,5-T immunotoxicity, I: 123 2,4,5-T mechanism of action, III: 47–48 2,4,5-T mechanism of toxicity, II: 49–50; IV: 37 2,4,5-T pharmacokinetics, I: 182 2,4,5-T toxicity profile update summary, II: 49; IV: 37 2,4,5-T toxicokinetics, II: 49; III: 47; IV: 37 Ah receptor, I: 3, 123, 134; II: 3–4, 51–53, 54–56, 57–62; III: 54–58, 129; IV: 4, 30, 386 amyloidosis, IV: 512 blood abnormalities, I: 125; IV: 496 breast cancer, IV: 29, 317–318 cacodylic acid acute toxicity, I: 188 cacodylic acid carcinogenicity, I: 118, 119, 187; IV: 5, 387 cacodylic acid chronic exposure, I: 188–189 cacodylic acid developmental toxicity, I: 189 cacodylic acid genotoxicity, I: 187–188 cacodylic acid mechanism of action, II: 50; III: 49–50 cacodylic acid mechanism of toxicity, II: 50–51; IV: 24 cacodylic acid pharmacokinetics, I: 186–187 cacodylic acid renal toxicity, II: 50–51 cacodylic acid reproductive toxicity, I: 189 cacodylic acid toxicity summary, II: 50; IV: 38 cacodylic acid toxicokinetics, II: 50; III: 48; IV: 24, 27, 38 characteristics of, I: 111–114; IV: 48 epidemiologic studies, IV: 359, 361, 369, 381 evidentiary role, I: 228; IV: 85, 106, 385, 515–516 generalizability, I: 112, 113, 114, 118, 122–123, 160; IV: 26, 85, 426, 459 hepatic abnormalities, I: 124–125, 688; IV: 25, 57, 59–60 human health relevance of toxicology, III: 35–36; IV: 26, 48 male-mediated disorders, I: 593–594 nonhuman primates, I: 151 picloram in, I: 118, 119, 125, 190–192; III: 51 squamous cell carcinomas, IV: 284 TCDD acute toxicity, II: 75–76 TCDD and bladder cancer in; IV: 342 TCDD and bone cancer in; IV: 290 TCDD and Hodgkin’s disease in; IV: 367 TCDD and leukemia disease in; IV: 380 TCDD and multiple myeloma in; IV: 374 TCDD and nasal and nasopharyngeal cancer in; IV: 275 TCDD and non-Hodgkin’s lymphoma in; IV: 358 TCDD and prostate cancer in; IV: 332 TCDD and soft-tissue sarcoma in; IV: 279 TCDD carcinogenicity, I: 3, 116, 138–142; II: 3, 65–68; IV: 26, 305, 311 TCDD cardiovascular toxicity, I: 171; II: 76; III: 74–75 TCDD dermal toxicity, I: 173–174; II: 76 TCDD developmental toxicity, I: 123–124, 156–157, 159–160; II: 3, 71, 72–73; III: 92–105; IV: 58 TCDD disease outcomes, II: 3; III: 39–43, 71–105; IV: 3, 23 TCDD endocrine effects, III: 83–84 TCDD gastrointestinal toxicity, I: 169–170; IV: 256 TCDD hepatotoxicity, I: 124–125, 151–156; II: 3, 73–75; III: 76–79 TCDD immunotoxicity, I: 119–122, 146– 151; II: 3, 68–71; III: 85–92; IV: 3, 26 TCDD-induced diabetes, IV: 488 TCDD-induced wasting syndrome, I: 162–166; II: 76–77; III: 80–83; IV: 57, 76 TCDD lethality, III: 71–73; IV: 76 TCDD mechanism of action, II: 3, 54–65; III: 51–53, 54–58, 62–63, 67–69; IV: 3, 24

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Veterans and Agent Orange: Update 2000 TCDD mechanism of toxicity, II: 65–77 TCDD metabolic toxicity, I: 166–169 TCDD neurotoxicity, I: 160–166; II: 3, 75; III: 84–85; IV: 352, 458 TCDD pharmacokinetics, I: 127–133 TCDD renal toxicity, II: 77; III: 75–76; IV: 348 TCDD reproductive toxicity, I: 123–124, 156–159; II: 3, 71–72; III: 92–105; IV: 26, 64, 323, 337, 411, 432, 434 TCDD respiratory tract toxicity, I: 170 TCDD toxicity update summary, II: 51–53 TCDD toxicokinetics, II: 3, 53–54; III: 4–5, 33; IV: 3, 23, 41, 47 toxicity, potential health risks and contributing factors, III: 106, 107, 108 Anthropometry. See Body weight AOR. See Agent Orange Registry Apoptosis, TCDD and, II: 3, 67 Arctic, Inuit natives, III: 50–51 Argentina, III: 224 Arkansas, I: 373–374, 663; III: 234; IV: 149, 231 Armed Forces Institute of Pathology, I: 494 Army. See U.S. Army Army Chemical Corps. See U.S. Army Chemical Corps Army Reserve Personnel Center, II: 152 ARNT, II: 4, 45, 55, 56, 57, 58, 66; III: 38, 54–58, 63; IV: 30, 47–56, 61, 67, 69–73, 86 See also Ah receptor (AhR) Arsenic cacodylic acid component, IV: 117–118 respiratory cancer and latency, II: 268; III: 420 Aryl hydrocarbon hydroxylase, I: 135, 153, 155–156, 170 Aryl hydrocarbon receptor (AhR). See Ah receptor (AhR) Asbestos, respiratory cancer and latency, II: 268; III: 420 Asia, III: 471 Asian Americans, II: 188 See also Race/ethnicity Aspartate aminotransferase (AST), II: 331, 333; III: 45, 509; IV: 37 Assembly of Life Sciences (ALS), I: 62, 63 Association of Birth Defect Children, II: 292 AST. See Aspartate aminotransferase (AST) Asthma, I: 708, 711, 713; IV: 199 See also Respiratory disorders Ataxia, I: 658 See also Motor/coordination dysfunction; Neurobehavioral toxicity Atlanta Congenital Defects Program, I: 387 Atlanta, Georgia, II: 241, 296; III: 229 CDC Birth Defects Study, II: 9; III: 438; IV: 237 Atlantic Ocean, III: 108 Australia, I: 61, 91, 340, 406, 418, 444, 470, 488–489, 537, 546, 614–615, 633, 702, 710; II: 113, 132, 149, 160, 202, 293; III: 216–217, 218, 237, 244–245; IV: 8, 10, 144, 150, 159, 210, 304 Air Force veterans, III: 244 Army veterans, III: 244, 245; IV: 159 Australian National Service Vietnam veterans, III: 273, 286 Bureau of Statistics Health Interview Survey, 1989–1990, III: 245, 485, 511, 517 Department of Defense, III: 244, 245 Department of Veterans Affairs, III: 244, 245 Electoral Commission rolls, III: 245 Health Insurance Medicare, III: 245 herbicide use by forces, III: 137–138 lung cancer mortality in Vietnam veterans, III: 424 National Death Index, III: 245 Navy veterans, III: 244 Victorian Cancer Registry, III: 232; IV: 144 Vietnam veterans epidemiologic studies, III: 9, 273, 285–286, 290, 294, 295, 298, 299, 303, 310, 311, 314, 315, 327, 329, 339, 340, 343, 346, 349, 353, 355, 359, 365, 380, 389, 469, 486, 489, 500, 506, 512–513, 517; IV: 244–247, 255, 259, 262, 264, 266, 272, 276, 280, 283, 287, 295, 298–299, 305–308, 310, 313, 319, 323–326, 332, 334–335, 337, 339, 345, 350, 355, 362–363, 371, 376, 380, 383, 404–405 See also Tasmania Austria, IV: 138–139, 189, 467–468, 500 Autoimmune disease, I: 697–699; IV: 475–481 See also Immune system disorders; Systemic autoimmune disease; Systemic lupus erythematosus Autoimmunity, I: 693, 697–699; II: 7, 21, 327, 329; III: 487–488; IV: 476–477 See also Immune system disorders

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Veterans and Agent Orange: Update 2000 B B cell function, I: 147, 148 Baltic Sea, II: 329; III: 108, 236, 272, 285, 358, 484, 515 Basal/squamous cell skin cancer biologic plausibility, III: 322; IV: 311 epidemiologic studies, III: 317–322, 323 herbicide environmental exposure and, III: 323; IV: 229, 309 herbicide occupational exposure and, III: 321, 323; IV: 309 herbicides association with, III: 317–322, 323 incidence, III: 319–320 mortality studies, III: 319, 321 scientific literature update, III: 319–320; IV: 309 Vietnam veterans and, III: 323 See also Melanoma; Skin cancer BASF, I: 312–313, 444, 530, 550, 558; II: 130–131, 238, 318–319, 325, 330–331, 332– 333, 334, 336; III: 153, 154, 174, 221–222, 269–270, 273, 297, 349, 484, 495, 506, 511; IV: 112, 188–189, 257, 260, 271, 285, 290, 301, 333, 343–344, 368, 382 Aktiengesellschaft, III: 221; IV: 137 Dioxin Investigation Programme, II: 131 Occupational Safety and Employee Protection Department, II: 131 Basic helix-loop-helix (BHLH), II: 54, 55, 56; IV: 49 Bayer, III: 154; IV: 112 Beck’s Depression Inventory, I: 650, 651 Benefits. See Compensation, veterans BHLH. See Basic helix-loop-helix (BHLH) Bias, methodological. See Methodological bias Binghamton, New York, III: 234; IV: 149 Biochemical warfare, I: 29, 45 Biologic plausibility, II: 88, 92; III: 2, 124, 128; IV: 2–3, 16, 20–22, 26, 29, 106–107, 249, 385–388 Ah receptor-TCDD interaction, I: 3, 133–137, 439, 452–453; III: 129; IV: 48, 86 altered sperm parameters, I: 634; III: 451 animal studies, I: 228; II: 176; III: 460–462, 474–475; IV: 431–435 basal/squamous cell skin cancer, III: 322 birth defects, II: 298; III: 444; IV: 403 bladder cancer, III: 351; IV: 342–343 bone cancer, I: 474; III: 304; IV: 290 brain tumors, I: 525; III: 362; IV: 352 breast cancer, II: 217; III: 327, 329; IV: 317–318 carcinogenicity, I: 116–118, 119, 146, 176–178, 182–184, 187, 190–191, 439, 451; II: 176; III: 394–397; IV: 385–387 childhood cancer, I: 630; II: 300; IV: 426 chloracne, I: 678; II: 320–321; III: 480; IV: 466 circulatory disorders, I: 708; III: 518; IV: 510 diabetes mellitus, I: 692; II: 335; III: 502–503; IV: 488 endometrial cancer, IV: 322 evidentiary role of, I: 111, 114, 223–224, 240–241, 434; II: 88, 92, 176; III: 23, 106–107 female reproductive system cancers, I: 512; III: 334; IV: 323 fetal/neonatal/infant death, I: 624; III: 453 gastrointestinal tract cancers, III: 281–282; IV: 256 gastrointestinal ulcers, III: 513–514 genitourinary tract cancers, I: 521–522 genotoxicity, I: 178–179, 184, 187–188, 191 hepatobiliary cancer, I: 453, 457; III: 286, 288; IV: 270 Hodgkin’s disease, I: 557; III: 377; IV: 367 hyperlipidemia, I: 692 immunotoxicity, I: 122, 146–151, 181, 192, 699; III: 491 infertility, I: 634; II: 282; III: 451 laryngeal cancer, III: 295; IV: 279 leukemia, I: 571; III: 390; IV: 380–381 liver disorders, I: 691–692; II: 335; III: 513–514; IV: 270 low birthweight outcomes, I: 628; III: 458 lung cancer, III: 302; IV: 284 male-mediated reproductive outcomes, I: 593–595; III: 451; IV: 413, 416–417, 426 melanoma, III: 317; IV: 305 motor/coordination dysfunction, I: 661; III: 475; IV: 448 multiple myeloma, I: 12, 563; III: 383; IV: 374 nasal/nasopharyngeal cancer, I: 460; III: 292; IV: 275 neurobehavioral disorders, II: 314; III: 474–475

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Veterans and Agent Orange: Update 2000 neuropsychological disorders, I: 658; IV: 457–459 non-Hodgkin’s lymphoma, I: 549; III: 366; IV: 358–359 peripheral nervous system disorders, I: 666 porphyria cutanea tarda, I: 679, 682; II: 323; III: 482; IV: 468 prostate cancer, III: 343; IV: 331–332 renal cancers, III: 356; IV: 348 renal toxicity, I: 179–180 reproductive outcomes, I: 123–124, 180–181, 185, 189, 192, 605, 618, 628; II: 300–301; III: 458, 460–462; IV: 411 respiratory cancers, I: 472 respiratory disorders, I: 713; III: 486 skin cancer, I: 503; IV: 305, 311 soft-tissue sarcoma, I: 500; III: 311; IV: 296 squamous cell carcinomas, IV: 284 testicular cancer, III: 347; IV: 337 See also TCDD biologic plausibility Biological samples, I: 20–21, 729–730 Biomarkers chloracne as, I: 4, 10, 172–173, 262, 401, 672–674; II: 318 exposure assessment and, I: 259–262, 280–284; II: 101–104; III: 146–147; IV: 111, 123, 479, 448 research recommendations, I: 17, 725; II: 25 sperm parameters as, I: 631 Bionetics Research Laboratory, I: 30 Birth defects biologic plausibility, III: 444; IV: 403 definition of, I: 605–606; II: 286; III: 435; IV: 400 epidemiologic studies, II: 140, 286–296; III: 436, 437–438, 443; IV: 247, 403 epidemiology, I: 606; II: 286; III: 435–436 evaluation of epidemiologic data, I: 615–618; IV: 144–145, 403 herbicide association first reports, I: 1 herbicide association in, I: 13–14, 618; II: 7, 11, 20, 286–296; III: 436–444; IV 400–405 herbicide environmental exposure studies, I: 608–609; II: 140, 287–288, 297; III: 437 herbicide occupational exposure studies, I: 607–608; II: 286–287, 297; III: 437; IV: 197 Ranch Hand participants’ children and, II: 293–296; III: 436, 438, 439; IV: 18 risk factors of, I: 606–607; II: 298; III: 444 scientific literature update, III: 437, 439–443; IV: 401–402 Seveso, Italy, study, II: 287; III: 436 summary, II: 295–296; IV: 400–401 TCDD biologic plausibility in, I: 618; II: 298; III: 460–461 Vietnam veterans’ children and, I: 609–615, 618; II: 288–296, 297, 298; III: 435, 436, 437–438; IV: 403 See also Cleft lip/palate; Neural tube defects; Reproductive disorders; Spinabifida; Teratogenicity Birth Defects Study, II: 9, 290–291, 296; III: 147, 436, 438, 439; IV: 405, 429 See also Centers for Disease Control and Prevention (CDC) Births. See Birth defects; Low birthweight; Perinatal death; Preterm delivery (PTD) Bladder cancer and disorders biologic plausibility, III: 351; IV: 342–343 epidemiologic studies, I: 515–517; II: 225–227; III: 347–351; IV: 19, 339–347, 385, 387 epidemiology; II: 223; III: 347 herbicide association in, I: 12, 521, 576; II: 7, 12, 21, 225–227, 250; III: 3, 10, 21, 132, 347–351; IV: 19, 31, 40 herbicide environmental exposure and, III: 349, 350–351; IV: 341 herbicide occupational exposure and, III: 348, 350; IV: 340–341 histopathology, I: 513 incidence, I: 513 incidence, data by age/gender/race, for selected age groups, III: 347; IV: 340 risk factors, I: 513–514 scientific literature update, II: 226–227; III: 348–349; IV: 340 TCDD, association with, IV: 19, 24 Vietnam veterans’ risk, I: 513, 517, 522; II: 223, 226; III: 349, 351 See also Genitourinary cancers Body mass index (BMI), II: 281; III: 499, 502 Body weight, loss of and TCDD, II: 3 Boehringer-Ingelheim, I: 313; III: 153–154; IV: 111–112 Bone cancer biologic plausibility, III: 304 children and, I: 628 chondrosarcomas of the skull, III: 2, 10, 266, 304

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Veterans and Agent Orange: Update 2000 epidemiologic studies, III: 303–305 epidemiology, I: 472–473; II: 204; III: 302 herbicide association in, I: 13, 473–474, 577; II: 6, 11, 20, 204–205, 249–250; III: 7, 10, 303–305 herbicide environmental exposure and, III: 303, 305; IV: 289 herbicide occupational exposure and, III: 303, 305; IV: 288 incidence of, data by gender/race, for selected age groups, III: 302; IV: 288 scientific literature update, II: 204–205; III: 303; IV: 288 Vietnam veterans’ risk, I: 473, 474; II: 204; IV: 290 Vietnam veterans’ studies, III: 303, 305; IV: 289 Boston Hospital for Women, II: 291–292 Brain tumors, I: 339; IV: 350 2,4-D exposure and, I: 119, 176–177 agricultural workers and, I: 320; II: 136 biologic plausibility, III: 362; IV: 352 clinical features, I: 522 epidemiologic studies, II: 136, 229–230; III: 356–361; IV: 198 epidemiology, I: 522–523; II: 228–229; III: 356 herbicide association in, I: 12, 525, 576; II: 7, 12, 21, 229–230, 250; III: 8, 12, 21, 356–362; IV: 19 herbicide environmental exposure and, III: 358, 361; IV: 351 herbicide occupational exposure and, III: 357–358, 360; IV: 351 incidence, data by gender/race, for selected age groups, III: 356; IV: 351 scientific literature update, II: 229–230; III: 357–359; IV: 351 TCDD, association with, IV: 19 Vietnam veterans’ risk, I: 525; II: 228–229, 230; IV: 353 Vietnam veterans’ studies, III: 358–359, 361; IV: 352 Breast cancer agricultural workers and, I: 510; IV: 140 biologic plausibility, II: 217; III: 327, 329; IV: 318 epidemiologic studies, II: 214–216, 217; III: 324–328; IV: 318–320 epidemiology, I: 505, 506–507; II: 213–214; III: 322, 324; IV: 144 herbicide association in, I: 13; II: 6, 11, 12, 20, 89, 213–217, 249–250; III: 7, 10, 324–329; IV: 24, 29, 38, 73 herbicide environmental exposure studies, I: 511, 512; III: 328; IV: 315 herbicide occupational exposure studies, II: 214–216; III: 324–326, 328; IV: 315 histopathology, I: 505–506 incidence in US women, data by race, for selected age groups, III: 324; IV: 314 risk, estimated, II: 218 risk factors, I: 507 scientific literature update, III: 326–327; IV: 315 Vietnam veterans’ risk, I: 213, 216–217, 505, 511; III: 329; IV: 318 Vietnam veterans’ studies, III: 326, 328; IV: 316 See also Reproductive system cancers, women British Columbia, Canada, III: 10, 227–228, 338, 439–440, 447–448, 449, 452, 453, 457; IV: 419 Cancer Incidence File, III: 227 Death File, III: 227 Division of Vital Statistics, III: 452, 457 Health Surveillance Registry, III: 227, 439 Bronchitis, I: 708, 711, 713 See also Respiratory disorders Bronchus cancer. See Lung cancer Brown, Jesse, II: 24; III: 24, 25 Bureau of Census, III: 231 Bureau of Labor Statistics, I: 79, 80 n-Butyl esters, I: 27; IV: 117–119 C Ca Mau peninsula, I: 100, 104 Cacodylic acid, I: 88–89; II: 4; III: 5, 19, 32, 135, 136, 137, 218; IV: 22, 117–118, 133 acute toxicity, I: 188 animal studies, I: 185–189; II: 50–51; III: 34, 38, 48, 49–50, 396; IV: 5 carcinogenicity, I: 118, 119, 187; II: 40; III: 396 chemical properties/structure, I: 111, 114, 186; II: 38; III: 32 chronic exposure, I: 188–189 developmental toxicity, I: 124, 189

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Veterans and Agent Orange: Update 2000 dimethylarsenic radical formation and, II: 4 disease outcomes, III: 34, 50; IV: 25, 31 domestic use, I: 185–186 genotoxicity, I: 119, 187–188 kidney toxicity, I: 125; II: 42 mechanism of action, II: 50; III: 38, 49–50 mechanisms of toxicity, II: 50–51 metabolism, I: 115, 116 Operation Ranch Hand, use in, IV: 117 pharmacokinetics, I: 186–187 renal toxicity, II: 50–51 reproductive toxicity, I: 124, 189; II: 42; IV: 403 toxicity update summary, II: 50; IV: 23, 33, 38 toxicokinetics, II: 50; III: 32–33, 48; IV: 24, 27–29 Vietnam formulations, I: 186 volume used in Operation Ranch Hand, data, III: 136 Calcium, homeostasis of and 2,4,5-T, II: 4 California, I: 341; III: 232 See also Irvine, California Camp Drum, New York, I: 25–26, 89 Canada, I: 11, 319–320, 323, 374–375, 443, 467–468, 537–539, 620, 650; II: 8, 132, 135–136, 140, 219–220, 243, 248; III: 226, 232, 303, 309, 335, 344, 348, 353; IV: 141, 199, 209, 257, 296, 333, 353, 360, 374, 381 Census of Agriculture, 1971, II: 135 Census of Population, 1971, II: 135 Central Farm Register, 1971, II: 135 Central Farm Register, 1981, II: 135 Mortality Data Base, II: 135; III: 227 Mortality Study of Canadian Male Farm Operators, II: 135–136; III: 224; IV: 140, 198–200 Saskatchewan Cancer Foundation, II: 139 Saskatchewan Hospital Services Plan, II: 139 Statistics Canada, III: 227 See also Alberta, Canada; British Columbia, Canada; Manitoba, Canada; New Brunswick, Canada; Ontario, Canada; Saskatchewan, Canada Cancer age-specific incidence, I: 436–438; IV: 250, 267, 273, 277, 281, 288, 292, 300, 314, 321, 327, 335, 346, 351, 356, 365, 372, 378 agriculture workers and, I: 320–323, 443; II: 136, 137–138 biologic plausibility, I: 116–118, 119, 434; II: 176; III: 394–397; IV: 249, 256, 270, 275, 279, 284, 290, 296, 305, 311, 318, 322, 323, 331, 332, 337, 342, 343, 348, 352, 358, 359, 367, 374, 380, 381, 385 children and, I: 14, 594–595, 628–631; IV: 345, 399, 400, 417–429 clinical features, I: 433–436 epidemiologic studies, I: 45, 317, 320–323, 325–326, 367, 383–384, 391–393, 443– 445; II: 133–138, 147–148; IV: 182, 251–255, 268–269, 274–275, 277–278, 282–283, 288–289, 292–295, 302–304, 309–310, 315–316, 321–323, 327–329, 336–337, 340–342, 346–347, 351–352, 356–358, 365–367, 372–373, 379–380 epidemiology, I: 433, 435–438, 442, 525; II: 175; III: 265–266 herbicide association, insufficient evidence for determining, I: 13–14, 577–578; II: 249–250; III: 393; IV: 268, 270, 274, 279, 286, 302, 305, 311, 314, 318, 321, 323, 336, 337, 338, 340, 342, 346, 348, 374, 378, 380, 384 herbicide association, limited/suggestive evidence of, I: 10–12, 574–576; II: 247– 249; III: 393; IV: 256, 278, 279, 283, 331, 373, 384, 385 herbicide association, no evidence of, I: 12–13, 576–577; II: 250; III: 393–394; IV: 254, 256, 269, 289, 317 herbicide association, sufficient evidence of, I: 8–10, 572–574; II: 175, 176, 247; III: 390, 392; IV: 295, 358, 367, 384 herbicide environmental exposure epidemiologic studies, I: 444, 469; II: 147–148; IV: 254, 269, 274, 278, 282, 289, 293, 302, 309, 315, 321, 329, 336, 341, 347, 351, 357, 366, 372, 379 herbicide exposure measures, II: 175, 176; III: 265–266 herbicide occupational exposure studies, I: 443–444; II: 133, 134; IV: 251, 268, 274, 282, 288, 292, 302, 309, 315, 321, 327, 336, 340, 346, 351, 356, 365, 372, 379 herbicide/pesticide applicators and, I: 320–321, 323, 325–326, 443, 447, 466–468, 488, 491; II: 137–138; IV: 276

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Veterans and Agent Orange: Update 2000 nasal/nasopharyngeal cancer and, I: 460; IV: 274–275 neuropsychiatric outcomes and, I: 649–650, 651–652, 656, 657–658; II: 308 neurotoxicity, I: 160–166, 642; II: 3, 75; III: 84–85, 469, 470–471; IV: 31 non-Ah-mediated toxicity, I: 138 non-Hodgkin’s lymphoma and, I: 8, 9, 528–529, 574; II: 5, 6, 231–234; III: 364, 429; IV: 357 occupational exposure, I: 36–39, 262–267, 269–270, 303; II: 108–109, 113–140, 178–179, 190, 191–200, 219–220, 222, 232–234, 237–238; III: 153, 154, 155, 219, 220, 221–222, 223, 224 284–285, 293, 296–297, 303; IV: 111–114, 134– 147, 187–190, 195–196, 251, 257, 259–260 , 262, 265, 268, 271, 277, 280, 282, 284, 289, 290, 292, 306, 312, 318, 341, 343, 346, 348, 353, 359, 374 opioid antagonist capacity, I: 164 oral administration, I: 128 perinatal death association, II: 285–286 peripheral neuropathy and, II: 310–311, 314; III: 470–471; IV: 184 pharmacokinetics, I: 127–133, 160, 259–261, 284 porphyria cutanea tarda and, II: 5, 6, 321–323; III: 481–482; IV: 466–468 potential health risk estimating, II: 63–65; III: 105–108 production of, I: 28, 114 prostate cancer association, II: 220–223, 273, 274, 275; III: 336–337, 425, 426; IV: 327–328, 329–331 protein kinases and, II: 60–62; III: 65–67 Qsar model approach, III: 106 Ranch Hand study, II: 109; III: 50, 146–147; IV: 18 renal cancer association, II: 225; III: 353; IV: 346–347 renal toxicity, II: 77; III: 75–76 reproductive toxicity, I: 123–124, 156–159, 368, 371–372, 597, 599, 605; II: 3, 41–42, 71–72; III: 92–105, 446, 449; IV: 398–438 passim respiratory cancers and, II: 13–14, 189–203, 269, 270, 272; IV: 282–283 respiratory disorders and, I: 170, 472, 709–710, 712–714; III: 484; IV: 471–474 sensitivity interspecies and interindividual differences, II: 63–64; III: 108 skin cancer and, I: 141, 142–143, 502–503; II: 209–211; III: 313–316, 317, 319, 320, 322 soft-tissue sarcoma and, I: 477, 478, 490, 498–500; II: 5, 6, 205–208; III: 307, 308; IV: 292–293 solubility, I: 114, 115–116, 127 teratogenicity, I: 28–29, 30, 31, 123, 159–160, 185, 368, 370, 372; III: 461 testicular cancer association, II: 228; III: 346; IV: 336 tissue specificity, II: 64 toxic equivalency factors approach, II: 63; III: 106, 158, 159 toxic equivalent concentration approach, III: 107 toxicity, factors influencing, II: 63–65; III: 105–108; IV: 83–84 toxicity profile, III: 50–108;33–84 toxicity update summary, II: 51–53; IV: 3–5, 22, 26, 44, 62, 64, 83–86 toxicokinetics, animal studies, II: 3, 53–54; III: 4–5, 48; IV: 41–46 Vietnam amount used, I: 27, 106; II: 26; IV: 122 Vietnam military exposure, I: 17, 26, 149–161; II: 21, 22, 181, 185, 187, 190, 201–202, 204, 205, 208, 209, 211, 212, 226, 276, 308; III: 146, 147, 237, 239, 240, 430–431; IV: 150–160 Vietnam veterans’ compensation, II: 28–29; III: 26–27 Vietnamese civilians exposure, II: 108–109, 148; III: 156–157; IV: 116–117, 148–149 wasting syndrome, I: 160–161, 162–166; II: 76–77; III: 80–83; IV: 25, 31, 57 See also Herbicides; Serum levels, TCDD; TCDD biologic plausibility 12-O-Tetradexanoylphorbol-13-acetate (TPA), II: 76 Texas, I: 60, 403–404, 696; III: 243 TGF. See Transforming growth factor T-H Agricultural & Nutrition Company, I: 35 Thailand, I: 26, 90 Thompson Chemicals Corporation, I: 35 Thyroid TCDD effects, I: 168–169; IV: 135, 386–387 thyroiditis, I: 697, 698 Times Beach, Missouri, I: 40–42, 268, 368–370, 693–694; II: 113, 144, 184; III: 200–201, 234, 283; IV: 115–116, 133, 148 Tissue distribution, TCDD, I: 129–131, 259

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Veterans and Agent Orange: Update 2000 TNF. See Tumor necrosis factor Tobacco exposure and use, I: 11, 223, 442, 461, 463; II: 190–191, 197; III: 299, 377 perinatal mortality and, I: 619–620 respiratory cancer and latency, II: 268; III: 418 Tollerud, David, III: 25 Topography, I: 25 Tordon 101, IV: 117–118. See also 2,4-Dichlorophenoxyacetic acid (2,4-D); Picloram Toxic equivalency factors (TEFs), II: 45, 52, 63; III: 37, 105, 106, 108; IV: 83–84 Toxic equivalent concentration (TEC), III: 105, 107 Toxicity 2,4-D profile update, II: 46–49; III: 43–47; IV: 33–37 2,4,5-T profile update, II: 49–50; III: 47–48; IV: 37–38 cacodylic acid profile update, II: 50–51; III: 48–50; IV: 38–40 contributing factors, III: 105–108 definition, II: 35 health risk estimation, III: 105–108 picloram profile update, II: 51; III: 50; IV: 40–41 TCDD profile update, II: 51–77; III: 50–108; IV: 41–81 Toxicokinetics, III: 32–36 2,4-D, II: 46–47; III: 32–33, 43–44; IV: 24, 33 2,4,5-T, II: 49; III: 47; IV: 24, 37 cacodylic acid, II: 50; III: 32–33, 48; IV: 24, 38–39 definition, II: 35 literature update, II: 36; III: 36–37 picloram, IV: 24 previous reports summary, II: 38–39 TCDD, II: 53–54; III: 33, 53, 161; IV: 23–24, 27–28, 41–46, 85–86 Toxicology cacodylic acid profile update, II: 50–51; III: 48–50 2,4-D profile update, II: 46–49; III: 43–47 disease outcomes, II: 37, 48–49, 50–51, 65–77; III: 33–35, 38–43, 44–47, 48, 50, 71–105 earlier reports summary, II: 37–42; III: 36 evaluation issues, III: 108–110 human health relevance, III: 35–36; IV: 43 literature update, II: 43–45; III: 36–43 mechanisms of toxic action, II: 36, 47–48, 50, 54–65; III: 33, 38, 44, 47–48, 49–50, 53–71; IV: 24 picloram profile update, II: 51; III: 50 studies evaluation, III: 128–129 summary, II: 35–37; III: 3–5, 32–36; IV: 24–25 TCDD profile update, II: 51–77; III: 50–108 toxicity profiles update, II: 45–77; III: 45–108 2,4,5-T profile update, II: 49–50; III: 47–48 TPA. See 12-O-Tetradecanoylphorbol-13-acetate Trail-Making Test, II: 308 Transforming growth factor, I: 145; II: 59, 74 2,4,5-Trichlorophenol (TCP), I: 28; II: 319; III: 152, 153, 219, 220, 223, 515; IV: 16, 134, 136, 138, 186, 251, 268, 292, 500 2,4,5-Trichlorophenoxyacetic acid (2,4,5-T); II: 4, 18; III: 5, 19, 218, 219, 220, 223, 224, 226, 234; IV: 2, 22, 110, 251, 268, 292, 474, 478, 479 acute toxicity, I: 184 Agent Orange and, I: 27; II: 26 animal studies, I: 181–185; II: 49–50; III: 47–48, 396, 462; IV: 34, 426, 434–435, 458, 459, 512, 517 birth defects and, II: 287; III: 462; IV: 404, 405n calcium homeostasis and, II: 4 carcinogenicity, I: 37, 118, 119, 182–184; II: 40; III: 396; IV: 387 chemical properties, I: 114, 182; II: 38; III: 32 chemical structure, I: 111, 114 chloracne and, I: 36; IV: 135, 500 chronic exposure, I: 184 circulatory disorders and, I: 700–701 development of, I: 24, 26, 35, 181; III: 135, 136, 137, 138, 140 developmental toxicity, I: 185; II: 42, 49–50 disease outcomes, III: 48 domestic use, I: 181 environmental exposure events, I: 42–43 genotoxicity, I: 119, 184 half-life of, II: 4 infertility and, II: 280–282 liver toxicity, I: 125; II: 42; III: 524 mechanisms of action, III: 33, 38, 47–48 mechanisms of toxicity, II: 49–50 metabolism, I: 115, 116 military applications, I: 26, 88; II: 26

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Veterans and Agent Orange: Update 2000 myelotoxicity, IV: 5, 31 neurobehavioral toxicity, III: 475 pharmacokinetics, I: 182 porphyria cutanea tarda and, II: 322 reproductive toxicity, I: 185; II: 42; III: 462; IV: 407, 413, 416, 426, 431, 434–435 respiratory disorders and, I: 709 suspension of use, I: 1, 39, 42–43, 92, 181–182 TCDD contamination of, I: 2, 3, 27, 91, 114, 126, 182; III: 140 teratogenicity, I: 30, 92, 373–374 toxicity profile update summary, II: 49; IV: 22–24, 28–29, 31, 37–41 toxicokinetics, II: 49; III: 47 volume used in Operation Ranch Hand, data, III: 136 See also Herbicides; 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) Triglyceride levels, I: 688–689; III: 520–521 Trinoxol, I: 91; III: 137; IV: 119 Tuberculosis, I: 711 See also Respiratory disorders Tumor necrosis factor (TNF), I: 148; II: 59, 60; III: 87, 88 Twin studies, I: 398–399, 406, 703, 711 U UDP glucuronyl transferase (UGT1), II: 74; III: 37, 52 Uerdingen, Germany, III: 154; IV: 124 UGT1. See UDP glucuronyl transferase Ulcers, gastrointestinal, I: 690–692 epidemiologic studies, II: 334; III: 510–513; IV: 500–504 epidemiology, II: 334; III: 508–509; IV: 498–499 herbicide exposure association with, II: 334; III: 510–514; IV: 505 herbicide occupational exposure and, III: 510–512; IV: 500–501 scientific literature update, II: 334; III: 510–513; IV: 500–504 Vietnam veterans and, III: 512–513; IV: 502–505 See also Metabolic and digestive disorders Umea, Sweden, III: 228, 229 Uniroyal Inc., I: 35 United Kingdom, I: 315–316, 340, 382, 444, 462–463, 464, 477, 479, 537, 565, 595, 689; II: 194, 196, 269; III: 223, 224, 420 England National Cancer Register, III: 232; IV: 144 herbicide exposure assessment, III: 151; IV: 139 Parkinson’s Disease Society Brain Bank, IV: 445 See also Yorkshire, England United Nations, I: 45 United Paperworkers International Union, III: 232 Update 1996. See Veterans and Agent Orange: Update 1996 (Update 1996) Uppsala, Sweden, III: 228 Urinary bladder cancer. See Bladder cancer Uroporphyrinogen decarboxylase (UROD), II: 321; III: 480, 481 U.S. Air Force, I: 81, 113; III: 29, 138, 218, 237, 239, 339, 513, 517 Armstrong Laboratory, Population Research Branch, III: 29 Baseline Morbidity Report, II: 32 Baseline Mortality Report, 1982, II: 31 Follow-Up Examination Results, 1985, 1987, 1992, II: 32 Human Resources Laboratory records, II: 150, 152; III: 237 Military Personnel Center records, II: 151; III: 238; IV: 151 Mortality Updates, 1984, 1985, 1986, 1989, 1991, II: 32 Reproductive Outcomes, II: 32 Serum Dioxin Level Follow-Up Examination Results, II: 32 TCDD half-life investigations, II: 104–105 Vietnam casualties, I: 83 women veterans mortality studies, II: 152–153 See also Air Force Health Study (AFHS); Operation Ranch Hand U.S. Army, I: 81, 280, 281, 702; II: 140, 185; IV: 121–22, 126 Army Chemical Corps Vietnam Veterans Health Study proposal, II: 24 Army I Corps, IV: 157 Environmental Support Group (ESG), II: 152 Vietnam casualties, I: 83

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Veterans and Agent Orange: Update 2000 Vietnam veteran studies, II: 201, 226, 244; III: 240, 241, 283, 294, 298, 313, 315, 318, 338, 339, 344, 346, 348, 365, 373, 380, 485, 512, 517; IV: 21 women veterans mortality studies, II: 152–153, 201 See also U.S. Army Chemical Corps; U.S. Special Forces U.S. Army Chemical Corps, I: 13, 15, 16–17, 94–95, 272, 273, 286, 394, 470, 571, 703–704, 705, 711, 722–725; II: 5, 23, 24, 101, 103, 104, 201–202, 245; III: 6, 23, 138–139, 146–147, 241, 272, 298, 309, 314, 344, 358–359, 385, 389, 485, 512, 517; IV: 120–124, 157, 287 U.S. Coast Guard, I: 81 U.S. Congress, I: 2, 31, 46–52; III: 25–28, 237, 240 See also Congressional hearings; Legislation USDA. See Department of Agriculture, U.S. U.S. Marine Corps, I: 81, 96, 280, 545, 702, 710; II: 185, 201, 226, 244; III: 140; IV: 121 non-Hodgkin’s lymphoma in, I: 542, 545, 546–547 Vietnam casualties, I: 83 Vietnam veterans studies, III: 241, 242, 283, 294, 298, 309, 313, 315, 338, 339, 346, 348, 365, 373, 380, 485, 489, 512, 517; IV: 287, 298, 339 women veterans mortality studies, II: 152–153 U.S. Military Assistance Command, III: 138; IV: 119 U.S. Navy, I: 81, 280–281, 286; II: 185, 228; III: 339, 344 herbicide use in, I: 95; II: 104; III: 135, 139, 140 non-Hodgkin’s lymphoma odds ratio in, I: 542 Vietnam casualties, I: 83 women veterans mortality studies, II: 152–153 U.S. Special Forces, I: 286; II: 103–104; III: 138 USSR, I: 317; III: 224 See also Russia Utah, I: 560; II: 241 Uterine cancer, I: 506; III: 329, 333 herbicide association evidence, I: 13; II: 6, 211, 213; III: 333; IV: 323–324 See also Reproductive system cancers, women V VAO. See Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Verona, Missouri, II: 128–129; III: 219, 220; IV: 135, 148 Very low density lipoprotein (VLDL) receptors, II: 333; III: 503 VES. See Vietnam Experience Study Veterans. See Foreign veterans; Vietnam veterans; Women veterans Veterans Administration. See Department of Veterans Affairs (DVA) Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (VAO), II: 1, 2, 5, 8, 10, 11, 12, 35, 45, 63, 65, 71, 89, 90, 91, 96, 97, 99, 101, 102, 104, 107, 112, 132, 176, 179, 180, 181, 187, 190, 196, 207, 209, 210, 214, 218, 225, 228, 232, 236, 237, 246, 247, 249, 250, 266, 271, 278, 279, 286, 293, 296, 300, 305, 312, 323, 328, 357; III: 1, 2, 3, 5, 12, 32, 43, 85, 124, 125, 126, 132, 150, 157, 169, 220, 221, 223, 286, 303, 311, 320, 359, 389, 390, 416, 434, 435, 519, 522; IV: 5, 156–159 background, II: 17–19; III: 17–23; IV: 15, 103–104, 110, 132, 137, 249, 268, 351 basal/squamous cell skin cancer studies summary, III: 317–318, 321, 323; IV: 308, 312–313 birth defects studies summary, III: 436–439; IV: 400–401, 404, 435 bladder cancer studies summary, II: 225–226; III: 347–348, 350–351; IV: 340, 343–345 bone cancer studies summary, II: 204; III: 302, 305; IV: 288, 290–291 brain tumor studies summary, II: 229; III: 356–357, 360, 361; IV: 351, 353–355 breast cancer studies summary, III: 324–326, 328; IV: 314–315, 319–320 childhood cancer studies summary, II: 299; IV: 418, 429 chloracne studies summary, II: 318; III: 479–480; IV: 465 chronic persistent peripheral neuropathy studies summary, II: 310; IV: 454 circulatory disorders studies summary, II: 335–336; III: 514; IV: 506

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Veterans and Agent Orange: Update 2000 cognitive and neuropsychiatric disorders studies summary, II: 307; III: 468–469; IV: 441–442 congressional hearings on Agent Orange, II: 27–28; III: 25 Department of Veterans Affairs Task Force, II: 4–26; III: 24–25 diabetes mellitus studies summary, II: 330; III: 496–497; IV: 482, 487, 488, 490, 492 federal government response to concerns over military use of herbicides in Vietnam, II : 27–32; III: 25–30 female reproductive cancers studies summary, II: 211–212; III: 330–331, 332, 333; IV: 321, 324–325 gastrointestinal tract tumors studies summary, II: 177–178; III: 268, 274–281; IV: 251, 256 gastrointestinal ulcers studies summary, II: 334; III: 510; IV: 500 health outcomes conclusions, II: 19–23; III: 19–20; IV: 11, 18–19, 20, 21, 384, 385, 414, 465, 467, 471, 513, 514 hepatobiliary cancers studies summary, III: 282–283, 287–288; IV: 268, 269 herbicide environmental exposure studies, II: 142–143, 144, 145–146; III: 197–202, 203–205, 275, 277, 279, 281, 283, 288, 291, 301, 316, 323, 328, 336, 342, 345, 350–351, 354, 369, 382, 392, 437, 454, 455, 456, 459, 479, 520; IV: 147–149, 261, 264, 266–267, 271–272, 276, 286, 291 herbicide occupational exposure studies, II: 114, 115–116, 117–118, 119–120, 121–126 ; III: 170–174, 176–178, 180–182, 183–185, 188–196, 274–275, 276–277, 278–279, 280, 282–283, 286, 291, 294, 300–301, 305, 310, 312, 316, 317, 321, 323, 324–326, 328, 332, 333, 335–336, 345, 350, 354, 360, 367–369, 374–376, 381–382, 391–392, 454, 455, 456, 459, 496, 520; IV: 137, 139, 140–142, 144–146, 257–261, 263, 265–266, 271, 276, 280, 285, 290 Hodgkin’s disease studies summary, II: 235; III: 372, 374–375, 376; IV: 365, 368 immune system disorders, studies summary, II: 327; III: 488–489; IV: 477 impact of report, II: 24–26; III: 23–25 infertility studies summary, II: 280; III: 445–446, 450; IV: 406, 409 laryngeal cancer studies summary, III: 293, 294; IV: 277, 280 legislation on Agent Orange, II: 28–29; III: 26–27 leukemia studies summary, II: 245; III: 385–386, 391–392; IV: 378–379, 381, 383 lipid abnormalities studies summary, II: 333; III: 504, 520, 521; IV: 483 liver toxicity studies summary, II: 332; III: 510; IV: 500 low birthweight studies summary, III: 456–457, 459; IV: 399, 400, 412 lung cancer studies summary, III: 296, 300–301; IV: 281, 285–286 melanoma studies summary, III: 313–314, 316, 317; IV: 302, 306 metabolic and digestive disorders, studies summary, II: 330, 332, 333, 334; IV: 500 motor/coordination dysfunction studies summary, II: 309; III: 469–470; IV: 443–444 multiple myeloma studies summary, III: 377–378, 381–382; IV: 372, 375–376 nasal/nasopharyngeal cancer studies summary, III: 290, 291;274; IV: 274 non-Hodgkin’s lymphoma studies summary, II: 231–232; III: 362–363, 367–369, 370–371; IV: 356, 360–363 perinatal death studies summary, II: 285; III: 451, 454, 455, 456; IV: 412 peripheral neuropathy studies summary, III: 470–471, 473; IV: 454 porphyria cutanea tarda studies summary, II: 321–322; III: 481–482; IV: 467 prostate cancer studies summary, III: 335–336, 341, 342; IV: 327, 333–335 renal cancer studies summary, II: 224; III: 352–353, 354, 355; IV: 346, 349–350 research recommendations, II: 23–24; III: 23; IV: 21 respiratory disorders studies summary, II: 324–325; III: 483; IV: 471 sex ratios of offspring, IV: 429–430 skin cancer studies summary, III: 312; IV: 299–314 soft-tissue sarcomas studies summary, II: 205–206; III: 306–308; IV: 292, 297–299

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Veterans and Agent Orange: Update 2000 spontaneous abortion studies summary, II: 283; IV: 410 summary of, II: 37–42 testicular cancer studies summary, III: 343–344, 345–346; IV: 336, 338–339 toxicology, overview, III: 36; IV: 22, 38, 41 Veterans and Agent Orange: Herbicides/ Dioxin Exposure and Type 2 Diabetes (Type 2 Diabetes), IV: 1, 10–11, 16, 104 Veterans and Agent Orange: Update 1996 (Update 1996); III: 1, 2, 3, 6, 8, 10, 32, 37, 43, 44, 50, 85, 106, 109, 125, 126, 132, 150, 157, 159, 169, 220, 221, 222, 223, 266, 286, 295, 298, 303, 309, 311, 319, 320, 339, 349, 359, 389, 390, 416, 417–418, 424, 426, 428, 434, 435, 444, 458, 519, 522, 533; IV: 1 background, III: 17–23; IV: 15–21, 110, 132, 137, 247, 251 basal/squamous cell skin cancer studies summary, III: 317–318, 321, 323; IV: 308–314 birth defects studies summary, III: 436–439; IV: 400–401, 435 bladder cancer studies summary, III: 347–348, 350; IV: 330–345 bone cancer studies summary, III: 302, 305; IV: 287–291 brain tumor studies summary, III: 356–357, 360, 361; IV: 350–355 breast cancer studies summary, III: 324–326, 327, 328; IV: 314–320 childhood cancers, IV: 418 chloracne studies summary, III: 479–480; IV: 465 circulatory disorders studies summary, III: 514; IV: 506 cognitive/neuropsychiatric disorders studies summary, III: 468–469; IV: 441–442 congressional hearings on Agent Orange, III: 25 Department of Veterans Affairs Task Force, III: 24–25 diabetes mellitus studies summary, III: 496; IV: 482–483, 490 federal government response to concerns over military use of herbicides in Vietnam, III: 25–30 female reproductive system cancers studies summary, III: 330–331, 332, 333; IV: 321–326 gastrointestinal tract tumors studies summary, III: 268, 274–281; IV: 257–264 gastrointestinal ulcers studies summary, III: 510; IV: 500 health outcomes conclusions, III: 19–20 hepatobiliary cancers studies summary, III: 282–283, 287–288; IV: 267–272 herbicide environmental exposure studies, III: 197, 201, 203, 275, 277, 279, 283, 288, 323, 328, 336, 342, 345, 354, 369, 375, 382, 392; IV: 147, 149 herbicide occupational exposure studies, III: 170, 172, 174, 175–176, 179, 183, 186–187, 274, 276, 278, 280, 282–283, 286, 291, 294, 300, 305, 316, 317, 321, 324–326, 328, 332, 333, 335–336, 345, 350, 354, 360, 367, 374, 381, 391, 496; IV: 135–137, 140–142, 144 Hodgkin’s disease studies summary, III: 373, 374, 375, 376; IV: 364–371 impact of report, III: 23–25 infertility studies summary, III: 445–446; IV: 406–408 laryngeal cancer studies summary, III: 293, 294; IV: 277–281 legislation on Agent Orange, III: 26–27 leukemia studies summary, III: 385–386, 391, 392; IV: 377–383 lipid abnormalities studies summary, III: 504; IV: 493 liver disorders studies summary, III: 510; IV: 500 low birthweight studies summary, III: 456–457; IV: 412 lung cancer studies summary, III: 296, 298, 300; IV: 281–287 melanoma studies summary, III: 313–314, 316, 317; IV: 302–308 motor/coordination dysfunction studies summary, III: 469–470; IV: 444 multiple myeloma studies summary, III: 377–378, 381, 382; IV: 371–377 nasal/nasopharyngeal cancer studies summary, III: 290, 291; IV: 273–276 non-Hodgkin’s lymphoma studies summary, III: 362–363, 367, 369, 370; IV: 355–364 pancreatic cancer, IV: 264–267 perinatal death studies summary, III: 451; IV: 412

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Veterans and Agent Orange: Update 2000 peripheral neuropathy studies summary, III: 470–471, 473; IV: 18 porphyria cutanea tarda studies summary, III: 481–482; IV: 467 prostate cancer studies summary, III: 335–336, 341, 342; IV: 326–335 renal cancers studies summary, III: 352–353, 354, 355; IV: 345–350 research recommendations, III: 23 respiratory disorders studies summary, III: 483; IV: 471–472 sex ratios of offspring, IV: 429–430 skin cancer, IV: 299–301 soft-tissue sarcoma studies summary, III: 306–308; IV: 291–299 testicular cancer studies summary, III: 343–344, 345; IV: 335–339 toxicology, overview, III: 36; IV: 22 Veterans and Agent Orange: Update 1998 (Update 1998) Australian Veterans, IV: 159 background of, IV: 1, 3, 8–10, 110, 132, 247, 251, 399–400 basal/squamous cell skin cancer studies summary, IV: 308–314 birth defects studies summary, IV: 400–401, 435 bladder cancer studies summary, IV: 330– 345 bone cancer studies summary, IV: 287–291 brain tumor studies summary, IV: 350–355 breast cancer studies summary, IV: 314–320 childhood cancers, IV: 418, 426 hepatobiliary cancers studies summary, IV: 267–272 Hodgkin’s disease studies summary, IV: 364–371 infertility studies summary, IV: 406–408 mortality in, IV: 254 Department of Veterans Affairs and, IV: 157–158 environmental exposure, IV: 148–149 epidemiology, IV: 257 female reproductive system cancers studies summary, IV: 321–326 gastrointestinal tract tumors studies summary, IV: 257–264 laryngeal cancer studies summary, IV: 277–281 leukemia studies summary, IV: 377–383 low birthweight studies summary, IV: 412 lung cancer studies summary, IV: 281–287 melanoma studies summary, IV: 302–308 multiple myeloma studies summary, IV: 371–377 nasal/nasopharyngeal cancer studies summary, IV: 273–276 non-Hodgkin’s lymphoma studies summary, IV: 355–364 occupational exposure, IV: 135–137, 139–142, 144 Operation Ranch Hand, IV: 150, 152 pancreatic cancer, IV: 264–267 prostate cancer studies summary, IV: 326–335 renal cancers studies summary, IV: 345–350 sex ratios of offspring, IV: 429–430 skin cancer; IV: 299–301 soft-tissue sarcoma studies summary, IV: 291–299 spontaneous abortion, IV: 408–412 testicular cancer studies summary, IV: 335–339 toxicology overview, IV: 22 Veterans’ benefits. See Compensation, veterans Veterans’ compensation. See Compensation, veterans Veterans’ Dioxin and Radiation Exposure Compensation Standards Act of 1984. See Public Law 98–542 Veterans’ Health Care Eligibility Reform Act of 1996. See Public Law 104–262 Veterans’ Health Care, Training, and Small Business Loan Act of 1981. See Public Law 97–72 Veterans’ Health Programs Extension and Improvement Act of 1979, III: 240 Vietnam, III: 533 herbicide latency issues, methodology, II: 13; III: 12–14 herbicide targeting in, I: 99–106; IV: 116–117 herbicide use in, concerns about, I: 29–32, 45; II: 1, 2, 4, 11, 17, 18, 26; III: 1, 2, 5, 12, 13, 17, 18, 25 research in, I: 30–31 troop movements in, I: 52–53, 96, 287 U.S. casualties in, I: 82–83 U.S. involvement, I: 75–76, 84 U.S. military herbicide use in, I: 1, 3, 24, 27, 84–85, 89–93, 94–96, 98–107, 286; II: 17, 18, 26, 27–32; III: 135–142

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Veterans and Agent Orange: Update 2000 See also Ca Mau peninsula; Con Thieu province, Vietnam; Hanoi, Vietnam; Ho CM Minh City, Vietnam; Khe Sanh-Thonh Son Lam area; Mekong Delta; Rung Sat Special Zone; Vietnamese Vietnam Experience Study (VES), III: 26, 240, 512 birth defects in offspring, II: 288, 289, 290; III: 436, 438, 439, 445 cancer mortality in, I: 444–445 childhood cancer in, I: 629; II: 300 chloracne in, I: 677 circulatory disorders in, I: 702 exposure assessment use, II: 101; III: 146 hepatobiliary cancers, II: 185; III: 283 Hodgkin’s disease in, I: 556 immune system disorders in, I: 696 infertility in, II: 280 liver cancer in, I: 455 low birthweight outcomes in, I: 626 lung cancer in, I: 469 methodology, I: 57–58, 281, 284, 389–391 multiple myeloma, II: 244 neonatal death in, I: 622 neurologic/neuropsychiatric outcomes in, I: 656 non-Hodgkin’s lymphoma in, I: 542–543 origins, I: 50 reproductive outcomes in, I: 601, 609, 610–611, 626, 632 respiratory cancer in, II: 201 respiratory disorders in, I: 710–711 spina bifida in offspring, II: 9; IV: 8 Vietnam herbicides use by military, II: 26–27 Vietnam Veteran Agent Orange Health Study, I: 741 Vietnam veterans, I: 1; II: 2 acute and subacute transient peripheral neuropathy, II: 313; III: 473; IV: 6, 459 advocacy groups, I: 60–61 Air Force research activities, II: 31–32; III: 28–29; IV: 13, 42–43, 150–156, 160–161 altered sperm parameters in, I: 632, 634; III: 445, 446, 450; IV: 7 amyloidosis, IV: 7 Australian, I: 61, 91, 406, 418, 444, 470, 496–497, 546, 614–615, 633, 702, 710; II: 113, 149, 160, 202, 293; III: 9, 216–217, 218, 237, 244–245, 273, 285–286, 290, 294, 295, 298, 299, 303, 310, 311, 314, 315, 327, 329, 339, 340, 343, 346, 349, 353, 355, 359, 365, 380, 389, 413, 424, 425, 469, 486, 489, 500, 506, 512–513, 517; IV: 9, 10, 159–160, 322–333, 402, 421–422 autoimmune disease in, I: 698, 699 basal/squamous cell skin cancer in, III: 323; IV: 309–310 birth defects in children of, I: 609–615, 618; II: 288–296, 298, 300; III: 435, 436, 437–438; IV: 7, 402 bladder cancer in, I: 517; II: 223–224; III: 349, 351; IV: 7, 342 bone cancer in, I: 473, 474–475; II: 204; III: 303, 305; IV: 7, 289 brain tumors in, I: 522, 523, 525; III: 358–359, 361; IV: 7, 352 breast cancer in, II: 213, 217, 218; III: 326, 328, 329; IV: 7, 316 cancer expected incidence, I: 439–440, 442, 446, 452, 461, 501, 505, 513, 522, 526, 564; II: 176–177; III: 266–267, 430–431; IV: 249–250 cancer in children of, I: 629, 630–631; II: 299; IV: 7, 420–422 cancer mortality, I: 444–445 cancer studies, I: 391–393, 401, 402–403, 405, 436–438; II: 176–177; III: 266–267, 430–431 chloracne in, I: 677–679; II: 317, 318, 321; III: 479–480; IV: 6, 135, 485 chronic persistent peripheral neuropathy in, II: 311; IV: 7, 456 circulatory disorders in, I: 702–705; II: 336; III: 516–518; IV: 7, 508–509 class action suit, I: 34–35 cognitive/neuropsychiatric disorders in, II: 318; III: 469; IV: 7, 443 compensation for, I: 34–35, 47, 50–51, 55–56; II: 28–29, 30–31; III: 26–27, 28 congressional responses to concerns of, I: 46–52; II: 27–29; III: 25–28 defining, I: 78 demographics, I: 79, 80–84 developmental toxicity, II: 72 diabetes mellitus in, I: 684, 685, 698; II: 330; III: 495, 497, 498, 500, 502; IV: 6, 485–487 disabilities discharges, I: 32 disease increased risk for, I: 14–15, 221, 225–226, 247–248, 578; II: 14, 22–23, 88, 89, 91, 218, 223, 251, 276, 298, 300–301, 314, 321, 323; III: 14–15, 22–

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Veterans and Agent Orange: Update 2000 23, 124, 127–128, 329, 334, 343, 397, 430–431, 444, 462, 475–476, 491, 503, 507–508, 525; IV: 12, 256, 270, 275, 279, 284, 290, 296, 305–306, 311, 318, 323–324, 332, 338, 343, 348, 353, 359, 367, 374, 381, 403, 407, 411–412, 413, 417, 426, 466, 468, 475, 489, 495, 505, 510, 513 distribution by branch of service, I: 81 Environmental Protection Agency research activities, II: 32; III: 29–30 epidemiologic studies, I: 50, 57–59, 62–63, 384–418; II: 3, 6–7, 28, 113, 149–161; III: 26, 206–217, 236–245, 272–273, 275, 277–278, 279, 281, 283, 285–286, 288, 290, 291, 294–295, 298, 301, 303, 305, 309–310, 312, 316, 317, 323, 326, 328, 333, 336, 338, 339, 340, 342, 343–344, 345–346, 349, 351, 353, 355, 358–359, 361, 363, 365, 370–371, 372, 373, 376, 380, 382, 385, 386, 389, 392, 435, 436, 437–438, 445, 446, 450, 454, 455, 456, 457, 459, 467, 468, 469, 470, 473, 479, 480, 481, 482, 485–486, 489, 491, 495, 497, 498, 500, 502, 505–506, 512–513, 516–518, 521; IV: 150–160, 255, 269, 275, 278, 283, 294–295, 303–304, 309–310, 316, 322–323, 329, 336–337, 342, 347, 357–358, 366–367, 373, 380, 402, 411, 420–422, 474, 485–487, 494, 502–504, 508–509 federal government activities/research on military use of herbicides, II: 27–32; III: 25–30 female reproductive system cancers in, I: 505, 511–512, 577; II: 211, 212; III: 333; IV: 7, 322–323 gastrointestinal tract cancers in, I: 446; II: 177, 180–181; IV: 7, 255 gastrointestinal ulcers in, I: 691, 692; III: 512–513; IV: 502–504 genitourinary tract cancers in, I: 513, 518, 522; II: 223–224; III: 272–273, 275, 277–278, 279, 281; IV: 7, 342 health care of, II: 28, 29; III: 26, 27 health concerns of, I: 1, 32–34, 46–47; II: 17–24, 26–27; III: 17–30 hepatic enzyme disorders in, I: 687 hepatobiliary cancers in, I: 455, 457; II: 181, 185, 187; III: 283, 285–286, 288; IV: 7, 269 herbicide exposure assessment issues, II: 4–5, 14, 17–24, 26–27; III: 2, 5–6, 142, 143, 146–150; IV: 122–127 herbicide exposure assessment strategies for, I: 270–284; II: 99–109; III: 144–145 Hodgkin’s disease in, I: 526, 554–556, 557; II: 235, 236; III: 372, 373, 376; IV: 6, 366–367 immune modulation in, I: 695–696, 699; III: 489, 491 infertility, I: 632, 633, 634; II: 280; III: 445, 446, 450; IV: 7 International Agency for Research on Cancer research activities, III: 30 laryngeal cancer in, III: 294–295; IV: 6, 9, 278 latency relevance for assessing herbicides effect on cancer risk in, II: 276; III: 12–13, 430–431 legislation concerning herbicide exposure and health of, II: 28–29; III: 26–27 leukemia in, I: 13, 564, 570, 571–572; II: 245, 246; III: 385, 386, 389, 392; IV: 7, 380 lipid abnormalities in, I: 689, 692; II: 333; III: 505–506, 521; IV: 7, 494 liver toxicity in, II: 332; III: 512–513; IV: 502–504 low birthweight outcomes for, I: 626, 628; III: 457, 459; IV: 7 lung cancer in, III: 298, 301; IV: 6, 283 melanoma in, III: 316, 317; IV: 303–304 military experiences, I: 75, 82, 272, 286, 399 motor/coordination dysfunction in, I: 659–660, 662; II: 309, 310; III: 469, 470; IV: 7,448 multiple myeloma in, I: 526, 562, 563; II: 244; III: 380, 382; IV: 6, 10, 373 nasal/nasopharyngeal cancer in, I: 459, 460; II: 189; III: 290, 291; IV: 7, 275 National Personnel Records Center listing, I: 17 neural tube defects in offspring, numbers, II: 297; IV: 7, 18, 404–405 neurobehavioral disorders in, II: 305, 308, 309, 310, 311, 313, 314; III: 467, 468; IV: 457–459 neuropsychiatric outcomes, I: 653–656, 658; II: 308; III: 469; IV: 443 non-Hodgkin’s lymphoma in, I: 526, 541–

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Veterans and Agent Orange: Update 2000 548, 549; II: 234; III: 363, 365, 370–371; IV: 6, 357–358 number of, I: 3, 4, 74, 75–80 outreach activities; II: 31; III: 28 Parkinson’s disease in, II: 309–310 perinatal deaths in offspring, II: 285; III: 454, 455, 456; IV: 7 peripheral nervous system disorders in, I: 665, 666; II: 311, 313; III: 473, 475; IV: 6, 7, 456 porphyria cutanea tarda in, I: 681, 682–683; II: 321–322, 323; III: 481, 482; IV: 6, 8 prostate cancer in, I: 513, 518, 519, 522; II: 9, 217–218, 221, 223; III: 336, 338, 339, 340, 342; IV: 6, 8, 10, 329 records-based exposure assessment, I: 271–280; IV: 121–126 records identification, II: 24–25 renal cancers in, III: 352, 353, 355; IV: 7, 347 reproductive outcomes, I: 405–406, 418, 601–603, 609–615, 618, 620–622, 625; II: 71, 278, 300–301; III: 435, 436, 437–438, 445, 446, 450, 454, 455, 456, 457, 459; IV: 7, 402 research recommendations, II: 23–25; III: 23 respiratory cancers in, I: 469–470, 472; II: 190, 201–202, 203; IV: 6, 283 respiratory disorders in, I: 710–712, 713–714; III: 485–486; IV: 7, 474 risk assessment for, I: 14–15, 221, 225–226, 247–248, 578; II: 14, 22–23, 89, 91, 251, 276, 298, 300–301, 314, 321, 323, 349–357; III: 14–15, 22–23, 124, 127–128, 430–431; IV: 20, 105–108 serum testing, I: 20–21 skin cancer in, I: 501, 505; II: 209; III: 312; IV: 7, 301 soft-tissue sarcoma in, I: 475, 492–498, 500; II: 205, 208; III: 309–310; IV: 6, 294–295 South Korea, I: 61–62 spina bifida in offspring, II: 9–10, 296, 298, 301; III: 7, 8, 9–10, 21, 24–25, 437–438; IV: 7, 10, 18, 402 spontaneous abortions in, I: 601–603, 605; II: 283; IV: 7, 411 state-sponsored studies of, II: 152–153, 158–159, 161, 202, 292; III: 213–215, 243–244; IV: 158–159 suicide incidence, I: 655–656 testicular cancer in, II: 153; III: 343–344, 345–346; IV: 7, 336–337 twin studies, I: 398–399, 406, 703, 711 Vietnamese veterans, Vietnamese studies of, III: 245 women, I: 50, 83–84; II: 152–153, 180, 181, 190, 201, 204, 205, 209, 211, 212, 213, 216–217, 218, 223, 226, 228, 229, 231, 245, 278, 280; III: 326–329, 333, 434–435; IV: 316 See also Air Force Health Study (AFHS); Compensation, veterans; Demographic data, Vietnam veterans; Operation Ranch Hand; Risk assessment, Vietnam veterans Vietnam veterans’ exposure studies, II: 154, 156–157, 158–159; III: 206–209, 210–217 , 275, 278, 279, 281, 283, 288, 291, 305, 310, 312, 316, 317, 323, 326, 328, 336, 342, 345–346, 351, 355, 370–371, 376, 382, 437–438, 450, 454, 455, 456, 459, 497, 521; IV: 150, 156–158, 262, 264, 272–273, 276–277 Vietnam veterans’ increased disease risk, II: 22–23; III: 22–23 Vietnam Veterans of America, I: 60 Vietnamese birth defects and herbicide exposure, II: 287–288 cancer in, II: 148; III: 283 epidemiologic studies, I: 599–601; II: 113, 144–145, 148, 184, 287–288; III: 202, 234, 283 herbicide environmental exposure, II: 144–145, 148, 287–288; III: 283 herbicide exposure assessment, I: 269, 370–372; II: 4–5, 108–109; III: 156–157; IV: 116–117 herbicide exposure indices development, II: 107–108 reproductive outcomes, I: 599–601, 608–609; IV: 148–149 research recommendations, I: 731 scientists in, studies of Vietnamese veterans, III: 245 Vietnamese Veterans, IV: 160 Viral infection immune system response, I: 692–693 TCDD-enhanced susceptibility, I: 149 teratogenic potential, I: 607 See also Immune system disorders

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Veterans and Agent Orange: Update 2000 Vitamin A, I: 174 VLDL. See Very low density lipoprotein (VLDL) receptors W Wales. See United Kingdom War Research Service, I: 25 Washington, D.C., II: 343; III: 533 Washington state, I: 336–338, 341, 487–488, 535; II: 149, 241; III: 229, 230, 232, 234; IV: 149, 215 Wasting syndrome, TCDD-induced, I: 162–166; II: 76–77; III: 80–83; IV: 25, 31, 57, 76 Wechsler Adult Intelligence Scales, I: 641 Western Europe, II: 268; III: 510 West Germany, II: 328–329; III: 223, 337, 379, 387, 483, 506, 511, 515 West Virginia, I: 60, 404, 470, 496, 546, 621, 662–663, 686, 689, 700; II: 202; III: 243; IV: 364, 371 See also Nitro, West Virginia Wilm’s tumor, I: 594 See also Children, cancer in; Kidney cancer Wisconsin, I: 37, 60, 336, 404–405, 445, 455, 470, 496, 517, 523, 534, 546, 556, 560, 702, 710; II: 185, 202, 226, 229, 239, 241; III: 229, 243, 283, 313, 348; IV: 259, 262, 264, 267, 272, 291, 299, 301, 335, 339, 345, 350, 355, 361, 363–364, 371, 375 Women. See Breast cancer; Cervical cancer; Demographic data, Vietnam veterans; Gender; Ovarian cancer; Reproductive system cancers, women; Reproductive system disorders; Uterine cancer; Women veterans Women veterans, I: 79; II: 30 breast cancer estimated risk, II: 218; III: 329; IV: 318 breast cancer expected incidence, I: 440, 461, 501, 505, 513, 522, 526, 564; II: 213; IV: 314 breast cancer in, II: 213, 216–217; III: 322, 324–328, 329; IV: 314–320 circulatory disease in, I: 702 epidemiologic studies, I: 50, 81; II: 28, 152–153, 180, 181, 190, 201, 204, 205, 209, 211, 212, 213–217, 218, 219–223, 226, 228, 229, 231, 245, 278, 280; III: 324–328, 333; IV: 314–320 mortality studies, I: 394–395, 470, 545; II: 152–153, 180, 201 reproductive outcomes, III: 434–435; IV: 399–400 reproductive system cancers in, II: 211, 212; III: 333; IV: 320–326 research recommendations, I: 728 statistics, I: 83–84 See also Reproductive system cancers, women Women Veterans Health Programs Act of 1992. See Public Law 102–585 World Health Organization, II: 282; III: 30, 454, 492; IV: 413, 415 Mortality Data Bank, I: 314; II: 132; III: 223, 378, 484–485, 512, 516 World War II; I: 25, 32, 82; II: 150, 268; III: 237, 420 X Xenobiotic responsive elements (XREs), II: 56, 57, 58, 71; III: 66, 67, 104 Y Yorkshire, England, III: 234; IV: 149

Representative terms from entire chapter:

epidemiologic studies