6

Cancer

Cancer is the second leading cause of death in the United States. Among men aged 45–64, the group that includes most Vietnam veterans, the risk of dying from cancer nearly equals the risk of dying from heart disease, the overall leading cause of death in the United States (US Census, 1999). In 2002, about 555,500 Americans are expected to die from cancer—more than 1,500 people per day. In the United States, one of every four deaths is from cancer (ACS, 2002).

In this chapter, the committee summarizes and reaches conclusions about the strength of the evidence from epidemiologic studies regarding associations between exposure to herbicides and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and each type of cancer under consideration in this report. The cancer types are, with minor exceptions, discussed in the order in which they are listed in the International Classification of Diseases, Ninth Edition (ICD-9). ICD-9 is a standardized means of classifying medical conditions used by physicians and researchers around the world. Appendix B lists ICD-9 codes for the major forms of cancer. The categories of association and the committee's approach to categorizing the health outcomes are discussed in Chapters 1 and 2.

In assessing a possible relation between herbicide exposure and risk of cancer, one key issue is the magnitude of exposure of those included in a study. As noted in Chapter 5, the detail and accuracy of exposure assessment vary widely among the studies reviewed by the committee. A small number of studies use a biomarker of exposure, for example, the presence of TCDD in serum or tissues; some develop an index of exposure from employment or activity records; and others use a surrogate measure of exposure, such as being present when herbicides were used. Inaccurate assessment of exposure can obscure the presence or absence of exposure–disease associations and thus make it less likely that a true risk will be identified.



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Veterans and Agent Orange: Update 2002 6 Cancer Cancer is the second leading cause of death in the United States. Among men aged 45–64, the group that includes most Vietnam veterans, the risk of dying from cancer nearly equals the risk of dying from heart disease, the overall leading cause of death in the United States (US Census, 1999). In 2002, about 555,500 Americans are expected to die from cancer—more than 1,500 people per day. In the United States, one of every four deaths is from cancer (ACS, 2002). In this chapter, the committee summarizes and reaches conclusions about the strength of the evidence from epidemiologic studies regarding associations between exposure to herbicides and 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and each type of cancer under consideration in this report. The cancer types are, with minor exceptions, discussed in the order in which they are listed in the International Classification of Diseases, Ninth Edition (ICD-9). ICD-9 is a standardized means of classifying medical conditions used by physicians and researchers around the world. Appendix B lists ICD-9 codes for the major forms of cancer. The categories of association and the committee's approach to categorizing the health outcomes are discussed in Chapters 1 and 2. In assessing a possible relation between herbicide exposure and risk of cancer, one key issue is the magnitude of exposure of those included in a study. As noted in Chapter 5, the detail and accuracy of exposure assessment vary widely among the studies reviewed by the committee. A small number of studies use a biomarker of exposure, for example, the presence of TCDD in serum or tissues; some develop an index of exposure from employment or activity records; and others use a surrogate measure of exposure, such as being present when herbicides were used. Inaccurate assessment of exposure can obscure the presence or absence of exposure–disease associations and thus make it less likely that a true risk will be identified.

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Veterans and Agent Orange: Update 2002 In this chapter, background information about each cancer, including data on its incidence in the general US population, is followed by a brief summary of the findings described in the previous Agent Orange reports (Veterans and Agent Orange, hereafter referred to as VAO, IOM, 1994; Veterans and Agent Orange: Update 1996, hereafter, Update 1996, IOM, 1996; Veterans and Agent Orange: Update 1998, hereafter, Update 1998, IOM, 1999; and Veterans and Agent Orange: Update 2000, hereafter, Update 2000, IOM, 2001), a discussion of the most recent scientific literature, and a synthesis of the material reviewed. Where appropriate, the literature is discussed by exposure type (occupational, environmental, and Vietnam veteran). Each section ends with the committee's conclusion regarding the strength of the evidence from epidemiologic studies, biologic plausibility, and evidence regarding Vietnam veterans. As mentioned above, data on cancer incidence in the general US population are included in the background sections. Those data provide context for the consideration of cancer risks in Vietnam veterans. Incidences are reported for people 45–59 years old because most Vietnam-era veterans are in this age group. The data, which were collected as part of the Surveillance, Epidemiology, and End Results (SEER) Program of the National Center for Health Statistics (NCHS), are categorized by sex, age, and race because these can have a profound effect on risk. Prostatic cancer incidence, for example, is nearly 11 times higher in men 55–59 years old than in men 45–49 years old and more than twice as high in blacks 45–59 years old as in whites in this age group (NCI, 2000). The figures presented for each cancer are estimates for the entire US population, not precise predictions for the Vietnam-veteran cohort. It should be remembered that numerous factors may influence the incidences reported here—including personal behavior (such as smoking and diet), genetic predisposition, and medical history. Those factors may make a particular person more or less likely than the average person to contract a given cancer. Incidence data are reported for all races and also separately for blacks and whites. The data reported are for 1995–1999, the most recent data available at the time this report was written. Great uncertainties remain about the magnitude of potential risk posed by exposure to herbicides and TCDD in the occupational, environmental, and veteran studies reviewed by the committee. Many of those studies have inadequate controls for important confounders, and the information needed to extrapolate from the exposure in the studies to that of individual Vietnam veterans is lacking. The committee therefore cannot measure the risk likely to have been experienced by Vietnam veterans due to exposure to herbicides in Vietnam; it offers qualitative observations where data permit. GASTROINTESTINAL TRACT TUMORS Gastrointestinal tract tumors include some of the most common cancers. The committee reviewed the data on colon cancer (ICD-9 153.0–153.9), rectal cancer

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Veterans and Agent Orange: Update 2002 (ICD-9 154.0–154.1), stomach cancer (ICD-9 151.0–151.9), and pancreatic cancer (ICD-9 157.0–157.9). According to American Cancer Society (ACS) estimates, about 200,200 people will be diagnosed with those cancers in the United States in 2002 and some 98,700 will die from them (ACS, 2002). Colon cancer accounts for about half those diagnoses and deaths. Collectively, gastrointestinal tract tumors are expected to account for 15% of new diagnoses and 18% of cancer deaths in 2002. The average annual incidences for gastrointestinal cancers are shown in Table 6-1. The incidences of stomach, colon, rectal, and pancreatic cancers increase with age in people 45–59 years old. In general, incidence is higher in men than in women, and is higher in blacks than in whites. Besides age and race, risk factors for those cancers vary but always include family history of the same form of cancer, some diseases of the affected organ, and dietary factors. Cigarette-smoking is a risk factor for pancreatic cancer and may also increase the risk of stomach cancer (Miller et al., 1996). Infection with the bacterium Helicobacter pylori also increases the risk of stomach cancer. Summary of VAO, Update 1996, Update 1998, and Update 2000 The committee responsible for VAO found that there was limited or suggestive evidence of no association between exposure to the chemicals of interest (2,4-dichlorophenoxyacetic acid, 2,4-D; 2,4,5-trichlorophenoxyacetic acid, 2,4,5- TABLE 6-1 Average Annual Incidence (per 100,000) of Selected Gastrointestinal Cancers in United Statesa   45–49 Years of Age 50–54 Years of Age 55–59 Years of Age All Races White Black All Races White Black All Races White Black Stomach Males 5.9 4.6 11.7 10.0 9.2 16.9 18.1 15.7 24.3 Females 2.7 2.1 4.8 4.7 3.6 10.6 7.3 6.1 11.3 Colon Males 15.3 14.6 21.3 34.2 32.0 56.8 62.5 61.0 85.0 Females 15.9 14.1 25.8 27.5 24.5 46.3 47.9 45.6 73.5 Rectal Males 8.6 7.9 10.3 16.5 15.1 21.6 26.7 27.0 26.2 Females 6.0 5.6 6.0 9.6 9.0 12.0 15.2 14.6 16.6 Pancreatic Males 6.1 5.8 10.3 12.8 12.0 25.7 21.6 19.8 42.5 Females 3.5 3.3 6.0 7.9 7.4 11.7 14.6 13.8 25.3 aSEER nine standard registries, crude age-specific rates, 1995–1999.

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Veterans and Agent Orange: Update 2002 T, or its contaminant TCDD; picloram; or cacodylic acid) and gastrointestinal tumors. Additional information available to the committees responsible for Update 1996, Update 1998, and Update 2000 did not change that finding (see Tables 6-2, 6-3, 6-4, and 6-5 for a summary of the studies). Update of the Scientific Literature Occupational Studies In an occupational study, Burns et al. (2001) updated the mortality in chemical workers exposed in the production of 2,4-D. Members of that cohort are male employees of Dow Chemical Company who manufactured or formulated 2,4-D in 1945–1994. Their mortality experience is compared with national rates and with that in more than 40,000 other company employees who worked at the same location. There were 330 deaths in the 1,517 male employees who have an average follow-up of 26.2 years. Fewer deaths than expected from all malignant neoplasms and specifically cancers of the digestive organs and peritoneum (International Classification of Diseases, Eighth Revision 150–59) were found. There were 16 observed deaths compared with 21.5 expected, for a standardized mortality ratio (SMR) of 0.7 (0.4–1.2, 95% confidence interval [CI]). Environmental Studies An environmental study of residents of Chapaevsk, a Russian industrial community on the Volga River with documented contamination of the food and water supply by dioxins and other chemicals, demonstrated a higher incidence of colon cancer in males (22.7 per 100,000 per year) than Russia as a whole (17.9) or the Samara region of Russia (21.7), which includes Chapaevsk. Female residents of Chapaevsk did not have a higher incidence (13.3) than Russia as a whole (14.1) or Samara (15.4) (Revich et al., 2001). However, female residents of Chapaevsk did have a higher incidence of stomach cancer (33.9) than Russia (20.7) or Samara (17.6). Male residents of Chapaevsk had a lower incidence of stomach cancer (45.3) than Russia (48.1) but a higher incidence than Samara (44.0). Both male and female residents of Chapaevsk had a lower incidence of rectal cancer (15.3 and 7.0, respectively) than Russia (16.6 and 10.3) or Samara (17.1 and 11.2). Because of the lack of adjustment for confounding, the likelihood of multiple exposures, the absence of information on the completeness and accuracy of cancer diagnoses, and the ecologic study design, this study provides little evidence for associations with gastrointestinal cancers. Vietnam-Veteran Studies No relevant Vietnam-veteran studies have been published since Update 2000.

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Veterans and Agent Orange: Update 2002 Synthesis With only rare exceptions, studies on gastrointestinal cancers and exposure to herbicides in production, from agricultural use, from environmental sources, and among veteran populations found estimated relative risks close to 1.0, providing no evidence of any increase in risk. The updated analysis of mortality among US chemical workers at a Dow plant (Burns et al., 2001) did not report site-specific gastrointestinal cancers, and there was a nonsignificant increase in the SMR for all gastrointestinal cancers in the highest-exposed subgroups. Conclusions Strength of Evidence from Epidemiologic Studies VAO and the previous updates concluded that there is limited or suggestive evidence of no association between exposure to the chemicals of interest (2,4-D, 2,4,5-T or its contaminant TCDD, picloram, or cacodylic acid) and gastrointestinal cancers (stomach, pancreatic, rectal, and colon cancers). The evidence regarding association was drawn from occupational and other studies in which subjects were exposed to a variety of herbicides and herbicide components. On the basis of its evaluation of the epidemiologic evidence reviewed in this and previous Veterans and Agent Orange reports, the present committee finds that there is still limited or suggestive evidence of no association between exposure to the chemicals of interest and gastrointestinal cancers. Biologic Plausibility No animal studies have found an increased incidence of gastrointestinal cancer after exposures to the chemicals of interest. A summary of the biologic plausibility of the carcinogenicity of TCDD and the herbicides in general is presented at the end of this chapter. Chapter 3 discusses recent toxicologic studies that concern biologic plausibility. Increased Risk of Disease Among Vietnam Veterans The available data on Vietnam veterans do not suggest an association between TCDD or herbicide exposure and any gastrointestinal cancers.

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Veterans and Agent Orange: Update 2002 TABLE 6-2 Selected Epidemiologic Studies—Stomach Cancer Reference Study Population Exposed Casesa Estimated Relative Risk (95% CI)a OCCUPATIONAL New Studies Burns et al., 2001 Dow 2,4-D production workers— cancer of the digestive organs 16 SMR 0.7 (0.4–1.2) Studies Reviewed in Update 2000 Steenland et al., 1999 US chemical production workers 13 1.0 (0.6–1.8) Hooiveld et al., 1998 Dutch chemical production workers 3 1.0 (0.2–2.9) Rix et al., 1998 Danish paper mill workers       Male 48 1.1 (0.8–1.4)   Female 7 1.0 (0.4–2.1) Studies Reviewed in Update 1998 Gambini et al., 1997 Italian rice growers 39 0.9 (0.7–1.3) Kogevinas et al., 1997 IARC cohort     Workers exposed to TCDD (or higher-chlorinated dioxins) 42 0.9 (0.6–1.2) Workers not exposed to TCDD (or higher-chlorinated dioxins) 30 0.9 (0.6–1.3) Workers exposed to any phenoxy herbicide or chlorophenol 72 0.9 (0.7–1.1) Becher et al., 1996 German chemical production workers     Plant I 12 1.3 (0.7–2.2) Plant II 0   Plant III 0   Plant IV 2 0.6 (0.1–2.3) Ott and Zober, 1996 BASF cleanup workers 3 1.0 (0.2–2.9) TCDD <0.1 µg/kg of body wt 0   TCDD 0.1–0.99 µg/kg of body wt 1 1.3 (0.0–7.0) TCDD >1 µg/kg of body wt 2 1.7 (0.2–6.2) Ramlow et al., 1996 Pentachlorophenol production workers     0-year latency 4 1.7 (0.4–4.3) 15-year latency 3 1.8 (0.4–5.2) Studies Reviewed in Update 1996 Blair et al., 1993 US farmers in 23 states     White males 657 1.0 (1.0–1.1) Nonwhite females 23 1.9 (1.2–2.8) Bueno de Mesquita et al., 1993 Phenoxy herbicide workers 2 0.7 (01.–2.7) Collins et al., 1993 Monsanto 2,4-D production workers 0 0 (0.0–1.1) Kogevinas et al., 1993 IARC cohort—females   NS Studies Reviewed in VAO Ronco et al., 1992 Danish male self-employed farm workers 286 0.9 (*) Swaen et al., 1992 Dutch herbicide appliers 1 0.5b (0.0–2.7) Fingerhut et al., 1991 NIOSH cohort 10 1.0 (0.5–1.9) Manz et al., 1991 German production workers 12 1.2 (0.6–2.1) Saracci et al., 1991 IARC cohort 40 0.9 (0.6–1.2) Wigle et al., 1990 Canadian farmers 246 0.9 (0.8–1.0)

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Veterans and Agent Orange: Update 2002 Reference Study Population Exposed Casesa Estimated Relative Risk (95% CI)a Zober et al., 1990 BASF production workers—basic cohort 3 3.0 (0.8–11.8) Alavanja et al., 1989 USDA forest or soil conservationists 9 0.7 (0.3–1.3) Henneberger et al., 1989 Paper and pulp workers 5 1.2 (0.4–2.8) Solet et al., 1989 Paper and pulp workers 1 0.5 (0.1–3.0) Alavanja et al., 1988 USDA agricultural extension agents 10 0.7 (0.4–1.4) Bond et al., 1988 Dow 2,4-D production workers 0 — (0.0–3.7) Thomas, 1987 Flavor and fragrance chemical production workers 6 1.4 (*) Coggon et al., 1986 British MCPA production workers 26 0.9 (0.6–1.3) Robinson et al., 1986 Paper and pulp workers 17 1.2 (0.7–2.1) Lynge, 1985 Danish male production workers 12 1.3 (*) Blair et al., 1983 Florida pesticide appliers 4 1.2 (*) Burmeister et al., 1983 Iowa residents—farming exposures 1,812 1.3 (p < 0.05) Wiklund, 1983 Swedish agricultural workers 2,599 1.1 (1.0–1.2)c Burmeister, 1981 Farmers in Iowa 338 1.1 (p < 0.01) Axelson et al., 1980 Swedish railroad workers—total exposure 3 2.2 (*) ENVIRONMENTAL New Studies Revich et al., 2001 Residents of Chapaevsk, Russia Age-adjusted incidence (100,000) of stomach cancer in males   45.3 in Chapaevsk; 44.0 in Samara Regiond   Age-adjusted incidence (100,000) of stomach cancer in females   33.9 in Chapaevsk; 17.6 in Samara Regiond   Mortality standardized to Samara Region   Males 59 1.7 (1.3–2.2)   Females 45 0.7 (0.5–0.9) Studies Reviewed in Update 2000 Bertazzi et al., 2001 Seveso residents—20-year follow-up       Zone A males 1 0.5 (0.1–3.2)   Zone A females 2 1.4 (0.3–5.5)   Zone B males 15 1.0 (0.6–1.6)   Zone B females 9 1.0 (0.5–1.9) Bertazzi et al., 1998 Seveso residents—15-year follow-up       Zone A females 1 0.9 (0.1–6.7)   Zone B males 10 0.8 (0.4–1.5)   Zone B females 7 1.0 (0.5–2.2) Studies Reviewed in Update 1998 Bertazzi et al., 1997 Seveso residents—15-year follow-up       Zone A females 1 0.9 (0.0–5.3)   Zone B males 10 0.8 (0.4–1.5)

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Veterans and Agent Orange: Update 2002 Reference Study Population Exposed Casesa Estimated Relative Risk (95% CI)a   Zone B females 7 1.0 (0.4–2.1)   Zone R males 76 0.9 (0.7–1.1)   Zone R females 58 1.0 (0.8–1.3) Svensson et al., 1995 Swedish fishermen—mortality       East coast 17 1.4 (0.8–2.2)   West coast 63 0.9 (0.7–1.2)   Swedish fishermen—incidence       East coast 24 1.6 (1.0–2.4)   West coast 71 0.9 (0.7–1.2) Studies Reviewed in Update 1996 Bertazzi et al., 1993 Seveso residents—10-year follow-up—morbidity Zone B males 7 1.0 (0.5–2.1) Zone B females 2 0.6 (0.2–2.5) Zone R males 45 0.9 (0.7–1.2) Zone R females 25 1.0 (0.6–1.5) Studies Reviewed in VAO Pesatori et al., 1992 Seveso residents     Zones A, B males 7 0.9 (0.4–1.8) Zones A, B females 3 0.8 (0.3–2.5) Bertazzi et al., 1989a Seveso residents—10-year follow-up     Zones A, B, R males 40 0.8 (0.6–1.2) Zones A, B, R females 22 1.0 (0.6–1.5) Bertazzi et al., 1989b Seveso residents—10-year follow-up     Zone B males 7 1.2 (0.6–2.6) VIETNAM VETERANS Studies Reviewed in Update 1998 Crane et al., 1997a Australian military Vietnam veterans 32 1.1 (0.7–1.5) Crane et al., 1997b Australian national service Vietnam veterans 4 1.7 (0.3–>10) Studies Reviewed in VAO Breslin et al., 1988 Army Vietnam veterans 88 1.1 (0.9–1.5)   Marine Vietnam veterans 17 0.8 (0.4–1.6) Anderson et al., 1986a Wisconsin Vietnam veterans 3 — Anderson et al., 1986b Wisconsin Vietnam veterans 1 — a Given when available. b Risk estimate is for stomach and small intestine. c 99% CI. d Incidence rates provided in absence of information on exposed cases or estimated relative risk for morbidity. * Information not provided by study authors. — When information was denoted by a dash in the original study. ABBREVIATIONS: 2,4-D, 2,4-dichlorophenoxyacetic acid; IARC, International Agency for Research on Cancer; MCPA, methyl-4-chlorophenoxyacetic acid; NIOSH, National Institute for Occupational Safety and Health; NS, not significant; SMR, standardized mortality ratio; USDA, US Department of Agriculture.

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Veterans and Agent Orange: Update 2002 TABLE 6-3 Selected Epidemiologic Studies—Colon Cancer Reference Study Population Exposed Casesa Estimated Relative Risk (95% CI)a OCCUPATIONAL Studies Reviewed in Update 2000 Steenland et al., 1999 US chemical production workers 34 1.2 (0.8–1.6) Hooiveld et al., 1998 Dutch chemical production workers 3 1.4 (0.3–4.0) Rix et al., 1998 Danish paper mill workers       Males 58 1.0 (0.7–1.2)   Females 23 1.1 (0.7–1.7) Studies Reviewed in Update 1998 Gambini et al., 1997 Italian rice growers 27 1.1 (0.7–1.6) Kogevinas et al., 1997 IARC cohort       Workers exposed to TCDD higher-chlorinated dioxins) 52 1.0 (0.8–1.3)   Workers not exposed to TCDD (or higher-chlorinated dioxins) 33 1.2 (0.8–1.6)   Workers exposed to any phenoxy herbicide or chlorophenol 86 1.1 (0.8–1.3) Becher et al., 1996 German chemical production workers       Plant I 2 0.4 (0.0–1.4)   Plant II 0     Plant III 1 2.2 (0–12)   Plant IV 0   Ott and Zober, 1996b BASF cleanup workers 5 1.0 (0.3–2.3) TCDD <0.1 µg/kg of body wt 2 1.1 (0.1–3.9) TCDD 0.1–0.99 µg/kg of body wt 2 1.4 (0.2–5.1) TCDD >1 µg/kg of body wt 1 0.5 (0.0–3.0) Ramlow et al., 1996 Pentachlorophenol production workers       0-year latency 4 0.8 (0.2–2.1)   15-year latency 4 1.0 (0.3–2.6) Studies Reviewed in Update 1996 Blair et al., 1993 US farmers in 23 states—white males 2,291 1.0 (0.9–1.0) Bueno de Mesquita et al., 1993 Phenoxy herbicide workers 3 1.8 (0.4–5.4) Collins et al., 1993 Monsanto 2,4-D production workers 3 0.5 (0.1–1.3) Studies Reviewed in VAO Ronco et al., 1992 Danish male self-employed farm workers 277 0.7 (p < 0.05) Swaen et al., 1992 Dutch herbicide appliers 4 2.6 (0.7–6.5) Fingerhut et al., 1991 NIOSH cohort 25 1.2 (0.8–1.8) Manz et al., 1991 German production workers 8 0.9 (0.4–1.8) Saracci et al., 1991 IARC cohort 41 1.1 (0.8–1.5) Zober et al., 1990b BASF production workers—basic cohort 2 2.5 (0.4–14.1) Alavanja et al., 1989 USDA forest conservationists * 1.4 (0.7–2.8)   USDA soil conservationists * 1.2 (0.7–2.0) Henneberger et al., 1989 Paper and pulp workers 9 1.0 (0.5–2.0) Solet et al., 1989 Paper and pulp workers 7 1.5 (0.6–3.0) Alavanja et al., 1988 USDA agricultural extension agents * 1.0 (0.7–1.5) Bond et al., 1988 Dow 2,4-D production workers 4 2.1 (0.6–5.4)

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Veterans and Agent Orange: Update 2002 Reference Study Population Exposed Casesa Estimated Relative Risk (95% CI)a Thomas, 1987 Flavor and fragrance chemical production workers 4 0.6 (*) Coggon et al., 1986 British MCPA production workers 19 1.0 (0.6–1.6) Robinson et al., 1986 Paper and pulp workers 7 0.4 (0.2–0.9) Lynge, 1985 Danish male production workers 10 1.0 (*) Blair et al., 1983 Florida pesticide appliers 5 0.8 (*) Wiklund, 1983 Swedish agricultural workers 1,332 0.8 (0.7–0.8)c Thiess et al., 1982 BASF production workers 1 0.4 (*) Burmeister, 1981 Farmers in Iowa 1,064 1.0 (NS) Hardell, 1981 Residents of Sweden       Exposed to phenoxy acids 11 1.3 (0.6–2.8)   Exposed to chlorophenols 6 1.8 (0.6–5.3) ENVIRONMENTAL New Studies Revich et al., 2001 Residents of Chapaevsk, Russia       Age-adjusted incidence (100,000) of colon cancer in males   22.7 in Chapaevsk; 21.7 in Samara regiond   Age-adjusted incidence (100,000) of colon cancer in females   13.3 in Chapaevsk; 15.4 in Samara regiond   Mortality standardized to Samara region   Males 17 1.3 (0.8–2.2)   Females 24 1.0 (0.7–1.5) Studies Reviewed in Update 2000 Bertazzi et al., 2001 Seveso residents—20-year follow-up       Zone A females 2 1.8 (0.4–7.0)   Zone B males 10 1.2 (0.6–2.2)   Zone B females 3 0.4 (0.1–1.3) Bertazzi et al., 1998 Seveso residents—15-year follow-up       Zone A females 2 2.6 (0.6–10.5)   Zone B males 5 0.8 (0.3–2.0)   Zone B females 3 0.6 (0.2–1.9) Studies Reviewed in Update 1998 Bertazzi et al., 1997 Seveso residents—15-year follow-up       Zone A females 2 2.6 (0.3–9.4)   Zone B males 5 0.8 (0.3–2.0)   Zone B females 3 0.6 (0.1–1.8)   Zone R males 34 0.8 (0.6–1.1)   Zone R females 33 0.8 (0.6–1.1)

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Veterans and Agent Orange: Update 2002 Reference Study Population Exposed Casesa Estimated Relative Risk (95% CI)a Svensson et al., 1995 Swedish fishermen—mortality     East coast 4 0.1 (0.0–0.7) West coast 58 1.0 (0.8–1.3) Swedish fishermen—incidence East coast 5 0.4 (0.1–0.9) West coast 82 0.9 (0.8–1.2) Studies Reviewed in Update 1996 Bertazzi et al., 1993 Seveso residents—10-year follow-up—morbidity   Zone B males 2 0.5 (0.1–2.0)   Zone B females 2 0.6 (0.1–2.3)   Zone R males 32 1.1 (0.8–1.6)   Zone R females 23 0.8 (0.5–1.3) Studies Reviewed in VAO Lampi et al., 1992 Finnish community exposed to chlorophenol contamination 9 1.1 (0.7–1.8) Pesatori et al., 1992 Seveso residents Zones A, B males 3 0.6 (0.2–1.9) Zones A, B females 3 0.7 (0.2–2.2) Bertazzi et al., 1989a Seveso residents—10-year follow-up   Zones A, B, R males 20 1.0 (0.6–1.5)   Zones A, B, R females 12 0.7 (0.4–2.2) VIETNAM VETERANS Studies Reviewed in Update 2000 AFHS, 2000b Air Force Ranch Hand veterans 7 1.5 (0.4–5.5) AIHW, 1999b Australian Vietnam veterans—male 188 221 expected (191–251) CDVA, 1998a Australian Vietnam veterans—male 405e 117 expected (96–138) CDVA, 1998b Australian Vietnam veterans—female 1e 1 expected (0–5) Studies Reviewed in Update 1998 Crane et al., 1997a Australian military Vietnam veterans 78 1.2 (1.0–1.5) Crane et al., 1997b Australian national service Vietnam veterans 6 0.6 (0.2–1.5) Studies Reviewed in Update 1996 Dalager et al., 1995 Women Vietnam veterans 4 0.4 (0.1–1.2)   Nurses 4 0.5 (0.2–1.7) Studies Reviewed in VAO Breslin et al., 1988f Army Vietnam veterans 209 1.0 (0.7–1.3)   Marine Vietnam veterans 33 1.3 (0.7–2.2) Anderson et al., 1986a Wisconsin Vietnam veterans 4 — Anderson et al., 1986b Wisconsin Vietnam veterans 6 1.0 (0.4–2.2)

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Veterans and Agent Orange: Update 2002 Axelson O, Sundell L, Andersson K, Edling C, Hogstedt C, Kling H. 1980. Herbicide exposure and tumor mortality. An updated epidemiologic investigation on Swedish railroad workers. Scandinavian Journal of Work, Environment, and Health 6(1):73–79. Bagga D, Anders KH, Wang HJ, Roberts E, Glaspy JA. 2000. Organochlorine pesticide content of breast adipose tissue from women with breast cancer and control subjects. Journal of the National Cancer Institute 92(9):750–753. Balarajan R, Acheson ED. 1984. Soft tissue sarcomas in agriculture and forestry workers. Journal of Epidemiology and Community Health 38(2):113–116. Becher H, Flesch-Janys D, Kauppinen T, Kogevinas M, Steindorf K, Manz A, Wahrendorf J. 1996. Cancer mortality in German male workers exposed to phenoxy herbicides and dioxins [see comments]. Cancer Causes and Control 7(3):312–321. Bender AP, Parker DL, Johnson RA, Scharber WK, Williams AN, Marbury MC, Mandel JS. 1989. Minnesota highway maintenance worker study: cancer mortality. American Journal of Industrial Medicine 15(5):545–556. Bertazzi PA, Zocchetti C, Pesatori AC, Guercilena S, Sanarico M, Radice L. 1989a. Mortality in an area contaminated by TCDD following an industrial incident. Medicina Del Lavoro 80(4):316– 329. Bertazzi PA, Zocchetti C, Pesatori AC, Guercilena S, Sanarico M, Radice L. 1989b. Ten-year mortality study of the population involved in the Seveso incident in 1976. American Journal of Epidemiology 129(6):1187–1200. Bertazzi PA, Zocchetti C, Pesatori AC, Guercilena S, Consonni D, Tironi A, Landi MT. 1992. Mortality of a young population after accidental exposure to 2,3,7,8-tetrachlorodibenzodioxin International Journal of Epidemiology 21(1):118–123. Bertazzi A, Pesatori AC, Consonni D, Tironi A, Landi MT, Zocchetti C. 1993. Cancer incidence in a population accidentally exposed to 2,3,7,8-tetrachlorodibenzo-para-dioxin [see comments]. Epidemiology 4(5):398–406. Bertazzi PA, Zochetti C, Guercilena S, Consonni D, Tironi A, Landi MT, Pesatori AC. 1997. Dioxin exposure and cancer risk: a 15-year mortality study after the “Seveso accident.” Epidemiology 8(6):646–652. Bertazzi PA, Bernucci I, Brambilla G, Consonni D, Pesatori AC. 1998. The Seveso studies on early and long-term effects of dioxin exposure: a review. Environmental Health Perspectives 106(Suppl 2):625–633. Bertazzi PA, Consonni D, Bachetti S, Rubagotti M, Baccarelli A, Zocchetti C, Pesatori AC. 2001. Health effects of dioxin exposure: a 20-year mortality study. American Journal of Epidemiology 153(11):1031–1044. Blair A, Kazerouni N. 1997. Reactive chemicals and cancer. Cancer Causes and Control 8(3):473– 490. Blair A, White DW. 1985. Leukemia cell types and agricultural practices in Nebraska. Archives of Environmental Health 40(4):211–214. Blair A, Grauman DJ, Lubin JH, Fraumeni JF Jr. 1983. Lung cancer and other causes of death among licensed pesticide applicators Journal of the National Cancer Institute 71(1):31–37. Blair A, Dosemeci M, Heineman EF. 1993. Cancer and other causes of death among male and female farmers from twenty-three states. American Journal of Industrial Medicine 23(5):729–742. Blair A, Zahm SH, Cantor KP, Ward MH. 1997. Occupational and environmental risk factors for chronic lymphocytic leukemia and non-Hodgkin's lymphoma. In: Marti GE, Vogt RF, Zenger VE, eds. Proceedings of the USPHS Workshop on Laboratory and Epidemiologic Approaches to Determining the Role of Environmental Exposures as Risk Factors for B-Cell Chronic Lymphocytic and Other B-Cell Lymphoproliferative Disorders. US Department of Health and Human Services, Public Health Service Bloemen LJ, Mandel JS, Bond GG, Pollock AF, Vitek RP, Cook RR. 1993. An update of mortality among chemical workers potentially exposed to the herbicide 2,4-dichlorophenoxyacetic acid and its derivatives Journal of Occupational Medicine 35(12):1208–1212.

OCR for page 242
Veterans and Agent Orange: Update 2002 Boffeta P, Stellman SD, Garfinkel L. 1989. A case-control study of multiple myeloma nested in the American Cancer Society prospective study. International Journal of Cancer 43(4):554–559. Bond GG, Wetterstroem NH, Roush GJ, McLaren EA, Lipps TE, Cook RR. 1988. Cause specific mortality among employees engaged in the manufacture, formulation, or packaging of 2,4-dichlorophenoxyacetic acid and related salts. British Journal of Industrial Medicine 45(2):98– 105. Bosl GJ, Motzer RJ. 1997. Testicular germ-cell cancer. New England Journal of Medicine 337(4): 242–253. Boyle C, Decoufle P, Delaney RJ, DeStefano F, Flock ML, Hunter MI, Joesoef MR, Karon JM, Kirk ML, Layde PM, McGee DL, Moyer LA, Pollock DA, Rhodes P, Scally MJ, Worth RM. 1987. Postservice Mortality Among Vietnam Veterans. Atlanta: Centers for Disease Control. CEH 86-0076. 143 pp. Breslin P, Lee Y, Kang H, Burt V, Shepard BM. 1986. A Preliminary Report: The Vietnam Veterans Mortality Study. Washington, DC: Veterans Administration, Office of Environmental Epidemiology. Breslin P, Kang H, Lee Y, Burt V, Shepard BM. 1988. Proportionate mortality study of U.S. Army and U.S. Marine Corps veterans of the Vietnam War. Journal of Occupational Medicine 30(5): 412–419. Brown LM, Blair A, Gibson R, Everett GD, Cantor KP, Schuman LM, Burmeister LF, Van Lier SF, Dick F. 1990. Pesticide exposures and other agricultural risk factors for leukemia among men in Iowa and Minnesota. Cancer Research 50(20):6585–6591. Brown LM, Burmeister LF, Everett GD, Blair A. 1993. Pesticide exposures and multiple myeloma in Iowa men. Cancer Causes and Control 4(2):153–156. Bueno de Mesquita HB, Doornbos G, Van der Kuip DA, Kogevinas M, Winkelmann R. 1993. Occupational exposure to phenoxy herbicides and chlorophenols and cancer mortality in the Netherlands. American Journal of Industrial Medicine 23(2):289–300. Bullman TA, Kang HK, Watanabe KK. 1990. Proportionate mortality among U.S. Army Vietnam veterans who served in Military Region I. American Journal of Epidemiology 132(4):670–674. Bullman TA, Watanabe KK, Kang HK. 1994. Risk of testicular cancer associated with surrogate measures of Agent Orange exposure among Vietnam veterans on the Agent Orange Registry Annals of Epidemiology 4(1):11–16. Burmeister LF. 1981. Cancer mortality in Iowa farmers, 1971–1978. Journal of the National Cancer Institute 66(3):461–464. Burmeister LF, Van Lier SF, Isacson P. 1982. Leukemia and farm practices in Iowa. American Journal of Epidemiology 115(5):720–728. Burmeister LF, Everett GD, Van Lier SF, Isacson P. 1983. Selected cancer mortality and farm practices in Iowa. American Journal of Epidemiology 118(1):72–77. Burns CJ, Beard KK, Cartmill JB. 2001. Mortality in chemical workers potentially exposed to 2,4-dichlorophenoxyacetic acid (2,4-D) 1945–1994: an update. Occupational and Environmental Medicine 58(1):24–30. Burt VL, Breslin PP, Kang HK, Lee Y. 1987. Non-Hodgkin's Lymphoma in Vietnam Veterans. Department of Medicine and Surgery, Veterans Administration, 33 pp. Cantor KP. 1982. Farming and mortality from non-Hodgkin's lymphoma: a case-control study. International Journal of Cancer 29(3):239–247. Cantor KP, Blair A. 1984. Farming and mortality from multiple myeloma: a case control study with the use of death certificates. Journal of the National Cancer Institute 72(2):251–255. Caplan LS, Hall HI, Levine RS, Zhu K. 2000. Preventable risk factors for nasal cancer. Annals of Epidemiology 10(3):186–191. CDC (Centers for Disease Control and Prevention). 1988. Health status of Vietnam veterans. II. Physical health. Journal of the American Medical Association 259(18):2708–2714.

OCR for page 242
Veterans and Agent Orange: Update 2002 CDC. 1990. The association of selected cancers with service in the U.S. military in Vietnam. III. Hodgkin's disease, nasal cancer, nasopharyngeal cancer, and primary liver cancer. The Selected Cancers Cooperative Study Group [see comments]. Archives of Internal Medicine 150(12):2495–2505. CDVA (Commonwealth Department of Veterans' Affairs). 1998a. Morbidity of Vietnam Veterans: A Study of the Health of Australia 's Vietnam Veteran Community. Volume 1: Male Vietnam Veterans Survey and Community Comparison Outcomes. Canberra: Department of Veterans' Affairs. CDVA. 1998b. Morbidity of Vietnam Veterans: A Study of the Health of Australia 's Vietnam Veteran Community. Volume 2: Female Vietnam Veterans Survey and Community Comparison Outcomes. Canberra: Department of Veterans' Affairs. Clapp RW. 1997. Update of cancer surveillance of veterans in Massachusetts, USA. International Journal of Epidemiology 26(3):679–681. Clapp RW, Cupples LA, Colton T, Ozonoff DM. 1991. Cancer surveillance of veterans in Massachusetts, 1982–1988. International Journal of Epidemiology 20(1):7–12. Coggon D, Pannett B, Winter PD, Acheson ED, Bonsall J. 1986. Mortality of workers exposed to 2-methyl-4-chlorophenoxyacetic acid Scandinavian Journal of Work, Environment, and Health 12(5):448–454. Coggon D, Pannett B, Winter P. 1991. Mortality and incidence of cancer at four factories making phenoxy herbicides. British Journal of Industrial Medicine 48(3):173–178. Collins JJ, Strauss ME, Levinskas GJ, Conner PR. 1993. The mortality experience of workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin in a trichlorophenol process accident. Epidemiology 4(1):7–13. Cordier S, Le TB, Verger P, Bard D, Le CD, Larouze B, Dazza MC, Hoang TQ, Abenhaim L. 1993. Viral infections and chemical exposures as risk factors for hepatocellular carcinoma in Vietnam. International Journal of Cancer 55(2):196–201. Corrao G, Caller M, Carle F, Russo R, Bosia S, Piccioni P. 1989. Cancer risk in a cohort of licensed pesticide users. Scandinavian Journal of Work, Environment, and Health 15(3):203–209. Costani G, Rabitti P, Mambrini A, Bai E, Berrino F. 2000. Soft tissue sarcomas in the general population living near a chemical plant in northern Italy. Tumori 86(5):381–383. Crane PJ, Barnard DL, Horsley KW, Adena MA. 1997a. Mortality of Vietnam Veterans: The Veteran Cohort Study. A Report of the 1996 Retrospective Cohort Study of Australian Vietnam Veterans Canberra: Department of Veterans' Affairs. Crane PJ, Barnard DL, Horsley KW, Adena MA. 1997b. Mortality of National Service Vietnam Veterans: A Report of the 1996 Retrospective Cohort Study of Australian Vietnam Veterans. Canberra: Department of Veterans' Affairs. Dalager NA, Kang HK. 1997. Mortality among Army Chemical Corps Vietnam veterans. American Journal of Industrial Medicine 31(6):719–726. Dalager NA, Kang HK, Burt VL, Weatherbee L. 1991. Non-Hodgkin's lymphoma among Vietnam veterans. Journal of Occupational Medicine 33(7):774–779. Dalager NA, Kang HK, Thomas TL. 1995. Cancer mortality patterns among women who served in the military: the Vietnam experience. Journal of Occupational and Environmental Medicine 37(3):298–305. Dean G. 1994. Deaths from primary brain cancers, lymphatic and haematopoietic cancers in agricultural workers in the Republic of Ireland. Journal of Epidemiology and Community Health 48(4):364–368. Demers PA, Boffetta P, Kogevinas M, Blair A, Miller BA, Robinson CF, Roscoe RJ, Winter PD, Colin D, Matos E, et al. 1995. Pooled reanalysis of cancer mortality among five cohorts of workers in wood-related industries. Scandinavian Journal of Work, Environment and Health 21(3):179–190. Demers A, Ayotte P, Brisson J, Dodin S, Robert J, Dewailly E. 2000. Risk and aggressiveness of breast cancer in relation to plasma organochlorine concentrations. Cancer Epidemiology, Biomarkers and Prevention 9(2):161–166.

OCR for page 242
Veterans and Agent Orange: Update 2002 Demers A, Ayotte P, Brisson J, Dodin S, Robert J, Dewailly E. 2002. Plasma concentrations of polychlorinated biphenyls and the risk of breast cancer: A congener-specific analysis. American Journal of Epidemiology. 155(7):629–635. Dich J, Wiklund K. 1998. Prostate cancer in pesticide applicators in Swedish agriculture. Prostate 34(2):100–112. Donna A, Betta P-G, Robutti F, Crosignani P, Berrino F, Bellingeri D. 1984. Ovarian mesothelial tumors and herbicides: a case–control study. Carcinogenesis 5(7):941–942. Dubrow R, Paulson JO, Indian RW. 1988. Farming and malignant lymphoma in Hancock County, Ohio. British Journal of Industrial Medicine 45(1):25–28. Duell EJ, Millikan RC, Savitz DA, Newman B, Smith JC, Schell MJ, Sandler DP. 2000. A population-based case–control study of farming and breast cancer in North Carolina. Epidemiology 11(5):523–531. Duell EJ, Millikan RC, Savitz DA, Schell MJ, Newman B, Tse CJ, Sandler DP. 2001. Reproducibility of reported farming activities and pesticide use among breast cancer cases and controls: A comparison of two modes of data collection. Annals of Epidemiology 11(3):178–185. Eriksson M, Karlsson M. 1992. Occupational and other environmental factors and multiple myeloma: a population based case–control study. British Journal of Industrial Medicine 49(2):95– 103. Eriksson M, Hardell L, Berg NO, Moller T, Axelson O. 1979. Case–control study on malignant mesenchymal tumor of the soft tissue and exposure to chemical substances. Lakartidningen 76(44):3872–3875. Eriksson M, Hardell L, Berg NO, Moller T, Axelson O. 1981. Soft-tissue sarcomas and exposure to chemical substances: a case-referent study. British Journal of Industrial Medicine 38(1):27–33. Eriksson M, Hardell L, Malker H, Weiner J. 1992. Malignant lymphoproliferative diseases in occupations with potential exposure to phenoxyacetic acids or dioxins: a register-based study American Journal of Industrial Medicine 22:305–312. Fett MJ, Nairn JR, Cobbin DM, Adena MA. 1987. Mortality among Australian conscripts of the Vietnam conflict era. II. Causes of death. American Journal of Epidemiology 125(15):878–884. Fingerhut MA, Halperin WE, Marlow DA, Piacitelli LA, Honchar PA, Sweeney MH, Greife AL, Dill PA, Steenland K, Suruda AJ. 1991. Cancer mortality in workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. New England Journal of Medicine 324(4):212–218. Fleming LE, Bean JA, Rudolph M, Hamilton K. 1999a. Mortality in a cohort of licensed pesticide applicators in Florida Journal of Occupational and Environmental Medicine 56(1):14–21. Fleming LE, Bean JA, Rudolph M, Hamilton K. 1999b. Cancer incidence in a cohort of licensed pesticide applicators in Florida. Journal of Occupational and Environmental Medicine 41(4): 279–288. Gallagher RP, Bajdik CD, Fincham S, Hill GB, Keefe AR, Coldman A, McLean DI. 1996. Chemical exposures, medical history, and risk of squamous and basal cell carcinoma of the skin. Cancer Epidemiology, Biomarkers and Prevention 5(6):419–424. Gambini GF, Mantovani C, Pira E, Piolatto PG, Negri E. 1997. Cancer mortality among rice growers in Novara Province, northern Italy. American Journal of Industrial Medicine 31(4):435–441. Gann PH. 1997. Interpreting recent trends in prostate cancer incidence and mortality Epidemiology 8(2):117–120. Garland FC, Gorham ED, Garland CF, Ferns JA. 1988. Non-Hodgkin's lymphoma in U.S. Navy personnel. Archives of Environmental Health 43(6):425–429. Green LM. 1991. A cohort mortality study of forestry workers exposed to phenoxy acid herbicides. British Journal of Industrial Medicine 48(4):234–238. Greenwald P, Kovasznay B, Collins DN, Therriault G. 1984. Sarcomas of soft tissues after Vietnam service. Journal of the National Cancer Institute 73(5):1107–1109. Hansen ES, Hasle H, Lander F. 1992. A cohort study on cancer incidence among Danish gardeners. American Journal of Industrial Medicine 21(5):651–660.

OCR for page 242
Veterans and Agent Orange: Update 2002 Hardell L. 1981. Relation of soft-tissue sarcoma, malignant lymphoma and colon cancer to phenoxy acids, chlorophenols and other agents. Scandinavian Journal of Work, Environment, and Health 7(2):119–130. Hardell L, Bengtsson NO. 1983. Epidemiological study of socioeconomic factors and clinical findings in Hodgkin's disease, and reanalysis of previous data regarding chemical exposure. British Journal of Cancer 48(2):217–225. Hardell L, Eriksson M, Lenner P. 1980. Malignant lymphoma and exposure to chemical substances, especially organic solvents, chlorophenols, and phenoxyacetates. Lakartidningen 77(4):208– 210. Hardell L, Johansson B, Axelson O. 1982. Epidemiological study of nasal and nasopharyngeal cancer and their relation to phenoxy acid or chlorophenol exposure. American Journal of Industrial Medicine 3(3):247–257. Hardell L, Bengtsson NO, Jonsson U, Eriksson S, Larsson LG. 1984. Aetiological aspects on primary liver cancer with special regard to alcohol, organic solvents and acute intermittent porphyria: an epidemiological investigation. British Journal of Cancer 50(3):389–397. Hardell L, Eriksson M, Degerman A. 1994. Exposure to phenoxyacetic acids, chlorophenols, or organic solvents in relation to histopathology, stage, and anatomical localization of non-Hodgkin's lymphoma. Cancer Research 54(9):2386–2389. Hardell L, Nasman A, Ohlson CG, Fredrikson M. 1998. Case–control study on risk factors for testicular cancer. International Journal of Oncology 13(6):1299–1303. Hardell L, Lindström G, van Bavel B, Hardell K, Linde A, Carlberg M, Liljegren G. 2001. Adipose tissue concentrations of dioxins and dibenzofurans, titers of antibodies to Epstein-Barr virus early antigen and the risk for non-Hodgkin's lymphoma. Environmental Research 87(2):99– 107. Hayes RB. 1997. The carcinogenicity of metals in humans. Cancer Causes and Control 8(3):371– 385. Hazleton Laboratories America. 1986. Combined Toxicity and Oncogenicity Study in Rats with 2,4-Dichlorophenoxyacetic Acid (2,4-D). Final Report. Prepared for the Industry Task Force on 2, 4-D Research Data. Henneberger PK, Ferris BG Jr, Monson RR. 1989. Mortality among pulp and paper workers in Berlin, New Hampshire. British Journal of Industrial Medicine 46(9):658–664. Hertzman C, Teschke K, Ostry A, Hershler R, Dimich-Ward H, Kelly S, Spinelli JJ, Gallagher RP, McBride M, Marion SA. 1997. Mortality and cancer incidence among sawmill workers exposed to chlorophenate wood preservatives. American Journal of Public Health 87(1):71–79. Hoar SK, Blair A, Holmes FF, Boysen CD, Robel RJ, Hoover R, Fraumeni JF. 1986. Agricultural herbicide use and risk of lymphoma and soft-tissue sarcoma Journal of the American Medical Association 256(9):1141–1147. Hoffman RE, Stehr-Green PA, Webb KB, Evans RG, Knutsen AP, Schramm WF, Staake JL, Gibson BB, Steinberg KK. 1986. Health effects of long-term exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Journal of the American Medical Association 255(15):2031–2038. Holford TR, Zheng T, Mayne ST, Zahm SH, Tessari JD, Boyle P. 2000. Joint effects of nine polychlorinated biphenyl (PCB) congeners on breast cancer risk. International Journal of Epidemiology. 29(6):975–82. Holmes AP, Bailey C, Baron RC, Bosanac E, Brough J, Conroy C, Haddy L. 1986. West Virginia Department of Health Vietnam-Era Veterans Mortality Study: Preliminary Report. Charlestown: West Virginia Health Department. Hooiveld M, Heederik DJ, Kogevinas M, Boffetta P, Needham LL, Patterson DG Jr, Bueno de Mesquita HB. 1998. Second follow-up of a Dutch cohort occupationally exposed to phenoxy herbicides, chlorophenols, and contaminants. American Journal of Epidemiology 147(9):891– 901. Hoyer AP, Jorgensen T, Brock JW, Grandjean P. 2000. Organochlorine exposure and breast cancer survival. Journal of Clinical Epidemiology 53(3):323–330.

OCR for page 242
Veterans and Agent Orange: Update 2002 Huff JE, Salmon AG, Hooper NK, Zeise L. 1991. Long-term carcinogenesis studies on 2,3,7,8-tetrachlorodibenzo-p-dioxin and hexachlorodibenzo-p-dioxins. Cell Biology and Toxicology 7(1): 67–94. IARC (International Agency for Research on Cancer). 2001. Pathology and genetics of tumours of the haemopoietic and lymphoid tissues. In: Jaffe NL, Harris H, Stein, Vardiman JW, eds. World Health Organization, IARC. IOM (Institute of Medicine). 1994. Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam Washington, DC: National Academy Press. IOM. 1996. Veterans and Agent Orange: Update 1996. Washington, DC: National Academy Press. IOM. 1999. Veterans and Agent Orange: Update 1998. Washington, DC: National Academy Press. IOM. 2001.Veterans and Agent Orange: Update 2000. Washington, DC: National Academy Press. Kang HK, Weatherbee L, Breslin PP, Lee Y, Shepard BM. 1986. Soft tissue sarcomas and military service in Vietnam: a case comparison group analysis of hospital patients. Journal of Occupational Medicine 28(12):1215–1218. Kang HK, Mahan CM, Lee KY, Magee CA, Selvin S. 2000. Prevalence of gynecologic cancers among female Vietnam veterans. Journal of Occupational & Environmental Medicine 42(11): 1121–1127. Keller-Byrne JE, Khuder SA, Schaub EA, McAfee O. 1997. A meta-analysis of non-Hodgkin's lymphoma among farmers in the central United States. American Journal of Industrial Medicine 31(4):442–444. Ketchum NS, Michalek JE, Burton JE. 1999. Serum dioxin and cancer in veterans of Operation Ranch Hand. American Journal of Epidemiology 149(7):630–639. Kociba RJ, Keys DG, Beyer JE, Careon RM, Wade CE, Dittenber DA, Kalnins RP, Frauson LE, Park CN, Barnar SD, Hummel RA, Humiston CG. 1978. Results of a two-year chronic toxicity and oncogenicity study of 2,3,7,8-tetrachlorodibenzo-p-dioxin in rats. Toxicology and Applied Pharmacology 46:279–303. Kogan MD, Clapp RW. 1988. Soft tissue sarcoma mortality among Vietnam veterans in Massachusetts, 1972 to 1983. International Journal of Epidemiology 17(1):39–43. Kogevinas M, Saracci R, Bertazzi PA, Bueno De Mesquita BH, Coggon D, Green LM, Kauppinen T, Littorin M, Lynge E, Mathews JD, Neuberger M, Osman J, Pearce N, Winkelmann R. 1992. Cancer mortality from soft-tissue sarcoma and malignant lymphomas in an international cohort of workers exposed to chlorophenoxy herbicides and chlorophenols. Chemosphere 25:1071– 1076 Kogevinas M, Saracci R, Winkelmann R, Johnson ES, Bertazzi PA, Bueno de Mesquita BH, Kauppinen T, Littorin M, Lynge E, Neuberger M. 1993. Cancer incidence and mortality in women occupationally exposed to chlorophenoxy herbicides, chlorophenols, and dioxins. Cancer Causes and Control 4(6):547–553. Kogevinas M, Kauppinen T, Winkelmann R, Becher H, Bertazzi PA, Bas B, Coggon D, Green L, Johnson E, Littorin M, Lynge E, Marlow DA, Mathews JD, Neuberger M, Benn T, Pannett B, Pearce N, Saracci R. 1995. Soft tissue sarcoma and non-Hodgkin's lymphoma in workers exposed to phenoxy herbicides, chlorophenols and dioxins: two nested case–control studies. Epidemiology 6(4):396–402. Kogevinas M, Becher H, Benn T, Bertazzi PA, Boffetta P, Bueno de Mesquita HB, Coggon D, Colin D, Flesch-Janys D, Fingerhut M, Green L, Kauppinen T, Littorin M, Lynge E, Mathews JD, Neuberger M, Pearce N, Saracci R. 1997. Cancer mortality in workers exposed to phenoxy herbicides, chlorophenols, and dioxins. An expanded and updated international cohort study, American Journal of Epidemiology 145(12):1061–1075. Lampi P, Hakulinen T, Luostarinen T, Pukkala E, Teppo L. 1992. Cancer incidence following chlorophenol exposure in a community in southern Finland. Archives of Environmental Health 47(3):167–175.

OCR for page 242
Veterans and Agent Orange: Update 2002 LaVecchia C, Negri E, D'Avanzo B, Franceschi S. 1989. Occupation and lymphoid neoplasms. British Journal of Cancer 60(3):385–388. Lawrence CE, Reilly AA, Quickenton P, Greenwald P, Page WF, Kuntz AJ. 1985. Mortality patterns of New York State Vietnam veterans. American Journal of Public Health 75(3):277–279. Lynge E. 1985. A follow-up study of cancer incidence among workers in manufacture of phenoxy herbicides in Denmark. British Journal of Cancer 52(2):259–270. Lynge E. 1993. Cancer in phenoxy herbicide manufacturing workers in Denmark, 1947 –87—an update. Cancer Causes and Control 4(3):261–272. Mack TM. 1995. Sarcomas and other malignancies of soft tissue, retroperitoneum, peritoneum, pleura, heart, mediastinum, and spleen. Cancer 75(1):211–244. Mahan CM, Bullman TA, Kang HK, Selvin S. 1997. A case–control study of lung cancer among Vietnam veterans. Journal of Occupational and Environmental Medicine 39(8):740–747. Manz A, Berger J, Dwyer JH, Flesch-Janys D, Nagel S, Waltsgott H. 1991. Cancer mortality among workers in chemical plant contaminated with dioxin. Lancet 338(8773):959–964. McDuffie HH, Klaassen DJ, Dosman JA. 1990. Is pesticide use related to the risk of primary lung cancer in Saskatchewan Journal of Occupational Medicine 32(10):996–1002. McDuffie HH, Pahwa P, McLaughlin JR, Spinelli JJ, Fincham S, Dosman JA, Robson D, Skinnider LF, Choi NW. 2001. Non-Hodgkin's lymphoma and specific pesticide exposures in men: cross-Canada study of pesticides and health. Cancer Epidemiology, Biomarkers & Prevention 10(11): 1155–1163. Mellemgaard A, Engholm G, McLaughlin JK, Olsen JH. 1994. Occupational risk factors for renal-cell carcinoma in Denmark. Scandinavian Journal of Work, Environment, and Health 20(3):160– 165. Michalek JE, Wolfe WH, Miner JC. 1990. Health status of Air Force veterans occupationally exposed to herbicides in Vietnam. II. Mortality. Journal of the American Medical Association 264(14):1832–1836. Miller BA, Kolonel LN, Bernstein L, Young, Jr. JL, Swanson GM, West D, Key CR, Liff JM, Glover CS, Alexander GA, et al. (eds). 1996. Racial/Ethnic Patterns of Cancer in the United States 1988–1992. Bethesda, MD: National Cancer Institute. NIH Pub. No. 96-4104. Morris PD, Koepsell TD, Daling JR, Taylor JW, Lyon JL, Swanson GM, Child M, Weiss NS. 1986. Toxic substance exposure and multiple myeloma: a case–control study. Journal of the National Cancer Institute 76(6):987–994. Morrison H, Semenciw RM, Morison D, Magwood S, Mao Y. 1992. Brain cancer and farming in western Canada. Neuroepidemiology 11(4-6):267–276. Morrison H, Savitz D, Semenciw RM, Hulka B, Mao Y, Morison D, Wigle D. 1993. Farming and prostate cancer mortality. American Journal of Epidemiology 137(3):270–280. Morrison HI, Semenciw RM, Wilkins K, Mao Y, Wigle DT. 1994. Non-Hodgkin's lymphoma and agricultural practices in the prairie provinces of Canada. Scandinavian Journal of Work, Environment, and Health 20(1):42–47. Mueller N. 1995. Overview: viral agents and cancer. Environmental Health Perspectives 103(Suppl 8):259–261. Musicco M, Sant M, Molinari S, Filippini G, Gatta G, Berrino F. 1988. A case–control study of brain gliomas and occupational exposure to chemical carcinogens: the risks to farmers. American Journal of Epidemiology 128:778–785. Nanni O, Amadori D, Lugaresi C, Falcini F, Scarpi E, Saragoni A, Buiatti E. 1996. Chronic lymphocytic leukaemias and non-Hodgkin's lymphomas by histological type in farming-animal breeding workers: a population case–control study based on a priori exposure matrices Occupational and Environmental Medicine 53(10):652–657. NCI (National Cancer Institute). 2000. Surveillance, Epidemiology, and End Results (SEER) Program, Cancer Query System on the Web 1973–1997. http://www.seer.cancer.gov/Scientific Systems/Canques/spool/AAAfra434.html (accessed November 11).

OCR for page 242
Veterans and Agent Orange: Update 2002 NTP (National Toxicology Program). 1982. Technical Report Series No. 209. Carcinogenesis Bioassay of 2,3,7,8-Tetrachlorodibenzo-p-dioxin (CAS No. 1746-01-6) in Osborne-mendel Rats and B6c3F1 Mice (Gavage Study). NIH Publication No. 82-1765. 195 pp. National Toxicology Program, Research Triangle Park, NC, and Bethesda, MD. O'Brien TR, Decoufle P, Boyle CA. 1991. Non-Hodgkin's lymphoma in a cohort of Vietnam veterans. American Journal of Public Health 81:758–760. Ojajärvi IA, Partanen TJ, Ahlbom A, Boffetta P, Hakulinen T, Jourenkova N, Kauppinen TP, Kogevinas M, Porta M, Vainio HU, Weiderpass E, Wesseling CH. 2000. Occupational exposures and pancreatic cancer: a meta-analysis. Occupational and Environmental Medicine 57: 316–324. Olsson H, Brandt L. 1988. Risk of non-Hodgkin's lymphoma among men occupationally exposed to organic solvents. Scandinavian Journal of Work, Environment, and Health 14:246–251. Ott MG, Zober A. 1996. Cause specific mortality and cancer incidence among employees exposed to 2,3,7,8-TCDD after a 1953 reactor accident. Occupational and Environmental Medicine 53:606– 612. Pearce NE, Smith AH, Fisher DO. 1985. Malignant lymphoma and multiple myeloma linked with agricultural occupations in a New Zealand cancer registry-based sudy. American Journal of Epidemiology 121:225–237. Pearce NE, Smith AH, Howard JK, Sheppard RA, Giles HJ, Teague CA. 1986. Non-Hodgkin's lymphoma and exposure to phenoxyherbicides, chlorophenols, fencing work, and meat works employment: a case control study. British Journal of Industrial Medicine 43:75–83. Pearce NE, Sheppard RA, Smith AH, Teague CA. 1987. Non-Hodgkin's lymphoma and farming: an expanded case–control study. International Journal of Cancer 39:155–161. Percy C, Ries GL, Van Holten VD. 1990. The accuracy of liver cancer as the underlying cause of death on death certificates. Public Health Reports 105:361–368. Persson B, Dahlander AM, Fredriksson M, Brage HN, Ohlson CG, Axelson O. 1989. Malignant lymphomas and occupational exposures. British Journal of Industrial Medicine 46:516–520. Persson B, Fredriksson M, Olsen K, Boeryd B, Axelson O. 1993. Some occupational exposures as risk factors for malignant lymphomas Cancer 72:1773–1778. Pesatori AC, Consonni D, Tironi A, Landi MT, Zocchetti C, Bertazzi PA. 1992. Cancer morbidity in the Seveso area, 1976–1986. Chemosphere 25:209–212. Pesatori AC, Zocchetti C, Guercilena S, Consonni D, Turrini D, Bertazzi PA. 1998. Dioxin exposure and nonmalignant health effects: a mortality study Occupational and Environmental Medicine 55(2):126–131. Ramlow JM, Spadacene NW, Hoag SR, Stafford BA, Cartmill JB, Lerner PJ. 1996. Mortality in a cohort of pentachlorophenol manufacturing workers, 1940–1989. American Journal of Industrial Medicine 30:180–194. Revich B, Aksel E, Ushakova T, Ivanova I, Zhuchenko N, Klyuev N, Brodsky B, Sotskov Y. 2001. Dioxin exposure and public health in Chapaevsk, Russia. Chemosphere 43(4-7):951–966. Riedel D, Pottern LM, Blattner WA. 1991. Etiology and epidemiology of multiple myeloma. In: Wiernick PH, Camellos G, Kyle RA, Schiffer CA, eds. Neoplastic Disease of the Blood and Blood Forming Organs. New York: Churchill Livingstone. Riihimaki V, Asp S, Hernberg S. 1982. Mortality of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichlorophenoxyacetic acid herbicide applicators in Finland: first report of an ongoing prospective cohort study. Scandinavian Journal of Work, Environment, and Health 8:37–42. Rix BA, Villadsen E, Engholm G, Lynge E. 1998. Hodgkin's disease, pharyngeal cancer, and soft tissue sarcomas in Danish paper mill workers. Journal of Occupational and Environmental Medicine 40(1):55–62. Robinson CF, Waxweiler RJ, Fowler DP. 1986. Mortality among production workers in pulp and paper mills. Scandinavian Journal of Work, Environment, and Health 12:552–560.

OCR for page 242
Veterans and Agent Orange: Update 2002 Ronco G, Costa G, Lynge E. 1992. Cancer risk among Danish and Italian farmers. British Journal of Industrial Medicine 49:220–225. Saracci R, Kogevinas M, Bertazzi PA, Bueno De Mesquita BH, Coggon D, Green LM, Kauppinen T, L'Abbe KA, Littorin M, Lynge E, Mathews JD, Neuberger M, Osman J, Pearce N, Winkelmann R. 1991. Cancer mortality in workers exposed to chlorophenoxy herbicides and chlorophenols. Lancet 338:1027–1032. Schreinemachers DM. 2000. Cancer mortality in four northern wheat-producing states. Environmental Health Perspectives 108(9):873–881. Semenciw RM, Morrison HI, Morison D, Mao Y. 1994. Leukemia mortality and farming in the prairie provinces of Canada Canadian Journal of Public Health 85:208–211. Sharma-Wagner S, Chokkalingam AP, Malker HS, Stone BJ, McLaughlin JK, Hsing AW. 2000. Occupation and prostate cancer risk in Sweden. Journal of Occupational and Environmental Medicine 42(5):517–525. Smith AH, Pearce NE. 1986. Update on soft tissue sarcoma and phenoxyherbicides in New Zealand Chemosphere 15:1795–1798. Smith AH, Fisher DO, Giles HJ, Pearce NE. 1983. The New Zealand soft tissue sarcoma case– control study: interview findings concerning phenoxyacetic acid exposure. Chemosphere 12: 565–571. Smith AH, Pearce NE, Fisher DO, Giles HJ, Teague CA, Howard JK. 1984. Soft tissue sarcoma and exposure to phenoxyherbicides and chlorophenols in New Zealand. Journal of the National Cancer Institute 73:1111–1117. Smith JG, Christophers AJ. 1992. Phenoxy herbicides and chlorophenols: a case control study on soft tissue sarcoma and malignant lymphoma. British Journal of Cancer 65:442–448. Smith-Warner SA, Spiegelman D, Yaun SS, van den Brandt PA, Folsom AR, Goldbohm RA, Graham S, Holmberg L, Howe GR, Marshall JR, Miller AB, Potter JD, Speizer FE, Willett WC, Wolk A, Hunter DJ. 1998. Alcohol and breast cancer in women: a pooled analysis of cohort studies Journal of the American Medical Association 279(7):535–540. Solet D, Zoloth SR, Sullivan C, Jewett J, Michaels DM. 1989. Patterns of mortality in pulp and paper workers. Journal of Occupational Medicine 31:627–630. Steenland K, Piacitelli L, Deddens J, Fingerhut M, Chang LI. 1999. Cancer, heart disease, and diabetes in workers exposed to 2,3,7,8-tetrachlorodibenzo-p-dioxin. Journal of the National Cancer Institute 91(9):779–786. Suskind RR, Hertzberg VS. 1984. Human health effects of 2,4,5-T and its toxic contaminants. Journal of the American Medical Association 251:2372–2380. Svensson BG, Mikoczy Z, Stromberg U, Hagmar L. 1995. Mortality and cancer incidence among Swedish fishermen with a high dietary intake of persistent organochlorine compounds. Scandinavian Journal of Work, Environmental and Health 21(2):106–115. Swaen GMH, van Vliet C, Slangen JJM, Sturmans F. 1992. Cancer mortality among licensed herbicide applicators. Scandinavian Journal of Work, Environment, and Health 18:201–204. Sweeney MH, Calvert GM, Egeland GA, Fingerhut MA, Halperin WE, Piacitelli LA. 1997/98. Review and update of the results of the NIOSH medical study of workers exposed to chemicals contaminated with 2,3,7,8-tetrachlorodibenzodioxin Teratogenesis, Carcinogenesis, and Mutagenesis 17(4–5):241–247. Tarone RE, Hayes HM, Hoover RN, Rosenthal JF, Brown LM, Pottern LM, Javadpour N, O'Connell KJ, Stutzman RE. 1991. Service in Vietnam and risk of testicular cancer. Journal of the National Cancer Institute 83:1497–1499. Thiess AM, Frentzel-Beyme R, Link R. 1982. Mortality study of persons exposed to dioxin in a trichlorophenol-process accident that occurred in the BASF AG on November 17, 1953. American Journal of Industrial Medicine 3:179–189. Thomas TL. 1987. Mortality among flavour and fragrance chemical plant workers in the United States. British Journal of Industrial Medicine 44:733–737.

OCR for page 242
Veterans and Agent Orange: Update 2002 Thomas TL, Kang HK. 1990. Mortality and morbidity among Army Chemical Corps Vietnam veterans: a preliminary report. American Journal of Industrial Medicine 18:665–673. Thomas TL, Kang H, Dalager N. 1991. Mortality among women Vietnam veterans, 1973–1987. American Journal of Epidemiology 134:973–980. Thörn A, Gustavsson P, Sadigh J, Westerlund-Hännerstrand B, Hogstedt C. 2000. Mortality and cancer incidence among Swedish lumberjacks exposed to phenoxy herbicides. Occupational and Environmental Medicine 57:718–720. US Census. 1999. Statistical Abstract of the United States: 1999, 119th Edition. Washington, DC: US Bureau of the Census. Viel JF, Arveux P, Baverel J, Cahn JY. 2000. Soft-tissue sarcoma and non-Hodgkin's lymphoma clusters around a municipal solid waste incinerator with high dioxin emission levels. American Journal of Epidemiology 152(1):13–19. Villanueva EV. 2001. The validity of self-reported weight in US adults: a population based cross-sectional study. BMC Public Health 1(1):11. Vineis P, Terracini B, Ciccone G, Cignetti A, Colombo E, Donna A, Maffi L, Pisa R, Ricci P, Zanini E, Comba P. 1986. Phenoxy herbicides and soft-tissue sarcomas in female rice weeders. A population-based case-referent study. Scandinavian Journal of Work, Environment, and Health 13:9–17. Vineis P, Faggiano F, Tedeschi M, Ciccone G. 1991. Incidence rates of lymphomas and soft-tissue sarcomas and environmental measurements of phenoxy herbicides. Journal of the National Cancer Institute 83:362–363. Visintainer PF, Barone M, McGee H, Peterson EL. 1995. Proportionate mortality study of Vietnam-era veterans of Michigan Journal of Occupational and Environmental Medicine 37(4): 423–428. Warner M, Eskenazi B, Mocarelli P, Gerthoux PM, Samuels S, Needham L, Patterson D, Brambilla P. 2002. Serum dioxin concentrations and breast cancer risk in the Seveso Women's Health Study. Environmental Health Perspectives 110(7):625–628. Watanabe KK, Kang HK. 1995. Military service in Vietnam and the risk of death from trauma and selected cancers. Annals of Epidemiology 5:407–412. Watanabe KK, Kang HK. 1996. Mortality patterns among Vietnam veterans: a 24-year retrospective analysis. Journal of Occupational and Environmental Medicine 38(3):272–278. Watanabe KK, Kang HK, Thomas TL. 1991. Mortality among Vietnam veterans: with methodological considerations Journal of Occupational Medicine 33:780–785. Waterhouse D, Carman WJ, Schottenfeld D, Gridley G, McLean S. 1996. Cancer incidence in the rural community of Tecumseh, Michigan: a pattern of increased lymphopoietic neoplasms. Cancer 77(4):763–770. Weiderpass E, Adami HO, Baron JA, Wicklund-Glynn A, Aune M, Atuma S, Persson I. 2000. Organochlorines and endometrial cancer risk. Cancer Epidemiology, Biomarkers and Prevention 9:487–493. Wigle DT, Semenciw RB, Wilkins K, Riedel D, Ritter L, Morrison HI, Mao Y. 1990. Mortality study of Canadian male farm operators: non-Hodgkin's lymphoma mortality and agricultural practices in Saskatchewan. Journal of the National Cancer Institute 82:575–582. Wiklund K. 1983. Swedish agricultural workers: a group with a decreased risk of cancer Cancer 51:566–568. Wiklund K, Lindefors BM, Holm LE. 1988. Risk of malignant lymphoma in Swedish agricultural and forestry workers British Journal of Industrial Medicine 45:19–24. Wiklund K, Dich J, Holm LE, Eklund G. 1989a. Risk of cancer in pesticide applicators in Swedish agriculture. British Journal of Industrial Medicine 46:809–814. Wiklund K, Dich J, Holm LE. 1989b. Risk of soft tissue sarcoma, Hodgkin's disease and non-Hodgkin's lymphoma among Swedish licensed pesticide applicators. Chemosphere 18:395– 400.

OCR for page 242
Veterans and Agent Orange: Update 2002 Willman EJ, Hertz-Picciotto I, Keller JA, Martinez E, Charles MJ. 2001. A reproducible approach to the reporting of organochlorine compounds in epidemiologic studies. Chemosphere 44(6):1395– 402. Wolfe WH, Michalek JE, Miner JC, Rahe A, Silva J, Thomas WF, Grubbs WD, Lustik MB, Karrison TG, Roegner RH, Williams DE. 1990. Health status of Air Force veterans occupationally exposed to herbicides in Vietnam. I. Physical health. Journal of the American Medical Association 264:1824–1831. Woods JS, Polissar L, Severson RK, Heuser LS, Kulander BG. 1987. Soft tissue sarcoma and non-Hodgkin's lymphoma in relation to phenoxy herbicide and chlorinated phenol exposure in western Washington. Journal of the National Cancer Institute 78:899–910. Zack JA, Suskind RR. 1980. The mortality experience of workers exposed to tetrachlorodibenzodioxin in a trichlorophenol process accident. Journal of Occupational Medicine 22:11–14. Zahm SH, Fraumeni JF Jr. 1997. The epidemiology of soft tissue sarcoma. Seminars in Oncology 24(5):504–514. Zahm SH, Weisenburger DD, Babbitt PA, Saal RC, Vaught JB, Cantor KP, Blair A. 1990. A case– control study of non-Hodgkin's lymphoma and the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D) in eastern Nebraska. Epidemiology 1:349–356. Zahm SH, Blair A, Weisenburger DD. 1992. Sex differences in the risk of multiple myeloma associated with agriculture (2). British Journal of Industrial Medicine 49:815–816. Zahm SH, Weisenburger DD, Saal RC, Vaught JB, Babbitt PA, Blair A. 1993. The role of agricultural pesticide use in the development of non-Hodgkin 's lymphoma in women. Archives of Environmental Health 48:353–358. Zhong Y, Rafnsson V. 1996. Cancer incidence among Icelandic pesticide users. International Journal of Epidemiology 25(6):1117–1124. Zhu K, Levine RS, Brann EA, Gnepp DR, Baum MK. 1995. A population-based case–control study of the relationship between cigarette smoking and nasopharyngeal cancer (United States). Cancer Causes and Control 6(6):507–512. Zober A, Messerer P, Huber P. 1990. Thirty-four-year mortality follow-up of BASF employees exposed to 2,3,7,8-TCDD after the 1953 accident. International Archives of Occupational and Environmental Health 62:139–157.