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Veterans and Agent Orange: Update 2002 (2003)
Board on Health Promotion and Disease Prevention (HPDP)
 Institute of Medicine (IOM)

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Veterans and Agent Orange: Update 2002

Low birthweight

Childhood cancer in offspring, including acute myelogenous leukemia

Abnormal sperm characteristics and infertility

Cognitive and neuropsychiatric disorders

Motor or coordination dysfunction

Chronic peripheral nervous system disorders

Gastrointestinal, metabolic, and digestive disorders (changes in liver enzymes, lipid abnormalities, and ulcers)

Immune system disorders (immune suppression and autoimmunity)

Circulatory disorders

Respiratory disorders

AL-type primary amyloidosis

Endometriosis

Effects on thyroid homeostasis

Limited or Suggestive Evidence of No Association

Several adequate studies, covering the full range of levels of exposure that human beings are known to encounter, are consistent in not showing a positive association between any magnitude of exposure to herbicides and the outcome. A conclusion of “no association” is inevitably limited to the conditions, exposure, and length of observation covered by the available studies. In addition, the possibility of a very small increase in risk at the exposure studied can never be excluded. There is limited or suggestive evidence of no association between exposure to herbicides and the following health outcomes:

Gastrointestinal tumors (stomach cancer, pancreatic cancer, colon cancer, and rectal cancer)

Brain tumors

aHerbicides refers to the major herbicides used in Vietnam: 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) and its contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD or dioxin), cacodylic acid, and picloram. The evidence regarding association is drawn from occupational and other studies in which subjects were exposed to a variety of herbicides and herbicide components.

up to the unavailability of the information that would be necessary to measure the risk to people exposed to herbicides during service in Vietnam during the Vietnam conflict.

Despite those limitations, some general conclusions can be drawn regarding the risks to Vietnam veterans, depending on the category of the association between exposure and a given health outcome. Even for outcomes for which there is “sufficient” or “limited or suggestive” evidence of an association with herbicide exposure, it is not possible to calculate precise estimates of risk, if any, among Vietnam veterans because of the lack of exposure information for this population. Such estimates are also not possible when there is “inadequate or insufficient” evidence of an association. But, when there is “limited or suggestive evidence of

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