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Index A B Abrams tanks, 15, 93â94, 96â97 Background, 13â22 ventilation in, 16, 95 dose-response modeling and risk Absorption, 25â27 assessment, 20â21 increased by skin excoriation, 27 exposure of military personnel to depleted skin, 27 uranium, 14â16 via deep wounds, 27 radiologic and chemical effects of exposure Accuracy impairment (A-IIac), 209 to depleted uranium, 17â20 Acute lymphocytic leukemia, 107 uses of depleted uranium, 14 Acute myeloid leukemia, 107 Balkans studies, 151â153 Aerosols, inhalable, 93â94 Baltimore Veterans Affairs Medical Center Afghanistan. See Operation Enduring Freedom (BVAMC), 15, 97, 143â151, 204, in Afghanistan 209â210, 212 A-IIac. See Accuracy impairment Beck Depression Inventory (BDI), 145, 147, Alpha particles, 17 209 Amyotrophic lateral sclerosis, 114 Becquerel (Bq), 17 Animal studies. See Nonhuman studies Beta particles, 18 Association Bias defining, 75 control of, 82â83 tests of, 81â82 studies vulnerable to, 86 Asthma, 113â114 Biokinetic models of exposure, 25 Atomic Weapons Establishment workers, Biologic plausibility, 80 142 of neurologic effects, 36 Automated Neuropsychological Assessment Biomarkers, 80, 160 Metrics Test Library, 148 Biotransformation, 27 263
264 INDEX Birth defects, and other adverse reproductive Categories of strength of association, 90â91 outcomes, 114â115 inadequate/insufficient evidence to Bladder cancer, 109â110, 199 determine whether an association exists, Blood-brain barrier, 31 4, 91, 195â202, 207, 209â211, 214â215 BNFL. See British Nuclear Fuels PLC limited/suggestive evidence of an Bone, a primary reservoir of uranium, 28â29 association, 4, 91 Bone cancer, 108â109, 153, 198 limited/suggestive evidence of no Bosnia-Herzegovina war, 14, 16, 153 association, 4, 91 Bq. See Becquerel origin of, 90 Bradley fighting vehicles, 15, 93, 95, 97 sufficient evidence of a causal relationship, Brain and other central nervous system cancers, 4, 90 110, 200 sufficient evidence of an association, 4, 91 Brain lipid oxidation, 35 Causation Brain regions, accumulation in, 28 defining, 75 Breast cancer, 106 true cause-effect association, 80 British Nuclear Fuels PLC (BNFL), 136â137, CEDR. See Comprehensive Epidemiology Data 204 Resource Bronchial cancer, 123 Cell toxicity, evaluating, 80 BVAMC. See Baltimore Veterans Affairs Central nervous system cancers, 110, 200 Medical Center Chemical effects, of exposure to depleted uranium, 17â20 Chemical toxicity, 19â20 C Chest X-ray testing, 114 Chondrosarcoma, 109 Camp Doha fire, 15, 94â95 Chordoma, 109 Cancer Chromosomal aberrations, 30â31 biological latency of, 80 Chronic bronchitis, 113 causes of, 105 Chronic kidney disease (CKD), 111 incidence of, 193 Chronic lymphocytic leukemia, 107 Cancer outcomes, 105â111, 193â203 Chronic myeloid leukemia, 107 bladder cancer, 109â110, 199 Chronic nephritis, 132, 203â204 bone cancer, 108â109, 153, 198 Chronic obstructive pulmonary disease brain and other central nervous system (COPD), 113â114 cancers, 110, 200 CKD. See Chronic kidney disease in depleted-uraniumâexposed animals, Cleft lip and palate, 114 29â30 Clinical end points of interest, 105â116 leukemias, 107, 196 cancer outcomes, 105â111 lung cancer, 88â89, 106â107, 123, noncancer outcomes, 111â115 126â135, 138, 194â196 Clinical outcomes, adverse, 81 lymphomas, 107â108, 197â198 Coexposures, 83â84 male genital cancers, 111, 201â202 to other agents, 89 other cancers, 203 synergism, 83â84 renal cancer, 109, 132, 198â199 Cohort descriptions, 117â192 stomach cancer, 110, 134, 200â201 depleted-uranium studies, 143â153 Capstone report, 16, 24, 93â96, 98, 208 environmental-exposure studies, 153â163 Carcinogenic effects, 29â30 summary, 163â190 Cardiovascular effects, 39, 126, 212 uranium-processing cohorts, 118â143 Case-control studies, 75, 85â86 Cohort studies, 75, 84â85 nested, 86, 130, 161, 163 prospective, 85 retrospective, 133 retrospective, 83, 85, 135, 140, 151 Case reports and case series, 87 Colon cancer, 156
INDEX 265 Colorado Plateau uranium-mill workers, DOD. See US Department of Defense 119â123, 203, 208, 212 DOE. See US Department of Energy Committee Dose reconstruction, 89 approach to its charge, 3â4 Dose-response modeling and risk assessment, charge to, 3 20â21, 79, 128, 131â132, 139, 159, 195 task of, 10 Dosimeter, thermoluminescent, 100 Comparison-group issues, in study populations, Down syndrome, 114 77 Drinking water and residential exposure, 206 Comprehensive Epidemiology Data Resource Dupree-Ellis et al., 2000, 198, 200, 203 (CEDR), 124â125 Dusts, uranium-particle-containing, 25 Computerized Occupational Referent Population System (CORPS), 126 Conclusions, 193â262 E cancer outcomes, 193â203 noncancer outcomes, 203â214 Ecologic studies, 87 summary, 214â215 Effective dose equivalent, 19 Conditional logistic regression, 130 Egyptian processors, 142â143, 207 Confidence interval, 204 Electromagnetic separation, 127 Control of bias, 82â83 Emphysema, 113, 123, 126 information bias, 83 End Stage Renal Disease Program Management selection bias, 77, 83 and Medical Information System COPD. See Chronic obstructive pulmonary (ESRD), 122â123 disease Environmental-exposure studies CORPS. See Computerized Occupational cohort descriptions, 153â163 Referent Population System Finnish well-water studies, 157â163 Cox proportional-hazard models, 140 residential studies, 153â157 Cox regression analyses, 141 Environmental monitoring, 80 Cross-sectional studies, 75, 86â87 Epidemiologic studies controlling for risk factors, 75 principal objectives of, 75â76 D Epidemiologic-study designs, 84â87 case-control studies, 85â86 Danish Cancer Society, 152 case reports and case series, 87 Death-certificate data, 113, 119â121, 127â128, cohort studies, 84â85 132, 137 cross-sectional studies, 86â87 Depleted Uranium Follow-up Program, 15, ecologic studies, 87 143â144, 148, 209â210, 212 ESRD. See End Stage Renal Disease Program Depleted-uranium studies Management and Medical Information Balkans studies, 151â153 System Baltimore Veterans Affairs Medical Center, EUROCAT Protocol, 153 15, 143â151 Ewing tumor, 109 cohort descriptions, 143â153 Excretion and retention, 28â29 UK Gulf War studies, 151 Exposure assessment, 77â80, 93â103. See Deposition pattern in the human body, Levels I, II, III especially airways, 89 classifying workers by maximum exposure, Dermal effects, 40 78â79 Developmental studies. See Reproductive and direct measurement in individual workers, 78 developmental studies estimation of exposure to depleted uranium Direct measurement, in individual workers, during the Gulf War, 93â100 78, 95 exposure-monitoring methods, 100â102 Disease occurrence, 86â87 exposure of military personnel to depleted Distribution issues, 27â28 uranium, 14â16
266 INDEX other methods of estimating exposures, H 79â80 self-reporting in, 79 Half-life, radioactive, 17 using work history to model cumulative Hazard ratios (HRs), 161â163 exposure, 78 Healthy-warrior effect, 77, 85 Healthy-worker effect, 77, 204 Heavy-armor tanks, 14. See also individual F vehicle listings Hematologic effects, 41, 213 False-negative results, 79 Hematopoietic cancer, 123, 134 Fernald Feed Materials Production Center Hepatotoxicity, 36â37 (FFMPC) workers, 97, 123â126, 133, Hodgkin lymphoma, 107, 121, 123, 152, 197 156, 206, 208, 212 HPRT mutation frequency, 148â150 Fernald Resident Medical Monitoring Program HRs. See Hazard ratios (FMMP), 156â157 Human Respiratory Tract Model, 101 FFMPC. See Fernald Feed Materials Production Center Fibrosarcoma, 109 I Finnish well-water studies, 157â163 FMMP. See Fernald Resident Medical IARC. See International Agency for Research Monitoring Program on Cancer Friendly-fire incidents, 94 ICP-MS. See Inductively coupled plasma-mass spectrometry Immune system effects, 38â39, 213 G In vitro models, 24 to assess neurologic effects, 33â34 Gamma rays, 18 In vivo models, to assess neurologic effects, Gastric cancer, 110 34â36 Gastrointestinal effects, 36 Inadequate/insufficient evidence to determine absorption of uranium, 26 whether an association exists, 4, 91, Genitourinary diseases, 204 195â202, 207, 209â211, 214â215 Genotoxic effects, 26, 30â31, 147, Inclusion criteria, 88 212 Inductively coupled plasma-mass spectrometry tests for, 148 (ICP-MS), 26, 28, 31, 33â35 Geographic proximity modeling, 80 Information bias, 83 German peacekeeping personnel, 16 Information-gathering strategy, 73â74 Glomerular filtration rate (GFR), 111â112 Inhalation studies, 26 Greenham Common US Air Force base, Interaction. See Synergism 153 Internal comparison groups, 77 Gulf War and Health, Volume 1: Depleted Internal dose, of radiation, 78 Uranium, Pyridostigmine Bromide, International Agency for Research on Cancer Sarin, Vaccines, 2â5, 9â10, 24, 27, (IARC), 75, 90 29â32, 36â41, 73, 88â89, 117â118, 144, International Classification of Diseases 193, 195, 203, 207â208 ICD-6, 120 summary of findings in the section on ICD-8, 127â128 depleted uranium in, 9 ICD-9, 122, 151, 156â157 Gulf War veterans, 3, 7â8, 14, 20â21, 30, 76, ICD-10, 107â108 81, 93, 97â98, 106, 114, 117â118, International Classification of Diseases 143â144, 146, 148â151, 193, 201â203, Adapted for Use in the United States, 209â210, 212â213 ICDA-8, 130 depleted-uranium surveillance study of, International Commission on Radiological 204â206 Protection, 13, 25, 102, 140, 162
INDEX 267 International Red Cross and Red Crescent Medical Subject Heading (MeSH), 73 Movement, 16 Metallotoxic effects, 31 Intervention strategies, 20 Metastasis, from other primary cancers, 131 Italian Ministry of Defense, 152 Methodology, 73â92 categories of strength of association, 90â91 considerations in statistical inference, 81â84 K epidemiologic-study designs, 84â87 exposure assessment, 77â80 Kidneys, a primary reservoir of uranium, 28â29 factors influencing the relevance and quality Kinetic-energy cartridges and ammunition of studies, 76â84 rounds, 2, 14 inclusion criteria, 88 Kosovo war, 2, 14, 16 information-gathering strategy, 73â74 Kuwait, invasion of, 7 outcome assessment, 80â81 principal objectives of epidemiologic studies, 75 L rationale for not including studies of Leukemias, 107, 196 uranium miners, 88â90 Level I exposure, 15, 94 study populations, 76â77 Level II exposure, 15, 94, 98â100 Monsonâs life-table analysis, 125 Level III exposure, 15â16, 94â95, 117 Morbidity, 204â207 Life Table Analysis System (LTAS) drinking water and residential exposure, 206 modified, 120â122 Gulf War veterans depleted-uranium Monsonâs, 125 surveillance study, 204â206 Limited/suggestive evidence of an association, occupational uranium exposure, 206â207 4, 91 Mortality, 113, 119, 123, 129â131, 133, 135, Limited/suggestive evidence of no association, 138â139, 141, 203â204 4, 91 all-cause, 81, 126â127 Linear no-threshold model, validity of, 21 cause-specific, 120, 128 Linear regression, 143, 160 patterns of, 118 Longitudinal studies, 84 Motor vehicle department records (state), 128, LTAS. See Life Table Analysis System 134 Lung cancer, 88â89, 106â107, 123, 126â135, Musculoskeletal effects, 40â41 138, 194â196 Mutations, 105. See also HPRT mutation Lymphatic cancer, 123, 134 frequency Lymphomas, 107â108, 197â198. See also Hodgkin lymphoma; Non-Hodgkin lymphoma N Lymphosarcoma, 123 National Center for Health Statistics, 154 National Council on Radiation Protection and Measurements, 98 M National Death Index (NDI), 122, 125, 130, Male genital cancers, 111, 201â202 132, 139 Malignant fibrous histiocytoma, 109 National Health and Nutrition Examination Malignant neoplasms, 126 Survey, 111 Mallinckrodt Chemical Workers (MCW), National Health Interview Survey, 209 131â133, 203, 212 National Health Services Central Register MCW. See Mallinckrodt Chemical Workers (NHSCR), 136â138, 151 Mechanism-of-action studies, 23 National Institute for Occupational Safety and Mechanisms of toxicity, radiologic vs chemical, Health (NIOSH), 121â122, 124, 126, 89 134
268 INDEX National Report on Human Exposure to O Environmental Chemicals, 101 National Research Council, 16, 20, 24, 96, 162, Oak Ridge nuclear facilities workers, 126â131, 208 194, 204 National Technical Information Service, 73 Occupational studies, 84 NDI. See National Death Index of uranium exposure, 206â207 Nephrotoxic effects, 208 Ocular effects, 40 Nested case-control studies, 86, 130, 161, 163 Office for National Statistics (ONS), Neurobehavioral and neurocognitive effects, 136â138 114 Office of the Special Assistant for Gulf War Neurocognitive tests, 147 Illnesses, 15 Neurologic effects, 32â36, 114, 209â210 OIF. See Operation Iraqi Freedom biologic plausibility, 36 ONS. See Office for National Statistics in vitro models to assess, 33â34 Operation Enduring Freedom in Afghanistan, 9 in vivo models to assess, 34â36 Operation Iraqi Freedom (OIF), 2, 9, 14, 76, Neuronal lethality, 33 117, 144 Neuropsychologic tests, 146 Osteosarcoma, 109 NHANES III. See Third National Health and Outcome assessment, 80â81 Nutrition Examination Survey adequate followup period, 80â81 NHIS. See US National Health Interview Study adverse clinical outcomes, 81 NHL. See Non-Hodgkin lymphoma biological plausibility, 80 NHSCR. See National Health Services Central biomarkers, 80 Register Outcomes, 105â116, 193â262 NIOSH. See National Institute for Occupational cancer outcomes, 105â111, 193â203 Safety and Health noncancer outcomes, 111â115, 203â214 Noncancer outcomes, 111â115, 203â214 specificity of, 81 birth defects and other adverse reproductive summary, 214â215 outcomes, 114â115 neurobehavioral and neurocognitive effects, 114 P neurologic effects, 114, 209â210 p values, 82 nonmalignant renal disease, 111â112, Pension Benefit Information, 132 203â208 Persian Gulf War. See Gulf War veterans nonmalignant respiratory disease, 113â114, Persian Gulf War Veterans Act, 1, 7 208â209 Person-years at risk (PYARs), 134â135, 142 other health outcomes, 211â214 Peyerâs patches, 26, 29 reproductive and developmental effects, Pharmacokinetics, of uranium, 28 210â211 Phosphate-fertilizer production workers, Non-Hodgkin lymphoma (NHL), 107â108, 197 134â135 Nonhuman studies, 23â24, 29â30 Physicochemical properties, differences in, 89 Nonmalignant renal disease, 111â112, 203â208 Pleura, cancer of, 138 conclusion, 207â208 Pneumoconiosis, 113, 123 morbidity, 204â207 Pneumonia, 113 mortality, 203â204 Poisson regression analysis, 128â129 Nonmalignant respiratory disease, 113â114, Portsmouth Uranium Enrichment facility 122â123, 208â209 workers, 133â134 North Atlantic Treaty Organization, 14 Prevalence odds ratios, 86â87 No-threshold model, linear, 21 Prospective cohort studies, 85 Nuclear-fuels fabrication workers, 135â136 Prostatic cancer, 106, 111, 142, 201â202 Nuclear Regulatory Commission, 140 PubMed, 73 Null hypotheses, 81â82
INDEX 269 Pulmonary fibrosis, uraniumâs ability to induce, Rocketdyne/Atomics International (RAI) 30â31 workers, 139â141, 212 PYARs. See Person-years at risk Royal Society report, 16, 93â96, 98, 100 RRs. See Risk ratios R S Radiation estimates of risk, 19 Sandia report, 93â96, 98, 100 film badges measuring, 78, 100, 132 Savannah River Plant workers, 141â142, internal dose of, 78 204 Radioactive decay, 17 SCEs. See Sister-chromatid exchanges Radioactivity, 17 Selection bias, 77, 83 Radiogenic-cancer risk estimation, 20 Self-reporting, 79 Radiologic considerations, 17â19 Sievert, 19 Radiologic effects, of exposure to depleted SIRs. See Standardized incidence ratios uranium, 17â20 Sister-chromatid exchanges (SCEs), 212 Radiologic vs chemical mechanisms of toxicity, Skeletal effects, 213 89 Sleep-wake cycle disturbances, 35 RAI. See Rocketdyne/Atomics International Smoking, a confounding variable, 89 workers SMRs. See Standardized mortality ratios RCCs. See Renal-cell carcinomas Springfields processing plant, 201 Rectal cancer, 156 Standardized incidence ratios (SIRs), 135, 152, Regression analyses, 146 155, 198, 202 Cox, 141 Standardized mortality ratios (SMRs), 77, REM sleep, 35â36 81, 85, 120â122, 128â142, 154â155, Renal cancer, 109, 132, 198â199 194â196, 198 Renal-cell carcinomas (RCCs), 109 cause-specific, 135 Renal disease, 157 Statistical inference, 81â84 Renal dysfunction, evaluating, 80 coexposures, 83â84 Renal effects, 31â32 control of bias, 82â83 Renal toxicants, 19â20 the p value, 82 Reproductive and developmental studies, tests of association, 81â82 37â38, 145, 210â211 type I and type II, 82 multigenerational, 39 Stomach cancer, 110, 134, 200â201 Residential studies, 100, 153â157 Structure-activity relationships, 23 Respiratory effects, 31 Study populations, 76â77 neoplasms, 129 comparison-group issues, 77 Reticulosarcoma, 123 relevance to veteran populations, 76 Retrospective case-control studies, 133 Sufficient evidence of a causal relationship, Retrospective cohort studies, 83, 85, 135, 140, 4, 90 151 Sufficient evidence of an association, Review of Toxicologic and Radiologic Risks to 4, 91 Military Personnel from Exposure to Summary, 1â5, 214â215 Depleted Uranium During and After of findings in the section on depleted Combat, 16, 24, 208 uranium in Gulf War and Health, Risk estimates, 20â21 Volume 1, 9 of radiation, 19 Swedish Armed Forces, 151 Risk ratios (RRs), 84, 131, 136â138, 141, 155, Swedish Cancer Registry, 152 198 Swedish Rescue Services Agency, 151â152 Risk transfer, 89 Synergism, 83â84, 89
270 INDEX T Uranium, 13 accumulations of, 28 Tennessee Eastman Corporation (TEC), isotopes of, 18â19 126â127, 133 naturally occurring, 101 Test statistics, 82 pharmacokinetics of, 28 Testicular cancer, 106, 111, 138, 202 Uranium intoxication, 40 Tests of association, 81â82 Uranium minersâ studies Texas Department of Health, 155 coexposures to other agents, 89 Third National Health and Nutrition deposition pattern in the human body, Examination Survey (NHANES III), especially airways, 89 157 differences in physicochemical properties, Thyroid diseases, 157 89 Toxicity studies, 29â41 radiological vs chemical mechanisms of application of the toxicologic data, toxicity, 89 41â66 rationale for not including, 88â90 carcinogenic effects, 29â30 Uranium-processing cohorts, 118â143 cardiovascular effects, 39 Atomic Weapons Establishment workers, dermal effects, 40 142 gastrointestinal effects, 36 Colorado Plateau uranium-mill workers, genotoxic effects, 30â31 119â123 hematologic effects, 41 Egyptian processors, 142â143 hepatotoxicity, 36â37 Fernald Feed Materials Production Center immune system effects, 38â39 workers, 123â126 musculoskeletal effects, 40â41 Mallinckrodt Chemical Workers, 131â132 neurologic effects, 32â36 nuclear-fuels fabrication workers, 135â136 ocular effects, 40 Oak Ridge nuclear facilities workers, renal effects, 31â32 126â131 reproductive and developmental effects, phosphate-fertilizer production workers, 37â38 134â135 respiratory effects, 31 Portsmouth Uranium Enrichment facility as secondary information sources, 42 workers, 133â134 summary of previous report, 24 Rocketdyne/Atomics International workers, Toxicokinetics, 25â29. See also Mechanisms 139â141 of toxicity Savannah River Plant workers, 141â142 absorption, 25â27 United Kingdom processors, 136â137 distribution issues, 27â28 workers at four uranium-processing excretion and retention, 28â29 operations, 133 transport and biotransformation, 27 US Army, 2, 14, 16, 24, 208 Toxicology, 23â72 US Congress, 1 Toxicology Literature Online (TOXLINE), 73 US Department of Defense (DOD), 2, 15, 94, Tracheal cancer, 123 144 Transport and biotransformation, 27 US Department of Energy (DOE), 16, 97, 124, Type I and type II statistical inference, 82 140 US Department of Veterans Affairs (VA), 1, 7, 143 U request for this study, 9â10 US Environmental Protection Agency, 38 Union Carbide, 127 US National Guard, 16 United Kingdom (UK) Gulf War studies, 151 US National Health Interview Study (NHIS), United Kingdom (UK) Ministry of Supply, 138 157 United Kingdom (UK) processors, 136â137 US Nuclear Regulatory Commission, 19, 98
INDEX 271 US Postal Service, 122 Volume 1. See Gulf War and Health, Volume US Public Health Service, 119 1: Depleted Uranium, Pyridostigmine US Surgeon General, 119 Bromide, Sarin, Vaccines Uterine cancer, 138 W V WHO. See World Health Organization VA. See US Department of Veterans Affairs Whole-body radiation counting, 97 Vaccines, given to US troops, health effects Wide Range Achievement Test 3 Reading of, 90 (WRAT-3), 145, 147, 209 Ventilation, in tanks, 16, 93 Work history, using to model cumulative Veteran populations exposure, 78 applicability of study results to, 76 World Health Organization (WHO), 90, 105, Veterans Programs Enhancement Act, 1, 7 145, 210 WRAT-3. See Wide Range Achievement Test 3 Reading