Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 272
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Appendix E
Details of Epidemiologic Studies on Trichloroethylene and Perchloroethylene
OCR for page 273
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
TABLE E-1 Exposure Information on Epidemiologic Studies Involving Exposure to TCE or PCE
Reference
Study Design, Exposure, Outcomes
Exposure Assessment
Exposure Metrics
Comments
Aschengrau et al. 2003
Population-based case-control
Relative dose of PCE estimated by algorithm with variables for residential history, water flow (geometry, load on water-distribution system), pipe characteristics (such as pipe diameter, age); inputs determined from maps from local water suppliers or state DEPs
Ever vs never exposed (served by private well for entire Cape Cod residence)
Nine latency periods examined (0, 5, 7, 9, 11, 13, 15, 17, 19 years)
Cape Cod, MA
Cumulative exposure for each latency period: sum of RDDs for each residence (mass of TCE entering home in tap water over time at each address); categorized as never, low (up to and including median RDD), high RDD (above 50th, 75th, or 99th percentile)
PCE from inner vinyl liner in cement pipes distributing tap water
Breast cancer
Blair et al. 2003
Cohort study of dry cleaners
Exposure score for jobs based on published monitoring studies of dry-cleaning industry; scores increased with proximity
Exposure score assigned on basis of jobs held (cleaners, high, score of 40; pressers, sewers, counter workers, score of 7; pickup workers, low, score of 0)
Adjustment for age, sex, calendar time
PCE used as solvent in dry cleaning
Cancers, other causes of death
Little or no exposure (score of 0) vs medium-high exposure (score of 7 or 40)
Boice et al. 2006
Cohort of rocket-engine testing-facility workers
All Rocketdyne workers employed on or after Jan. 1, 1948, for 6+ mo at SSFL, nearby facilities (for comparison group); identified from personnel files, work history cards; exposed were test-stand mechanics, inspectors, test-stand engineers, research engineers; personnel listings used to place test-stand mechanics at specific stands in calendar years; descriptive industrial-hygiene information to classify potential exposure to hydrazine, TCE, other chemicals; discussions with workers
Duration of employment (years) (SMR)
Adjustment for year of birth, year of hire
Hydrazine, TCE
Potential for exposure (flush engine parts or utility solvent use) (SMR)
All causes of death
Duration of employment (RR)
4 decades of employment (RR)
Years worked as test-stand mechanic (RR)
Years worked with any potential TCE exposure (less than 4 years vs at least 4 years) (RR)
Years worked with potential TCE exposure via engine cleaning, weighted by number of engine tests (less than 4 test-years vs at least 4 test-years )
OCR for page 274
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Design, Exposure, Outcomes
Exposure Assessment
Exposure Metrics
Comments
Brüning et al. 2003
Hospital-based case-control
Telephone interview, occupational questionnaire devoted to screw-cutting industry and general for other jobs; TCE, PCE exposure for at least one job period (1+ year), cumulative of TCE in ppm per job per year in job, peaks; assessment semiquantitative for exposure to TCE, PCE; qualitative for other occupational exposures; confidence score (certain, probable, possible) used for each exposure assessed; assessed industry and job-title codes
Ever employed in specific occupations
West Germany (site of metal, paper, wood-processing industries)
Longest job held
TCE, PCE
Ever worked in tasks, occupations, or industries with TCE or PCE exposure
Renal-cell cancer
Cumulative exposure assessed with JEM (Pannet et al. 1985): none, low, high (dichotomized at median)
Self-reported exposure to TCE, PCE (separately)
Occurrence of narcotic symptoms (any, nondaily, or daily) (TCE)
Duration of exposure to TCE (none, less than 10 years, 10 to less than 20 years, 20+ years), PCE (none, less than 10 years, 10+ years)
Chang et al. 2003
Cohort-mortality study of electronics factory workers
Employment histories at different factories, changes in insurance status from Bureau of Labor Insurance computer database for 1978-1997; confirmed, supplemented with list of names of patients in labor-insurance hospitalization dataset, United Labor Association; duration of employment calculated from insurance records, operation history of index electronics factory (1968-1992); EPA in Taiwan verified pollution of wells with TCE, PCE
Duration of employment (SMR) categorized as 1 year or less, more than 1 year but less than or equal to 5 yrs, more than 5 years)
Taiwan
Year of death from cancer (1985-1990, 1991-1997)
TCE, PCE
Cancers
Charbotel et al. 2006
Case-control
Information from occupational questionnaires, task-exposure matrix for screw-cutting tasks; employee’s activity, job title encoded; assessed for exposure to solvents, oils, welding fumes, etc.; semiquantitative assessment for exposure to TCE, qualitative (low, medium, high) for other exposures
By industry (NACE codes) (OR)
Adjustment for tobacco-smoking, BMI
Arve Valley (France)
By Job title (ILO 68 codes) (OR)
TCE used as degreasing agent in screw-cutting industry in Arve Valley
Ever vs never exposed (OR)
Cumulative exposure (ppm-years); task-exposure matrix used to estimate cumulative
OCR for page 275
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Other exposures (chlorinated solvents, oxygenated solvents, white-spirit and petroleum solvents), oils, welding fumes, lead, cadmium, asbestos
dose for each job period (OR) (categorized into tertiles)
Cumulative exposure with assessment for peaks (low-medium without peaks, low-medium with peaks, high without peaks, high with peaks) (OR)
Renal-cell cancer
Cumulative exposure with assessment for peaks (low-medium without peaks, low-medium with peaks, high without peaks, high with peaks) with only exposures scored certain or probable summed in cumulative-exposure score (OR)
Costas et al. 2002
Case-control
Exposure assessed based on potential for residence to receive water from contaminated wells G and H, not on actual contaminant concentration in wells; water-distribution model used, validated; cumulative exposure based on exposure periods, operation of wells
With water-distribution model, exposure index developed for each hydraulic area and month (exposure index: fraction of month when contaminated water reached hydraulic area multiplied by fraction of water supplied by contaminated wells)
Woburn, MA
TCE-contaminated groundwater wells in Woburn, MA (site of tannery, chemical manufacturing wastes)
Average, cumulative exposure scores (for seven etiologic windows) categorized as never vs some or never, least, most (median of some exposure used to define least, most)
TCE (primary), PCE
Childhood leukemia
Etiologic windows: entire etiologic period (2 years before conception to date of case diagnosis); preconception period, duration of pregnancy; 1st, 2nd, 3nd trimester of pregnancy; period from time of birth to case diagnosis
De Roos et al. 2001
Case-control (cases identified from hospitals participating in two pediatric collaborative clinical trials)
Self-reported occupational exposures to solvents obtained by telephone interview; industrial-hygienist review of self-reported exposures
Self-reported parental exposure to five categories of chemicals (halogenated hydrocarbons; nonvolatile hydrocarbons; volatile hydrocarbons; paints, inks, pigments; metals, alloys, solders (any vs none)
Adjustment for child’s age, maternal race, maternal age, maternal education
Occupational exposure to five categories of chemicals
Neuroblastoma
Industrial hygienist reviewed assessment of exposure on basis of questionnaire data (probable exposure assigned yes, otherwise no)
OCR for page 276
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Design, Exposure, Outcomes
Exposure Assessment
Exposure Metrics
Comments
Diot et al. 2002
Hospital-based case-control
Employment periods of over 6 mo recorded from interview, but only employment corresponding to period before patient’s diagnosis was included; exposure to various occupational hazards asked; expert committee (occupational physicians, epidemiologists, industrial hygienists) assessed exposure
Ever vs never exposed
Central region of France
High cumulative exposure score vs those without high cumulative exposure score
Occupational exposures to silica, organic solvents (including TCE)
Cumulative exposure score: sum of exposure scores for each employment
Systemic sclerosis
Exposure score: probability × intensity × frequency × duration; probability of exposure: 0 = nonexposure, 0.25 = possible exposure, 0.75 = probable exposure, 1 = certain exposure; intensity of exposure: 0 for nonexposure to 1 for highest level of exposure; length of time worked daily: <10% = 0.05, 10-50% = 0.30, >50% = 0.75; number of years worked
Fabbro-Peray et al. 2001
Population-based case-control
Cohort interviewed about occupational exposures, including chemicals, pesticides, electromagnetic radiation; asked about smoking; subjects considered exposed if exposure lasted more than 1 year
Self-reported exposure (yes vs no)
Lag time of 5 years before diagnosis (or interview for controls)
Languedoc-Roussillon, France
Age at first exposure
Occupational exposure to benzene, rubber, coal tar, paints, waste oil, dry-cleaning solvents, petroleum products, pesticides
Duration of exposure (never, up to 15 years, over 15 years)
Adjustment for age, sex, urban setting, education
Cumulative exposure (lifetime-days of exposure) (never-erratic, up to 810 days, over 810 days)
Time since first exposure (never, up to 10 years, over 10 years)
Non-Hodgkin lymphoma
Further classifications for benzene, pesticides
Garabrant et al. 2003
Case-control
Women asked whether ever worked at least once a week for 3 mo or more in any of 16 jobs or hobbies that commonly involve solvents; information obtained on job title, years, specific tasks, nine specific solvents (paint thinners and removers, mineral spirits naphtha or white spirits, gasoline, toluene, xylene, benzene, TCE, PCE, trichloroethane), other solvents), safety precautions; reviewed by expert
Self-reported exposure to specific, all solvents
Adjustment for age, year of birth
Michigan, Ohio
Occupational or hobby-related exposure to hydrocarbons, chlorinated solvents
Expert-reviewed exposure to specific, all solvents
Self-reported jobs, hobbies
Systemic sclerosis
OCR for page 277
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Hansen et al. 2001
Cohort
Historical files of individual air, urinary measurements of TCE exposure ( from Labor Inspection Services of Denmark); job information reconstructed from national pension fund
Period of first employment (1947-1964, 1965-1989)
Sensitivity analyses: 10-year, 20-year lag periods (data not shown; no change in results)
Denmark
Duration of employment (less than 75 mo vs at least 75 mo)
TCE
Cancer
Average personal TCE exposure (less than 19 mg/m3 vs at least 19 mg/m3)
Cumulative TCE exposure (less than 1,080 months-mg/m3 vs at least 1,080 months-mg/m3)
Infante-Rivard et al. 2005
Population-based case-control
Maternal occupational exposures to solvents before and during pregnancy estimated by coding by job for specific contaminants (also called expert method); coded for 21 solvents; home exposure to solvents evaluated on basis of activities, including hobbies, furniture stripping, electronic and motor-vehicle repair, home painting
Jobs held during 2 years before, during pregnancy coded as “possible,” “probable,” “definite”; level assigned (low = 1, medium = 2, high = 3)
Adjustment for age, education
Quebec, Canada
Maternal occupational exposure to solvents, solvent mixtures
Any vs no exposure
Childhood ALL
Any vs no exposure (none and “possible” vs “probable” and “definite”)
Level of exposure (0 = baseline, 1 = some exposure (concentration × frequency less than 4), 2 = greater exposure (concentration × frequency at least 4)
Krishnadasan et al. 2007
Nested case-control
Workers employed 1950-1992 at nuclear-energy, rocket-engine-testing facility; company records used to construct JEM for exposures to hydrazine, TCE, PAHs, benzene, mineral oil; from job-description manuals, walk-throughs, interviews; industrial hygienist created estimate of likelihood, intensity of exposures during three periods (1950s-1960s, 1970s, 1980s-1990s); duration of employment of longest-held job (and others)
Industry-based JEM (for all jobs held)
20-year (and zero lag) exposure estimates
Nuclear-energy, rocket-engine development, testing facility in Southern California
For each job and by chemical, likelihood (none, low, high), intensity (low, medium, high) for three periods (1950-1969, 1970-1979, 1989-1999)
Adjustment for occupational physical activity, SES, other chemical exposures
PAHs, TCE, hydrazine, mineral oil, benzene
Cumulative-exposure score for each worker for all jobs held (none, low, moderate, high); cumulative-exposure score = sum of duration of employment × estimated intensity for each job
Prostatic cancer
Cumulative-exposure scores categorized by quartiles: unexposed vs low-moderate vs high
OCR for page 278
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Design, Exposure, Outcomes
Exposure Assessment
Exposure Metrics
Comments
Lee et al. 2003
Case-control; residents of two villages in vicinity of electronics factory
Groundwater sampling from off-site residential wells in nearby communities October 1999-May 2000; exposed were downstream residents; stratified on calendar periods based on establishment of factory (allowing 10 years to detect health effects of exposure)
Upstream (referent) vs downstream village (validated by groundwater well samples—detectable vinyl chloride, TCE, PCE, 1,1-dichloroethylene, 1,1,1,-trichloroethane, cis-1,2-dichloroethylene, 1,1-dichloroethane)
Chlorinated hydrocarbons in groundwater contaminated by hazardous-waste site (formerly electronics factory)
Period of death: 1966-1979 (referent), 1980-1989, 1990-1997
Hepatic-cancer mortality
Lynge et al. 2006
Nested case-control; cohort of laundry, dry-cleaning workers
Occupation code “laundry and dry-cleaning worker” or industry code “laundry and dry cleaning”; categorized on basis of fewer than 10 workers in shop, laundry workers and other workers in dry-cleaning shops; length of employment in shop where worked in 1970 (only the period of 1964-1979 was included); interviews with next of kin; detailed history of dry cleaning in Nordic countries
Exposure categories: unexposed, dry cleaner and other exposed, other in dry cleaning, unclassifiable
Denmark, Finland, Norway, Sweden
Dry cleaner length of employment (0-1 years, 2-4 years, 5-9 years, at least 10 years, unknown)
Occupational exposure to dry-cleaning solvents (predominantly PCE)
Cancer
Miligi et al. 2006
Population-based case-control study
Job-exposure matrix of most frequent job titles and sectors to assign probability- and intensity-weighted scales of exposure to solvents, five specific categories of chemical classes, eight individual chemicals; occupational history questionnaires
Unexposed vs very low, low and medium, high intensity levels and duration of exposure (15 yr or less vs 15 yr)
Adjustment for sex, age, education, area
Italy
Occupational solvent use in manufacturing industries or agriculture
Lymphoma
Morgan and Cassady 2002
Cohort study of residents with contaminated drinking water
Residence in census tracts near Redlands, CA (where concerns about contamination of groundwater, drinking water with TCE, ammonium perchlorate; 1980 assessment of TCE in Redlands wells ranged from 0.09 to 97 ppb; since 1991, wells either treated or removed to maintain TCE under 5 ppb
None (SIRs—indirect standardization)
San Bernardino County, CA (13 census tracts)
PCE, chlorate, TCE
Cancers
OCR for page 279
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Perrin et al. 2007
Cohort study; offspring of dry cleaners
Occupations of parents obtained from birth certificate
Mother and/or father dry cleaner(s) at time of birth (yes vs no)
Jerusalem, Israel
Maternal or paternal occupational (dry-cleaning) exposure to TCE
Schizophrenia in offspring
Raaschou-Nielsen et al. 2003
Cohort
Employment based on companies classified by air TCE measurements in workplace 1947-1989 by Danish Labor Inspection Service, area and personal measurements (after 1974);included companies determined by size; iron and metal, electronics, painting, printing, chemical, dry cleaning, other; workers identified by Pension Fund or Central Population Registry (most recent job title)
Duration of employment (less than 1 year, 1-4.9 years, at least 5 years)
Stratified analysis by sex
Denmark
TCE
Year of first employment (before 1970, 1970-1979, 1980-)
Cancers, including non-Hodgkin lymphoma, renal-cell carcinoma, esophageal adenocarcinoma
Lag time (none, 20 years)
Number of employees (fewer than 50, 50-99, 100-200)
Radican et al. 2006
Retrospective cohort; aircraft workers
Subjects identified from database of former civilian employees of Hill Air Force Base I, Utah; semiquantitative estimate of TCE exposure obtained from comprehensive exposure assessment; cumulative exposure score computed for each subject
Cumulative-exposure score: frequency (times/day), duration (min/day), calendar period of use, years of exposure; categorized into tertiles
TCE, 1,1,1-trichloroethane, methylene chloride, carbon tetrachloride, JP4 gasoline, Freon, isopropyl alcohol, acetone, toluene, methyl ethyl ketone, o-dichlorobenzene, PCE, chloroform, stoddard solvent, styrene, xylene
End-stage renal disease
OCR for page 280
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Design, Exposure, Outcomes
Exposure Assessment
Exposure Metrics
Comments
Ruder et al. 2001 (in IOM report)
Cohort study; dry-cleaning workers
Dry-cleaning union records , people not known to ever have been exposed to carbon tetrachloride who had worked 1+ year before 1960 in shop using PCE; shops visited to verify solvent use history; PCE-only subcohort, PCE-plus cohort (records inadequate to confirm PCE use or another solvent, mostly Stoddard solvent or other petroleum solvents)
Time since first employment (less than 20 years, at least 20 years), duration of employment in dry-cleaning shops (1-5 years, 5+ years)
San Francisco, Oakland, CA; Chicago, IL; Detroit, MI; New York, NY
PCE only solvent, PCE and other solvents used in dry-cleaning shops
Occupational exposure to PCE
Cancer deaths
Schreiber et al. 2002
Cross-sectional; residents above dry-cleaning shops, day-care workers sharing building with dry cleaner compared with NY State Department of Health controls, matched by age (within 2 years), sex
Apartment residents above dry cleaner; air sampling of PCE in apartments; day-care workers sharing building with dry cleaner
Personal monitoring of PCE with passive monitors (3M organic vapor monitors) for exposed persons
Creatinine-adjusted urinary PCE, trichloroacetic acid, trichloroethanol for exposed persons
PCE
Exposed vs control groups
Visual contrast sensitivity
Seidler et al. 2007
Population-based case-control
Complete occupational history obtained by interview: dates, job title, industry, job tasks, job-task-specific supplementary questions; industrial physician assessed intensity, frequency of exposure to specific chlorinated hydrocarbons (including TCE, PCE), aromatic hydrocarbons
Intensity of exposure (low, medium, high—assigned in ppm depending on chemical); frequency of exposure based on 40-h workweek (low = 1-5%, medium = over 5 to 30%, high = over 30%); confidence (possible but not probable, probable, certain)
Germany
Occupational exposure to chlorinated, organic solvents
Lymphoma
Cumulative exposure (ppm × years): sum of intensity × frequency × duration for all jobs held; categorized among controls at 50th, 90th percentiles
Sonnefeld et al. 2001
Case-control
Residents of Tarawa Terrace were considered exposed; exposure magnitude determined by length of residence
Duration of exposure (never exposed, 1-3 weeks, 4-10 weeks, 11-20 weeks, over 20 weeks and less than entire pregnancy, entire pregnancy and less than 1 year before LMP, entire pregnancy and at least 1 year before LMP
Camp Lejeune, NC
Contaminated drinking-water TCE, other compounds
Birthweight, small for gestational age, preterm birth
OCR for page 281
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Sung et al. 2007
Retrospective cohort; female workers at electronics factory
Female workers of former electronics factory identified through Bureau of labor Insurance 1973-1997; duration of employment
Duration of employment (less than 1 mo, 1-11 mo, 1-4 years, 5-9 years, at least 10 years)
Latency accounted for in assessing person-years at risk (5 years, cancer of thyroid, leukemia; 15 years, breast cancer; 10 years, other cancers) Stratified by calendar year (in which regulations were enacted on use of organic solvents in factories): before and after June 20, 1974
Taoyuan, Taiwan
Occupational exposure to solvents
Cancer
Vieira et al. 2005
Population-based case-control
Used personal delivered-dose model that included personal data on tap-water consumption, bathing habits from subjects or next of kin
PDD: sum of PCE from inhalation, dermal absorption, ingestion based on RDD; categorized into four groups based on distribution among exposed controls: at least 50th percentile, over 50th percentile, over 75th percentile, over 90th percentile; ever vs never exposed
Nine latency periods examined (0, 5, 7, 9, 11, 13, 15, 17, 19 years)
Cape Cod, MA
PCE from inner vinyl liner leaching from cement pipes distributing tap water
Adjustment for age at diagnosis or index year, family history of breast cancer, personal history of breast cancer, age at first live birth or stillbirth, occupational exposure to PCE
Breast cancer
Inhalation exposure: function of temperature, frequency, duration of baths, showers, concentration of PCE volatilized in air from water
Dermal absorption: function of surface area, Fick’s law
Ingestion: function of volume of tap water consumed
Yauck et al. 2004
Case-control Milwaukee,WI
GIS used to calculate distances between maternal residence, TCE sites; classification tree analysis used to determine distance for dichotomizing exposure: within or outside 1.32 miles of at least one TCE site
Proximity measure using classification-tree method: distance from maternal residence to TCE-emitting facility dichotomized into exposed (residence within 1.32 miles of at least one site), nonexposed (residence more than 1.32 miles of at least one site
TCE-emitting sites in Milwaukee, surrounding areas, 1996-1999
Congenital heart defects
OCR for page 282
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Design, Exposure, Outcomes
Exposure Assessment
Exposure Metrics
Comments
Zhao et al. 2005
Retrospective cohort; Rockwell/Rocketdyne (now Boeing) aerospace male workers employed before 1980
California aerospace workers 1950-1993 at several Boeing North America facilities in LA, employed before 1980 in aerospace division of SSFL, worked 2+ years and never monitored for radiation exposure; extensive industrial-hygienist review interested in exposure to rocket fuel hydrazine, TCE, PAHs, mineral oil, benzene
JEM used to assess exposure in each job group: Intensity (0-3) (1950-1969, 1970-1979, 1980-1989) × duration
Adjustment for time since first employment, SES, age at diagnosis
Los Angeles, CA
Cumulative-exposure score: low (up to 3), medium (over 3 up to 12), high (over 12)
Hydrazine, TCE, PAHs, mineral oil, benzene
Cancer mortality, incidence
Abbreviations: ALL = acute lymphocytic leukemia, BMI = body-mass index, DEP = Department of Environmental Protection, EPA = U.S. Environmental Protection Agency, GIS = geographic information system, ILO = International Labor Organization, IOM = Institute of Medicine, JEB = job-exposure matrix, LMP = last menstrual period, OR = odds ratio, PAH = polycyclic aromatic hydrocarbon, PCE = perchloroethylene, PDD = personal delivered dose, RDD = relative delivered dose, RR = relative risk, SES = socioeconomic status, SIR = standardized incidence ratio, SMR = standardized mortality ratio, SSFL = Santa Susana Field Laboratory, TCE = trichloroethylene
OCR for page 308
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Population
No. Exposed Persons
MOR, OR, RR, SIR, or SMR (95% CI)
Case-Control Studies
Aschengrau et al. 2003
Women with breast cancer in Cape Cod, MA, towns:g
≤ median exposure (latency 0-15 years)
377
0.9-1.5 OR
> median exposure (latency 0-15 years)
402
1.1-1.4 OR
> 75th percentile exposure (latency 0-15 years)
253
1.6-1.9 OR
> 90th percentile exposure (latency 0-15 years)
90
1.3-1.9 OR
Vieira et al. 2005
Women with breast cancer in Cape Cod, MA, towns:
0-year latency:
Nonproxy subjects
101
1.1 (0.8-1.5) OR
All subjects
155
1.1 (0.8-1.4) OR
5-year latency
Nonproxy subjects
87
1.2 (0.9-1.8) OR
All subjects
129
1.1 (0.9-1.6) OR
7-year latency
Nonproxy subjects
71
1.1 (0.8-1.6) OR
All subjects
111
1.1 (0.8-1.5) OR
9-year latency
Nonproxy subjects
63
1.1 (0.7-1.6) OR
All subjects
97
1.1 (0.8-1.5) OR
11-year latency
Nonproxy subjects
49
1.1 (0.6-1.7) OR
All subjects
79
1.2 (0.8-1.7) OR
13-year latency
Nonproxy subjects
43
1.3 (0.7-2.1) OR
All subjects
61
1.3 (0.9-2.0) OR
15-year latency
Nonproxy subjects
30
1.4 (0.7-2.6) OR
All subjects
44
1.4 (0.9-2.3) OR
17-year latency
Nonproxy subjects
15
1.0 (0.4-2.2) OR
All subjects
21
1.0 (0.6-2.0) OR
19-year latency
Nonproxy subjects
6
1.1 (0.3-3.5) OR
All subjects
9
1.1 (0.4-2.9) OR
CERVICAL CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
29
0.65 (99%CI 0.38-1.02) SIR
OCR for page 309
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Chang et al. 2005
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE (women):
Employed <1 year
177
1.1 (0.9-1.2) SIR
Employed 1-5 years
69
1.1 (0.8-1.3) SIR
Employed 5-10 years
26
1.6 (1.1-2.4) SIR
Employed >10 years
1
0.1 (0.0-0.8) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO:
27
1.6 (1.0-2.3) SMR
Little or no exposure
12
1.5 (0.8-2.7) SMR
Medium-high exposure
11
1.4 (0.7-1.7) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE (women):
21
0.80 (0.49-1.22) SMR
Employed <1 year
14
0.84 SMR
Employed 1-5 years
6
0.89 SMR
Employed >5 years
1
0.34 SMR
Case-Control Studies
Lynge et al. 2006
Nordic dry-cleaning workers
36
0.98 (0.65-1.47) RR
UTERINE CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
124
1.35 (99%CI 1.06-1.70) SIR
Chang et al. 2005
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE
337h
1.06 (0.95-1.18) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO
15
1.1 (0.6-1.8) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE (women):
5
0.91 (0.29-2.13) SMR
Employed <1 year
3
0.88 SMR
Employed 1-5 years
2
1.42 SMR
Employed >5 years
0
—
OVARIAN CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
81
1.16 (99%CI 0.85-1.53) SIR
PROSTATIC CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
483
1.11 (99%CI 0.98-1.25) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO
17
1.0 (0.6-1.6) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE (men)
0
—
OCR for page 310
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Population
No. Exposed Persons
MOR, OR, RR, SIR, or SMR 95% CI)
TESTICULAR CANCER
Cohort Studies—Incidence
Chang et al. 2005
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE
1i
0.14 (0.00-0.76) SIR
Cohort Studies—Mortality
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE (men)
0
—
RENAL CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
54
0.80 (99%CI 0.54-1.12) SIR
Chang et al. 2005
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
8j
1.06 (0.45-2.08) SIR
Women
12j
1.09 (0.56-1.91) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO:
8
1.0 (0.4-2.0) SMR
Little or no exposure
1
0.3 (<0.1-1.6) SMR
Medium-high exposure
7
1.5 (0.6-3.1) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
0j
—
Women
3j
1.18 (0.24-3.44) SMR
Employed <1 year
1j
0.62 SMR
Employed 1-5 years
2j
3.08 SMR
Employed >5 years
0j
—
Case-Control Studies
Brüning et al. 2003
Hospital-based study in Arnsberg, Germany:
Self-reported exposure
7
1.64 (0.61-4.40) OR
Self-reported narcotic symptoms
5
1.84 (0.57-5.96) OR
Duration of self-reported exposure:
None
127
1 OR
<10 years
4
2.46 (0.65-9.34) OR
10+ years
3
1.02 (0.24-4.27) OR
Lynge et al. 2006
Nordic dry-cleaning workers
29
0.67 (0.43-1.05) RR
BLADDER CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
82
0.98 (99%CI 0.71-1.29) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO:
12
1.3 (0.7-2.4) SMR
Little or no exposure
5
1.4 (0.4-3.2) SMR
OCR for page 311
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Medium-high exposure
7
1.5 (0.6-3.1) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
1
0.96 (0.01-5.36) SIR
Women
1
0.96 (0.01-5.33) SIR
Case-Control Studies
Lynge et al. 2006
Nordic dry-cleaning workers:
93
1.44 (1.07-1.93) RR
Employed 0-1 years
6
1.50 (0.57-3.96) RR
Employed 2-4 years
10
2.39 (1.09-5.22) RR
Employed 5-9 years
17
0.91 (0.52-1.59) RR
Employed 10 years or more
53
1.57 (1.07-2.29) RR
SKIN MELANOMAS
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
137
1.42 (99%CI 1.13-1.77) SIR
Chang et al. 2005
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
2
0.48 (0.05-1.73) SIR
Women
13
0.99 (0.53-1.69) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO
4
0.8 (0.2-2.1) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
0
—
Women
0
—
CENTRAL NERVOUS SYSTEM CANCER
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
37
1.54 (99%CI 0.96-2.31) SIR
Chang et al. 2005
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
2
0.40 (0.05-1.46) SIR
Women
15
0.97 (0.54-1.61) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO
5
0.6 (0.2-1.4) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
1
0.48 (0.01-2.66) SMR
Women
6
0.91 (0.33-1.99) SMR
CENTRAL NERVOUS SYSTEM CANCER IN CHILDREN
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
6
1.05 (99%CI 0.24-2.70) SIR
LYMPHATIC AND HEMATOPOIETIC CANCER
Cohort Studies—Incidence
OCR for page 312
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Population
No. Exposed Persons
MOR, OR, RR, SIR, or SMR (95% CI)
Chang et al. 2005
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
6
0.73 (0.27-1.60) SIR
Women
16
0.65 (0.37-1.05) SIR
Cohort Studies—Mortality
MALIGNANT LYMPHOMA
Case-Control Studies
Seidler et al. 2007
Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year
16
1.1 (0.5-2.3) OR
>9.1 to ≤78.8 ppm-year
13
1.0 (0.5-2.2) OR
>78.8 ppm-year
2
3.4 (0.7-17.3) OR
NON-HODGKIN LYMPHOMA
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
111
1.09 (99%CI 0.84-1.38) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO
12
0.9 (0.5-1.6) SMR
Case-Control Studies
Lynge et al. 2006
Nordic dry-cleaning workers
42
0.95 (0.65-1.41) RR
Miligi et al. 2006
Cases with occupational exposure in Italy:
Very low-low
18
0.6 (0.3-1.2) OR
Medium-high
14
1.2 (0.6-2.5) OR
≤15 years
10
1.3 (0.5-3.3) OR
>15 years
3
—
Seidler et al. 2007
Cases with occupational exposure in Germany:
B-non-Hodgkin lymphoma:
>0 to ≤ 9.1 ppm-year
12
0.9 (0.4-2.0) OR
>9.1 to ≤78.8 ppm-year
12
1.0 (0.5-2.3) OR
>78.8 ppm-year
5
3.2 (0.6-16.7) OR
T-non-Hodgkin lymphoma:
>0, ≤ 9.1 ppm-year
1
1.7 (0.2-14.4) OR
>9.1 to ≤78.8 ppm-year
1
1.5 (0.2-12.5) OR
>78.8 ppm-year
1
—
HODGKIN DIESASE
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE via drinking water
17
0.93 (99%CI 0.44-1.67) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO
5
2.0 (0.6-4.6) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
OCR for page 313
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Men
0
—
Women
1
2.23 (0.03-12.40) SMR
Case-Control Studies
Seidler et al. 2007
Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year
3
1.7 (0.4-6.9) OR
>9.1 to ≤78.8 ppm-year
1
0.7 (0.1-6.3) OR
>78.8 ppm-year
0
—
MULTIPLE MYELOMA
Cohort Studies—Mortality
Blair et al. 2003
Dry cleaners in St. Louis, MO
7
0.8 (0.3-1.6) SMR
Case-Control Studies
Seidler et al. 2007
Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year
3
1.8 (0.5-6.7) OR
>9.1 to ≤78.8 ppm-year
0
—
>78.8 ppm-year
0
—
LEUKEMIA
Cohort Studies—Incidence
Morgan and Cassady 2002
Redlands, CA, community exposed to TCE, PCE in drinking water
77k
1.02 (99%CI 0.74-1.35) SIR
Cohort Studies—Mortality
Blair et al. 2003
Dry-cleaners in St. Louis, MO
12
0.8 (0.4-1.4) SMR
Chang et al. 2003
Electronics-manufacturing workers in Taiwan exposed to TCE, PCE:
Men
2
0.44 (0.05-1.59) SMR
Women
8
0.54 (0.23-1.07) SMR
CHRONIC LYMPHOCYTIC LEUKEMIA
Case-Control Studies
Seidler et al. 2007
Cases with occupational exposure in Germany:
>0, ≤ 9.1 ppm-year
1
—
>9.1, ≤78.8 ppm-year
2
0.6 (0.1-2.8) OR
>78.8 ppm-year
0
—
DIFFUSE LARGE B-CELL LYMPHOMA
Case-Control Studies
Seidler et al. 2007
Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year
3
0.9 (0.3-3.9) OR
>9.1 to ≤78.8 ppm-year
6
2.1 (0.8-5.9) OR
>78.8 ppm-year
1
2.3 (0.2-26.0) OR
FOLLICULAR LYMPHOMA
Case-Control Studies
Seidler et al. 2007
Cases with occupational exposure in Germany:
OCR for page 314
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Reference
Study Population
No. Exposed Persons
MOR, OR, RR, SIR, or SMR (95% CI)
>0 to ≤ 9.1 ppm-year
2
1.2 (0.3-5.5) OR
>9.1 to ≤78.8 ppm-year
0
—
>78.8 ppm-year
0
—
MARGINAL ZONE LYMPHOMA
Seidler et al. 2007
Cases with occupational exposure in Germany:
>0 to ≤ 9.1 ppm-year
1
—
Costas et al. 2002
Cases in Woburn, MA (drinking water contaminated with TCE, PCE, other chemicals):
Ever exposed:
From 2 years before conception to case diagnosis
16
2.39 (0.54-10.59) OR
During 2 years before conception
8
2.61 (0.47-14.37) OR
During pregnancy
10
8.33 (0.73-94.67) OR
From birth to diagnosis
12
1.18 (0.28-5.05) OR
Cumulative exposure:
From 2 years before conception to case diagnosis:
Least exposed
9
5.00 (0.75-33.50) OR
Most exposed
7
3.56 (0.51-24.78) OR
During 2 years before conception:
Least exposed
4
2.48 (0.42-15.22) OR
Most exposed
4
2.82 (0.30-26.42) OR
During pregnancy:
Least exposed
3
3.53 (0.22-58.14) OR
Most exposed
7
14.30 (0.92-224.52) OR
From birth to diagnosis:
Least exposed
7
1.82 (0.31-10.84) OR
Most exposed
5
0.90 (0.18-4.56) OR
Infante-Rivard et al. 2005
Maternal occupational exposure:
2 years before pregnancy up to birth
0.96 (0.41-2.25) OR
During pregnancy
0.84 (0.30-2.34) OR
aDigestive organs and peritoneum.
bColon and rectum.
cResults are for liver and biliary cancer combined.
dLungs and bronchi.
eTrachea, bronchi, and lungs.
fBone and articular cartilage.
gCombined data from present and previous study by Aschengrau et al. (1998).
hFemale genital organs.
OCR for page 315
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
iTestes and other male genital organs.
jKidney and other unspecified urinary organs.
kAll leukemias.
Abbreviations: CI = confidence interval, MOR = mortality odds ratio, OR = odds ratio, PCE = perchloroethylene, RR= relative risk, SIR = standardized incidence ratio, SMR = standardized mortality ratio, TCE = trichloroethylene.
OCR for page 316
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
TABLE E-5a Studies of Noncancer End Points and Exposure to PCE
Reference
Study Population
No. Exposed Persons
OR (95% CI)
SYSTEMIC SCLEROSIS
Case-Control Studies
Garabrant et al. 2003
Women in Michigan, Ohio:
Self-reported exposure
7
1.4 (0.6-3.4)
Expert-confirmed exposure
5
1.1 (0.4-2.9)
PRETERM LOSS
Sonnefeld et al. 2001
Infants of Camp Lejeune residents, 1968-1985:
Exposure 1-3 weeks
14
1.0 (90% CI 0.6-1.6)
Exposure 4-10 weeks
55
1.3 (90% CI 1.0-1.7)
Exposure 11-20 weeks
86
1.3 (90% CI 1.1-1.6)
Exposure >20 weeks, less than entire pregnancy
94
0.8 (90% CI 0.7-1.0)
Exposure, entire pregnancy, less than 1 year before last menstrual period
158
1.1 (90% CI 0.9-1.3)
Exposure entire pregnancy, at least 1 year before last menstrual period
36
0.8 (90% CI 0.6-1.1)
SMALL FOR GESTATIONAL WEIGHT
Sonnefeld et al. 2001
Infants of Camp Lejeune residents, 1968-1985
Exposure 1-3 weeks
15
0.9 (90% CI 0.5-1.3)
Exposure 4-10 weeks
60
1.1 (90% CI 0.9-1.4)
Exposure 11-20 weeks
84
1.0 (90% CI 0.8-1.2)
Exposure >20 weeks, less than entire pregnancy
16
1.2 (90% CI 1.0-1.4)
Exposure entire pregnancy, less than 1 year before last menstrual period
207
1.2 (90% CI 1.0-1.3)
Exposure entire pregnancy, at least 1 year before last menstrual period
61
1.1 (90% CI 0.9-1.4)
All births
622
1.2 (90% CI 1.0-1.3)
Mother’s age <35 years
611
1.1 (90% CI 0.9-1.2)
Mother’s age ≥ 35 years
11
2.1 (90% CI 0.9-4.9)
Mother had no previous fetal losses
475
1.1 (90% CI 0.9-1.2)
Mother had one previous fetal loss
104
1.5 (90% CI 1.1-2.0)
Mother had at least two previous fetal losses
43
2.5 (90% CI 1.5-4.3)
MEAN BIRTH WEIGHT
Sonnenfeld et al. 2001
Infants of Camp Lejeune residents, 1968-1985
Exposure 1-3 weeks
189
Mean difference: 18 g (90% CI -40 to 76)
Exposure 4-10 weeks
597
Mean difference: -17 g (90% CI -51 to 17)
Exposure 11-20 weeks
915
Mean difference: -31 g (90% CI -59 to -3)
Exposure >20 weeks, less than entire pregnancy
1,551
Mean difference: -28 g (90% CI -50 to -5)
OCR for page 317
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
Exposure entire pregnancy , less than 1 year before last menstrual period
1,994
Mean difference: -15 g (90% CI -35 to 5)
Exposure entire pregnancy, at least 1 year before last menstrual period
605
Mean difference: -18 g (90% CI -51 to 16)
All births
6,039
Mean difference: -26 g (90% CI -43 to -9)
Mother’s age <35 years
5,968
Mean difference: -2 g (90% CI -17 to 13)
Mother’s age ≥ 35 years
71
Mean difference: -130 g (90% CI -236 to -23)
Mother had no previous fetal losses
4,985
Mean difference: -2 g (90% CI -17 to 13)
Mother had one previous fetal loss
806
Mean difference: -16 g (90% CI -79 to 24)
Mother had at least two previous fetal losses
245
Mean difference: -104 g (90% CI -174 to -34)
NEUROBLASTOMA
Case-Control Studies
De Roos et al. 2001
Offspring with paternal occupational exposure (Unites States, Canada)
Self-reported exposure to PCE
8
0.5 (0.2-1.4) OR
Industrial-hygiene-reviewed exposure
4
0.5 (0.1-1.7) OR
SCHIZOPHRENIA
Cohort Studies—Incidence
Perrin et al. 2007
Offspring of dry cleaners in Jerusalem
4
3.4 (1.3-9.2) RR
NEUROBEHAVIORAL
Cohort Studies
Janulewicz et al. 2008
(Note: end point included two diagnoses—ADD and HD—and six indicators of learning disabilities)
Offspring of Cape Cod, MA, residents born 1969-1983
1,349
Prenatal exposure:
1,244
Low exposure
1.0-1.5 (0.7-2.7) OR
High exposure
0.8-1.1 (0.4-1.6) OR
Exposure 5 years postnatally:
1,326
Low exposure
0.9-1.4 (0.7-2.5) OR
High exposure
0.6-1.0 (0.3-1.7) OR
Abbreviations: ADD = attention deficit disorder, CI = confidence interval, HD = hyperactivity disorder, OR = odds ratio, PCE = perchloroethylene.
OCR for page 318
Contaminated Water Supplies at Camp Lejeune: Assessing Potential Health Effects
TABLE E-5b Visual Contrast Sensitivity and Visual Acuity
Reference
Population
Exposure, Duration
Effects
Schreiber et al. 2002
Apartment residents above dry cleaner
Mean, 778 μg/m3
Visual contrast sensitivity trend in Lanthony D15-d; no change in visual acuity
Median, 350 μg/m3
Mean residence, 5.8 years
Lifetime dose, 3,400 μg/m3
Day-care workers sharing building with dry cleaner
Mean, 2,150 μg/m3
Visual contrast sensitivity; no change in visual acuity
Median, 2,150 μg/m3
Mean work, 4.0 years
Lifetime dose, 1,978 μg/m3
