TABLE 4-1 Cancer

Study

Design

Population

Outcomes

Results

Adjustments

Comments

Brain cancer

Bullman et al., 2005 (Vol. 4)

Cohort mortality study (population from same source as Kang and Bullman, 1996, 2001)

100,487 US Army GWVs exposed to chemical warfare agents at Khamisiyah; 224,980 nonexposed Army GWVs; exposure determined from the DoD plume model

Brain cancer mortality through December 2000 ascertained from BIRLS and NDI

Exposed (25 cases) vs unexposed (27 cases) RR 1.94 (95% CI 1.12-3.34);

Exposed 1 day: RR 1.72 (95% CI 0.95-3.10)

Exposed 2+ days: RR 3.26 (95% CI 1.33-7.96)

Age at entry, race, sex, unit component, and rank

9-year follow-up likely too short to examine brain cancer risk (increases with time since exposure); multiple comparisons; death certificate diagnosis

Barth et al., 2009 (Update)

Mortality cohort study, follow-up through 2004 of same cohort as Kang and Bullman (2001)

621,902 US GWVs and 746,248 nondeployed era veterans; 98,406 GWVs exposed to Khamisiyah nerve agents; 123,478 GWVs exposed to oil-well fire smoke

Brain cancer mortality

GWVs (144 cases) compared to era veterans (228 cases) MRR 0.90 (95% CI 0.73-1.11)

Khamisiyah exposed: MRR 2.71 (95% CI 1.25-5.87)

Oil-well fire smoke exposed: MRR 1.81 (95% CI 1.00-3.27)

Race, service branch, type of unit, age, marital status, and sex

Similar results after 19 misclassified cancers were removed from analysis

Testicular cancer

Knoke et al., 1998 (Vol. 4)

Cohort study (follow-up of Gray et al., 1996)

US, all regular, active-duty male servicemembers

GWVs (n = 517,223)

NDVs (n = 1,291,323)

First diagnosis of testicular cancer at US military hospitals worldwide (7/31/1991-3/31/1996)

GWVs (134 cases) vs NDVs (371 cases)

RR 1.05 (95% CI 0.86-1.29)

Race or ethnicity, age, occupation

Short follow-up time, but right age range; no specific exposures evaluated; military hospitals only

Levine et al., 2005 (Vol. 4)

Population-based survey—pilot study

US, all personnel (including reserves) deployed to Gulf War (GWVs) and random sample of NDVs;

GWVs (n = 621,902)

NDVs (n = 746,248)

Testicular cancers diagnosed 1991-1999 and registered by DC or NJ Cancer Registries

GWVs (cases = 17) vs NDVs (cases = 11) (358 males with cancer)

PIR 2.33 (95% CI 0.95-5.70)

Age, state of residence, deployment status, race

 



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