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Veterans and Agent Orange: Update 2012 (2014)

Chapter: Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers

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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×

Appendix C


Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers

In response to a request from the Department of Veterans Affairs, the committee responsible for Update 2006 prepared Table C-1 to demonstrate how conclusions provided for the full range of cancer types and to clarify into which groupings any specific cancer diagnosis falls. The committee for Update 2010 reframed its overview of lymphohematopoietic neoplasms according to the World Health Organization (WHO) classification system (WHO, 2008), which partitions these disorders first according to the lymphoid or myeloid lineage of the transformed cells rather than as lymphomas or leukemias; this emphasizes the close etiologic relationship of chronic lymphocytic leukemia and hairy-cell leukemia with Hodgkin and non-Hodgkin lymphomas and with the neoplasm multiple myeloma and its related condition AL amyloidosis.

The major portion of evidence compiled for review in the Veterans and Agent Orange (VAO) series comes from cohort studies, primarily of mortality but some of incidence. Other data have been generated by case-control studies, which follow the only design amenable to studying very infrequent or very specific health outcomes. How researchers are able to group, analyze, and report their findings is influenced by the distribution of cases that they observe, so the data that VAO committees have had available for review reflect mortality experience at a level of specificity concordant with statistical analysis.

The International Classification of Diseases (ICD) system is used by physicians and researchers around the world to group related diseases and procedures so that morbidity and mortality information can be classified for statistical purposes in a standard form that is amenable to data storage and retrieval. It is a comprehensive hierarchic system that permits great detail but can be collapsed into broad categories. Codes mentioned in VAO reports are stated in terms of

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×

TABLE C-1 Mapping of Groupings of Malignant Neoplasms That Are the Subjects of Conclusions in the Veterans and Agent Orange Series with ICD-9 Codes

Agent Orange Series with ICD-9 Codes
NIOSH Category for Cause of Death NIOSH Groupings of Cancer Sites “VAO Characterization of Grouping”a Subsites ICD-9 Codes
Major Minor
02 Buccal cavity and pharynx “Oral, nasal, and pharyngeal”
004

Lip

140
005

Tongue

141
006

Other parts of buccal cavity

Salivary glands 142
Floor of mouth 144
Gum and other mouth 143, 145
007

Pharynx

Oropharynx 146

Tonsil

146.0–146.2

Nasopharynx 147
Hypopharynx 148
Other buccal cavity and pharynx 149
(160 = nasal below)
03 Digestive organs and peritoneum
008

Esophagus

“Esophagus” 150
009

Stomach

“Stomach” 151
010

Intestine except rectum

“Colorectal”

Small intestine

152

Colon (large intestine)

153

011

Rectum

154
012

Biliary passages, liver, and gall bladder

“Hepatobiliary”
Liver and intrahepatic bile ducts 155
Gallbladder and extrahepatic bile ducts 156
013

Pancreas

157
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
014

Retroperitoneum and other and unspecified digestive organs

158–159
04 Respiratory system “Respiratory”
015

Larynx

“Larynx” 161
016

Trachea, bronchus, and lung

“Lung” 162
Trachea 162.0 (there is no ICD 162.1)
Lung and bronchus 162.2–162.9
017

Pleura

163
018

Other respiratory

Nasal cavity, middle ear, and accessory sinuses (160, above with oral and pharyngeal)
Thymus, heart, and mediastinum 164 (164.0, below with endocrine; 164.1, below with soft tissue sarcoma)
Other respiratory, unspecified 165 (discontinuity with ICD codes)
05 019 Breast (male and female) “Breast” 174, 175
06 Female genital organs “Female reproductive”
020

Cervix uteri

180
021

Other unspecified parts of uterus

179, 181, 182
Uterus, parts unspecified 179
Placenta 181
Body of uterus 182
022

Ovary, fallopian tube, and broad ligament

183
Ovary 183.0 (there is no ICD 183.1)
Fallopian tube and other uterine adnexa 183.2–183.9
023

Other female genital organs

184
07 Male genital system 185, 186
024

Prostate

“Prostate” 185
025

Testis

“Testicular” 186

Penis and other male genital organs

[for NIOSH in minor group 036] 187
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
NIOSH Category for Cause of Death NIOSH Groupings of Cancer Sites “VAO Characterization of Grouping”a Subsites ICD-9 Codes
Major Minor
08 Urinary system
026

Kidney (including renal pelvis and ureter)

“Renal” 189.0–189.2
027

Bladder and other urinary organs

“Urinary bladder” 188, 189.3–189.9
Bladder

188

Urethra, paraurethral glands, other and unspecified urinary

189.3–189.9

(discontinuity with ICD codes)
09 Other and unspecified sites
028

Bone (“and articular cartilage” in ICD nomenclature)

“Bone and joint” 170
029

Melanoma

“Melanoma” 172
030

Other malignant skin neoplasm

“Non-melanoma skin” 173
031

Mesothelioma

No codes (new minor code, above with lung)
032

Connective (“and other soft” in ICD nomenclature) tissue

“Soft-tissue sarcoma” 171
(heart) (164.1)
033

Brain and other parts of nervous system (ICD “soft tissue” includes peripheral nerves and autonomic nervous system)

“Brain” 191–192
034

Eye

190
035

Thyroid

193
(thymus) 164.0
036

Other and unspecified sites

Other endocrine cancers 194
Other and ill-defined sites 195
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Stated or assumed to be secondary of specified sites 196–198
Site unspecified 199
10 Lymphatic and hematopoietic tissue Lymphoma
037

Hodgkin disease

201
038

Non-Hodgkin lymphoma

200, 202 (excluding 202.4), 273.3
039 Multiple myeloma 203 (excluding 203.1)
040 Leukemia and aleukemia “Leukemia (other than chronic B-cell leukemias)” 204–208

Lymphocytic

primary grouping now with other neoplasms of lymphocytic origin, lymphomas and multiple myeloma
Acute lymphocytic 204.0
“Chronic lymphocytic (including hairy cell leukemia)” 204.1
Other lymphocytic 202.4, 204.2–204.9

Myeloid (granulocytic)

Acute myeloid
Acute 205.0
Acute erythremia and erythroleukemia 207.0
Megakaryocytic leukemia 207.2
Chronic myeloid 205.1
Other myeloid 205.2–205.3, 205.8–205.9

Monocytic

Acute monocytic 206.0
Chronic monocytic 206.1
Other monocytic 206.2–206.9

Other leukemia

Other acute 208.0
Other chronic 207.1, 208.1
Aleukemic, subleukemia and “not otherwise specified” 203.1, 207.2, 207.8, 208.2–208.9

aBoldface cancer (sub)site: most comprehensive grouping for which a conclusion has been drawn.

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×

ICD, Revision 9 (ICD-9). ICD-7, ICD-8, and ICD-9 were in effect for deaths that occurred in 1960–1967, 1968–1978, and 1979–1998, respectively; the differences among them are fairly subtle. Although ICD-10, which went into effect for coding causes of deaths that occurred from 1999 on, appears radically different from the earlier versions, it corresponds in large part to basically the same disease entities (see Table C-2). Most published epidemiologic studies considered in the VAO series have been related to health outcomes that occurred and were encoded before ICD-10 went into effect.

Since 1983, the National Institute for Occupational Safety and Health (NIOSH) has maintained software for generating standardized expectations, as derived from US mortality data assembled by the National Center for Health Statistics, for ICD-encoded mortality datasets. An article by Robinson et al. (2006) discusses revisions to that standard software to incorporate deaths coded according to ICD-10 and includes conversions and equivalences among ICD-7, ICD-8, ICD-9, and ICD-10 for 119 exhaustive categories of cause of death. Codes for malignant neoplasms span the ICD-9 range 140.0–208.9, NIOSH’s major categories 02–10, or NIOSH’s more specific minor categories 004–040.

The NIOSH death codes for neoplasms provide comprehensive scaffolding for organizing the committee’s reviews and conclusions by cancer type that is somewhat simpler than ICD classifications but maps completely to the ICD system as it has evolved. Because the NIOSH system has been used to mediate analysis of many sets of cohort data, its groupings correspond quite closely to the published research findings available for review by VAO committees. In general cohort studies, one is unlikely to encounter results on more specific groupings than NIOSH’s minor categories.

As discussed in Chapter 2, the VAO committees have not framed its conclusions strictly in terms of ICD codes, but the ICD system has been a valuable tool for the work of VAO committees. There can be coding errors on hospital records or death certificates, but when researchers present their results labeled with ICD codes, there can be little ambiguity about what they intended. When their most definitive indication is something like “respiratory cancers,” however, there can be uncertainty about where the evidence should be considered. In such cases, the committee has done its best to follow the hierarchy laid out in Table C-1.

As indicated above, many of the studies reviewed by the committee use or were written up at a time when ICD-9 was in place. Accordingly, ICD references in this report use that scheme. ICD-10 began to be implemented in the United States in 1999. It differs from ICD-9 in level of detail (about 8,000 categories vs about 5,000 in ICD-9) and nomenclature (alphanumeric vs the numeric codes of ICD-9); additions and modifications were also made with regard to some coding rules and the rules for selecting an underlying cause of death (Anderson et al., 2001). Table C-2 lists the ICD-9 and ICD-10 codes for the various forms of malignant neoplasm addressed in this report. In situ neoplasms, benign neoplasms,

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×

TABLE C-2 Surveillance, Epidemiology, and End Results (SEER) Program Malignant Neoplasm Site Groupings for ICD-9 and ICD-10

Cancer Site ICD-9 Codes ICD-10 Codes

Buccal cavity and pharynx

Lip

140.0–140.9

C00.0–C00.9

Tongue

141.0–141.9

C01, C02.1–C02.9

Salivary glands

142.0–142.9

C07, C08.0–C08.9

Floor of mouth

144.0–144.9

C04.0–C04.9

Gum and other mouth

143.0–143.9, 145.0–145.6, 145.8–145.9

C03.0–C03.9, C05.0–C05.9, C06.0–C06.9

Nasopharynx

147.0–147.9

C11.1–C11.9

Tonsil

146.0–146.2

C09.0–C09.9

Oropharynx

146.3–146.9

C10.1–C10.9

Hypopharynx

148.0–148.9

C12, C13.0–C13.9

Other buccal cavity and pharynx

149.0–149.9

C14.0–C14.9

Digestive system

Esophagus

150.0–150.9

C15.0–C15.9

Stomach

151.0–151.9

C16.0–C16.9

Small intestine

152.0–152.9

C17.0–C17.9

Colon excluding rectum

153.0–153.9, 159.0

C18.0–C18.9, C26.0

Rectum and rectosigmoid junction

154.0–154.1

C19, C20

Anus, anal canal, and anorectum

154.2–154.3, 154.8

C21.0–C21.9

Liver and intrahepatic bile duct Liver

155.0,155.2

C22.0, C22.2–C22.4, C22.7–C22.9

Intrahepatic bile duct

155.1

C22.1

Gallbladder

156.0

C23

Other biliary

156.1–156.9

C24.0–C24.9

Pancreas

157.0–157.9

C25.0–C25.9

Retroperitoneum

158.0

C48.0

Peritoneum, omentum, and mesentery

158.8–158.9

C48.1–C48.2

Other digestive organs

159.8–159.9

C26.8–26.9, C48.8

Respiratory system

Nasal cavity, middle ear, and accessory sinuses

160.0–160.9

C30.0, C30.1, C31.0–C31.9

Larynx

161.0–161.9

C32.0–C32.9

Lung and bronchus

162.2–162.9

C34.0–C34.9

Pleura

163.0–163.9

C38.4

Trachea, mediastinum, and other respiratory organs

162.0, 164.2–165.9

C33, C38.1–C38.3, C38.8, C39

Bones and joints

170.0–170.9

C40.0–C40.9, C41.0–C41.9

Soft tissue (including heart)

171.0–171.9, 164.1

C38.0, C47.0–C47.9, C49.0–C49.9

Skin

Malignant melanomas

172.0–172.9

C43.0–C43.9

Other malignant skin neoplasms

173.0–173.9

C44.0–C44.9

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×

Cancer Site ICD-9 Codes ICD-10 Codes

Breast (male and female)

174.0–174.9, 175

C50.0–C50.9

Female genital system

Cervix

180.0–180.9

C53.0–C53.9

Corpus

182.0–182.1, 182.8

C54.0–C54.9

Uterus, not otherwise specified

179

C55

Ovary

183.0

C56.0–C56.9

Vagina

184.0

C52

Vulva

184.1–184.4

C51.0–C51.9

Other female genital organs

181, 183.2–183.9, 184.8, 184.9

C57.0–C57.9, C58

Male genital system

Prostate

185

C61

Testis

186.0–186.9

C62.0–C62.9

Penis

187.1–187.4

C60.0–C60.9

Other male genital organs

187.5–187.9

C63.0–C63.9

Urinary system

Urinary bladder

188.0–188.9

C67.0–C67.9

Kidney and renal pelvis

189.0, 189.1

C64.0–C64.9, C65.0–C65.9

Ureter

189.2

C66.0–C66.9

Other urinary organs

189.3–189.4, 189.8–189.9

C68.0–C68.9

Eye and orbit

190.0–190.9

C69.0–C69.9

Brain and other nervous system

Brain

191.0–191.9

C71.0–C71.9

Meninges

192.1

C70.0–C70.9

Other nervous systema

192.0, 192.2–192.9

C72.0–C72.9

Endocrine system

Thyroid

193

C73

Other endocrine (including thymus)

164.0, 194.0–194.9

C37, C74.00–C74.92, C75.0–C75.9

Lymphomas

Hodgkin’s disease

201.0–201.9

C81.0–81.9

Non-Hodgkin’s lymphomas

200.0–200.8, 202.0–202.2, 202.8–202.9

C82.0–C82.9, C83.0–C83.9, C84.0–C84.5, C85.0–C85.9, C96.3

Multiple myeloma

203.0, 238.6

C90.0, C90.2

Leukemias
Lymphocytic

Acute lymphocytic

204.0

C91.0

Chronic lymphocytic

204.1

C91.1

Other lymphocytic

202.4, 204.2–204.9

C91.2-C91.4, C91.7, C91.9

Myeloid (granulocytic)

Acute myeloid

205.0, 207.0, 207.2

C92.0, C92.4–C92.5, C94.0, C94.2

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×

Cancer Site ICD-9 Codes ICD-10 Codes

Chronic myeloid

205.1

C92.1

Other myeloid

205.2–205.3, 205.8–205.9

C92.2–C92.3, C92.7, C92.9

Monocytic

Acute monocytic

206.0

C93.0

Chronic monocytic

206.1

C93.1

Other monocytic

206.2–206.9

C93.2, C93.7, C93.9

Other leukemia

Other acute

208.0

C94.4, C94.5, C95.0

Other chronic

207.1, 208.1

C94.1, C95.1

Aleukemic, subleukemic and “not otherwise specified”

203.1, 207.2, 207.8, 208.2–208.9

C90.1, C91.5, C94.3, C94.7, C95.2, C95.7, C95.9

Miscellaneous malignant neoplasms

159.1, 195.0–195.8, 196.0–196.9, 199.0–199.1, 202.3, 202.5–202.6, 203.8

C26.1, C76.0–C76.8, C77.0–C77.9, C78.0–C78.8, C79.0–C79.8, C80, C88.0–C88.9, C96.0–C96.2, C96.7, C96.9, C97

aCancers of the peripheral nerves and the autonomic nervous system are classified as “soft tissue” in ICD. Adapted from Ries et al. (2003), Table A-4.

neoplasms of uncertain behavior, and neoplasms of unspecified behavior have separate codes in both schemes.

REFERENCES

Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. 2001. Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. National Vital Statistics Reports 49(2):1–32.

Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Fay MP, Feuer EJ, Edwards BK (eds). 2003. SEER Cancer Statistics Review, 1975–2000. Bethesda, MD: National Cancer Institute.

Robinson CF, Schnorr TM, Cassinelli RT, Calvert GM, Steenland K, Gersic CM, Schubauer-Berigan MK. 2006. Tenth revision U.S. mortality rates for use with the NIOSH Life Table Analysis System. Journal of Occupational and Environmental Medicine 48(7):662–667.

WHO (World Health Organization). 2008. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissue (4th edition). Lyon, France: World Health Organization.

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Page 973
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Page 974
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Page 975
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Page 976
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Page 977
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Page 978
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to National Institute for Occupational Safety and Health Cause-of-Death Codes and International Classification of Diseases Codes for Cancers." Institute of Medicine. 2014. Veterans and Agent Orange: Update 2012. Washington, DC: The National Academies Press. doi: 10.17226/18395.
×
Page 979
Next: Appendix D: Biographies of Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Ninth Biennial Update) and Staff »
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From 1962 to 1971, the US military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam.

Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academy of Sciences (NAS) was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations are conducted every two years to review newly available literature and draw conclusions from the overall evidence.Veterans and Agent Orange: Update 2012 reviews peer-reviewed scientific reports concerning associations between health outcomes and exposure to TCDD and other chemicals in the herbicides used in Vietnam that were published in October 2010--September 2012 and integrates this information with the previously established evidence database. This report considers whether a statistical association with herbicide exposure exists, taking into account the strength of the scientific evidence and the appropriateness of the statistical and epidemiological methods used to detect the association; the increased risk of disease among those exposed to herbicides during service in the Republic of Vietnam during the Vietnam era; and whether there exists a plausible biological mechanism or other evidence of a causal relationship between herbicide exposure and the disease.

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