Veterans and Agent Orange Update 2004 (2005) / Chapter Skim
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4 Epidemiology
4 Epidemiology
Pages 118-164
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From page 118... ...
. Primary emphasis is put on describing work new to this review contained in publications appearing since Veterans and Agent Orange: Update 2002 (hereafter, Update 2002)
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From page 119... ...
Detailed descriptions of many of the study populations can be found in Chapter 2 of the original report of this committee, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam (hereafter referred to as VAO; IOM, 1994) , and the criteria for inclusion in the review are discussed in Appendix A of that report.
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From page 120... ...
For the sake of thoroughness, the discussions of specific health outcomes in Chapters 69 include references to studies discussed in previous Agent Orange reports and to new studies. However, in making its conclusions, the committee focused on the most recent update when multiple reports on the same cohorts and endpoints were available.
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From page 121... ...
and one in veterans of Operation Ranch Hand in which the herbicides were sprayed from planes in Vietnam (Henriksen et al., 1997)
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and a large-scale cohort mortality study of workers exposed to herbicides in several of its plants (Bloemen et al., 1993; Bond et al., 1988; Burns et al., 2001; Ramlow et al., 1996) also were conducted.
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A cohort study of cancer incidence and mortality was conducted among 701 women from 7 countries who were occupationally exposed to chlorophenoxy herbicides, chlorophenols, and dioxins (Kogevinas et al., 1993)
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Study details can be found in this chapter under the heading Dow Chemical Company. Other Chemical Plants Studies have reviewed health outcomes among UK chemical workers exposed to TCDD as a result of an industrial accident in 1968 (Jennings et al., 1988; May, 1982, 1983)
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From page 125... ...
, a Dutch study of forestry workers exposed to 2,4,5-T investigated the prevalence of acne and liver dysfunction (van Houdt et al., 1983) , and another study examined mortality and cancer incidence in a cohort of Swedish lumberjacks (Thörn et al., 2000)
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From page 126... ...
(2003) examined the correlation between exposure to agricultural pesticides, including 2,4-D and 2,4,5-T and prostate cancer incidence among pesticide appliers in Iowa and North Carolina in the Agricultural Health Study.
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(2004) published an updated mortality study of a cohort of 1,341 licensed herbicide appliers in the Netherlands (Swaen et al., 1992)
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; STS and malignant lymphomas in the Victorian Cancer Registry of Australia (Smith and Christophers, 1992) ; lymphoid cancer in Milan, Italy (LaVecchia et al., 1989)
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. Other studies examined specific health effects associated with TCDD exposure among Seveso residents: chloracne, birth defects, spontaneous abortion, and crude birth and death rates (Bisanti et al., 1980)
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From page 130... ...
That study group consisted of 301 women from the original SWHS cohort of 981; women who were over the age of 44, who had surgical or natural menopause, who had Turner syndrome, or who were pregnant, breastfeeding, or had used an intrauterine device or hormonal medicine such as contraceptives within the previous year were excluded from this study. Researchers who were blinded to participants' serum TCDD and zones of residence obtained sociodemographic data, information about personal habits, work histories, and medical and reproductive histories (gynecologic, menstrual, and pregnancy related factors)
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From page 131... ...
Of the SWHS cohort, 92% -- 899 of 981 women -- had serum TCDD concentrations measured between 1976 and 1977, 54 (5%) serum measurements between 1978 and 1981, and 28 (3%)
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From page 132... ...
Peripheral blood lymphocytes, extracted from study participant's plasma, were evaluated to measure the expression of several genes involved in the AhR pathway, specifically AhR, ARNT, and CYP1A1, CYP1B1, and CYP1A1-associated EROD activity. Those AhR pathways were further evaluated in relation to serum TCDD concentrations to determine whether associations existed between them and whether environmental or host factors affected the association.
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(2003) completed a population-based cross-sectional study in several Belgian towns to assess the association between serum dioxin concentrations and the prevalence of diabetes and endometriosis.
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From page 134... ...
This section is organized primarily by research sponsor because it is more conducive to methodologic presentation of the articles. Exposure measures fall on a crude scale from individual exposures of Ranch Hand personnel, as reflected in serum TCDD measurements, to some statewide studies' use of service in Vietnam as a surrogate for TCDD exposure.
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From page 135... ...
To determine whether exposure to herbicides, including Agent Orange, had adverse human health effects, the Air Force made a commitment to Congress and the White House in 1979 to conduct an epidemiologic study of Ranch Hands (AFHS, 1982)
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From page 136... ...
(1998b) reported on a 15-year follow-up of postservice mortality in veterans of Operation Ranch Hand, updating their cause-specific mortality study (1990)
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Internal comparisons were made between Ranch Hand veterans who had existing serum dioxin measurements and who served in Vietnam (N = 2,965) and veterans who served in Southeast Asia but did not spray herbicides.
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(2003) studied the relationship of serum TCDD to thyroid function in the cohort of veterans of Operation Ranch Hand previously described by Wolfe et al.
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(1990) examined whether Army I Corps Vietnam veterans had cancer mortality similar to that of other Army Vietnam-era veterans, using the study design of Breslin et al.
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Most of those publications do not discuss exposure to Agent Orange; exposure to "combat" is evaluated as the risk factor of interest. No new VA studies have been published since Update 2002.
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(2003) published a cross-sectional epidemiologic study examining the effect of Agent Orange exposure in 1,224 male Korean Vietnam veterans and in 154 Korean non-Vietnam veterans between the ages of 45 and 64.
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From page 142... ...
examined the immunotoxicologic effects of Agent Orange exposure. Study participants were divided into three categories based on general health and TCDD exposure: veteranspatient (24 veterans with chronic disease who were exposed to TCDD while serving in Vietnam)
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American Journal of Industrial Medicine 14:167176. Alavanja MC, Merkle S, Teske J, Eaton B, Reed B
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American Journal of Industrial Medicine 26:243253. Assennato G, Cervino D, Emmett E, Longo G, Merlo F
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American Journal of Industrial Medicine 32(3)
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American Journal of Industrial Medicine 23:289300. Bullman TA, Kang HK.
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American Journal of Industrial Medicine 25:559571. Calvert GM, Wall DK, Sweeney MH, Fingerhut MA.
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1989a. Comparison of Serum Levels of 2,3,7,8-Tetrachlorodibenzo-p-dioxin with Indirect Estimates of Agent Orange Exposure Among Vietnam Veterans: Final Report.
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American Journal of Industrial Medicine 31(6)
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British Journal of Industrial Medicine 45:2528. Egeland GM, Sweeney MH, Fingerhut MA, Wille KK, Schnorr TM, Halperin WE.
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American Journal of Industrial Medicine 31(4)
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American Journal of Industrial Medicine 21:651660. Hardell L
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1997. Serum dioxin and diabetes mellitus in veterans of Operation Ranch Hand.
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American Journal Industrial Medicine 38(4)
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1992. Cancer mortality from soft-tissue sarcoma and malignant lymphomas in an international cohort of workers exposed to chlorophenoxy herbicides and chlorophenols.
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1988. Agent Orange exposure and posttraumatic stress disorder.
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2001b. Serum dioxin and peripheral neuropathy in veterans of Operation Ranch Hand.
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American Journal of Public Health 81:758760. Olsson H, Brandt L
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1989. Estimates of the half-life of 2,3,7,8-tetrachlorodibenzo-p-dioxin in Vietnam veterans of Operation Ranch Hand.
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1991. Cancer mortality in workers exposed to chlorophenoxy herbicides and chlorophenols.
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. American Journal of Industrial Medicine 23:845858.
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American Journal of Industrial Medicine 18:665673. Thomas TL, Kang H, Dalager N
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American Journal of Industrial Medicine 11:685691. Weisglas-Kuperus N, Sas TC, Koopman-Esseboom C, van der Zwan CW, De Ridder MA, Beishuizen A, Hooijkaas H, Sauer PJ.
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1995. Pater nal serum dioxin and reproductive outcomes among veterans of Operation Ranch Hand.
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