National Academies Press: OpenBook

Veterans and Agent Orange: Update 2014 (2016)

Chapter: Front Matter

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Veterans

and Agent

Orange


Update 2014

Committee to Review the Health Effects in
Vietnam Veterans of Exposure to Herbicides
(Tenth Biennial Update)

Board on the Health of Select Populations

Institute of Medicine

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THE NATIONAL ACADEMIES PRESS

Washington, DC

www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

THE NATIONAL ACADEMIES PRESS    500 Fifth Street, NW    Washington, DC 20001

This study was supported by Contract/Grant No. VA241-P-2024 between the National Academy of Sciences and the US Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-38066-9
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Ralph J. Cicerone is president.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

COMMITTEE TO REVIEW THE HEALTH EFFECTS
IN VIETNAM VETERANS OF EXPOSURE TO
HERBICIDES (TENTH BIENNIAL UPDATE)

KENNETH S. RAMOS (Chair), Associate Vice President for Precision Health Sciences and Professor of Medicine, Arizona Health Sciences Center, University of Arizona

ILIR AGALLIU, Assistant Professor, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York

ERIN M. BELL, Associate Professor, Department of Environmental Health Sciences, School of Public Health, University at Albany, New York

MAARTEN BOSLAND, Professor of Pathology, College of Medicine, University of Illinois at Chicago

ROBERT CANALES, Assistant Professor, Community, Environment and Policy Department, Mel & Enid Zuckerman College of Public Health, University of Arizona

MICHAEL J. CARVAN, Shaw Professor, School of Freshwater Sciences, University of Wisconsin–Milwaukee

MELISSA GONZALES, Associate Professor, Department of Internal Medicine, University of New Mexico

KARL T. KELSEY, Professor, Epidemiology and Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island

KEVIN E. KIP, Executive Director of the Research Center, Professor of Epidemiology and Biostatistics, College of Nursing, University of South Florida

STEPHEN KRITCHEVSKY, Director, J. Paul Sticht Center on Aging, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina

ELAN D. LOUIS, Chief, Division of Movement Disorders and Professor of Neurology and Epidemiology, Yale School of Medicine and Yale School of Public Health, Yale University, New Haven, Connecticut

DAVID RICHARDSON, Associate Professor, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill

MITCHELL TURKER, Senior Scientist, Oregon Institute of Occupational Health Sciences, Professor of Molecular and Medical Genetics, School of Medicine, Oregon Health & Science University

LORI WHITE, Associate Professor, Department of Biochemistry and Microbiology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Study Staff

MARY BURR PAXTON, Study Co-Director

JENNIFER A. COHEN, Study Co-Director

HEATHER L. CHIARELLO, Research Associate

NICOLE FREID, Senior Program Assistant

JULIE WILTSHIRE, Financial Officer

ROBERT POOL, Editor

FREDERICK (RICK) ERDTMANN, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of the independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We thank the following for their review of the report:

Cande V. Ananth, Columbia University

Frederick R. Appelbaum, Fred Hutchinson Cancer Research Center

Margit L. Bleecker, Center for Occupational and Environmental Neurology

Linda S. Birnbaum, National Institute of Environmental Health Sciences and National Toxicology Program

David E. Cohen, New York University School of Medicine

David L. Eaton, University of Washington

Warren G. Foster, Michael G. DeGroote School of Medicine and McMaster University

Michael Gochfeld, Rutgers Robert Wood Johnson Medical School Environmental and Occupational Health Sciences Institute

Robert G. Holloway, University of Rochester

Linda A. McCauley, Emory University

Michael D. McClean, Boston University School of Public Health

Gail S. Prins, University of Illinois at Chicago

David Strogatz, Bassett Research Institute

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Elizabeth A. Stuart, Johns Hopkins Bloomberg School of Public Health

Grace Wahba, University of Wisconsin–Madison

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of the report was overseen by Kristine M. Gebbie, Flinders University School of Nursing and Midwifery, Australia. She was responsible for making certain that an independent examination of the report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Preface

This is the Tenth Biennial Update of the Veterans and Agent Orange (VAO) series. This update focuses on the relevant scientific studies published from September 30, 2012, through September 30, 2014, that is, after the literature considered in Update 2012. A series of biennial updates has been completed by the National Academy of Sciences (NAS) as mandated in Public Law 102-4 to respond to the concerns and opinions voiced by Vietnam veterans and their families, and to inform the Department of Veterans Affairs and other stakeholders on the evidence regarding possible associations between exposure to chemical compounds contained in herbicides used in Vietnam and health effects, and to identify areas in which the scientific data were insufficient or inadequate to evaluate possible associations.

To accomplish its task, the Institute of Medicine (IOM) established a committee of 14 members representing a wide array of expertise to evaluate the newest scientific evidence and to integrate its findings with the totality of the evidence reviewed in VAO and updated in Update 1996, Update 1998, Update 2000, Update 2002, Update 2004, Update 2006, Update 2008, Update 2010, and Update 2012. A link to the experience and expertise of previous committees was provided by recruiting six members from committees responsible for earlier updates. The committee operated under the assumption that (unless there is new congressional action) this will be the final update in the IOM VAO series.

The committee sought the most accurate information and advice from the widest possible array of knowledgeable sources. In keeping with National Academies of Sciences, Engineering, Medicine’s procedures, the committee met in a series of closed sessions in which members freely examined, characterized, and weighed the strengths and limitations of the scientific evidence. The committee

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

also convened three open meetings to provide an opportunity for veterans and veterans service organizations, researchers, policy makers, and other interested parties to present their views and concerns, review their independent research procedures and findings, and exchange information directly with the committee. The scheduling of these meetings was widely disseminated through targeted invitations to veterans’ organizations and to other organizations known to have an interest in this issue. The insights gained during open sessions into the health problems experienced by Vietnam veterans were of great value to the committee. The committee also benefited from the input provided concerning B-cell neoplasms by Daniel Persky and Lisa Rimsza of the University of Arizona, Elaine Jaffe of the National Cancer Institute and members of the National Cancer Institute’s InterLymph Project, Annaclaire De Roos, Martha Linet, and Lindsay Morton.

The committee is most grateful to Mary Paxton and Jennifer Cohen, who skillfully and elegantly served as study co-directors for this project and who shared with the committee their valuable experiences and insights from shepherding the production of previous VAO reports. The excellent work of IOM staff members Heather Chiarello, Nicole Freid, and Frederick (Rick) Erdtmann is also acknowledged and appreciated. Thanks are also extended to Julie Wiltshire, who handled the finances for the project; Robert Pool, who provided editorial assistance; and Daniel Bearss and Genevia Chamblee, who conducted database searches and helped with compiling and accessing reference materials.

The committee is pleased with its final product and optimistic that the recommendations contained in its report will help establish a path forward in continuing to meet our responsibility to Vietnam veterans and to veterans of all conflicts.

Kenneth S. Ramos, Chair

Committee to Review the Health Effects
in Vietnam Veterans of Exposure to
Herbicides (Tenth Biennial Update)

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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TABLES

S-1   Summary of tenth biennial Update of Findings on Vietnam-Veteran, Occupational, and Environmental Studies Regarding Scientifically Relevant Associations Between Exposure to Herbicides and Specific Health Outcomes

S-2   Suggested Activities to Follow Completion of the Veterans and Agent Orange Report Series Mandated by the Agent Orange Act

1-1   Age Distributions of Deployed and Non-Deployed Male Veterans of Vietnam Era (August 1964–April 1975) in Civilian Population Over Series of Current Population Surveys (CPSs) from Bureau of Labor Statistics (BLS)

1-2   Summary of ninth biennial Update of Findings on Vietnam-Veteran, Occupational, and Environmental Studies Regarding Scientifically Relevant Associations Between Exposure to Herbicides and Specific Health Outcomes

3-1   Military Use of Herbicides in Vietnam (1961–1971)

3-2   Distribution of Perceived Herbicide Exposure Among 114,562 Korean Vietnam Veterans

3-3   Distribution of EOI Scores on Two-Level Scale in Epidemiology Studies Among Korean Vietnam Veterans

3-4   Distribution of EOI Scores on Four-Level Scale

3-5   Current Committee Guidance for the Classification of Exposure Information in Epidemiologic Studies That Focus on the Use of Pesticides or Herbicides, and Relevance of the Information to the Committee’s Charge to Evaluate Exposures to 2,4-D and 2,4,5-T (Phenoxy Herbicides), Cacodylic Acid, and Picloram

3-6   Current Committee Guidance for the Classification of Exposure Information in Epidemiologic Studies That Focus on Exposure to Dioxin-Like Chemicals and Relevance of the Information to the Committee’s Charge

4-1   Estimates of TCDD Half-Life in Humans and Animals

4-2   World Health Organization Toxicity Equivalence Factors (TEFs) for Dioxin-Like Chemicals (values revised as of 2005)

5-1   Publications Reporting a Single Health Outcome in New Populations

5-2   Publications on Multiple Health Outcomes in New Study Populations

5-3   Publications on Previously Studied Populations

7-1   Selected Epidemiologic Studies—Immune Effects in Adult Humans

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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8-1   Average Annual Incidence (per 100,000) of Nasal, Oral Cavity, and Pharyngeal Cancers in the United States

8-2   Selected Epidemiologic Studies—Oral, Nasal, and Pharyngeal Cancers

8-3   Average Annual Incidence (per 100,000) of Selected Gastrointestinal Cancers in the United States

8-4   Selected Epidemiologic Studies—Esophageal Cancer

8-5   Selected Epidemiologic Studies—Stomach Cancer

8-6   Selected Epidemiologic Studies—Colon and Rectal Cancers

8-7   Selected Epidemiologic Studies—Hepatobiliary Cancers

8-8   Selected Epidemiologic Studies—Pancreatic Cancer

8-9   Average Annual Cancer Incidence (per 100,000) of Laryngeal Cancer in the United States

8-10 Selected Epidemiologic Studies—Laryngeal Cancer

8-11 Average Annual Incidence (per 100,000) of Lung and Bronchial Cancers in the United States

8-12 Selected Epidemiologic Studies—Lung, Bronchus, or Trachea Cancer

8-13 Average Annual Incidence (per 100,000) of Bone and Joint Cancers in the United States

8-14 Selected Epidemiologic Studies—Bone and Joint Cancers

8-15 Average Annual Incidence (per 100,000) of Soft-Tissue Sarcomas (Including Malignant Neoplasms of the Heart) in the United States

8-16 Selected Epidemiologic Studies—Soft-Tissue Sarcomas

8-17 Average Annual Cancer Incidence (per 100,000) of Skin Cancers (Excluding Basal-Cell and Squamous-Cell Cancers) in the United States

8-18 Selected Epidemiologic Studies—Melanoma

8-19 Selected Epidemiologic Studies—Other Non-Melanoma (Basal-Cell and Squamous-Cell) Skin Cancers

8-20 Average Annual Incidence (per 100,000) of Breast Cancer in the United States

8-21 Selected Epidemiologic Studies—Breast Cancer

8-22 Estimates of New Cases of Deaths from Selected Cancers of the Female Reproductive System in the United States in 2015

8-23 Selected Epidemiologic Studies—Cervical Cancer

8-24 Selected Epidemiologic Studies—Uterine Cancer

8-25 Selected Epidemiologic Studies—Ovarian Cancer

8-26 Average Annual Incidence (per 100,000) of Prostate Cancer in the United States

8-27 Selected Epidemiologic Studies—Prostate Cancer

8-28 Average Annual Incidence (per 100,000) of Testicular Cancer in the United States

8-29 Selected Epidemiologic Studies—Testicular Cancer

8-30 Average Annual Incidence (per 100,000) of Bladder Cancer in the United States

Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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8-31 Selected Epidemiologic Studies—Urinary Bladder Cancer

8-32 Average Annual Incidence (per 100,000) of Kidney and Renal Pelvis Cancers in the United States

8-33 Selected Epidemiologic Studies—Renal Cancers

8-34 Average Annual Incidence (per 100,000) of Brain and Other Nervous System Cancers in the United States

8-35 Selected Epidemiologic Studies—Brain Tumors

8-36 Average Annual Incidence (per 100,000) of Endocrine System Cancers in the United States

8-37 Selected Epidemiologic Studies—Endocrine Cancers (Thyroid, Thymus, and Other)

8-38 Average Annual Incidence (per 100,000) of Hodgkin Lymphoma in the United States

8-39 Selected Epidemiologic Studies—Hodgkin Lymphoma

8-40 Average Annual Incidence (per 100,000) of Non-Hodgkin Lymphoma in the United States

8-41 Selected Epidemiologic Studies—Non-Hodgkin Lymphoma

8-42 Selected Epidemiologic Studies—Chronic Lymphocytic Leukemia

8-43 Average Annual Incidence (per 100,000) of Multiple Myeloma in the United States

8-44 Selected Epidemiologic Studies—Multiple Myeloma

8-45 Average Annual Incidence (per 100,000) of Leukemias in the United States

8-46 Selected Epidemiologic Studies—Leukemias

9-1   Selected Epidemiologic Studies—Endometriosis

9-2   Selected Epidemiologic Studies—Male Fertility (Altered Hormone Concentrations, Decreased Sperm Counts or Quality, Subfertility, or Infertility)

9-3   Selected Epidemiologic Studies—Female Fertility (Altered Hormone Concentrations, Subfertility, or Infertility)

9-4   Selected Epidemiologic Studies—Sex Ratio

9-5   Selected Epidemiologic Studies—Spontaneous Abortion

9-6   Selected Epidemiologic Studies—Birth Weight Following Paternal Exposure

9-7   Selected Epidemiologic Studies—Birth Weight Following Maternal Exposure

10-1 Selected Epidemiologic Studies—Birth Defects in Offspring of Subjects

10-2 Selected Epidemiologic Studies—Neural-Tube Defects in Offspring of Subjects

10-3 Selected Epidemiologic Studies—Childhood Cancer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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11-1 Epidemiologic Studies of Herbicide Exposure and Parkinson Disease and Parkinson-Like Conditions

11-2 Correspondence of ICD-9 and ICD-10 Codes for Parkinson Disease and Other Extrapyramidal Disease and Abnormal Movement Disorders

11-3 Epidemiologic Studies of Pesticide Exposure and Amyotrophic Lateral Sclerosis

12-1 Prevalence of and Mortality from Diabetes, Lipid Disorders, and Circulatory Disorders in the United States, 2009/2010

12-2 Selected Epidemiologic Studies—Diabetes and Related Health Outcomes

12-3 Selected Epidemiologic Studies—Circulatory Disorders

12-4 Epidemiologic Studies Providing Best Evidence in Terms of Design, Sample Size, and Relevance—Cerebrovascular Disorders/Stroke

13-1 Selected Epidemiologic Studies—Non-Cancer Respiratory Disease

13-2 Selected Epidemiologic Studies—COPD and Pulmonary Function

13-3 Selected Epidemiologic Studies—Thyroid Homeostasis

14-1 Summary of tenth biennial Update of Findings on Vietnam-Veteran, Occupational, and Environmental Studies Regarding Scientifically Relevant Associations Between Exposure to Herbicides and Specific Health Outcomes

14-2 Compendium of Research Recommendations from Previous and Current Veterans and Agent Orange Reports

14-3 Suggested Activities to Follow the Completion of the Veterans and Agent Orange Report Series Mandated by the Agent Orange Act

14-4 Studies Approved for Use of the AFHS Data or Biospecimens Since 2012

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

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

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×

Abbreviations and Acronyms

2,4-D 2,4-dichlorophenoxyacetic acid
2,4-DCP 2,4-dichlorophenol
2,4,5-T 2,4,5-trichlorophenoxyacetic acid
2,4,5-TCP 2,4,5-trichlorophenol
2,4,5-TP 2-(2,4,5-trichlorophenoxy) propionic acid, Silvex
   
ACC US Army Chemical Corps
ACS American Cancer Society
AD Alzheimer disease
ADM adrenomedullin
ADMS 3 second-generation Gaussian atmospheric-dispersion model/software
ADVA Australia Department of Veterans’ Affairs
AFHS Air Force Health Study (also referred to as the “Ranch Hand Study”)
AGDISP US Forest Service’s Agricultural Division
AGS a stomach-cancer cell line
AHR aryl hydrocarbon receptor
AHRE AHR-responsive element of the canonical DNA recognition motif of the AHR/ARNT complex, also referred to as the dioxin-responsive element (DRE) or the xenobiotic-responsive element (XRE)
AHS US Agricultural Health Study
AIHW Australian Institute of Health and Welfare
Page xxii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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AL amyloidosis amyloid light-chain amyloidosis in which the amyloid in deposits in various organs and tissues consists of antibody light chains
ALL acute lymphocytic leukemia
ALS amyotrophic lateral sclerosis (Lou Gehrig’s disease)
ALT alanine aminotransferase
AML acute myeloid leukemia (previously called “acute myelogenous leukemia”)
AO Agent Orange, often loosely used to refer to all herbicides sprayed by the US military in Vietnam
AOVS CDC Agent Orange Validation Study
ARNT aryl hydrocarbon nuclear translocator
ARVN Army of the Republic of Vietnam
ATSDR Agency for Toxic Substances and Disease Registry
   
β beta is the slope of a statistical model; a value of 0 corresponds to no effect
B[a]P benzo[a]pyrene
BIRLS VA’s Beneficiary Identification Records Locator Subsystem
BLS Bureau of Labor Statistics, US Department of Labor
BMD bone mineral density
BMI body mass index
BWIS Baltimore–Washington Infant Study
   
CALUX chemical-activated luciferase gene expression bioassay, a test for determination of dioxin-like activity in tissue samples
CARDIA Coronary Artery Risk Development in Young Adults cohort
CAS number number generated by the Chemical Abstracts Service that serves as unique identifier for every chemical
CATI computer-assisted telephone interview
CB chronic bronchitis
CC case control
CCSPH Cross-Canada Study of Pesticides and Health
CDC US Centers for Disease Control and Prevention
CDD chlorinated dibenzo-p-dioxin
CDF chlorinated dibenzofuran
CDVA Australian Commonwealth Department of Veterans’ Affairs
CER Swedish Cancer-Environment Register
CHAMACOS Center for the Health Assessment of Mothers and Children of Salinas cohort
CI confidence interval, as defined by lower upper confidence (LCL) and upper confidence limits (UCL)
Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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CIH Commonwealth Institute of Health
CLL chronic lymphocytic leukemia (now regarded as same disease as small lymphocytic leukemia [SLL] and designated by some as CLL/SLL)
CML chronic myeloid leukemia
CNS central nervous system
COI chemical(s) of interest to VAO series (TCDD, 2,4,5-T, 2,4-D, picloram, or cacodylic acid)
COPD chronic obstructive pulmonary disease
COX-2 cyclooxygenase
cPLA2 cytosolic phospholipase A2
CPS Current Population Survey
CRP C-reactive protein
CSF cerebrospinal fluid
CT computed tomography
CVD cardiovascular disease
CYP--- cytochrome P450 (specific members of this family of metabolizing enzymes are indicated by a number-letter-number suffix)
   
DEET N,N-diethyl-meta-toluamide
DHEA dehydroepiandrosterone
DIT developmental immunotoxicity
dl dioxin-like
dL deciliter
DLBCL diffuse large B-cell lymphoma
DLC dioxin-like compound (or chemical)
DMA dimethyl arsenic acid
DMAIII dimethyl arsenic acid of valence 3
DMAV dimethyl arsenic acid of valence 5; form of arsenic found in cacodylic acid
DMBA dimethylbenzanthracene
DMMTAV dimethylmonothioarsinic acid
DNA deoxyribonucleic acid
DOD US Department of Defense
DOHaD developmental origins of health and disease
DRE dioxin-responsive element, recognition motif of the AHR/ ARNT complex (also called AHRE or XRE)
DTH delayed-type hypersensitivity, a cell-mediated immune response
DXA dual-energy x-ray absorption
Page xxiv Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
   
E4 specific EOI score for potential exposure of ground troops to AO or other military herbicides generated by Stellman model
EA early antigen
EBV Epstein Barr virus
ECG electrocardiography
EDC endocrine-disrupting chemical
EEG electroencephalography
EF ejection fraction
EFED Environmental Fate and Effects Division
EOI exposure opportunity index, any metric of possible exposure
EPA US Environmental Protection Agency
EPILYMPH study a multi-center case-control study on lymphoma aetiology conducted in 22 centers of six European countries (six centers in Germany, two in Italy, four in Spain, six in Ireland, three in France, and one in the Czech Republic)
ER estrogen receptor
EU European Union
   
FAO/UNEP Food and Agriculture Organization, United Nations Environment Programme
FEF25–75 forced midexpiratory flow
FEV1 forced expiratory volume in 1 second
FSH follicle-stimulating hormone
FYD fetal Yusho disease
   
g gram
GAO US Government Accountability Office
GD gestation day
GERD gastroesophageal reflux disease
GGT β-glutamyltransferase
GHC Group Health Cooperative (University of Washington)
GI gastrointestinal
GIS geographic information system
   
HCH β-hexachlorocylohexane
HCL hairy-cell leukemia
HDL high-density lipoprotein
HERBS Herbicide Reporting System
HIV human immunodeficiency virus
HL Hodgkin lymphoma (previously referred to as Hodgkin’s disease [HD] in VAO series)
HPV human papilloma virus
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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HR hazard ratio
HRGC high-resolution chromotography
HRMS high-resolution mass spectrometry
HSC hematopoietic stem cell
HT hypertension
   
IARC International Agency for Research on Cancer
ICD-# international Classification of Diseases, Revision # (# = version current for records being abstracted)
ICD-#-CM international Classification of Diseases, Revision #, Clinical Modification
IgE immunoglobulin E
IGF insulin-like growth factor
IHD ischemic heart disease
IL interleukin
IL1RA interleukin 1 receptor antagonist
IMT intima-media thickness of arterial walls
InterLymph International Lymphoma Epidemiology Consortium
IOM Institute of Medicine
IU international unit
IUGR intrauterine growth retardation
IVRT isovolumic relaxation time
   
JEM job–exposure matrix
   
kg kilogram
KVHS Korean Veteran Health Study
   
L liter
LATIN study an international, multi-center case-controlled study of aplastic anemia and agranulocytosis in Latin American countries
LBW low birth weight
LDL low-density lipoprotein
LH luteinizing hormone
LHC lymphohematopoietic cancer
LN lymphoid neoplasm
LOD limit/level of detection
LPS lymphoproliferative syndrome
LVMI left ventricular mass index
   
MCPA 2-methyl-4-chlorophenoxyacetic acid
MCPB 4-(4-chloro-2-methylphenoxy) butanoic acid
Page xxvi Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
×
MCPP 2-(2-methyl-4-chlorophenoxy) propionic acid or Mecoprop
MDS myelodysplastic syndrome
MEG magnetoencephalography
MIH molar incisor hypomineralization
MIP macrophage-inflammatory protein
ml milliliter
MLR mixed lymphocyte response
MMAIII monomethyl arsonic acid of valency 3
MNU N-methyl-N-nitrosourea
MoBa Norwegian Mother and Child Cohort Study
MOS month of service
MRI magnetic resonance imaging
MS multiple sclerosis
MSWI municipal solid-waste incinerator
   
n number of study participants
na not applicable
NaOH sodium hydroxide
NAS National Academy of Sciences
NASA National Aeronautics and Space Administration
NBDPS US National Birth Defects Prevention Study
NCHS CDC National Center for Health Statistics
NCI National Cancer Institute
NCIDB Korean National Cancer Incidence Database
NDI National Death Index
NER nucleotide excision repair
NewGeneris Newborns and Genotoxic Exposure Risks cohort
ng nanogram (10−9 gram)
NHANES National Health and Nutrition Examination Survey
NHL non-Hodgkin lymphoma
NICHD National Institute of Child Health and Human Development
NIH National Institutes of Health
NIOSH National Institute for Occupational Safety and Health
NK cells natural killer cells
NLS nuclear-localization signal
nM nanomolar
NOAEL no-observed-adverse-effect level
NOEL no-observed-effect level
NOS not otherwise specified
nr not reported
NRC National Research Council
ns not statistically significant (usually refers to p < 0.05)
NTIS National Technical Information Service
Page xxvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Veterans and Agent Orange: Update 2014. Washington, DC: The National Academies Press. doi: 10.17226/21845.
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NTP National Toxicology Program
NVVLS National Vietnam Veterans Longitudinal Study (follow-up study based on sample in NVVRS)
NVVRS National Vietnam Veterans Readjustment Study
NZIC New Zealand Institute of Chemistry
   
OC organochlorine
OCDD octachlorodibenzo-p-dioxin (1,2,3,4,6,7,8,9-OCDD is the only dioxin congener that has eight chlorine atoms)
OFFHS Ontario Farm Family Health Study
Operation PACER IVY 1972 operation of the US Air Force that removed Agent Orange from South Vietnam and stored it on Johnston Atoll
Operation PACER HO 1977 operation of the US Air Force that incinerated the Agent Orange stored at Johnston Atoll aboard the Dutch-owned ship M/T Vulcanus
OR odds ratio
ORH Operation Ranch Hand
OSCAR Osteoporosis Cadmium as a Risk Factor cohort
   
p p-value; probability of the observed result or one more extreme under null hypothesis
PAH polycyclic aromatic hydrocarbon
PBPK model physiologically based pharmacokinetic model
PCB polychlorinated biphenyl
PCDD polychlorinated dibenzo-p-dioxin
PCDD/Fs polychlorinated dioxins and furans combined
PCDF polychlorinated dibenzofuran
PCMR proportionate cancer mortality ratio
PCP pentachlorophenol
PCT porphyria cutanea tarda
PD Parkinson disease
pg picogram (10−12 gram)
picloram 4-amino-3,5,6-trichloropicolinic acid
PIVUS Prospective Study of the Vasculature in Uppsala Seniors
PKC protein kinase C
PL Public Law
PM proportionate mortality
PMR proportional mortality ratio
PNS peripheral nervous system
POLAIR Gaussian plume model for dioxin concentrations
POP persistent organic pollutant
ppb parts per billion (ng/g)
ppm parts per million (µg/g = mg/kg)
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ppt parts per trillion (pg/g)
PSA prostate-specific antigen
PTD preterm delivery, premature birth at less than 259 days (37 weeks) gestation
PTSD posttraumatic stress disorder
PUR California’s Pesticide Use Reporting system
   
RANTES regulated on activation, normal t-cell–expressed, and secreted
RAST radioallergosorbent
RDD random-digit dialing
RNA ribonucleic acid
RR relative risk (also called “risk ratio”)
RWT relative wall thickness
   
SAB spontaneous abortion
SCE sister-chromatid exchange
SD standard deviation
SDTF Spray Drift Task Force
SEA Southeast Asia
SEER NCI’s Surveillance, Epidemiology, and End Results
SGA small for gestational age
SHBG steroid hormone binding globulin
SIDS Sudden Infant Death Syndrome
SIR standardized incidence ratio
SLE systemic lupus erythematosus
SMR standardized mortality ratio
SNP single-nucleotide polymorphism
SR sex ratio
STS soft-tissue sarcoma
SWAP Sawmill Workers Against Poisons
SWHS Seveso Women’s Health Study
   
T3 triiodothyronine
T4 thyroxine
TCDD 2,3,7,8-tetrachlorodibenzo-p-dioxin
TCP trichlorophenol
TEF toxicity equivalency factor, potency of a dioxin-like compound (DLC) relative to TCDD
TEQ (total) toxic equivalent (formerly “toxicity equivalent quotient”), cumulative toxic potency, sum of TEFs for a mixture of PCDDs, PCDFs, and PCBs
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tetraCDD tetrachlorodibenzo-p-dioxin, any of the 22 dioxin congeners that have four chlorine atoms, including TCDD as defined above
TGF transforming growth factor
TNF tumor necrosis factor
TPA tetradeconoyl phorbol acetate
TRF teacher report form
TSH thyroid-stimulating hormone
TTP time-to-pregnancy
TWA time-weighted average
   
UFW United Farm Workers of America
UGI upper gastrointestinal tract
UMHS Upper Midwest Health Study
UNEP United Nations Environmental Programme
UNICEF United Nations Children’s Fund (also known as United Nations International Children’s Emergency Fund)
US United States
USDA US Department of Agriculture
UV ultraviolet radiation
   
VA US Department of Veterans Affairs; previously, Veterans Administration
VAO Veterans and Agent Orange (refers to series of IOM committees and reports; italicized VAO, refers to the initial comprehensive review, published in 1994)
VES Vietnam Experience Study
VOC volatile organic compound
VV Vietnam veteran
VVFS Australian Vietnam Veteran Family Study
   
WBC white blood cell
WC waist circumference
WHO World Health Organization
WISC-R Wechsler Intelligence Scale for Children (revised edition)
   
XRE xenobiotic-responsive element, recognition motif of the AHR/ARNT complex (also called DRE or AHRE)
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Next: Summary »
Veterans and Agent Orange: Update 2014 Get This Book
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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 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 were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 2014 is the final and cumulative report of the series.

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