Veterans and Agent Orange Update 2000 (2001) / Chapter Skim
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1 Executive Summary
1 Executive Summary
Pages 1-14
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to conduct a comprehensive review and evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various chemical components of these herbicides, including dioxin. A committee convened by the Institute of Medicine (IOM)
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Chapter 6 provides a general review of the epidemiologic studies used to assess the potential association between herbicides and specific health outcomes. The chapter is organized to reflect similarities and differences in the nature of exposure among three types of study populations: occupationally exposed, environmentally exposed, and Vietnam veterans.
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TCDD affects the endocrine system of animals. Some experiments indicate that treating animals with TCDD alters thyroid hormone levels, but others do not, making the interpretation of effects on thyroid hormones difficult.
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The findings that many AhR-modulated genes and responses are regulated in a cell-, tissue-, developmental stage-, and species-specific pattern suggest that the molecular and cellular pathways leading to any particular toxic event are extremely complex and probably involve multiple events, genes, and signal transduction pathways. Further definition of the pathways regulated by the AhR in a tissue-specific fashion will help to clarify the understanding of the relationships between the dose of TCDD that reaches the tissue and the events leading to specific toxic end points.
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CONCLUSIONS ABOUT HEALTH OUTCOMES Chapters 7, 8, 9, and 10 provide a detailed evaluation of the epidemiologic studies reviewed by the committee and their implications for cancer, reproductive effects, neurobehavioral effects, and other health effects. As detailed in Chapter 4, the committee weighed the strengths and limitations of the epidemiologic evidence in previous Veterans and Agent Orange reports as well as the newly published scientific data and reached its conclusions by interpreting the new
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There is limited/suggestive evidence of an association between exposure to herbicides and the following health outcomes: Respiratory cancers (lung/bronchus, larynx, trachea) Prostate cancer Multiple myeloma Acute and subacute transient peripheral neuropathy Porphyria cutanea tarda Type 2 diabetes (category change from Update 1998)
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There is inadequate or insufficient evidence to determine whether an association exists between exposure to herbicides and the following health outcomes: Hepatobiliary cancers Nasal/nasopharyngeal cancer Bone cancer Skin cancers (melanoma, basal, and squamous cell) Breast cancer Female reproductive cancers (cervical, uterine, ovarian)
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Updates of the Air Force Health Study and Seveso populations did not add any new information on STS. An investigation of cancers in the vicinity of a solid waste incinerator in France found a statistically significant spatial cluster, although methodologic concerns lessen confidence in these findings.
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chemical production workers and Ranch Hand veterans continues to support the finding that there is limited/suggestive evidence for an association between the herbicides of concern in this report and the risk of these outcomes. Evidence for an exposure-response relationship has been slightly strengthened since Update 1998 but still does not support a conclusion of sufficient evidence.
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The committee is aware of no new publications that investigate the association between exposure to the compounds of interest and acute or subacute transient peripheral neuropathy, and knows of no evidence that new cases of these conditions that develop long after service in Vietnam would be associated with wartime herbicide exposure. Since Update 1998 was published, a validation study found a significant excess of spine bifida cases in the children born to Australian Vietnam veterans.
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The scientific evidence regarding each of these cancers is detailed in Chapter 7. Several reproductive effects are classified in this category, including spontaneous abortion, birth defects other than spine bifida, neonatal or infant death and stillbirths, low birthweight, childhood cancer in offspring (other than acute myelogenous leukemia)
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For those outcomes in the "sufficient" and "limited/ suggestive" categories, what can be said is that too little is known about the herbicide exposure of veterans to make a meaningful determination of the increased risk, if any, of these outcomes among Vietnam veterans. Where there is inadequate/insufficient evidence to determine whether an association exists between herbicide exposure and a particular health outcome, there is also inadequate/insufficient information to assess the increased risk, if any, of that outcome.
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is an epidemiologic study whose purpose is to determine whether exposure to the herbicides used in Vietnam may be responsible for any adverse health conditions observed in a cohort of Air Force personnel responsible for conducting aerial spray missions (the Ranch Hands)
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1997. Characterizing Exposure of Veterans to Agent Orange and Other Herbicides Used in Vietnam: Scientific Considerations Regarding a Request for Proposals for Research.
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