Veterans and Agent Orange: Update 2008

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Veterans and Agent Orange: Update 2008 is the eighth in a series of congressionally mandated studies that review and evaluate the available scientific evidence regarding the statistical association between exposure to herbicides used in Vietnam and various adverse health outcomes suspected to be linked with such exposures.

These previous volumes have noted that sufficient evidence exists to link chronic lymphocytic leukemia, soft-tissue sarcoma, non-Hodgkin's lymphoma, Hodgkin's disease, and chloracne with exposure. These books also noted that there is limited or suggestive evidence of an association between exposure and AL amyloidosis, hypertension, multiple myeloma, early-onset transient peripheral neuropathy, porphyria cutanea tarda, prostate cancer, laryngeal cancer, respiratory cancers, type 2 diabetes, and the congenital birth defect spina bifida in veterans' children.

This eighth volume focuses primarily on scientific studies and other information developed since the release of the earlier volumes. This book will be critically important to both policy makers and physicians in the federal government, Vietnam veterans and their families, Veterans' organizations, researchers, and health professionals.

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Product Details

  • ISBN-13: 9780309138840
  • Publisher: National Academies Press
  • Publication date: 11/20/2009
  • Pages: 708
  • Product dimensions: 6.10 (w) x 9.10 (h) x 1.60 (d)

Table of Contents

Abbreviations and Acronyms xvii

Summary 1

Charge to the Committee 2

Committee's Approach to Its Charge 3

Evidence Reviewed by the Committee 5

The Committee's Conclusions 6

Committee Recommendations 10

1 Introduction 13

Charge to the Committee 14

Conclusions of Previous Veterans and Agent Orange Reports 18

Organization of This Report 25

References 25

2 Evaluating the Evidence 27

Choice of Health Outcomes 27

Identification of Relevant Literature 28

Committee's Approach 33

Evaluation of the Evidence 37

References 44

3 Exposure to the Herbicides used in Vietnam 46

Military Use of Herbicides in Vietnam 47

TCDD in Herbicides Used in Vietnam 49

Exposure of Vietnam Veterans 51

Exposure of the Vietnamese Population 55

New Models for Characterizing Herbicide Exposure 56

Methodologic Issues in Exposure Assessment 57

References 61

4 Information Related to Biologic Plausibility 65


Phenoxy Herbicides: 2,4-D and 2,4,5-T 81

Cacodylic Acid 84

Picloram 89

References 92

5 Epidemiologic Studies-New Citations and Background on Repeatedly Studied Populations 104

New Citations 105

Relevant Populations: New Reports with Multiple Health Outcomes or with Results on Previously Studied Groups 115

Vietnam-Veteran Studies 115

Occupational.Studies 137

Environmental Studies 158

References 167

6 Cancer 202

Organization of Cancer Groupings 204

Biologic Plausibility 205

Oral, Nasal, and Pharyngeal Cancer 209

Cancers of the Digestive Organs 218

Esophageal Cancer 219

Stomach Cancer 223

Colorectal Cancer 233

Hepatobiliary Cancers 245

Pancreatic Cancer 252

Laryngeal Cancer 259

Lung Cancer 264

Bone and Joint Cancer 275

Soft-Tissue Sarcomas 279

Skin Cancer-Melanoma 289

Skin Cancer-Basal-cell Cancer and Squamous-cell Cancer (Nonmelanoma Skin Cancers) 297

Breast Cancer 301

Cancers of the Female Reproductive System 311

Prostate Cancer 317

Testicular Cancer 328

Bladder Cancer 332

Renal Cancer 339

Brain Cancer 345

Endocrine Cancers 354

Lymphohematopoietic Cancers (Lymphomas and Leukemias) 358

Hodgkin's Disease 360

Non-Hodgkin's Lymphoma 368

Multiple Myeloma 385

AL Amyloidosis 392

Leukemia 394

Chronic Lymphocytic Leukemia and Hairy Cell Leukemia 406

Summary 412

References 414

7 Reproductive Effects and Impacts on Future Generations 435

Biologic Plausibility of Reproductive Effects 436

Endometriosis 438

Fertility 444

Spontaneous Abortion 460

Stillbirth, Neonatal Death, and Infant Death 465

Birth Weight and Preterm Delivery 467

Birth Defects 469

Childhood Cancer 480

Effects Occurring Later in Offspring's Life or in Later Generations 489

Summary 494

References 495

8 Neurologic Disorders 510

Neurobehavioral (Cognitive or Neuropsychiatric) Disorders 512

Neurodegenerative Diseases 515

Parkinson's Disease and Parkinsonism 515

Amyotrophic Lateral Sclerosis 527

Peripheral Neuropathy 530

Summary 536

References 538

9 Other Health Effects 546

Chloracne 547

Porphyria Cutanea Tarda 549

Respiratory Disorders 552

Immune-System Disorders 566

Immune Suppression 567

Allergy 567

Autoimmune Disease 568

Type 2 Diabetes 571

Lipid and Lipoprotein Disorders 587

Gastrointestinal and Digestive Disease, Including Liver Toxicity 593

Peptic-Ulcer Disease 593

Liver Disease 594

Circulatory Disorders 597

Hypertension 620

Circulatory Diseases 623

Synthesis 627

Hypertension 627

Ischemic Heart Disease 628

Other Circulatory Disease 631

Thyroid Homeostasis 631

Summary 636

References 638

10 Conclusions and Recommendations 651

Synopsis of Committee Conclusions 651

Committee Recommendations 655

References 661


A Agendas of Public Meetings Held by the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Seventh Biennial Update) 663

B Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers 666

C Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Seventh Biennial Update) and Staff Biographies 676

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