The association of selected cancers with service in the US military in Vietnam; I. Non-Hodgkin's lymphoma

Article Abstract:

Concern over the health of American soldiers who served in Vietnam led to a Congressional directive for health studies to be conducted among Vietnam veterans. Because the incidence of cancers of the greatest concern were found to be low in an initial study, a second study, the Selected Cancers Study, was initiated. This study used different techniques to determine whether the risk of selected rare cancers was increased in these veterans, particularly as a consequence of exposure to Agent Orange. Industrial and agricultural exposure to the herbicides and contaminants in Agent Orange are variably associated with an increased risk for some cancers. This article presents the findings regarding non-Hodgkin's lymphoma (NHL), and details on the research methods are described. Results of studies on other cancers are presented in two other papers in the December 1990 issue of Archives of Internal Medicine. The cancers selected for study were chosen because of an experimentally observed link with exposure to phenoxy-containing herbicides and chlorophenols. Agent Orange, used to deforest Vietnam, contained both types of agents. Past exposure to Agent Orange is difficult to measure, and such exposure could only be estimated by characterizing military service in terms of service branch, region in Vietnam served, years of service, and specific duties involving herbicide handling. Veterans who served in Vietnam, but not elsewhere, had an approximately 50 percent greater risk of developing NHL within about 15 to 25 years after military service, and this was statistically significant. In this study, which used cancer registries covering about 10 percent of the US population, this group comprised 99 people, a small number about whom it is difficult to draw conclusions. The results suggest that the risk of NHL does not correspond to known patterns of Agent Orange spraying, as sea-going Navy veterans, who had little opportunity for exposure, had the highest risk of NHL. Risk was not greater among those stationed in Vietnam during times of heaviest spraying. No other factor associated with risk for NHL could be identified, and antimalarial therapy and illicit drug use do not seem to explain the increased incidence. The study strongly suggests that the increased risk of Vietnam veterans to develop NHL is not related to Agent Orange exposure. (Consumer Summary produced by Reliance Medical Information, Inc.)

Non-Hodgkin's lymphomas

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The association of selected cancers with service in the US military in Vietnam

Article Abstract:

The health consequences of military service in the Vietnam War have been greatly debated, but few substantial studies have addressed this issue. Of great concern to many has been the exposure of many US soldiers to the herbicide Agent Orange, which contained two herbicides, trichlorophenoxy acetic acid and dichlorophenoxy acetic acid, and which was contaminated with 2,3,7,8-tetrachlorodibenzo-p-dioxin (commonly called dioxin). Epidemiologic studies have been conducted of industrial workers exposed to these compounds, but the issue of health problems among Vietnam veterans has become highly polarized. Three articles describing the well-designed and -conducted studies by Brann and coworkers appear in the December 1990 issue of Archives of Internal Medicine. This research indicates that the risk of non-Hodgkin's lymphoma was about 50 percent higher among Vietnam veterans than other veterans or civilians, and the risk was higher among men with sea-based Navy service. Importantly, the risk was not associated with exposure to Agent Orange, even though these findings are reminiscent of increased incidence of non-Hodgkin's lymphoma among agricultural workers exposed to dichlorophenoxy acetic acid. In addition, no other elevated risk for sarcomas, Hodgkin's disease, cancers of the upper respiratory tract, or liver cancer was found in Vietnam veterans. The research included the Air Force group who handled Agent Orange. Although the factors underlying the increased incidence of non-Hodgkin's lymphoma in Vietnam veterans remain unclear, these studies show no basis for an association of Agent Orange exposure with multiple types of cancers. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cancer, editorial

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The association of selected cancers with service in the US military in Vietnam; II. Soft-tissue and other sarcomas

Article Abstract:

Concern over the health of American soldiers who served in Vietnam led to a Congressional directive for health studies among Vietnam veterans. Because the incidence of cancers of the greatest concern were found to be low in an initial study, a second study, the Selected Cancers Study, was initiated. This study used different techniques to determine whether the risk of selected rare cancers was increased in these veterans, particularly with reference to exposure to the herbicide Agent Orange. Industrial and agricultural exposure to the herbicides and contaminants in Agent Orange are variably associated with an increased risk for some cancers. This article addresses the incidence of sarcomas (cancers of connective tissue such as muscle or bone) and other soft-tissue cancers. Two other articles in the December 1990 issue of Archives of Internal Medicine address the risk of Non-Hodgkin's lymphoma and Hodgkin's disease, respiratory tract cancers, and liver cancer. This study did not find an increased risk of sarcoma or any subtype of soft-tissue sarcoma among Vietnam veterans, compared with risk among other veterans or civilians, nor was any subgroup of Vietnam veterans at higher risk for these tumors. The incidence of sarcoma among Vietnam veterans was not associated with Agent Orange exposure. These tumors are generally rare and sometimes difficult to diagnose correctly. The study results are such that a modest elevation in risk for the tumors would not be detectable, but a two-fold increased risk would be apparent during analysis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Sarcoma

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