Nancy A. Dalager

Cancer mortality among workers exposed to zinc chromate paints.

To evaluate the carcinogenicity of chromium compounds among user industries, the proportionate mortality experience of spray painters exposed to zinc chromate primer paints and electroplaters exposed to chromic acid in the aircraft maintenance industry was examined. Compared to the mortality patterns of U.S. white males, no excess of cancer was found in the 48 deaths among electroplaters. Analysis of the 202 deaths among spray painters revealed a significant excess of cancer, primarily of the respiratory tract. The relative increase of respiratory cancer showed a positive gradient with the length of estimated exposure time, and was confined to painters whose interval from first employment to death was at least 20 years. The findings are consistent with occupational exposure to chromium compounds, previously shown to he carcinogenic in manufacturing processes, but the effect of other paint constituents, tobacco smoking, or methodologic limitations could not be discounted.

Anthrax vaccination and self-reported symptoms, functional status, and medical conditions in the National Health Survey of Gulf War Era Veterans and Their Families

PURPOSEnTo evaluate the health status of Gulf War veterans who reported receipt of anthrax vaccination and a small group of Gulf War veterans for whom documentation of anthrax vaccination exists.nnnMETHODSnAmong the 11,441 Gulf War veterans who completed a health survey, 4601 reported receiving the anthrax vaccine during the war; 2979 veterans reported not receiving it; 3861 were uncertain. Also, 352 of these respondents were documented by the Department of Defense as having received anthrax vaccination. We compared the medical history of these groups of veterans using multivariate analyses. Finally, we analyzed perception of exposure and its relation to reporting bias.nnnRESULTSnThere were statistically significant differences in prevalence for almost all outcomes studied between those who reported having received anthrax vaccination and those who did not so report. However, when we compared the veterans for whom vaccination records exist to the group who self-reported that they had not received the vaccine, the significant differences in prevalence for almost all of the outcomes disappeared.nnnCONCLUSIONSnThe extent of a reporting bias should be carefully considered when one evaluates the health consequences of anthrax vaccination based on self-reported data.

Mortality among Army Chemical Corps Vietnam veterans.

Army Chemical Corps personnel who served in Vietnam were among those service personnel with the greatest potential for exposure to herbicides. An earlier evaluation of the mortality experience of 894 Army Chemical Corps Vietnam veterans found a statistically significant excess risk of dying from digestive disease, primarily due to cirrhosis of the liver, and from motor vehicle accidents. That study was expanded to include 2,872 Vietnam veterans who served with the Army Chemical Corps and a comparison cohort of 2,737 veterans who never served in Southeast Asia but who did serve in the same occupational category. The results of the analysis comparing the Vietnam cohort to the non-Vietnam cohort support the earlier finding of a significant excess of deaths from digestive diseases (adjusted relative risk (RR) = 3.88, 95% C.I. = 1.12-13.45) primarily due to liver cirrhosis. Non-significant elevated relative risks were observed for all cancers combined, digestive and respiratory systems cancers, skin cancer, lymphopoietic cancers, and respiratory system diseases. Compared to the mortality rates in the general population, the non-Vietnam Army Chemical Corps veterans had a statistically significant deficit in mortality from all causes combined, which is consistent with a healthy selection bias seen among military populations (SMR = 0.79, 95% C.I. = 0.66-0.94). For the Vietnam veterans, patterns of elevated but nonsignificant SMRs persisted for diseases of the digestive and respiratory systems and for selected cancer sites.

Ten years and 100,000 participants later: occupational and other factors influencing participation in US Gulf War health registries.

For more than a decade after the Gulf War, there has been concern that wartime exposures have resulted in significant morbidity among Gulf War veterans. After the end of the war, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) initiated health registries to provide systematic clinical evaluations of Gulf War veterans who chose to participate. By September 1999, there were 32,876 participants in the DoD Comprehensive Clinical Evaluation Program and 70,385 participants in the VA Gulf War Registry Health Examination Program. We identified demographic and military service factors, as well as potential war-related exposures associated with subsequent registry participation after 10 years of observation. Veterans potentially exposed to oil well fire smoke, those near Khamisiyah, Reserve and National Guard, Army veterans, and veterans in the theater of operations during intense combat periods were most likely to elect to participate in a registry. These findings support the hypothesis that certain occupational factors and wartime exposures may influence subsequent health care–seeking behavior.

Cancer mortality patterns among women who served in the military: the Vietnam experience.

In response to concerns of women veterans regarding the long-term health effects of military service in Vietnam, the Department of Veterans Affairs has been conducting a retrospective cohort mortality study of women Vietnam veterans. Military records were used to identify approximately 4600 women who served in Vietnam between July 4, 1965, and March 28, 1973, and a comparison cohort of nearly 5300 women who served during the same time frame but not in Southeast Asia or the Pacific theater. Current data include vital status determinations as of December 31, 1991, with a total of 532 deaths and an average follow-up of just over 20 years for both groups. Both the Vietnam and non-Vietnam women cohorts had a significant deficit of deaths from all causes compared to women in the US population. The two cohorts showed no difference in total mortality or in deaths from all cancers. A significant excess risk of pancreatic cancer was observed among Vietnam nurses compared to either non-Vietnam nurses (relative risk = 5.74) or women in the US population (standardized mortality ratio (SMR) = 2.78). Vietnam nurses also had an elevated risk of dying from cancer of the uterine corpus. Non-Vietnam nurses had a higher lung cancer mortality rate than women in the general population (SMR = 1.55) or nurses who served in Vietnam. Observed deficits of deaths from all causes and circulatory system diseases generally confirm a healthy selection bias for entry into and retention in the military that has been observed among men serving in the Armed Forces.

Non-Hodgkin's lymphoma among Vietnam veterans

In light of findings suggesting an increase in the risk for non-Hodgkins lymphoma among men exposed to phenoxyherbioides and concerns among veterans over Agent Orange exposure, a hospital-based case-control study was undertaken to examine the association between military service in Vietnam and non-Hodgkins lymphoma. The cases consisted of 201 Vietnam-era veteran patients who were treated in one of 172 Department of Veterans Affairs hospitals from 1969 through 1985 with a diagnosis of non-Hodgkins lymphoma. 358 Vietnam- era veteran patients with a diagnosis other than malignant lymphoma served as a comparison group. Military service information was obtained from a review of the veterans military personnel records. Service in Vietnam did not increase the risk of non-Hodgkin s lymphoma either in general (branch adjusted odds ratio = 1.03, 95% confidence interval = 0.70- 1.50) or with increased latency period as defined as the duration in years from first service in Vietnam to hospital discharge. Surrogate measures of potential Agent Orange exposure such as service in a specific military branch, in a certain region within Vietnam, or in a combat role as determined by military occupational specialty were not associated with any increased risk of non-Hodgkins lymphoma.

Cancer mortality risk among military participants of a 1958 atmospheric nuclear weapons test.

OBJECTIVESnThis study was undertaken to determine if Navy veterans who participated in an atmospheric nuclear test in 1958 were at increased risk of death from certain cancers.nnnMETHODSnCancer mortality risk of 8554 Navy veterans who participated in an atmospheric nuclear test in the Pacific was compared with that of 14,625 Navy veterans who did not participate in any test. Radiation dosage information was obtained from film badges for 88% of the test participants.nnnRESULTSnThe median radiation dose for the test participants was 388 mrem (3.88 millisieverts [mSv]). Among participants who received the highest radiation dose (> 1000 mrem, or 10 mSv), an increased mortality risk for all causes (relative risk [RR] = 1.23; 95% confidence interval [CI] = 1.04, 1.45), all cancers (RR = 1.42; 95% CI = 1.03, 1.96), and liver cancer (RR = 6.42; 95% CI = 1.17, 35.3) was observed. The risk for cancer of the digestive organs was elevated among test participants (rate ratio = 1.47; 95% CI = 1.06, 2.04) but with no significant dose-response trend. Many of the cancers of a priori interest were not significantly elevated in the overall test participant group or in the group that received the highest radiation dose.nnnCONCLUSIONSnMost of the cancers suspected of being radiogenic were not significantly elevated among the test participants. Nevertheless, increased risks for certain cancers cannot be ruled out at this time. Veterans who participated in the nuclear weapons tests should continue to be monitored.

US army chemical corps Vietnam veterans health study: preliminary results

The long-term health consequences of exposure to phenoxyherbicides used in Vietnam has been a great concern to the veterans. In addition to the Air Force Ranch Hand personnel, Army Chemical Corps personnel who served in Vietnam are thought to have had some of the highest herbicide exposures. The Department of Veterans Affairs commenced a study of veterans who served in Vietnam as members of the Army Chemical Corps and a comparison cohort of Army Chemical Corps personnel who served elsewhere. A total of 2872 Vietnam veterans and 2737 non-Vietnam veterans who served in the Army Chemical Corps were identified for inclusion in a telephone health interview survey with a random 20% sample of veterans receiving serum dioxin and other congeners assessments. In a feasibility study which included 284 Vietnam veterans and 281 non-Vietnam veterans, 100 serum assessments were conducted of which 95 were included in the analysis. Vietnam veterans with a history of spraying herbicides were found to have a statistically significant elevation in their current serum 2,3,7,8-TCDD concentrations compared to non-Vietnam veterans without a spray history (P = 0.05). Other 2,3,7,8-substituted dioxins levels were comparable to the levels found in the non-Vietnam veterans. This feasibility study demonstrated that serum dioxin concentrations from a sample of the study participants can be used to identify exposure variables in the health survey that can serve as a surrogate measure of phenoxyherbicide exposure.

The postwar hospitalization experience of Gulf War veterans participating in U.S. health registries.

In response to concerns that Gulf War veterans were experiencing increased morbidity resulting from wartime exposures in the Gulf War, the Department of Veterans Affairs and the Department of Defense (DoD) initiated clinical registries to provide systematic health evaluations for self-referred Gulf War veterans. The authors used Cox’s proportional hazard modeling with data from all DoD hospitals to estimate the probability of hospitalization resulting from any cause, resulting from diagnosis in a major diagnostic category, and resulting from a specific diagnosis of interest. After adjusting for other risk factors, registry participants were 1.43 times more likely to have a postwar hospitalization than registry nonparticipants (95% confidence interval, 1.40–1.46). These findings support the hypothesis that registry participants were more likely to experience postwar morbidity than veterans who chose not to enroll in the health registries.

Cancer mortality among the highest exposed US atmospheric nuclear test participants

Of the estimated 205,000 military personnel who participated in the US atmospheric nuclear weapons testing program from 1945 to 1962, less than 1% had ionizing radiation doses that met or exceeded the current federal occupational guideline for dose of 5 rem (roentgen equivalents in humans) in a 12-month period. The objective of this study was to determine whether veterans who received the highest gamma radiation doses (n = 1010) have experienced increased cancer mortality compared with a group of Navy veterans who received a minimal radiation dose as participants of HARDTACK I (n = 2870). Mortality from all causes of death (relative risk, 1.22; 95% confidence interval, 1.04 to 1.44) and from all lymphopoietic cancers (relative risk, 3.72; 95% confidence interval, 1.28 to 10.83) was significantly elevated among the 5-rem cohort compared with the Navy controls. The lack of statistically significant excesses in deaths from many of the known radiogenic cancers suggests that the observed excess mortality may be the result of many factors, of which radiation exposure was only one.