This report concentrates on the evidence published after the completion of work on Veterans and Agent Orange: Update 2000 (IOM, 2001) and Veterans and Agent Orange: Herbicide/Dioxin Exposure and Acute Myelogenous Leukemia in the Children of Vietnam Veterans (IOM, 2002). For each health outcome, the new evidence is reviewed in detail. Conclusions, however, are based on the totality of accumulated evidence, not just on recently published studies. That is, new evidence is interpreted not alone but in the context of evidence addressed in previous reports.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE TO REVIEW THE HEALTH EFFECTS IN VIETNAM VETERANS OF EXPOSURE TO HERBICIDES (FOURTH BIENNIAL UPDATE)
• Reviewers
• Preface
• Executive Summary
• 1. Introduction
  • CHARGE TO THE COMMITTEE
  • CONCLUSIONS OF PREVIOUS VETERANS AND AGENT ORANGE REPORTS
  • ORGANIZATION OF THIS REPORT
  • REFERENCES
• 2. Considerations in Evaluating the Evidence
  • CHOICE OF HEALTH OUTCOMES
  • IDENTIFICATION OF RELEVANT LITERATURE
  • COMMITTEE'S APPROACH TO ITS CHARGE
  • ISSUES IN EVALUATING THE EVIDENCE
  • REFERENCES
• 3. Toxicology
  • HIGHLIGHTS OF PREVIOUS REPORTS
  • TOXICITY PROFILE UPDATE OF 2,4-D
  • TOXICITY PROFILE UPDATE OF 2,4,5-T
  • TOXICITY PROFILE UPDATE OF CACODYLIC ACID
  • TOXICITY PROFILE UPDATE OF PICLORAM
  • TOXICITY PROFILE UPDATE OF TCDD
  • SUMMARY OF TOXICITY PROFILES
  • RELEVANCE TO HUMAN HEALTH
  • REFERENCES
• 4. Overview of Epidemiologic Studies
  • OCCUPATIONAL STUDIES
  • ENVIRONMENTAL STUDIES
  • VIETNAM-VETERAN STUDIES
  • REFERENCES
• 5. Exposure Assessment
  • EXPOSURE ASSESSMENT FOR EPIDEMIOLOGY
  • OCCUPATIONAL EXPOSURE TO HERBICIDES AND TCDD
  • ENVIRONMENTAL EXPOSURE TO HERBICIDES AND TCDD
  • MILITARY USE OF HERBICIDES IN VIETNAM
  • EXPOSURE ASSESSMENT IN STUDIES OF VIETNAM VETERANS
  • REFERENCES
• 6. Cancer
  • GASTROINTESTINAL TRACT TUMORS
  • HEPATOBILIARY CANCERS
  • NASOPHARYNGEAL CANCER
  • LARYNGEAL CANCER
  • LUNG CANCER
  • BONE AND JOINT CANCER
  • SOFT-TISSUE SARCOMAS
  • SKIN CANCER—MELANOMA
  • SKIN CANCER—BASAL-CELL AND SQUAMOUS-CELL (NONMELANOMA)
  • BREAST CANCER
  • CANCERS OF THE FEMALE REPRODUCTIVE SYSTEM
  • PROSTATE CANCER
  • TESTICULAR CANCER
  • URINARY BLADDER CANCER
  • RENAL CANCER
  • BRAIN TUMORS
  • NON-HODGKIN'S LYMPHOMA
  • HODGKIN'S DISEASE
  • MULTIPLE MYELOMA
  • LEUKEMIA
  • CHRONIC LYMPHOCYTIC LEUKEMIA
  • SUMMARY
  • REFERENCES
• 7. Reproductive and Developmental Effects
  • BIRTH DEFECTS
  • FERTILITY
  • SPONTANEOUS ABORTION
  • STILLBIRTH, NEONATAL DEATH, AND INFANT DEATH
  • LOW BIRTHWEIGHT AND PRETERM DELIVERY
  • CHILDHOOD CANCER
  • SEX RATIO
  • SUMMARY
  • REFERENCES
• 8. Neurobehavioral Disorders
  • COGNITIVE AND NEUROPSYCHIATRIC EFFECTS
  • MOTOR OR COORDINATION DYSFUNCTION
  • CHRONIC PERSISTENT PERIPHERAL NEUROPATHY
  • ACUTE AND SUBACUTE TRANSIENT PERIPHERAL NEUROPATHY
  • SUMMARY
  • REFERENCES
• 9. Other Health Effects
  • CHLORACNE
  • PORPHYRIA CUTANEA TARDA
  • RESPIRATORY DISORDERS
  • IMMUNE SYSTEM DISORDERS
  • DIABETES
  • LIPID AND LIPOPROTEIN DISORDERS
  • GASTROINTESTINAL AND DIGESTIVE DISEASE, INCLUDING LIVER TOXICITY
  • CIRCULATORY DISORDERS
  • AL AMYLOIDOSIS
  • ENDOMETRIOSIS
  • THYROID HOMEOSTASIS
  • SUMMARY
  • REFERENCES
• 10. Research Recommendations
  • VIETNAM-VETERAN STUDIES
  • STUDIES OF THE VIETNAMESE
  • OTHER RESEARCH
  • REFERENCES
• APPENDIX A Agendas of Public Meetings Held by the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Fourth Biennial Update)
• APPENDIX B ICD-9 Codes for Health Outcomes of Interest
• APPENDIX C Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Fourth Biennial Update)

The project was supported by Contract No. V101(93)P-1637 between the National Academy of Sciences and the US Department of Veterans Affairs. The views presented in this report are those of the Institute of Medicine Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Fourth Biennial Update) and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.