This book updates and evaluates the available scientific evidence regarding statistical associations between diseases and exposure to dioxin and other chemical compounds in herbicides used in Vietnam, focusing on new scientific studies and literature published since the release of Veterans and Agent Orange (1994). The update gives special attention to the relationship between exposure to herbicides and the development of birth defects and transient peripheral neuropathy, as well as the relationship between exposure to herbicides and the subsequent development of prostate, hepatobiliary, nasopharyngeal, and other cancers. The book also explores the relationship between the length of time since first exposure and the possible risk of cancer development. It reviews and summarizes the strength of scientific evidence concerning the association between herbicide use in Vietnam and each disease suspected to be associated with such exposure.

Contents

• Committee To Review The Health Effects In Vietnam Veterans Of Exposure To Herbicides
• Preface
• 1. Executive Summary
  • Organization And Framework
  • Toxicology Summary
  • Exposure Assessment
  • Conclusions About Health Outcomes
  • The Relationship Between the Length of Time Since Exposure and the Possible Risk of Cancer Development
  • Increased Risk of Disease in Vietnam Veterans
  • References
• 2. Veterans and Agent Orange: The Initial IOM Report
  • Background
  • Impact Of The Report
  • Military Use Of Herbicides In Vietnam
  • Federal Government's Response to Concerns Over the Military Use of Herbicides in Vietnam
  • References
• 3. Toxicology
  • Summary
  • Summary Of Vao
  • Literature Update
  • Update Of Toxicity Profiles
  • References
• 4. Methodologic Considerations in Evaluating the Evidence
  • Questions To Be Addressed
  • Issues In Evaluating The Evidence
  • Summary Of The Evidence
  • References
• 5. Exposure Assessment
  • Exposure Assessment In The Evaluation Of Epidemiologic Studies
  • Estimates Of Exposure To Herbicides And TCDD During Vietnam Service
  • Review Of The Recent Literature
  • References
• 6. Epidemiologic Studies
  • Occupational Studies
  • Environmental Studies
  • Vietnam Veterans
  • References
• 7. Cancer
  • Introduction
  • Gastrointestinal Tract Tumors
  • Hepatobiliary Cancers
  • Nasal/Nasopharyngeal Cancer
  • Respiratory Cancers
  • Bone Cancer
  • Soft-Tissue Sarcomas
  • Skin Cancers
  • Cancers of the Female Reproductive System
  • Breast Cancer
  • Prostate Cancer
  • Renal, Bladder, And Testicular Cancers
  • Renal Cancer
  • Bladder Cancer
  • Testicular Cancer
  • Brain Tumors
  • Malignant Lymphomas And Myeloma
  • Non-Hodgkin's Lymphoma
  • Hodgkin's Disease
  • Multiple Myeloma
  • Leukemia
  • Overall Summary For Cancer
  • References
• 8. Latency and Cancer Risk
  • Analysis Of Latency In Epidemiologic Studies
  • Results Of The Literature Review Of Herbicide Exposure And Cancer
  • Respiratory Cancer
  • Prostate Cancer
  • Relevance Of The Latency Issue In Assessing The Effect Of Herbicides On Cancer Risk In Vietnam Veterans
  • References
• 9. Reproductive Effects
  • Introduction
  • Fertility
  • Spontaneous Abortion
  • Stillbirth
  • Birth Defects
  • Childhood Cancer
  • Conclusions For Reproductive Effects
  • References
• 10. Neurobehavioral Disorders
  • Introduction
  • Cognitive And Neuropsychiatric Effects
  • Motor/Coordination Dysfunction
  • Chronic Persistent Peripheral Neuropathy
  • Acute And Subacute Transient Peripheral Neuropathy
  • Conclusions For Neurobehavioral Disorders
  • References
• 11. Other Health Effects
  • Introduction
  • Chloracne
  • Porphyria Cutanea Tarda
  • Respiratory Disorders
  • Immune System Disorders
  • Other Metabolic And Digestive Disorders
  • Circulatory Disorders
  • References
• Appendixes
  • Appendix A Information Gathering
  • Appendix B Risk of Disease in Vietnam Veterans
  • Appendix C Committee and Staff Biographies

Support for this study was provided by the Department of Veterans Affairs (contract no. V101(93)P-1331).

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.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.