Veterans and Agent Orange: Update 2010

This issue updates and recommends further research of links between Vietnam service and specific health outcomes, most importantly COPD, tonsil cancer, melanoma, brain cancer, Alzheimer's disease, and paternally transmitted effects to offspring.

The legislation directed the Secretary of Veterans Affairs (VA) to request the Institite of Medicine to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange and other herbicides used in Vietnam to be followed by biennial updates.

Contents
ABBREVIATIONS AND ACRONYMS
SUMMARY
Charge to the Committee
Committee’s Approach to Its Charge
Evidence Reviewed by the Committee
The Committee’s Conclusions
Committee Recommendations
1 INTRODUCTION
Charge to the Committee
Issues Raised in Public Sessions
Conclusions of Previous Veterans and Agent Orange Reports
Organization of This Report
2 EVALUATING THE EVIDENCE
Choice of Health Outcomes
Identification of Relevant Literature
Committee’s Approach
Evaluation of the Evidence
3 EXPOSURE TO THE HERBICIDES USED IN VIETNAM
Military Use of Herbicides in Vietnam
TCDD in Herbicides Used in Vietnam
Exposure of Vietnam Veterans
Exposure of the Vietnamese Population
Models for Characterizing Herbicide Exposure
Methodologic Issues in Exposure Assessment
4 INFORMATION RELATED TO BIOLOGIC PLAUSIBILITY
Picloram
Cacodylic Acid
Phenoxy Herbicides: 2,4-D and 2,4,5-T, TCDD
Limitations of Extrapolating Laboratory Studies to Human Responses
Emerging Subjects in Disease Etiology
5 EPIDEMIOLOGIC STUDIES: COMPENDIUM OF NEW PUBLICATIONS AND BACKGROUND ON MULTIPLE REFERENCED POPULATIONS
New Epidemiologic Publications
Study Populations: Previously Addressed or Having Multiple Health Outcomes
Vietnam-Veteran Studies
Occupational Studies
Environmental Studies
Case–Control Studies
6 IMMUNE-SYSTEM DISORDERS
Conclusion from VAO and Previous Updates
Update of the Epidemiologic Literature and Human Studies
Biologic Plausibility
Synthesis
Translation Between Animal and Human Studies
Subjects for Future Research
7 CANCER
Organization of Cancer Groups
Biologic Plausibility
The Committee’s View of “General” Human Carcinogens
Oral, Nasal, and Pharyngeal Cancer
Cancers of the Digestive Organs
Esophageal Cancer
Stomach Cancer
Colorectal Cancer
Hepatobiliary Cancer
Pancreatic Cancer
Laryngeal Cancer
Lung Cancer
Bone and Joint Cancer
Soft-Tissue Sarcomas
Skin Cancer—Melanoma
Skin Cancer—Basal-Cell Cancer and Squamous-Cell Cancer (Nonmelanoma Skin Cancers)
Breast Cancer
Cancers of the Female Reproductive System
Prostate Cancer
Testicular Cancer
Bladder Cancer
Renal Cancer
Brain Cancer
Endocrine Cancers
Lymphohematopoietic Cancers
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Multiple Myeloma
AL Amyloidosis
Leukemia
Summary
8 REPRODUCTIVE EFFECTS AND IMPACTS ON FUTURE GENERATIONS
Biologic Plausibility of Reproductive Effects Endometriosis
Fertility
Spontaneous Abortion
Stillbirth, Neonatal Death, and Infant Death
Birth Weight and Preterm Delivery
Birth Defects
Childhood Cancer
Effects Occurring Later in Offspring’s Life or in Later Generations
Summary
9 NEUROLOGIC DISORDERS
Neurobehavioral (Cognitive or Neuropsychiatric) Disorders
Neurodegenerative Diseases
Chronic Peripheral System Disorders
Hearing Loss
Summary
10 CARDIOVASCULAR AND METABOLIC EFFECTS
Type 2 Diabetes
Lipid and Lipoprotein Disorders
Circulatory Disorders
Summary
11 OTHER HEALTH EFFECTS
Respiratory Disorders
Gastrointestinal and Digestive Disease, Including Liver Toxicity
Thyroid Homeostasis
Eye Problems
Bone Conditions
Summary
12 CONCLUSIONS AND RECOMMENDATIONS
Synopsis of Committee Conclusions
Committee Recommendations
References
APPENDIXES
A Agendas of Public Meetings Held by the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eighth Biennial Update)
B Short-Term Adverse Health Responses
C Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers
D Biographies of Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eighth Biennial Update) and Staff