[CPEO-MEF] Gulf War and cancer

[Lenny Siegel <lsiegel@cpeo.org>]

The National Academies
FOR IMMEDIATE RELEASE
December 20, 2004

Latest IOM Gulf War Report Confirms Link Between Lung Cancer and
Combustion Products; Evidence on Other Health Problems Is Inconclusive

WASHINGTON -- The available evidence is too sparse or of insufficient 
quality to determine whether the majority of health problems that may be 
experienced by Gulf War veterans could be associated with exposures to 
fuels for military vehicles, propellants in Scud missiles, or substances 
given off by combustion sources such as oil-well fires, exhausts, and 
tent heaters, according to the latest report on the Gulf War and health 
from the Institute of Medicine of the National Academies. However, data 
from studies of occupational and environmental exposures to air 
pollution, vehicle exhaust, and other combustion products led the 
committee that wrote the report to conclude that exposure to such 
substances is associated with an increased risk of lung cancer.

"Studies of people exposed to air pollution, vehicle exhaust, and 
burning of coal or other heating and cooking fuels consistently show 
that such exposures are linked to an increased risk for developing lung 
cancer," said committee chair Lynn Goldman, professor, Bloomberg School 
of Public Health, Johns Hopkins University, Baltimore. "This provides 
sufficient evidence that exposure to combustion products during the Gulf 
War could be associated with lung cancer in some veterans." Military 
personnel may have encountered combustion products from diesel-fueled 
heaters in poorly ventilated tents, cooking stoves, vehicle exhaust 
systems, and oil-well fires. "It should be emphasized that smoking is 
the major culprit for lung cancer, accounting for 80 percent of all 
cases, according to the American Cancer Society," Goldman added.

The committee also found some evidence that exposure to combustion 
products is linked to asthma and cancers of the nose, mouth, throat, and 
bladder, as well as to low birth weight and premature births in women 
exposed while pregnant; the data were weaker in these cases, however. 
The data on whether the majority of cancers, neurological problems, and 
other health problems are associated with exposure to fuels, 
propellants, or combustion products were inadequate to draw conclusions. 
"While we would like to have more definitive answers to questions about 
the specific diseases that may be associated with these substances, in 
most cases the evidence simply is not strong enough or does not exist," 
Goldman said.

Because scant information exists on actual exposure levels experienced 
by individual service members -- a critical factor when assessing health 
effects -- the committee could not draw specific conclusions about Gulf 
War veterans' chances of developing lung cancer or any other health 
problems as a result of exposures. No systematic monitoring of air 
contamination from oil-well fires was conducted in the Persian Gulf 
region until May 1991, and this monitoring did not measure levels of 
contamination produced by other combustion sources, such as heaters or 
engines. Moreover, no data are available that would allow comparisons 
between levels of exposure to air contaminants during the Gulf War and 
exposures to similar contaminants in civilian occupational and 
environmental settings.

Veterans who have experienced chronic health problems following their 
service in the Persian Gulf region are asking whether exposure to 
various chemical, biological, or environmental agents might be 
responsible. This IOM report is the third in a series that responds to 
requests from the U.S. Department of Veterans Affairs and Congress to 
examine the health effects of potentially harmful agents to which Gulf 
War veterans might have been exposed. The first report focused on 
potential health effects from depleted uranium, pyridostigmine bromide, 
sarin, and vaccines; the second centered on insecticides and solvents. 
These reports did not directly assess whether health effects could occur 
as a result of service in the Gulf War.

For the current report, the committee evaluated the published, 
peer-reviewed research on exposure to unburned fuels, combustion 
products, and hydrazines and nitric acid -- components of the propellant 
used for Scud and other missiles -- for any evidence of links to 
specific cancers, neurological effects, or other health problems that 
persist after exposure. More than 600 oil-well fires were ignited in 
Kuwait by retreating Iraqi troops during the Gulf War conflict, sending 
up large plumes of smoke that occasionally remained low to the ground. 
Troops also may have been exposed to combustion products through vehicle 
exhaust, heaters in poorly ventilated tents, and cooking stoves. 
Military personnel may have had contact with hydrazines and nitric acid 
when they disarmed or disposed of Scud missiles or were downwind of a 
missile explosion. They also may have come into contact with fuels when 
refueling ground vehicles, aircraft, and equipment.

Of the approximately 800 studies reviewed in detail for this report, 
most involved individuals who were exposed to these agents in 
occupational settings over long periods of time. Only a small number 
actually studied veterans who may have been exposed while serving in the 
Persian Gulf. The committee carefully assessed the quality, limitations, 
and relevance of each epidemiologic study, and used five categories to 
describe the strength of the evidence.

Sufficient evidence of a causal relationship, the strongest level of 
evidence, means that many studies have established a clear link between 
exposure to an agent and a health outcome. Among the other requirements, 
there must be a plausible biological explanation for the relationship. 
None of the compounds evaluated in this report met these criteria.

Evidence that establishes a link between exposures and a health outcome 
with reasonable certainty, but fails to meet the higher standard of 
proof needed for causality, is characterized as sufficient evidence of 
an association. The evidence for an association between lung cancer and 
combustion products falls into this category.

When a limited number of studies suggest that a link exists, but without 
reasonable certainty, the evidence is said to be limited or suggestive 
of an association. This category describes the evidence for links 
between combustion products and nasal, oral, laryngeal, and bladder 
cancers; asthma; and low birth weight and preterm births by women 
exposed while pregnant. Likewise, the evidence for an association 
between hydrazine exposure and lung cancer fits this definition.

If several studies of adequate quality consistently fail to show a 
positive association at any level of exposure, the evidence is described 
as limited or suggestive of no association. And evidence that lacks 
sufficient quality, consistency, or statistical power to draw any 
conclusion is judged to be inadequate or insufficient to determine 
whether an association exists. The majority of the evidence on fuels, 
combustion products, and propellants falls into this final category.

The study was sponsored by the U.S. Department of Veterans Affairs. The 
Institute of Medicine is a private, nonprofit institution that provides 
health policy advice under a congressional charter granted to the 
National Academy of Sciences….

For the original press release and a link to the full report, go to
http://www4.nationalacademies.org/news.nsf/isbn/0309095271?OpenDocument



--
Lenny Siegel
Director, Center for Public Environmental Oversight
c/o PSC, 278-A Hope St., Mountain View, CA 94041
Voice: 650/961-8918 or 650/969-1545
Fax: 650/961-8918
http://www.cpeo.org

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