Gulf War and Health Volume 3: Fuels, Combustion Products, and Propellants (2005) / Chapter Skim
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60 4 CANCER Cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells (ACS 2003g; WHO 2003)
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CANCER 61 Those tables are presented in reverse chronological order by each type of study design. The committee reviewed over 500 epidemiologic studies on cancer related to exposure to fuels and combustion products and selected studies that met its inclusion criteria for more thorough evaluation.
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62 GULF WAR AND HEALTH nasopharynx (ICD-9 147) and of the nasal cavity and paranasal sinuses (ICD-9 160)
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64 GULF WAR AND HEALTH associated with both cancer at all sites (RR 1.48, 95% CI 1.09-2.01) and pharyngeal cancer (RR 1.52, 95% CI 0.94-2.45)
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CANCER 65 In the study by Huebner et al.
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66 GULF WAR AND HEALTH The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between exposure to fuels and cancers of the oral cavity and oropharynx. All available studies of exposure to combustion products and cancer of the oral cavity and oropharynx were of the case-control design, and all were adjusted for cigarette-smoking and other confounders.
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CANCER 67 Case-Control Studies Increased risk of nasopharyngeal cancer posed by 20 occupational exposures was assessed in a case-control study (Armstrong et al.
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68 GULF WAR AND HEALTH exposure 1.6; 10 years or more of exposure 7.6)
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CANCER 69 6.10) but not of squamous-cell carcinoma (OR 1.13, 95% CI 0.78-1.63)
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70 GULF WAR AND HEALTH The committee concludes, from its assessment of the epidemiologic literature, that there is limited/suggestive evidence of an association between exposure to combustion products and cancers of the nasal cavity and nasopharynx. ESOPHAGEAL CANCER This review focuses on esophageal cancer (ICD-9 150)
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CANCER 71 Cohort Studies Mortality and cancer incidence were determined in a retrospective cohort study conducted in Stockholm in relation to diesel exhaust and asbestos exposure in bus-garage workers (Gustavsson et al.
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72 GULF WAR AND HEALTH The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between exposure to fuels or combustion products and esophageal cancer. STOMACH CANCER This review focuses on gastric cancer (commonly known as stomach cancer)
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CANCER 73 Cohort Studies Several epidemiologic studies examined rates of stomach cancer in defined populations compared with the general population. Occupational information on persons with stomach cancer as reported to the Shanghai Cancer Registry in 1980-1984 was assessed (Kneller et al.
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74 GULF WAR AND HEALTH Conclusion No consistent association between fuels or combustion products and stomach cancer was observed in the studies reviewed by the committee. Two of the studies of fuel exposure (Hanis et al.
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CANCER 75 result of the analysis of these cancers was presented together) (Hanis et al.
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76 GULF WAR AND HEALTH An occupational case-control study evaluated the relationship between exposure to several types of engine exhausts and combustion products, based on an industrial-hygiene assessment of occupational history, and colon cancer (Siemiatycki et al.
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CANCER 77 rectal cancers were analyzed together, and the results are summarized in the colon-cancer section above. No increased risk of colorectal cancer was found in the workers.
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78 GULF WAR AND HEALTH exposed to gasoline exhaust (OR 1.2, 90% CI 1.0-1.5) , particularly in a subgroup exposed at high concentrations for more than 10 years (OR 1.6, 90% CI 1.1-2.3)
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CANCER 79 Case-Control Study The study by Stemhagen et al. included two occupations that are possibly relevant to the Gulf War combustion exposuresroad-building (RR 2.60, 95% CI 0.83-8.19)
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80 GULF WAR AND HEALTH Combustion Products Table 4.16 presents the most relevant findings reviewed by the committee in drawing its conclusion on the possibility of an association between exposure to combustion products and pancreatic cancer. Case-Control Studies Alguacil et al.
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CANCER 81 immune system, genetic factors, and some occupational exposures, such as to dusts from wood, textiles, and leather; glues; formaldehyde; solvents used in furniture and shoe production; mustard gas; isopropyl alcohol; and radium. In 2000, there were 4.0 new cases of laryngeal cancer per 100,000 people in the US (7.2 among men and 1.4 among women)
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82 GULF WAR AND HEALTH age. Standardized interviews were conducted and included occupational history with an exposure checklist and questions on smoking and drinking behavior.
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CANCER 83 JEM to work histories to estimate specific exposures. The adjusted risks of laryngeal cancer were positively associated with ever having been exposed to diesel exhaust (OR 1.5, 95% CI 1.3-1.9)
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84 GULF WAR AND HEALTH there was an association between laryngeal cancer and self-reported exposure to diesel exhaust, an independent review and coding of occupations and industries potentially exposed to diesel exhaust found no association with diesel-exhaust-exposed jobs. Researchers at the University of Heidelberg, Germany, conducted a hospital-based casecontrol study with 164 male incident laryngeal-cancer cases ascertained in February-June 1988 and November 1988-May 1989 (Dietz et al.
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CANCER 85 reported (Ahrens et al. 1991; Brown et al.
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86 GULF WAR AND HEALTH Fuels Table 4.19 presents the most relevant findings reviewed by the committee in drawing its conclusion on the possibility of an association between exposure to fuels and lung cancer. In a hospital-based case-control study conducted in Montreal in which exposures to multiple fuels were examined with an industrial-hygiene review of occupational history, exposure to kerosene was associated with an increased risk of squamous-cell lung cancer (OR 1.4, 90% CI 1.0-1.9)
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CANCER 87 Menvielle et al. 2003 (bus, truck drivers)
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88 GULF WAR AND HEALTH 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Ko et al. 1997 (coal)
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CANCER 89 Beeson et al. 1998 (Seventh Day Adventist study)
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90 GULF WAR AND HEALTH average annual exposure in their city of residence. In the Seventh-Day Adventist study, geostatistical interpolation of annual fixed-site monitor data was assigned to the address of each subject.
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CANCER 91 year lagged metric for exposure (NO2 over 29 µg/m3 OR 1.4, 95% CI 1.1-2.0; SO2 over 129µg/m3 OR 1.2, 95% CI 0.9-1.7)
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92 GULF WAR AND HEALTH (Jockel et al. 1998; Menvielle et al.
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CANCER 93 chimneys decreased the risk of lung cancer (RR < 0.6) and that the reduction occurred more than 10 years after the change.
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94 GULF WAR AND HEALTH MALIGNANT MELANOMA OF THE SKIN Skin cancer is the most common type of cancer (ACS 2004u)
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CANCER 95 Mortality has been assessed periodically among workers of Imperial Oil Limited of Canada (Hanis et al. 1979; Lewis et al.
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96 GULF WAR AND HEALTH Cohort Studies Boffetta et al.
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CANCER 97 were available for comparison, all the associated confidence intervals included unity, and no adjustment for possible confounders was attempted. Siemiatycki et al.
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98 GULF WAR AND HEALTH Conclusion Data from studies of the large Amoco (Nelson et al.
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CANCER 99 Retrieval from the cancer registry generated an identical number (seven) of melanoma and nonmelanoma skin cancers; this suggests that records were incomplete.
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100 GULF WAR AND HEALTH Case-Control Studies Hannukesela-Svahn et al.
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CANCER 101 toxicologic information only in a supportive role; that is, it did not base its conclusions solely on toxicologic information. Of the available epidemiologic studies that met the committees criteria, the Gallagher et al.
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102 GULF WAR AND HEALTH Combustion Products Table 4.26 presents the most relevant findings reviewed by the committee in drawing its conclusion on the possibility of an association between exposure to combustion products and breast cancer in women. Case-Control Studies Petralia et al.
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CANCER 103 In 2000, there were 1.3 new cases of breast cancer per 100,000 men and 0.4 deaths per 100,000 in the United States (Ries et al.
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104 GULF WAR AND HEALTH The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between exposure to fuels or combustion products and male breast cancer.
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CANCER 105 Combustion Products Table 4.30 presents the most relevant findings reviewed by the committee in drawing its conclusion on the possibility of an association between exposure to combustion products and cervical, endometrial, uterine, and ovarian cancers. Case-Control Studies A study explored the relationship between burning wood in the kitchen and the risk of cervical neoplasia in women in Honduras (Velema et al.
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106 GULF WAR AND HEALTH In 2000, there were 176.9 new cases of prostatic cancer per 100,000 men and 30.6 deaths per 100,000 in the US (Ries et al.
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CANCER 107 In another case-control study, the relationship between occupational risk factors and prostatic cancer was examined on the basis of job history obtained by interview (Krstev et al.
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108 GULF WAR AND HEALTH In 2000, there were 6.6 new cases of brain and other nervous system cancers per 100,000 people (8.0 among men and 5.4 among women) and 4.5 deaths per 100,000 (5.6 among men and 3.7 among women)
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CANCER 109 A nationwide survey of service stations in Italy defined a cohort of 2,665 managers alive at the beginning of 1981. Following their mortality through 1992, the study authors found 250 deaths among the 2,308 men and 20 among the 357 women (Lagorio et al.
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110 GULF WAR AND HEALTH Conclusion Several studies reported sporadic associations between fuel exposure and brain cancer (Carozza et al. 2000; Consonni et al.
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CANCER 111 Conclusion No studies were identified that evaluated exposure to fuels and an association between increased risk of ocular melanoma. Three studies, all lacking adequately specific exposure assessment, reported increased, but imprecise risks of ocular melanoma in occupations related to transportation (Ajani et al.
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112 GULF WAR AND HEALTH employment in petroleum-related industries or occupations, as abstracted from work histories, among the possible exposures analyzed. Several found associations between petroleum-related entries in work histories and the occurrence of bladder cancer (Howe et al.
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CANCER 113 too few subjects employed in fuel-related jobs for analysis (Silverman et al.
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114 GULF WAR AND HEALTH more uniform by limiting it to people 30-79 years old and to incident cases (only cases in those interviewed within 2 years of their diagnosis) ; this resulted in the exclusion of 755 male cases and 525 of their controls (Kogevinas et al.
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CANCER 115 study of this cohort by linking with cancer registries to identify 532 cohort members diagnosed through 1992 with urothelial cancer (including cancers of the ureter, renal pelvis, and urethra along with bladder cancers)
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116 GULF WAR AND HEALTH transportation-services industry (OR 2.8, 95% CI 0.7-11.8) or held the job of driver (OR 1.3, 95% CI 0.9-1.8)
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CANCER 117 (and later the 1970 census) have been linked with incident cancers reported in the national cancer registry for 1961-1979 (and later for 1971-1989)
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118 GULF WAR AND HEALTH of the exposed cases) had an increased risk (OR 1.7, 95% CI 1.2-2.4)
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CANCER 119 broad occupational and industrial categories, and the true exposure to fuels is unknown. The large EMBCS, which pooled data from 11 European study centers, overall yielded a negative finding for petroleum refining as an occupation (Kogevinas et al.
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120 GULF WAR AND HEALTH RCCs, that is indicated; otherwise, cancers of the renal pelvis were included in a more global class of kidney cancers that would have been dominated by RCCs. Smoking and obesity are the major risk factors for kidney cancer.
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CANCER 121 assessed exposure by evaluating every job with respect to five classes of HCs associated with various refinery processes; they used three-point scales for intensity and for frequency (daily, weekly, and monthly) of exposure to each HC class.
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122 GULF WAR AND HEALTH medical, and dietary)
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CANCER 123 and weight found increases in the risk of RCC in both men (OR 4.3, 95% CI 1.7-10.9) and women (OR 1.6, 95% CI 0.4-6.5)
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124 GULF WAR AND HEALTH estimation that incorporated information on tasks performed within jobs. For every subject, separate exposure indexes were derived for the exposure agents of interest on the basis of duration, probability, and intensity as characterized with each of the three JEMs.
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CANCER 125 The study of 164 RCC cases in Montreal reported by Sharpe et al.
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126 GULF WAR AND HEALTH estimates uniformly less than 1.0 in men (no results were presented for women)
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CANCER 127 Auperin et al.
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128 GULF WAR AND HEALTH Fuels Table 4.40 presents the most relevant findings considered by the committee in drawing its conclusion on the possibility of an association between exposure to fuels and NHL, presented in reverse chronologic order within type of study design. Cohort Studies In conjunction with a detailed exposure assessment of service-station attendants in Italy, Lagorio et al.
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CANCER 129 Adjusted for age and sex, the estimated risk of NHL in petrochemical workers (chemical workers were reported on separately) was somewhat increased (RR 1.83, 95% CI 0.87-3.84)
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130 GULF WAR AND HEALTH self-reported exposure to coal tar, soot, pitch, creosote, or asphalt. Exposure to mineral, cutting, or lubricating oils (which are often considered vehicles for PAH exposure)
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CANCER 131 Fuels Table 4.42 presents the most relevant findings considered by the committee in drawing its conclusion on the possibility of an association between exposure to fuels and HD, in reverse chronologic order within type of study design. Cohort Studies As noted above in the section on NHL, in their investigation of cancer morbidity among Swedish petroleum industry workers, Jarvholm et al.
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132 GULF WAR AND HEALTH Cohort Study As noted above in the section on NHL, the 2-year followup of the ACS prospective cohort yielded negative findings on an association between self-reported diesel exposure and all lymphomas; a nonspecified number of HD deaths were included in that category (Boffetta et al.
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CANCER 133 Fuels Table 4.44 presents the most relevant findings considered by the committee in drawing its conclusion on the possibility of an association between exposure to fuels and multiple myeloma (in reverse chronologic order within type of study design)
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CANCER 135 Combustion Products Table 4.45 presents the findings considered most relevant by the committee in drawing its conclusion on the possibility of an association between exposure to combustion products and multiple myeloma, presented in reverse chronologic order within type of study design. Nested Case-Control Studies On the basis of self-reported exposure to diesel-engine exhaust, Boffetta et al.
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136 GULF WAR AND HEALTH when proxy respondents were excluded from the analysis (OR 1.9, 95% CI 1.1-3.2)
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CANCER 137 Conclusion No consistent relationship between exposure to fuels and multiple myeloma was detected in the studies described above; most studies reported no association. On the basis of small numbers of cases considered to have fuel exposure and the imprecision of the exposure assessments accompanying the case-control and cohort studies considered, there was a limited ability to detect an association between exposure to fuels and multiple myeloma.
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138 GULF WAR AND HEALTH most common leukemia and usually affects adults, particularly men, although it can occur in children (ACS 2004f)
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CANCER 139 but when analysis was limited to those with at least 5 years in these jobs the risks were below unity. Flodin et al.
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140 GULF WAR AND HEALTH The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between exposure to combustion products and leukemia. MYELODYSPLASTIC SYNDROMES Myelodysplastic syndromes (MDSs)
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CANCER 141 February 1996 for the full set of 204 newly diagnosed cases and 204 sex- and age-matched population controls (Nisse et al.
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142 GULF WAR AND HEALTH Despite the apparent rigor of the data-collection methods used, the researchers analyses were rudimentary, and failed even to adjust for possible confounders when the information was at hand. The committee concludes, from its assessment of the epidemiologic literature, that there is inadequate/insufficient evidence to determine whether an association exists between fuels or combustion products and myelodysplastic syndromes.
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CANCER 143 Male breast cancer Female genital cancers (cervical, endometrial, uterine, and ovarian cancers) Prostate cancer Testicular cancer Nervous system cancers Kidney cancer Bladder cancer Hodgkins disease Non-Hodgkins lymphoma Multiple myeloma Myelodysplastic syndromes Combustion products and: Esophageal cancer Stomach cancer Colon cancer Rectal cancer Hepatic cancer Pancreatic cancer Melanoma Female breast cancer Male breast cancer Female genital cancers (cervical, endometrial, uterine, and ovarian cancers)
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144 GULF WAR AND HEALTH TABLES TABLE 4.1 Cancers of the Oral Cavity and Oropharynx and Exposure to FuelsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort StudiesMortality Ritz 1999 Uranium-processing workers in Fernald, Ohio (ICD-8 140-149)
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CANCER 145 TABLE 4.2 Cancers of the Oral Cavity and Oropharynx and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control StudiesAdjusted for smoking, unless otherwise noted Gustavsson et al.
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146 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Huebner et al.
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CANCER 147 TABLE 4.3 Cancers of the Nasal Cavity and Nasopharynx and Exposure to FuelsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control Studies Armstrong et al.
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148 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk Yu et al. 1990 306 nasopharyngeal cancer cases among residents of Guangzhou City, China; self-reported agents (not smokingadjusted)
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CANCER 149 TABLE 4.6 Esophageal Cancer and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort StudyMortality Gustavsson et al.
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150 GULF WAR AND HEALTH TABLE 4.7 Stomach Cancer and Exposure to FuelsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort StudiesMortality Lewis et al.
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CANCER 151 TABLE 4.8 Stomach Cancer and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort StudiesIncidence Chow et al.
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152 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Coal cooking 90 Digestive-cancer controls 1.00 (0.63-1.57)
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CANCER 153 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) 1987 Maintenance jobs 12 1.11 Operations jobs 12 1.19 Case-Control Studies Gerhardsson de Verdier et al.
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154 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Gerhardsson de Verdier et al.
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CANCER 155 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) 1987 Maintenance jobs 5 1.67 Operations jobs 5 1.78 Case-Control Studies Gerhardsson de Verdier et al.
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156 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Railway work 5 2.3 (0.5-10.4)
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CANCER 157 TABLE 4.15 Pancreatic Cancer and Exposure to FuelsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort Studies Lewis et al.
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158 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Natural-gas combustion 6 1.5 (0.7-3.1)
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CANCER 159 TABLE 4.18 Laryngeal Cancer and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort StudyIncidence Boffetta et al.
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160 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Probability of exposure Low 92 1.6 (1.2-2.2)
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CANCER 161 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Pintos et al.
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162 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Wortley et al.
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CANCER 163 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Mechanics and repairmen na 0.95 NOTE: na=not available; ns=not statistically significant (p < 0.5)
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164 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Squamous cell 1 0.2 (0.0-2.4)
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CANCER 165 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) O3 mean conc.; per 47.9 ppb 0.96 (0.86-1.06)
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166 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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CANCER 167 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) monitoring stations according to borough (smoking-adjusted)
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168 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) 10-19 yr after 0.24 (0.19-0.31)
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CANCER 169 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Indoor heating 30 1.0 No heating 39 13.7 (4.2-45.3)
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170 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Regular 196 1.08 (0.84-1.40)
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CANCER 171 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cooking fuelfemales Coal 81 1.0 Gas 8 0.90 (0.24-3.3)
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172 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) SIR reference group: population 0.76 (0.58-0.97)
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CANCER 173 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort StudiesMortality Jarvholm and Silverman 2003 Diesel-exposed construction workers in Sweden (smokingadjusted)
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174 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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CANCER 175 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Bruske-Hohlfeld et al.
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176 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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CANCER 177 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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178 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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CANCER 179 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Occupational exposure to PAHsadjusted for age only No exposure 487 1.0 1 tertile (low)
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180 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) exposure groups)
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CANCER 181 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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182 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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CANCER 183 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Nadon et al.
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184 GULF WAR AND HEALTH b Unadjusted ORs and 95% CIs calculated with standard methods from observed numbers presented in original paper. c 95% CIs calculated with standard methods from regression-model parameters presented in original paper.
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CANCER 185 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) 1970-1980; exposures by industrial-hygiene review of personnel records described in Nelson et al.
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186 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Jet-fuel exhaust 3 1.8 (0.5-6.4)
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CANCER 187 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Exposed 5+ yr 2 5.10 Excavating, grading, and road machinery operators 2 9.92 NOTE: na=not available; ns=risk estimate greater than unity not significant at 0.05 level.
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188 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Transportation and communication 232 0.9 (0.8-1.0)
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CANCER 189 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) 1994 reconstruction using monitoring)
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190 GULF WAR AND HEALTH TABLE 4.27 Male Breast Cancer and Exposure to FuelsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control Study (not adjusted for smoking)
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CANCER 191 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Probability of exposure Low 13 1.3 (0.7-2.6)
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192 GULF WAR AND HEALTH TABLE 4.30 Female Genital Cancers and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control Studies (not adjusted for smoking)
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CANCER 193 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Medium and high 1.7 (0.7-4.1)
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194 GULF WAR AND HEALTH TABLE 4.32 Prostatic Cancer and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control Studies (adjusted for smoking, unless noted otherwise)
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CANCER 195 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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196 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Motor oil units, >5 yr 6 3.14 (1.15-6.84)
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CANCER 197 TABLE 4.34 Brain/CNS Cancers and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control Studies (not adjusted for smoking)
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198 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Transport-equipment operators Males 5 1.4 (0.5-3.8)
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CANCER 199 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Steineck et al.
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200 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) adjusted for smoking)
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CANCER 201 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Railway brakemen, signalmen, and shunters 18 1.43 (0.77-2.63)
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202 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Task-based JEM Medium 70 0.7 (0.5-1.0)
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CANCER 203 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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204 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Steineck et al.
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CANCER 205 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) 5-9 102 1.3 10-14 58 1.7 15-24 59 2.2 25+ 54 1.1 Taxicab driver or chauffeur (usual)
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206 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Motor-vehicle sales and service <10 yr 25 1.8 (1.1-3.0)
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From page 207... ...
CANCER 207 TABLE 4.38 Kidney Cancer and Exposure to FuelsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort Studies (not adjusted for smoking, unless otherwise noted)
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From page 208... ...
208 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control Studies (adjusted for smoking, unless otherwise noted)
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From page 209... ...
CANCER 209 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Only diesel 6 0.68 (0.23-2.01)
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From page 210... ...
210 GULF WAR AND HEALTH original paper. b Error evident in original publication (Pesch et al., 2000)
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From page 211... ...
CANCER 211 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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From page 212... ...
212 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Occupational handling 14 2.42 (0.81-7.46)
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From page 213... ...
CANCER 213 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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From page 214... ...
214 GULF WAR AND HEALTH TABLE 4.41 Non-Hodgkins Lymphoma and Exposure to Combustion ProductsSelected Epidemiologic Studies Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Cohort StudyMortality Boffetta et al.
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From page 215... ...
CANCER 215 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Stanislawczyk 1977 Roswell Park Memorial Institute in Buffalo, New York (smoking-adjusted)
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From page 216... ...
216 GULF WAR AND HEALTH a Risk estimates and 95% CI were calculated with standard methods from observed and expected numbers presented in original paper. b 90% CIs reported in this paper.
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From page 217... ...
CANCER 217 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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From page 218... ...
218 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Possible exposure 200 1.1 (0.9-1.3)
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From page 219... ...
CANCER 219 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI)
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From page 220... ...
220 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Possible exposure 8 1.4 (0.6-3.2)
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From page 221... ...
CANCER 221 Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Case-Control Studies Costantini et al.
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From page 222... ...
222 GULF WAR AND HEALTH Reference Study Population Exposed Cases Estimated Relative Risk (95% CI) Oils and greases (≥low intensity)
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From page 223... ...
CANCER 223 REFERENCES Abbey DE, Nishino N, McDonnell WF, Burchette RJ, Knutsen SF, Beeson WL, Yang JX.
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From page 225... ...
CANCER 225 Aronson KJ, Siemiatycki J, Dewar R, Gerin M
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From page 226... ...
226 GULF WAR AND HEALTH Borgia P, Forastiere F, Rapiti E, Rizzelli R, Magliola ME, Perucci CA, Axelson O
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From page 227... ...
CANCER 227 Costantini AS, Miligi L, Kriebel D, Ramazzotti V, Rodella S, Scarpi E, Stagnaro E, Tumino R, Fontana A, Masala G, Vigano C, Vindigni C, Crosignani P, Benvenuti A, Vineis P
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From page 228... ...
228 GULF WAR AND HEALTH Farrow A, Jacobs A, West RR.
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From page 229... ...
CANCER 229 Gustavsson P, Jakobsson R, Nyberg F, Pershagen G, Jarup L, Scheele P
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From page 230... ...
230 GULF WAR AND HEALTH Huebner WW, Schoenberg JB, Kelsey JL, Wilcox HB, McLaughlin JK, Greenberg RS, Preston-Martin S, Austin DF, Stemhagen A, Blot WJ, Winn DM, Fraumeni J, Jr.
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From page 231... ...
CANCER 231 Kleinerman RA, Wang Z, Wang L, Metayer C, Zhang S, Brenner AV, Zhang S, Xia Y, Shang B, Lubin JH.
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From page 232... ...
232 GULF WAR AND HEALTH Leclerc A, Luce D, Demers PA, Boffetta P, Kogevinas M, Belli S, Bolm-Audorff U, Brinton LA, Colin D, Comba P, Gerin M, Hardell L, Hayes RB, Magnani C, Merler E, Morcet JF, Preston-Martin S, Vaughan TL, Zheng W
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From page 233... ...
CANCER 233 Mao Y, Hu J, Ugnat AM, White K
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From page 234... ...
234 GULF WAR AND HEALTH Nafstad P, Haheim LL, Oftedal B, Gram F, Holme I, Hjermann I, Leren P
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From page 235... ...
CANCER 235 Petralia SA, Vena JE, Freudenheim JL, Dosemeci M, Michalek A, Goldberg MS, Brasure J, Graham S
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From page 236... ...
236 GULF WAR AND HEALTH Ritchie G, Still K, Rossi J3rd, Bekkedal M, Bobb A, Arfsten D
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From page 237... ...
CANCER 237 Siemiatycki J, Wacholder S, Richardson L, Dewar R, Gerin M
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From page 238... ...
238 GULF WAR AND HEALTH Stern FB, Lemen RA, Curtis RA.
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From page 239... ...
CANCER 239 Wong O, Morgan RW, Kheifets L, Larson SR, Whorton MD.
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Key Terms
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