Contaminated Water Supplies at Camp Lejeune Assessing Potential Health Effects (2009) / Chapter Skim
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5 Review of Epidemiologic Studies
5 Review of Epidemiologic Studies
Pages 134-164
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From page 134... ...
Epidemiologic studies of former residents of Camp Lejeune are reviewed separately in Chapter 8. EVALUATING THE EPIDEMIOLOGIC LITERATURE To manage the review of the vast literature on the chemicals of concern at Camp Lejeune, the committee decided to use a categorization approached developed by the Institute of Medicine (IOM)
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From page 135... ...
Alternatively, several studies of less quality show consis tent positive associations, and the results are probably not due to bias, including confounding. Inadequate/Insufficient Evidence to Determine Whether an Association Exists Evidence from available studies is of insufficient quantity, quality, or consistency to permit a conclu sion regarding the existence of an association between exposure to a specific agent and a specific health outcome in humans.
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From page 136... ...
There was an indication of an increased risk in women potentially exposed to TCE in the Raaschou-Nielsen study, but the totality of the evidence does not indicate a consistent pattern of increased risk in TCE-exposed persons. The updated literature on PCE and oral cancer included two cohort studies with cancer mortality or incidence data (Blair et al.
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From page 137... ...
The updated literature on TCE and PCE continues to support a conclusion that there is inadequate/insufficient evidence to determine whether an association exists between chronic exposure to these solvents and laryngeal cancer. Esophageal Cancer IOM 2003 Conclusions IOM (2003)
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From page 138... ...
. The updated literature on TCE and PCE continues to support a conclusion that there is inadequate/insufficient evidence to determine whether an association exists between chronic exposure to these solvents and stomach cancer.
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From page 139... ...
IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to unspecified solvents and colon cancer. 2008 Evaluation The updated literature on TCE and colon cancer includes six occupational-cohort studies with incidence or mortality data on colon cancer or colon and rectal cancer.
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From page 140... ...
IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE, PCE, or other solvents and pancreatic cancer. 2008 Evaluation The updated literature on TCE and pancreatic cancer included five cohort studies with cancer incidence or mortality data (Chang et al.
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From page 141... ...
Hepatobiliary Cancer IOM 2003 Conclusions IOM (2003) did not find a consistent association between chronic exposure to TCE, PCE, or unspecified mixtures of organic solvents and an increased risk of hepatobiliary cancer (liver cancer and cancers of the gallbladder and biliary tract)
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From page 142... ...
Because of the small number of studies and the unstable estimates, IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE, PCE, or other solvents and bone cancer. 2008 Evaluation The committee found two cohort studies that yielded no evidence of an association between occupational exposure to TCE and bone-cancer incidence (three cases in exposed people)
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From page 143... ...
concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE, PCE, or unspecified mixtures of solvents and melanoma. 2008 Evaluation The updated literature on TCE and melanoma included seven cohort studies with cancer incidence or mortality data (Hansen et al.
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From page 144... ...
Breast Cancer IOM 2003 Conclusions IOM (2003) concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE, PCE, or unspecified mixtures of organic solvents and breast cancer.
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. IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to PCE or unspecified mixtures of organic solvents and cervical cancer.
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From page 146... ...
Furthermore, the number of cases in exposed people was extremely small: nine or fewer of either type in each study. Thus, IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE or PCE and ovarian or uterine cancer.
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From page 147... ...
. The evidence of an association with chronic exposure to unspecified mixtures of organic solvents was also determined to be limited/suggestive on the basis of consistent positive findings in four case-control studies (Schoenberg et al.
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IOM was unable to reach a consensus conclusion on unspecified mixtures of organic solvents. 2008 Evaluation The updated literature on TCE and kidney cancer included six cohort studies with cancer incidence or mortality data (Morgan and Cassady 2002; Chang et al.
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Although some positive associations were reported in studies of unspecified mixtures of solvents, the evidence was considered inadequate/insufficient to determine whether an association exists. 2008 Evaluation The updated literature on TCE and brain or CNS cancer included several cohort studies with cancer incidence or mortality data (Hansen et al.
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From page 150... ...
concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE, PCE, or unspecified mixtures of solvents and Hodgkin disease. 2008 Evaluation The updated literature on TCE and Hodgkin disease included five cohort studies with cancer incidence or mortality data (Hansen et al.
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From page 151... ...
IOM concluded that there was limited/suggestive evidence of an association between chronic exposure to unspecified mixtures of organic solvents and adult leukemia. 2008 Evaluation The updated literature on TCE and adult leukemia included five cohort studies with cancer incidence or mortality data (Morgan and Cassady 2002; Chang et al.
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From page 152... ...
IOM (2003) concluded that there was inadequate/insufficient evidence to determine whether an association exists between chronic exposure to solvents and neuroblastoma.
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From page 153... ...
There continues to be inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE or PCE and aplastic anemia. Congenital Malformations IOM 2003 Conclusions A small number of studies that examined parental solvent exposure before or during pregnancy
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From page 154... ...
The committee concludes that there continues to be inadequate/insufficient evidence to determine whether an association exists between chronic exposure to TCE or PCE and male infertility. Female Fertility IOM 2003 Conclusions A few studies have evaluated miscellaneous solvent exposure, not TCE or PCE specifically, in relation to fecundability (ability to become pregnant)
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From page 155... ...
, and they yielded little support of an association. IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between maternal preconception exposure to TCE, PCE, or other solvents reviewed and miscarriage or other adverse pregnancy outcomes.
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From page 156... ...
IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between paternal exposure to TCE, PCE, or other solvents reviewed and miscarriage or other adverse pregnancy outcomes. 2008 Evaluation No additional studies of paternal solvent exposure and pregnancy outcomes were identified.
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From page 157... ...
. The committee concludes that there continues to be inadequate/insufficient evidence determine whether an association exists between solvent exposure and changes in hepatic function or cirrhosis and limited/suggestive evidence of an association between chronic exposure to solvents and hepatic steatosis, which may persist after cessation of exposure.
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From page 158... ...
IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between exposure to TCE, PCE, or other solvents reviewed and chronic pancreatitis. 2008 Evaluation No additional studies of solvent exposure and gastrointestinal effects were identified.
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From page 159... ...
IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between solvent exposure and scleroderma. 2008 Evaluation Since the IOM review, there have been four studies of solvent exposure and scleroderma that used more sophisticated methods of assessing exposure.
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chronic exposure to TCE. The study was initiated because one of the workers had received a diagnosis of Parkinson disease and suspected that his occupational exposure to TCE was a factor in his disease.
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IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between exposure to TCE, PCE, or other solvents reviewed and MS. 2008 Evaluation No additional studies of solvent exposure and MS were identified.
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From page 162... ...
The committee concludes that there continues to be limited/suggestive evidence of an association between past solvent exposure and neurobehavioral outcomes. Long-Term Reduction in Color Discrimination IOM 2003 Conclusions IOM (2003)
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From page 163... ...
IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between exposure to TCE, PCE, or other solvents and long-term hearing loss. 2008 Evaluation No additional studies of solvent exposure and long-term hearing loss were identified.
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From page 164... ...
IOM concluded that there was inadequate/insufficient evidence to determine whether an association exists between exposure to TCE, PCE, or other solvents and long-term reduction in olfactory function. 2008 Evaluation No additional studies of solvent exposure and long-term reduction in olfactory function were identified.
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