Veterans and Agent Orange Update 2010 (2012) / Chapter Skim
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12 Conclusions and Recommendations
12 Conclusions and Recommendations
Pages 759-772
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From page 759... ...
The committee also notes that experimental data related to biologic plausibility of health conditions statistically associated with exposure to the components of Agent Orange have gradually emerged since the beginning of this series of VAO reports. These findings now better inform decisions about how to categorize the degree of association for individual conditions, so a footnote to this effect was added to Tables 1-1 and 12-1 by the committee for Update 2008.
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From page 760... ...
A thorough review of the existing literature in populations with members experiencing early-onset peripheral neuropathy, however, indicates that some individuals continue to manifest neuropathy symptoms long after ex ternal exposure has ceased, demonstrating that early-onset peripheral neuropathy is not necessarily a transient condition. Based on this literature, the committee elected to delete the word transient to recognize that symptoms of early-onset peripheral neuropathy may be protracted and recovery from those symptoms may be incomplete.
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From page 761... ...
Spina bifida in offspring of exposed people Inadequate or Insufficient Evidence to Determine Association The available epidemiologic studies are of insufficient quality, consistency, or statistical power to permit a conclusion regarding the presence or absence of an association. For example, studies fail to control for confounding, have inadequate exposure assessment, or fail to address latency.
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From page 762... ...
Cancers at other and unspecified sites Infertility Spontaneous abortion (other than for paternal exposure to TCDD, which appears not to be associated) b Neonatal or infant death and stillbirth in offspring of exposed people Low birth weight in offspring of exposed people Birth defects (other than spina bifida)
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From page 763... ...
In addition, the possibility of a very small increase in risk at the exposure studied can never be excluded. There is limited or suggestive evidence of no association between exposure to the herbicide component of interest and the following health outcomes: Spontaneous abortion and paternal exposure to TCDD aHerbicides indicates the following chemicals of interest: 2,4-dichlorophenoxyacetic acid (2,4-D)
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From page 764... ...
The information that had accumulated in VA's records clearly generated a signal that motivated VA to ask prior VAO committees to make special evaluations of whether several quite specific malignancies were associated with herbicide exposure; ancillary information was adequate to enable the committees to conclude that CLL and hairy-cell leukemia be long in the category of sufficient evidence of an association, but perhaps an answer for Vietnam veterans concerning tonsil cancer will only be found by a case–control study addressing deployment status and other emerging risk factors such as viral infection. In general, it is the committee's conviction that improved data linkage and sharing between DOD and VA would greatly enhance the conduct of
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From page 765... ...
For optimal use, however, such DOD information on a veteran's combat experience needs to be readily connected with future medical events, much of which resides with VA. Available information should be gleaned from existing cohort studies.
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From page 766... ...
Given its value as an impor tant source of epidemiologic data, the committee recommends that studies of the NIOSH cohort be extended. The committee also notes that future analyses of health outcomes in those and other important study populations should be as specific as possible because generic findings, such as those for "all respiratory outcomes," are not useful in addressing the committee's charge of determining associations of herbicide exposures with specific health conditions.
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From page 767... ...
There is a growing body of evidence that TCDD can induce epigenetic changes in animal models, but there remains extremely limited data on the risk of paternal exposure to xenobiotics in general, and the VAO chemicals of interest in particular, resulting in adverse effects on their offspring. VAO committees have been monitoring studies of morphological birth defects and cancer in the offspring of exposed parents, but this committee identified two major information gaps to assessing the link between expo sure of Vietnam veterans to the chemicals of interest and the development of disease in their offspring: (1)
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From page 768... ...
• Within the study populations reviewed, the committee recognized a possible interrelationship among the reported associations of serum concen trations of DLCs with certain health outcomes, including obesity, hypertri glyceridemia, type 2 diabetes, hypertension, and ischemic heart disease. The first four of those outcomes are key criteria for the diagnosis of metabolic syndrome, and the fifth is a major consequence of it.
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From page 769... ...
There is a need for new animal models to elucidate mechanisms of dis• eases and disease progression. The committee believes that experimental research in the mechanisms that underlie human health outcomes (particularly cardiovascular disease, B-cell cancers, and paternally mediated effects in offspring)
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From page 770... ...
Chapter 5 • Glean available information from existing cohort studies, particularly Epidemiologic Study those of Vietnam veterans (Air Force Health Study, Army Chemical Populations Corps cohort, female Vietnam veterans, National Vietnam Veterans Longitudinal Study) , the National Institutes of Safety and Health and International Agency for Research on Cancer cohorts of dioxin workers, the Agricultural Health Study, and the Seveso cohort.
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From page 771... ...
1996. Diseases associated with exposure to certain herbicide agents (prostate cancer and acute and subacute peripheral neuropathy)
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