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  • Formatas: 738 pages
  • Išleidimo metai: 20-Dec-2018
  • Leidėjas: National Academies Press
  • Kalba: eng
  • ISBN-13: 9780309477192

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From 1962 to 1971, the U.S. military sprayed herbicides over Vietnam to strip the thick jungle canopy that could conceal opposition forces, to destroy crops that those forces might depend on, and to clear tall grasses and bushes from the perimeters of US base camps and outlying fire-support bases. Mixtures of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), picloram, and cacodylic acid made up the bulk of the herbicides sprayed. The main chemical mixture sprayed was Agent Orange, a 50:50 mixture of 2,4-D and 2,4,5-T. At the time of the spraying, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), the most toxic form of dioxin, was an unintended contaminant generated during the production of 2,4,5-T and so was present in Agent Orange and some other formulations sprayed in Vietnam.



Because of complaints from returning Vietnam veterans about their own health and that of their children combined with emerging toxicologic evidence of adverse effects of phenoxy herbicides and TCDD, the National Academies of Sciences, Engineering, and Medicine was asked to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange, other herbicides used in Vietnam, and the various components of those herbicides, including TCDD. Updated evaluations were conducted every two years to review newly available literature and draw conclusions from the overall evidence. Veterans and Agent Orange: Update 11 (2018) examines peer-reviewed scientific reports concerning associations between various health outcomes and exposure to TCDD and other chemicals in the herbicides used in Vietnam that were published between September 30, 2014, and December 31, 2017, and integrates this information with the previously established evidence database.

Table of Contents



Front Matter Summary 1 Introduction 2 Background 3 Evaluation of the Evidence Base 4 Biologic Mechanisms 5 Background on Selected Epidemiologic Studies and Populations 6 Immune System Disorders 7 Cancer 8 Reproductive Health Effects and Effects on Descendants 9 Neurologic Disorders 10 Metabolic and Cardiovascular Disorders 11 Other Chronic Health Outcomes 12 Conclusions and Recommendations References Appendix A: Public Meeting Agendas Appendix B: Committee and Staff Biographies
Acronyms And Abbreviations xvii
Summary 1(16)
1 Introduction
17(8)
Previous Veterans and Agent Orange Reports
18(1)
Charge to the Committee
19(1)
Information Gathering
20(1)
Organization of the Report
21(4)
2 Background
25(20)
The Current Population of Vietnam Veterans
25(2)
Military Use of Herbicides in Vietnam
27(3)
Exposure of Different Groups of Vietnam Veterans
30(8)
Characterizing Exposure
38(5)
Determining Increased Risk in Vietnam Veterans
43(2)
3 Evaluation Of The Evidence Base
45(24)
Identification and Screening of the Literature
46(8)
Evaluation Process
54(15)
4 Biologic Mechanisms
69(46)
Picloram
72(3)
Cacodylic Acid
75(6)
Phenoxy Herbicides: 2,4-Dichlorophenoxy Acid and 2,4,5-Trichlorophenoxyacetic Acid
81(5)
2,3,7,8-Tetrachlorodibenzo-p-dioxin
86(17)
Overarching Toxicologic Issues Related to the Chemicals of Interest
103(8)
Mediators of Health Outcomes
111(4)
5 Background On Selected Epidemiologic Studies And Populations
115(80)
Vietnam-Veteran Studies
120(33)
Occupational Studies
153(16)
Environmental Studies
169(19)
Case-Control Studies
188(7)
6 Immune System Disorders
195(18)
Categories of Immune Dysfunction
196(3)
Conclusions from VAO and Previous Updates
199(3)
Update of Epidemiologic Literature
202(5)
Biologic Plausibility
207(3)
Synthesis
210(1)
Conclusion
211(2)
7 Cancer
213(152)
Organization of Cancer Groups
216(1)
Biologic Plausibility
216(5)
Current Views of Cancer Mechanisms
221(2)
Overview of Studies That Report Multiple Cancer Outcomes
223(1)
Studies of Overall Cancer Mortality or Incidence
224(3)
Oral, Nasal, and Pharyngeal Cancers
227(6)
Cancers of the Digestive Organs
233(22)
Laryngeal Cancer
255(3)
Lung Cancer
258(6)
Bone and Joint Cancers
264(1)
Soft-Tissue Sarcomas
265(5)
Skin Cancers
270(7)
Breast Cancer
277(11)
Cancers of the Female Reproductive System
288(4)
Prostate Cancer
292(10)
Testicular Cancer
302(3)
Bladder Cancer
305(5)
Renal Cancers
310(3)
Brain Cancer
313(8)
Endocrine Cancers
321(5)
Lymphohematopoietic Cancers
326(39)
8 Reproductive Health Effects And Effects On Descendants
365(68)
Biologic Plausibility of Reproductive Health Effects
367(2)
Male Reproductive Health
369(6)
Female Reproductive Health
375(8)
Gestation and Neonatal Effects in Offspring
383(23)
Effects Occurring Later in Offspring's Lives
406(21)
Biologic Plausibility of Possible Effects in Subsequent Generations
427(6)
9 Neurologic Disorders
433(32)
Biologic Plausibility
435(2)
Nervous System Disorders Reported Overall
437(2)
Neurobehavioral, Cognitive, and Neuropsychiatric Disorders
439(5)
Neurodegenerative Diseases
444(16)
Chronic Peripheral Nervous System Disorders
460(3)
Hearing Loss
463(2)
10 Metabolic And Cardiovascular Disorders
465(50)
Type 2 Diabetes
466(17)
Circulatory Disorders
483(32)
11 Other Chronic Health Outcomes
515(44)
Non-Cancerous Respiratory Disorders
516(10)
Gastrointestinal and Digestive Diseases, Including Liver Toxicity
526(8)
Kidney and Urinary Disorders
534(7)
Thyroid Homeostasis and Other Endocrine Functions
541(6)
Chronic Skin Disorders
547(6)
Eye Problems
553(2)
Bone Conditions
555(4)
12 Conclusions And Recommendations
559(14)
Synopsis of Committee Conclusions
559(5)
Other Committee Recommendations
564(8)
Final Observations
572(133)
References 573(132)
Appendixes
A Public Meeting Agendas
705(4)
B Committee and Staff Biographies
709