Clinical Topics

Bladder Cancer and Hyperthyroidism Linked to Agent Orange

In final report, committee urges VA to continue epidemiologic studies of exposed veterans.


 

There is “limited or suggestive evidence” that links Agent Orange exposure to bladder cancer and hyperthyroidism according to the biennial review of the Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides. The committee reviewed results from a study of veterans of the Korean War who also served in the Vietnam War that suggested an association for bladder cancer and hypothyroidism. The evidence, along with supportive epidemiologic findings, led the committee to strengthen the association between Agent Orange exposure and bladder cancer and hyperthyroidism.

The report is the final in a series of reviews mandated by Congress on the evidence of health problems that can be linked to exposure to Agent Orange and other herbicides used during the Vietnam War. Bladder cancer joins a host of other cancers and cancer-related conditions associated with Agent Orange exposure, include:

  • AL Amyloidosis;
  • Chronic B-cell Leukemias;
  • Hodgkin Disease;
  • Multiple Myeloma;
  • Non-Hodgkin Lymphoma;
  • Prostate Cancer;
  • Respiratory Cancers (including lung cancer);
  • Cancers of the lung, larynx, trachea, and bronchus; and
  • Soft Tissue Sarcomas.

The committee also concluded that there was not enough evidence to support an association between any birth defects and parental exposure to herbicides. According to the committee, “intensive investigation of possible heritable effects in animal models still has not demonstrated that herbicide exposure of adult males can produce birth defects in their offspring.” The committee downgraded spina bifida to the “inadequate or insufficient” evidence category—marking just the second time that a health outcome has been moved to a weaker category of association.

The committee also addressed the question of whether Parkinson-like symptoms should qualify the assignment of Parkinson disease to the limited or suggestive category of association with Agent Orange exposure. The committee determined that given “there is no rational basis for exclusion of individuals with Parkinson-like symptoms from the service-related category denoted as Parkinson disease.” The committee also suggested that “the onus should be on the VA on a case-by-case basis to definitively establish the role of a recognized factor other than the herbicides sprayed in Vietnam.”

In the final report, the committee urged the VA to:

  • Continue epidemiologic studies of exposed veterans;
  • Develop protocols to investigate paternal transmission of adverse effects to offspring;
  • Study the manifestations in humans of dioxin exposure and compromised immunity, which have been clearly demonstrated in animal models; and
  • Review evidence to determine whether paternal exposure to any toxicant has definitively resulted in birth defects.

A complete list of diseases associated with Agent Orange can be found at: http://www.publichealth.va.gov/exposures/agentorange/conditions/#sthash.vJTT3VdU.dpuf

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