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The Association Between Exposure To Fuels, Combustion Products,


Guest allan

Question

PREPUBLICATION COPY-UNCORRECTED PROOFS

TABLE ES.1 Summary of Findings Regarding the Association Between Exposure to Fuels, Combustion Products,

Hydrazines, and Nitric Acid and Specific Health Outcomes

Sufficient Evidence of a Causal Relationship

Evidence is sufficient to conclude that there is a causal association between exposure to a

specific agent and a specific health outcome in humans. The evidence is supported by

experimental data and fulfills the guidelines for sufficient evidence of an association (below).

The evidence must be biologically plausible and satisfy several of the guidelines used to

assess causality, such as: strength of association, dose.response relationship, consistency of

association, and a temporal relationship.

o No conclusions

Sufficient Evidence of an Association

Evidence is sufficient to conclude that there is a positive association. That is, a consistent

positive association has been observed between exposure to a specific agent and a specific

health outcome in human studies in which chance and bias, including confounding, could be

ruled out with reasonable confidence. For example, several high-quality studies report

consistent positive associations, and the studies are sufficiently free of bias, including

adequate control for confounding.

Combustion products and lung cancer

22 GULF WAR AND HEALTH

PREPUBLICATION COPY-UNCORRECTED PROOFS

Limited/Suggestive Evidence of an Association

Evidence is suggestive of an association between exposure to a specific agent and a specific

health outcome, but the body of evidence is limited by the inability to rule out chance and

bias, including confounding, with confidence. For example, at least one high-quality study

reports a positive association that is sufficiently free of bias, including adequate control for

confounding. Other corroborating studies provide support for the association, but they were

not sufficiently free of bias, including confounding. Alternatively, several studies of lower

quality show consistent positive associations, and the results are probably not due to bias,

including confounding.

Cancers

Combustion products and

o Cancers of the nasal cavity and nasopharynx

o Cancers of the oral cavity and oropharynx

o Laryngeal cancer

o Bladder cancer

Hydrazines and lung cancer

Reproductive Effects

Combustion products and

o Low birthweight/intrauterine growth retardation and exposure during

pregnancy

o Preterm birth and exposure during pregnancy

Respiratory Effects

Combustion products and incident asthma

Inadequate/Insufficient Evidence

Evidence is of insufficient quantity, quality, or consistency to permit a conclusion regarding

the existence of an association between exposure to a specific agent and a specific health

outcome in humans.

Cancers

Fuels and

o Cancers of the oral cavity and oropharynx

o Cancers of the nasal cavity and nasopharynx

o Esophageal cancer

o Stomach cancer

o Colon cancer

o Rectal cancer

o Hepatic cancer

o Pancreatic cancer

o Laryngeal cancer

o Lung cancer

o Melanoma

o Nonmelanoma skin cancer

o Female breast cancer

o Male breast cancer

EXECUTIVE SUMMARY 23

PREPUBLICATION COPY-UNCORRECTED PROOFS

o Female genital cancers (cervical, endometrial, uterine, and ovarian cancers)

o Prostatic cancer

o Testicular cancer

o Nervous system cancers

o Kidney cancer

o Bladder cancer

o Hodgkin.s disease

o Non-Hodgkin.s lymphoma

o Multiple myeloma

o Myelodysplastic syndromes

Combustion products and

o Esophageal cancer

o Stomach cancer

o Colon cancer

o Rectal cancer

o Hepatic cancer

o Pancreatic cancer

o Melanoma

o Female breast cancer

o Male breast cancer

o Female genital cancers (cervical, endometrial, uterine, and ovarian cancers)

o Prostatic cancer

o Testicular cancer

o Nervous system cancers

o Ocular melanoma

o Kidney cancer

o Non-Hodgkin.s lymphoma

o Hodgkin.s disease

o Multiple myeloma

o Leukemia

o Myelodysplastic syndromes

Hydrazines and

o Hematopoietic and lymphopoietic cancers

o Digestive tract cancers

o Pancreatic cancer

o Bladder cancer

o Kidney cancer

Nitric acid and:

o Stomach cancer

o Melanoma

o Lymphopoietic cancers

o Pancreatic cancer

o Laryngeal cancer

o Lung cancer

o Bladder cancer

24 GULF WAR AND HEALTH

PREPUBLICATION COPY-UNCORRECTED PROOFS

o Multiple myeloma

Reproductive Effects

Fuels and adverse reproductive or developmental outcomes (including infertility,

spontaneous abortion, childhood leukemia, CNS tumors, neuroblastoma, and

Prader-Willi syndrome)

Combustion products and

o Preterm births and exposure during any specific time period during

pregnancy (for example, the first trimester)

o Low birth weight and intrauterine growth retardation and exposure before

gestation or during any specific period during pregnancy (for example, the

first trimester)

o Specific birth defects, including cardiac effects, and exposure before

conception (maternal and paternal) or during early pregnancy (maternal)

o All childhood cancers identified, including acute lymphocytic leukemia,

leukemia, neuroblastoma, and brain cancer

Neurologic Effects

Fuels and

o Peripheral neuropathy

o Neurobehavioral effects

o Multiple Chemical Sensitivity symptoms

Combustion products and

o Neurobehavioral effects

o Posttraumatic stress disorder

o Nervous system subgroupings (or individual nervous system diseases)

o Multiple Chemical Sensitivity symptoms

Respiratory Effects

Fuels and

o Nonmalignant respiratory disease

o Chronic bronchitis

o Asthma

o Emphysema

Combustion products and:

o Chronic bronchitis (less than1 year of exposure)

o Emphysema

o Chronic obstructive pulmonary disease

Hydrazines and emphysema

Cardiovascular Effects:

Combustion products and ischemic heart disease or myocardial infarction (less

than 2 years of exposure)

Hydrazines and ischemic heart disease or myocardial infarction

Nitric acid and cardiovascular diseases

Dermal Effects:

EXECUTIVE SUMMARY 25

Fuels and dermatitis.irritant and allergic

Combustion products and dermatitis.irritant and allergic

Other Health Effects:

Fuels and sarcoidosis

Combustion products and sarcoidosis

Hydrazines and hepatic disease

Limited/Suggestive Evidence of No Association

Evidence is consistent in not showing a positive association between exposure to a specific

agent and a specific health outcome after exposure of any magnitude. A conclusion of no

association is inevitably limited to the conditions, magnitudes of exposure, and length of

observation in the available studies. The possibility of a very small increase in risk after

exposure studied cannot be excluded.

No conclusions

SOURCE: http://www1.va.gov/environagents/docs/Summ...Propellants.pdf

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