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Lung Cancer Link Seen in Gulf War Fires

Advisers issue new report on combustible products

MONDAY, Dec. 20, 2004 (HealthDayNews) -- Scientists advising the U.S. government said Monday that they have found evidence of an association between lung cancer in Gulf War veterans and exposure to combustible products used in the war.

They stopped short, however, of declaring a cause-and-effect relationship in their new report, adding that their conclusions were largely drawn from studies that didn't look at the veterans.

The Institute of Medicine (IOM) study also concluded that there is not enough quality evidence to say whether most of the other health problems experienced by Gulf War veterans are due to exposure to fuels, propellants in Scud missiles, or by-products from oil well fires, exhausts and tent heaters.

The report, entitled Gulf War and Health, Vol. 3: Fuels, Combustion Products and Propellants, is the third in a series examining the health effects of agents to which Gulf War veterans may have been exposed. The study was sponsored by the U.S. Department of Veterans Affairs.

Outside experts, however, said that the report does not go far enough.

"We knew that breathing in oil well fire smoke is bad for you. We don't need the Institute of Medicine to tell us that," said Steve Robinson, executive director of the National Gulf War Resource Center in Silver Spring, Md. "Part of the problem is that the charter does not ask them to take the next step, which is, 'What is the prevalence of lung cancer among Gulf War veterans?"

Many returning Gulf War veterans have reported health problems that they attribute to their tour of duty in that region in 1991. Among other things, these soldiers may have been exposed to smoke from 600 oil well fires ignited in Kuwait by retreating Iraqi troops; vehicle exhaust; heaters in poorly ventilated tents; cooking stoves; and hydrazines and nitric acid, which are ingredients used in Scud missile propellants.

In 1998, under a Congressional mandate, the IOM began investigating whether exposure to chemical, biological or environmental agents during the Gulf War might be responsible for various health complaints.

For this report, the authors reviewed about 800 published, peer-reviewed studies; only a few of them, however, actually studied veterans who had served in the Persian Gulf area.

"What they're saying is that exposure to these things does create health effects. They can't say whether or not they created health effects in Gulf War veterans because data was not collected on the battlefield," Robinson said.

In addition to the lung cancer association, the report found limited evidence of an association between exposure to combustible products and oral, nasal, larynx and bladder cancer as well as asthma and preterm birth and low birth weight.

There was not enough data to draw conclusions on other cancers, neurological problems and other health problems.

Of the propellant components of Scud missiles, only hydrazines were found to have a limited association with lung cancer.

Robinson is calling for a larger-scale epidemiological survey of Gulf War veterans to establish the prevalence of such health problems as cancer, birth defects, cognitive dysfunction, and neurological effects.

"If there are more people [among Gulf War veterans] developing cancer, then this plus the epidemiological information should be enough to force Congress and the Department of Veterans Affairs to act," he said. "If we see a statistically significant prevalence among Gulf War veterans for lung cancer and we know that they had an exposure, then the [government] must move to establish a presumptive service connection. That would allow veterans to file claims related to cancers that they developed."

Robinson also said he suspected that the numbers will be higher. "I have been in touch with increasingly more and more veterans who are having different kinds of cancer, so the evidence is beginning to come in, which is what we would expect after 13 or 14 years," he said.

The other issue is one of lessons learned, he added.

"The lessons learned from the first Gulf War are supposed to generate changes in health policy that will allow collection of information on the battlefield," he said. "We're going to be pushing for what changes have been and haven't been done."

More information

Visit the Institute of Medicine for more on this report and the two that preceded it.

SOURCES: Steve Robinson, executive director, National Gulf War Resource Center, Silver Spring, Md.; Dec. 20, 2004, Institute of Medicine report
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