1 15 2 https://www.nal.usda.gov/exhibits/speccoll/files/original/873afa4efa90b2c9b94828ca63a23588.pdf dc8a294f981627c6a59dae605d36adfa PDF Text Text Item ID Number 01768 AllthOT Kang, Han K. Corporate Author Roport/Artldo TltlO Soft Tissue Sarcomas and Military Service in Vietnam: a Case Comparison Group Analysis of Hospital Patients JOUrnal/BOOk TltlU Journal of Occupational Medicine Yoar 1986 MOUth/Day December Color a Number of Images 4 Descrlpton Notes Monday, June 11, 2001 Page 1769 of 1793 �Soft Tissue Sarcomas and Military Service in Vietnam: A Case Comparison Group Analysis of Hospital Patients Hem K. Kong, DrPH; Lee Weatherbee, MD; Patricia P. Breslin, PhD; Yvonne Lee, MS; and Barclay M. Shepard, MD The possibility that exposure to Agent Orange or phenoxy herbicides may have increased the risk of soft tissue sarcomas has been of genuine concern to Vietnam veterans and their families. A hospital-based case comparison group study was undertaken to examine, through a comprehensive review of medical records and military personnel records, the association between previous military service in Vietnam and soft tissue sarcomas. The case group comprised 834 Vietnam-era veteran patients who served in the US military between 1964 and 1975 and were treated in one of the 172 VA hospitals between 1969 and 1983 with a diagnosis of soft tissue sarcomas. The comparison group consisted of 13,496 patients who were systematically sampled from the same Vietnam-era veteran patient population from which the cases were drawn. Military service information, in particular Vietnam service status, for each case and control patient was obtained from a review of the patient's military personnel records archived at the National Personnel Records Center in St Louis, Missouri. No significant association of soft tissue sarcomas and previous military service in Vietnam was observed: odds ratio was 0.83 with a 95% confidence interval of 0.63 to 1.09. suggested persons reporting exposure to phenoxy herbicides Twoa Swedishcase-control studies havedevelopingthat have five- to sixfold higher risk of soft tissue sarcomas (STS) compared with persons without such exposure.1'2 In addition, several cases of soft tissue sarcomas have been reported in the US among workers involved in the manufacturing or use of phenoxy herbicides.3-5 Prom the Department of Medicine and Surgery, Veterans Administration, Washington, DC. Address correspondence to: VA Office of Environmental Epidemiology (10X8B), AFIP, Washington, DC 20306-6000 (Dr Rang, Director). 0096-1736/86/S813-1215$03.00/0 Copyright Cc) by American Occupational Modical Association These studies have generated much concern in the United States for Vietnam veterans—concern that, as a result of their exposure to Agent Orange in Vietnam, they may be at increased risk for soft tissue sarcomas in addition to several other medical and psychological problems. Agent Orange, a mixture of two commercial phenoxy herbicides, 3,4-dichlorophenoxyacetic acid (3,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), was the herbicide most comonly used by the US military in Vietnam. The principal concern over exposure to Agent Orange stems from the fact that during the manufacture of 2,4,5-T trace amounts of a highly toxic dioxin, 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD), appeared as a contaminant. Agent Orange was sprayed in Vietnam for defoliation and crop destruction from 1965 to 1970 in a military operation named Ranch Hand. The aerial application of Agent Orange reached its peak in 1967, leveled off slightly in 1968 and 1969, and declined rapidly in 1970. During the five-year period the US Air Force sprayed more than 11 million gallons of Agent Orange in South Vietnam. Approximately 2 million US military personnel served 1-year tours during the same period. Studies published subsequent to the Swedish studies have not yet demonstrated the association between soft tissue sarcomas and either exposure to phenoxy herbicides or military service in Vietnam.6-11 Two of the seven industrial workers previously reported to be cases of STS were also found to have not sarcomas but carcinomas.18 In view of the public concern about potential health risk among Vietnam veterans and conflicting research findings in the scientific literature, a case comparison group analysis of hospital patients for soft tissue sarcomas was undertaken to determine the association between previous military service in Vietnam and soft tissue sarcomas. Journal of Occupational Medicine/Volume 28 No. 12/December 1986 1215 �Materials and Methods The Veterans Administration Patient Treatment File (PTF) was used to identify all Vietnam era veterans whose conditions were diagnosed as soft tissue sarcomas from 1969 through 1983. The PTF is a computerized hospital data base of inpatient records, including patients' demographic data, surgical and procedural transactions, and patient movement and diagnoses. A record is created for each inpatient discharged from one of the 172 VA medical centers. The Vietnam-era veterans are defined as veterans who served in the US military sometime during Aug 5,1964, and May 7, 1975. A total of 418 cases with International Classification of Diseases (ICD) 171 diagnosis, ie, malignant neoplasm of connective and other soft tissue, were identified by computer search of the PTF for Vietnam-era veterans who were hospitalized between 1969 and 1983. A pathology report for each ICD 171 case was requested from each treating VA medical center. A review of 394 pathology reports received for these cases was made by a pathologist (L.W.) who has particular interest and experience in this group of malignancies. During the review he had no knowledge of Vietnam service status of any of the patients. On the basis of the review of the pathology reports, 151 ICD 171 cases were excluded as not likely being soft tissue sarcomas because of miscoding or misclassification and nine ICD 171 cases were put in a doubtful STS category, leaving 234 diagnoses of STS. All diagnoses were classified according to the World Health Organization classification system for soft tissue sarcomas.13 The comparison group consisted of 14,931 patients who were systematically sampled from the same Vietnam-era veterans patient population from which the STS case subjects were identified. Vietnam-era veteran patients who have predetermined numbers in the last two digits of their social security numbers were selected among all Vietnam-era veteran patients. Military service information, in particular Vietnam service status, for STS case subjects and control patients was obtained from a comprehensive review of the patient's military personnel records archived at the National Personnel Records Center (NPRC) in St Louis, Missouri. The General Services Administration (GSA), under an agreement with the Department of Defense, maintains the military personnel records of veterans, including those from the Vietnam era. Military personnel records were located and abstracted for all of the 234 STS case subjects and 13,496 of the 14,931 (90%) control patients. Results and Discussion Eighty-six of the 234 STS cases, or 36.8%, had served in Vietnam. As Table 1 indicates there was no one predominant type of STS. Distribution of tumor type of the 234 STS cases was similar to the results from the recently published New York state study of 281 cases of soft tissue sarcoma and Vietnam service.7 Greenwald et al reported that percentage distribution of malignant tumor of muscle tissue, fibrous tissue, adipose tissue, and other soft tissue was 23.8, 17.8, 16.4, and 42.0, respectively, among the men with soft tissue sarcomas diagnosed from 1962 through 1980, who were between the ages of 18 and 29 years any time between 1962 and 1971 and in the New York State Cancer Registry. Age distribution of STS case subjects was similar to the control group. No unusual influx of STS case subjects was observed at any interval as indicated by percent distribution of STS case subjects and control groups by hospitalization year (Table 2). Of the sample of 13,469 PTF Vietnam-era patients, 5,544 or 41% had served in Vietnam (Table 3). No significant association of soft tissue sarcomas and previous military service in Vietnam was observed among the Vietnam-era veterans who had come to the VA hospital for inpatient medical care. The odds ratio was 0.83 with a 95% confidence interval of 0.63 to 1.09. This suggests that the chance of having a diagnosis of STS among Vietnam veteran patients was not greater than that among veteran patients who did not serve in Vietnam. A differential ascertainment of military service status between the STS case subjects (100%) and the control patients (90%) should be noted. However, the difference is primarily a reflection of levels of efforts and manhours allocated for the personnel record search rather than any difference in availability of the military records between STS case subjects and control patients, or Vietnam veterans and non-Vietnam veterans. For ex- TABLE 1 Soft Tissue Sarcoma Type By Military Service Status Type Histology Tumors of muscle tissue Rhabdomyosarcoma Leiomyosarcoma Fibrosarcoma Synovial sarcoma Liposarcoma Angiosarcoma Malignant hemangiopericytoma Tumors of fibrous tissue Tumors of synovial tissue Tumors of adipose tissue Tumors of vascular origin Others Total (%) 1216 NonVietnam Veteran Vietnam Veteran 18 8 26 21 19 3 10 43 8 12 13 9 9 1 2 32 148 (63.2) 86 (36.8) Total (%) 26 20 39(16.7) 30(12.8) 28(12.0) 4 12 75 (32.0) 234 (100) Soft Tissue Sarcomas and Agent Orange/Kang et al �TABLE 2 Distribution by Age and Hospital Discharge Year for Soft Tissue Sarcoma Case Subjects and Comparison Group TABLE 4 Distribution of Soft Tissue Sarcoma Case Subjects and Comparison Group of Patients by Branch of Service in Vietnam Percentage Category STS Case Subjects Comparison Group Age group (yr) 20-29 30-34 35-39 40-44 45-49 50-59 60+ 9 18 42 11 4 10 6 6 29 37 11 4 8 5 Hospitalization (yr discharged) Before 1970 1971-1975 1976-1980 1981-1983 6 35 42 17 7 36 41 16 TABLE 3 Distribution of Soft Tissue Sarcoma Case Subjects and a Comparison Group of Patients by Vietnam Service Status* STS Case Subjects (%) Comparison Group (%) Total Yes No 86 (37) 148(63) 5,544(41) 7,952 (59) 5,630 8,100 Total 234 (100) 13,496 (100) 13,730 Vietnam Service * Odds ratio: 0.83 (95% confidence interval 0.63 to 1 .09); x2: 1 .78 ample, when the same levels of record search efforts made for the control patients were employed for the STS case subjects, the military record searchers at the NPRC were able to locate 214 of the 234 STS cases (91%); the yield for the control patients was 13,496 of the 14,931 (90%). Additional time-consuming manual tracking efforts were made for the 20 STS case subjects whose Vietnam service status was not determined because their personnel folders were misplaced, missing, or on loan to other agencies. Of the 20 STS case subjects, 12 did not serve in Vietnam and eight did serve in Vietnam: a ratio of 5:3.3. Prior to this exhaustive manual search the ratio among the 214 STS case subjects was 5:2.9. Even if one makes an extreme assumption, that is, that all of the remaining 10% of the control patients (1,435) whose military personnel records were not located did not serve in Vietnam, the conclusion of the study would not be altered. This assumption results in the odds ratio of 0.98. The other extreme assumption, that is, that all of the 1,435 control patients had served in Vietnam, results in the odds ratio of 0.66. There seems to be no propensity of ground troops (Army or Marines) among the STS case subjects compared with the comparison group (Table 4). It has been suggested that ground troops in Vietnam, by nature of their military operation through defoliated zones and by practice of base perimeter spraying, might have a higher probability of direct or indirect contact with Agent Orange than Air Force or Navy personnel. Branch STS Case Subjects Comparison Group (%) Army Air Force Marines Navy Coast Guard 45 (52) 6(7) 14(16) 21 (24) 3,528 (64) 367 (7) 921 (16) 721 (13) Total 86 (100) 5,544 (100) The findings of this study are consistent with a case control study recently published by Greenwald et al.7 Greenwald et al reported no significant association between STS among Vietnam-era veteran-age males and military service in Vietnam. Other studies of Vietnam-era veterans published to date also have failed to find an excess of STS among Vietnam veterans. A study of Ranch Hand personnel, a group of approximately 1,260 men who conducted the fixed-wing aerial herbicide spraying missions in Vietnam from 1962 through 1971, did not reveal a single death from STS.10 A proportionate mortality analysis of deaths among New York State Vietnam-era veterans between 1965 and 1980, exclusive of 1968 and 1969, also failed to show excess STS deaths among Vietnam veterans.14 Two of the 555 deaths reported among Vietnam veterans were due to cancer of connective and soft tissue (ICD 171), whereas three of 941 deaths among non-Vietnam veterans resulted from the same type of cancer. The mortality odds ratio (MOR) was 1.09 with a 95% confidence interval of 0.18 to 6.70. A mortality study of Australian Vietnam-era veterans reported 260 deaths among 19,205 Vietnam veterans and 263 deaths among 25,677 non-Vietnam veterans when followed from the end of their military service to Jan 1, 1982. There was no statistically significant difference in the death rates from STS.11 However, in all three mortality studies, it should be recognized that the design of the study is such that only very high risks for STS were likely to be detected: the number of person-years followed or number of deaths available for analysis was too small to detect moderately elevated relative risks of STS from Vietnam service. The absence of positive association between STS and Vietnam service might be a result of insufficient observation time since Agent Orange exposure in Vietnam. In general, it takes more than a decade for cancer to manifest itself if it is induced by a chemical carcinogen. More than 80% of STS case subjects in the study were observed less than 10 years after the last troops were exposed to Agent Orange in Vietnam. Another possibility is that although Agent Orange or dioxin can induce STS, Vietnam veterans as a group were exposed to such small amounts that the conventional epidemiologic study cannot detect the excess risk resulting from Agent Orange exposure in Vietnam. Or there is the possibility that Agent Orange does not induce STS in humans after all. Journal of Occupational Medicine/Volume 28 No. 12/December 1986 1217 �1. Hardell L, Sandstrom A: Case-control study: Soft tissue sarcoma and exposure to phenoxyacetic acids or chlorophenols. Br J Cancer 1979:89:711-717. 2. Eriksson M, Hardoll L, Berg NO, et al: Soft tissue sarcomas and exposure to chemical substances: A case-reference study. BrJInd Med 1981;38:37-33. 3. Cook RR: Dioxin, chloracne, and soft tissue sarcoma, letter. Lancet 1981:1:618-619. 4. Honchar PA, Halperin WE: 2,4,5-T, trichlorophenol, and soft tissue sarcoma. Lancet 1981:1:268-869. 5. Moses M, Selikoff IJ: Soft tissue sarcomas, phenoxy herbicides and chlorinated phenols. Lancet 1981;1:1370. 6. Riihimaki V, Sisko A, Hernberg S: Mortality of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichloroaeetic acid herbicide applicators in Finland. Sound J Work Environ Health 1982;8:37-42. 7. Grecnwald P, Kovasznay B, Collins UN, ot al: Sarcomas of soft tissue after Vietnam service. JNCI 1984:73:1107-1109. 8. Smith AH, Fisher DO, Pearco N, et al: Do agriculture chemicals cause soft tissue sarcoma? Initial findings of a case-control study in New Zealand. Community Health Stud 1988:6:114 119. 9. Smith AH, Perace NE, Fisher DO, et al: Soft tissue sarcoma and exposure to phenoxy herbicides and chlorophenols in New Zealand. JNCI 1984:73:1111-1117. 10. An epidemiologic investigation of health effects in Air Force personnel following exposure to herbicide: Mortality update. Epidemiology Division, USAF School of Aerospace Medicine, Brooks AFB, Texas. December 1984. 11. A retrospective cohort study of mortality among Australian national servicemen of the Vietnam conflict era. The Commonwealth Institute of Health, University of Sydney. Canberra, Australian Government Printing Service, 1984. 12. Fingerhut MA, Halporin WE, Honchar PA, et al: An evaluation of reports of dioxin exposure and soft tissue sarcoma pathology among chemical workers in the United States. Scand J Work Environ Health 1984:10:299-303. 13. Enzinger FM, Lattes R, Torloni H: Histological typing of soft tissue tumors, in International Histological Classification of Tumors, No. 3. Geneva, World Health Organization, 1969. 14. Lawrence C, Reilly AA, Quickenton P, ot al: Mortality patterns of Now York State Vietnam veterans. Am J Public Health 1986:75:277879. 1218 Soft Tissue Sarcomas and Agent Orange/Kang et al In conclusion, a study of STS case subjects and a comparison patients group in VA hospitals did not reveal a statistically significant positive association between STS and previous military service in Vietnam. References � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1768 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Kang, Han K. Lee Weatherbee Patricia P. Breslin Yvonne Lee Barclay M. Shepard Source A related resource from which the described resource is derived Journal of Occupational Medicine Date A point or period of time associated with an event in the lifecycle of the resource 1986-12-01 Title A name given to the resource Soft Tissue Sarcomas and Military Service in Vietnam: a Case Comparison Group Analysis of Hospital Patients Subject The topic of the resource cancer risk assessment dioxin ao_seriesIII https://www.nal.usda.gov/exhibits/speccoll/files/original/9c9f23c26722d230cc07a7c9a8547588.pdf 4624d4d4dae9a614631f333ac701ae0f PDF Text Text Item ID Number 01755 Author Kan 9-Han K- Corporate Author RopOrt/ArtlOlO TltlO Typescript: Soft Tissue Sarcoma and Military Service in Vietnam: a Case Comparison Group Analysis of Hospital Patients, February 1985 Journal/Book Title Year 000 ° Month/Day Color n Number of Images 14 DoSCrlptOH NotOS Submitted for publication in the American Journal of Industrial Medicine. Monday, June 11, 2001 Page 1766 of 1793 �Soft Tissue Sarcoma and Military Service in Vietnam: A Case Comparison Group Analysis of Hospital Patients Han K. Kang, Dr.P.H., Lee Weatherbee, M.D.*, Yvonne Lee, M.S., Patricia P. Breslin, Ph.D., Barclay M. Shepard, M.D. Department of Medicine and Surgery Veterans Administration Washington, D.C. 20420 (202) 389-5534 * Laboratory Service, Veterans Administration Medical Center 2215 Fuller Road, Ann Arbor, Michigan 48105 Submitted for publication in the American Journal of Industrial Medicine. February 1985. �Abstract - Soft tissue4 sarcoma and military service in Vietnam: A case comparison group analysis of hospital patients. The possibility that exposure to Agent Orange or phenoxy herbicides may have increased the risk of soft tissue sarcoma (STS) has been of genuine concern to Vietnam veterans and their families. A hospital-based case comparison group study was undertaken to examine, through a comprehensive review of medical records and military personnel records, the association between previous military service in Vietnam and soft tissue sarcoma. The case group comprised 234 Vietnam-era veteran patients who served in the U.S. military between 1964 and 1975 and were treated in one of the 172 VA hospitals between 1969 and 1983 with a histologically confirmed diagnosis of soft tissue sarcoma. The comparison group consisted of 13,496 patients who were systematically sampled from the same Vietnam-era veteran patient population from which the cases were drawn. Military service information, in particular Vietnam service status, for each case and control patient was obtained from a review of the patient's military personnel records archived at the National Personnel Records Center in St. Louis, Missouri. No significant association of soft tissue sarcoma and previous military service in Vietnam was observed: odds ratio was 0.83 with a 95% confidence interval of 0.63-1.09. Key word: Agent Orange, dioxin, phenoxy herbicides, TCDD, Vietnam veterans, and Vietnam era veterans. �Introduction Two Swedish case-control studies have suggested that persons reporting exposure to phenoxy herbicides have a 5 to 6 fold higher risk of developing soft tissue sarcoma compared to persons without such exposure (Hardell et al., 1979; Erikson et al., 1981). In addition, several cases of soft tissue sarcoma have been reported in the U.S. among workers involved in the manufacturing or use of phenoxy herbicides (Cook, 1981; Honchar and Halperin, 1981; Moses and Selikoff, 1981). These studies have generated much concern in the United States for Vietnam veterans that, as a result of their exposure to Agent Orange in Vietnam, they may be at increased risk for soft tissue sarcoma (STS) in addition to several other medical and psychological problems. Agent Orange, a mixture of two commercial phenoxy herbicides 2,4-dichlorophenoxyacetic acid (2,4-D) and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T), was the herbicide most commonly used by the U.S. military in Vietnam. The principle concern over exposure to Agent Orange stems from the fact that during the manufacture of 2,4,5-T trace amounts of a highly toxic dioxin, 2,3,7,8-tetrachlorodibenzo-para-dioxin (TCDD), appeared as a contaminant. During the five-year period from 1965 to 1970, the U.S. Air Force sprayed more than 11 million gallons of Agent Orange in South Vietnam. Approximately two million U.S. military personnel served one-year tours during the same period. Studies published subsequent to the Swedish studies have not yet demonstrated the association between STS and either exposure to phenoxy herbicides or military service in Vietnam (Riihimaki, 1982; Greenwald et �al., 1984; Smith, et al., 1982, 1984; U.S. Air Force, 1983; University of Sidney, 1984). Two of the 7 industrial workers previously reported to be cases of SI'S were also found to have not sarcoma but carcinomas (Fingerhut et al., 1984). In view of the public concern about potential health risk among Vietnam veterans and conflicting research findings in the scientific literature, a case comparison group analysis of hospital patients for soft tissue sarcoma was undertaken to determine the association between previous military service in Vietnam and soft tissue sarcoma. Materials and Methods 'Ihe Veterans Administration Patient Treatment File (PTF) was used to identify all Vietnam era veterans who were diagnosed as having soft tissue sarcoma from 1969 through 1983. Ihe PTF is a computerized hospital data base of in-patient records including patients' demographic data, surgical and procedural transactions, and patient movement and diagnoses. A record is created for each in-patient discharged from one of the 172 VA medical centers. The Vietnam era veterans are defined as veterans who served in the U.S. military sometime during August 5, 1964 and May 7, 1975. A total of 418 cases with International Classification of Disease (ICD) 171 diagnosis, i.e., malignant neoplasm of connective and other soft tissue, were identified by computer search of the FIF for Vietnam era . veterans who were hospitalized between 1969 and 1983. A pathology report for each ICD 171 case was requested from each treating VA medical center. A review of 394 pathology reports received for these cases was made by a pathologist (L.W.) who has particular interest and experience in this �group of malignancies. During the review he had no knowledge of Vietnam service status of any of the cases. On the basis of the review of the pathology reports, 151 ICD 171 cases were excluded as not likely being soft tissue sarcoma because of miscoding or misclassification and 9 ICD 171 cases were put in a doutbful STS category, leaving 234 histologically confirmed diagnoses of STS. All diagnoses were classified according to the WHO classification system for soft tissue sarcomas (Enzinger et al., 1969). The comparison group consisted of 14,931 patients who were systematically sampled from the same Vietnam era veterans patient population from which the STS cases were identified. Vietnam era veteran patients who have predetermined numbers in the last two digits of their social security numbers were selected among all Vietnam era veteran patients. Military service information, in particular Vietnam service status, for STS cases and control patient was obtained from a comprehensive review of the patient's military personnel records archived at the National Personnel Records Center (NPRC) in St. Louis, Missouri. The General Services Administration (GSA) under an agreement with the Department of Defense maintains the military personnel records of veterans including those from the Vietnam era. Military personnel records were located and abstracted for all of the 234 soft tissue sarcoma cases and 13,496 of the 14,931 (90%) control patients. �Results and Discussion Eighty-six of the 234 histoloqically confirmed soft tissue sarcoma cases, or 36.8%, had served in Vietnam. As Table 1 indicates there was no one predominant type of soft tissue sarcoma. Distribution of tumor type of the 234 STS cases was similar to the results from the recently published NY state study of 281 cases of soft tissue sarcoma and Vietnam service (Greenwald et al., 1984). Greenwald et al., reported that percentage distribution of malignant tumor of muscle tissue, fibrous tissue, adipose tissue, and other soft tissue were 23.8, 17.8, 16.4 and 42.0 respectively among the men with soft tissue sarcoma diagnosed from 1962 through 1980, who were between the ages of 18 and 29 years anytime between 1962 and 1971 and in the New York State Cancer Registry. Age distribution of STS cases was similar to the control group. No unusual influx of STS cases was observed at any interval as indicated by percent distribution of STS cases and control groups by hospitalization year (Table 2). Of the sample of 13,469 PTF Vietnam era patients, 5,544 or 41% had served in Vietnam (Table 3). No significant association of soft tissue sarcoma and previous military service in Vietnam was observed among the Vietnam era veterans who come to the VA hospital for inpatient medical care. The odds ratio was 0.83 with a 95% confidence interval of 0.63-1.09. This suggests that the chance of having diagnosis of STS among Vietnam veteran patients was not greater than that among veteran patients who did not serve in Vietnam. A differential ascertainment of military service status between the STS cases (100%) and the control patients (90%) should be noted. We believe, however, that the difference is primarily a reflection of levels of efforts and man-hours allocated for the personnel record search rather than any difference in availability of the military records between STS �cases and control patients, or Vietnam veterans and non-Vietnam veterans. For example, when the same levels of record search efforts as for the control patients were employed for the STS cases, the military record searchers at the NPRC were able to locate 214 of the 234 STS cases (91%); the yield for the control patients was 13,496 of the 14,931 (90%). Additional time-consuming manual tracking efforts were made for the 20 STS cases whose Vietnam service status was not determined because their personnel folder were misplaced, missing or on loan to other agencies. Of the 20 STS cases, 12 did not serve in Vietnam and 8 did serve in Vietnam: a ratio of 5:4. Prior to this exhaustive manual search the ratio among the 214 STS cases was 5:3. Even if one makes an extreme assumption, that is, that all of the remaining 10% of the control patients (1,435), whose military personnel records were not located, did not serve in Vietnam, the conclusion of the study would not be altered. This assumption results in the odds ratio of 0.98. The other extreme assumption, that is, that all of the 1,435 patients had served in Vietnam, results in the odds ratio of 0.66. There seems to be no propensity of ground troops (Army or Marines) among the STS cases as compared to the comparison group (Table 4). It has been suggested that ground troops, by nature of their military operation through defoliated zones and by practice of base perimeter spraying, might have a higher probability of direct or indirect contact with Agent Orange than Air Force or Navy personnel. The findings of this study are consistent with a case control study recently published by Greenwald et al. (1984). Greenwald et al. (1984) reported no significant association between STS among Vietnam era veteran age males and military service in Vietnam. �Other studies of Vietnam era veterans published to date also have failed to find an excess of STS among Vietnam veterans. A study of PANCH HAND personnel, a group of approximately 1,260 men who conducted the fixed wing aerial herbicide spraying missions in Vietnam from 1962 through 1971, did not reveal a single death from STS (USAF, 1983). A proportionate mortality analysis of deaths among New York State Vietnam era veterans between 1965 and 1980, exclusive of 1968 and 1969, also failed to show excess STS deaths among Vietnam veterans. Two of the 555 deaths reported among Vietnam veterans were due to cancer of connective and soft tissue (ICD 171), whereas 3 of 941 deaths among non-Vietnam veterans resulted from the same type of cancer. The mortality odds ratio (MOR) was 1.09 with a 95% confidence interval of 0.08-15.09 (Lawrence et al., 1985). A mortality study of Australian Vietnam era veterans reported 260 deaths among 19,205 Vietnam veterans and 263 deaths among 24,677 non-Vietnam veterans when followed from the end of their military service to January 1, 1982. There was no statistically significant difference in the death rates from STS (University of Sidney, 1984). However, in all three mortality studies, it should be recognized that the design of the study is such that only very high risks for STS were likely to be detected: the number of person years followed or number of deaths available for analysis was too small to detect moderately elevated relative risks of STS from Vietnam service. The absence of positive association between STS and Vietnam service might be a result of insufficient observation time since Agent Orange exposure in Vietnam. In general, it takes more than a decade for cancer to manifest itself if it is induced by a chemical carcinogen. Over 80% of STS cases in the study were observed less than 10 years after the last troops were exposed to Agent Orange in Vietnam. Another possibility is that although Agent Orange or dioxin can induce STS, Vietnam veterans as a 8 �group, were exposed to such small amounts that the conventional epidemiologic study cannot detect the excess risk resulting from Agent Orange exposure in Vietnam. Or, of course, there is the possibility that Agent Orange does not induce STS in humans after all. In conclusion, a study of STS cases and a comparison patients group in VA hospitals did not reveal a statistically significant positive association between STS and previous military service in Vietnam. \ �References 1. Cook, R. R. (1981). Dioxin, chloracne, and soft tissue sarcoma (letter). Lancet 1:618-619. 2. Eriksson, M., Hardell, L., Berg, N. 0., Moller, T., Axelson, 0. (1981). Soft tissue sarcomas and exposure to chemical substances: A case-reference study. Br. J. Ind. jted^ 38:27-33. 3. Fingerhut, M. A., Halperin, W. E., Honchar, P. A., Smith, A. b., Groth, D. H., Russell, W. 0. (1984). Iteview of exposure and pathology data for seven cases reported as soft tissue sarcoma among persons occupationally exposed to dioxin-contaminated herbicides. In Lowrance WW (ed): "Public Health Risks of the Dioxin." The Rockefeller University, pp 187-216. 4. Greenwald, P., Kovasznay, B., Collins, D. N., Iherriault, G. (1984). Sarcomas of soft tissue after Vietnam service. JNCI 73:1107-1109. 5. Hardell, L., Sandstrom, A. (1979). Case-control study: Soft tissue sarcoma and exposure to phenoxyacetic acids or chlorophenols. Br. J. Cancer 39:711-717. 6. Honchar, P. A., Halperin, W. E. (1981). 2,4,5-T, trichlorophenol, and soft tissue sarcoma. Lancet 1:268-269. 7. Lawrence, C., Iteilly, A. A., Quickenton, P., Greenwald, P., Page, W., Kuntz, A. (1985). Mortality patterns of New York State Vietnam veterans. Am. J. Public Health (in print). 8. Moses, M., Selikoff, I. J. (1981). Soft tissue sarcomas, phenoxy herbicides and chlorinated phenols. Lancet 1:1370. 9. Riihimaki, V., Sisko, A., Hernberg, S. (1982). Mortality of 2,4-dichlorophenoxyacetic acid and 2,4,5-trichloroacetic acid herbicide applicators in Finland. Scand. J. Work Environ. Health 8:37-42. 10. Smith, A. H., Fisher, D. 0., Pearce, N., Teague, C. A. (1982). Do agriculture chemicals cause soft tissue sarcoma? Initial findings of a case-control study in New Zealand. Community Health Stud. 6:114-119. 11. Smith, A. H., Pearce, N. E., Fisher, D. 0., Giles, H. J., Teague, C. A., Howard, J. K. (1984). Soft tissue sarcoma and exposure to phenoxy herbicides and chlorophenols in New Zealand. JNCI 73:1111-1117. 12. The Commonwealth Institute of Health, University of Sydney (1984). A retrospective cohort study of mortality among Australian national servicemen of the Vietnam conflict era. Australian Government Printing Service, Canberra. 13. USAF School of Aerospace Medicine, An epidemiologic investigation of health effects in Air Force personnel following exposure to herbicide. Baseline mortality study results. Epidemiology Division, USAF School of Aerospace Medicine, Brooks AFB, Texas. June 1983. 10 �Table 1 Soft Tissue Sarcoma Type By Military Service Status NDn-Vietnam Veteran Vietnam Veteran Phabdomyosarcomas 18 8 26 Le iomyosar comas J8 V2 2£ 26 20 46 (19.7) Type Histology Tumors of muscle tissue Total (%) Tumors of fibrous tissue Fibrosarcoma 26 13 39 (16.7) Tumors of synovia! tissue Synovial sarcoma 21 9 30 (12.8) Tumors of adipose tissue Liposarcoma 19 9 28 (12.0) Tumors of vascular origin Angiosarcoma 3 1 4 _1£ 2 11 13 3 16 (6.8) 43 32 75 (32.0) Malignant hemangiopericytomas Others Total (%) 148 (63.2) 86 (36.8) 234 (100) �Table 2 Distribution by Age and Hospital Discharge Year for STS Case and Comparison Group Category STS Cases Percentage Comparison Group Age group, years 20 - 29 9 6 30 - 34 18 29 35 - 39 42 37 40 - 44 11 11 45 - 49 4 4 50 - 59 10 8 6 5 6 7 1971 - 75 35 36 1976 - 80 42 41 1981 - 83 17 16 60+ Hospital ization, year Before 1970 �Table 3 Distribution of STS Cases and a Comparison Group of Patients by Vietnam Service Status Vietnam service STS Cases (%) Yes 86 (37) 5,544 (41) 5,630 No 148 (63) 7,952 (59) 8,100 234 (100) 13,496 (100) 13,730 Ibtal Comparison Group (%) Odds Ratio: 0.83 (95% confidence interval 0.63-1.09) X2: 1.78 (P>0.1) Ttotal �Table 4 Distribution of STS Cases and a Comparison Group of Patients by Branch of Service in Vietnam Branch STS Cases (%) Comparison Group (%) 45 (52) 3,528 (64) 6 (7) 367 (7) Marines 14 (16) 921 (16) Navy 21 (24) 721 (13) — 86 (100) 7 (*) Army Air Force Coast Guard Total *Less than 1% 5,544 (100) � Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Alvin L. Young Collection on Agent Orange Description An account of the resource <p style="margin-top: -1em; line-height: 1.2em;">The Alvin L. Young Collection on Agent Orange comprises 120 linear feet and spans the late 1800s to 2005; however, the bulk of the coverage is from the 1960s to the 1980s and there are many undated items. The collection was donated to Special Collections of the National Agricultural Library in 1985 by Dr. Alvin L. Young (1942- ). Dr. Young developed the collection as he conducted extensive research on the military defoliant Agent Orange. The collection is in good condition and includes letters, memoranda, books, reports, press releases, journal and newspaper clippings, field logs and notebooks, newsletters, maps, booklets and pamphlets, photographs, memorabilia, and audiotapes of an interview with Dr. Young.</p> <p>For more about this collection, <a href="/exhibits/speccoll/exhibits/show/alvin-l--young-collection-on-a">view the Agent Orange Exhibit.</a></p> Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Box The box containing the original item. 066 Folder The folder containing the original item. 1765 Series The series number of the original item. Series III Subseries III Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Creator An entity primarily responsible for making the resource Kang, Han K. Lee Weatherbee Yvonne Lee Patricia P. Breslin Barclay M. Shepard Title A name given to the resource Typescript: Soft Tissue Sarcoma and Military Service in Vietnam: a Case Comparison Group Analysis of Hospital Patients, February 1985 Subject The topic of the resource cancer risk assessment dioxin ao_seriesIII