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Link revealed between AML and Agent Orange
Newsdesk The US Institute of Medicine (IOM) has released a report linking Agent Orange, a defoliant used in the Vietnam War, with acute myelogenous leukemia (AML) in veterans’ children. The report, ‘Update 2000’ (April 2001) is based on three studies investigating exposure to dioxins and other chemical components of herbicides found in Agent Orange and concludes “there is limited suggestive evidence” of a connection between Agent Orange and AML in veterans’ children. The Secretary of Veterans’ Affairs, Anthony J Principi, ordered a benefit scheme to be set up by the Department of Veterans’ Affairs after he was granted White House approval to ask Congress for special compensation. An IOM spokesperson said, “these three studies combined highlight the link between AML and Agent Orange exposure in veterans” (Wen et al. Am J Epidemiol 2000; 151: 231–40; Australian Institute of Health and Welfare report AIHW 2000; PHE 28). Steven Smithson, the American Legion’s Assistant Director for Veterans’ Affairs in Washington said, “Our main concern is that the families of children who have died of AML are compensated as well. Most Vietnam veterans have already had children and compensation is required for medical expenses if the benefits are to be more than symbolic. We believe there is now enough scientific evidence to make a strong case for compensation.” However, the Department of Veterans’ Affairs is expected to only award compensation for claims made after it finalises the benefit scheme, which is currently under internal discussion. Both the US and Australian trials involved Vietnam war veterans; both found that the association between AML and Agent Orange “was specific and there was no excess risk for other forms of leukemia”. The two studies also found a strong link between very young children suffering from AML and fathers who were Vietnam war veterans. The Australian study of 50 000 veterans reported that “AML was three to six times more prevalent in veterans’ children than those of 326
men who did not fight in the Vietnam war”. A third study was carried out by the US Children’s Cancer Study Group, (Buckley JD et al. Cancer Res 1989; 49: 4030–37). The paper states that there was “a 2.7-fold increased risk of AML in the children of men with self-reported exposure of more than US plane sprays defoliants on dense jungle growth during the 1000 days to pesticides Vietnam War or weed killers”. The IOM is expected to release a a report every 2 years on the health final report on Agent Orange and it’s effects of Agent Orange. The health effects in 2002, following the Environmental Agents Service of the recent publication of another report Veterans’ Administration estimates linking Agent Orange and type 2 that up to 1000 children in the USA diabetes in veterans. In 1991, an Act of suffer from AML. Georgina Kenyon Congress instructed the IOM to issue
© AP Photo/Department of Defense
Link revealed between AML and Agent Orange
Good results with radiotherapy for BCCs What is the best approach for treating basal cell carcinomas (BCCs) in areas such as the nose, lips, and eyes? Recent research by radiation oncologists at the Alfried Krupp Krankenhaus (Essen, Germany) suggests that radiotherapy effectively prevents recurrences and yields “good to excellent” cosmetic results. BCCs occur mostly in the elderly; the tumours rarely metastasise, but are often locally invasive and destructive. Effective methods for treatment include excision, micrographic surgery, curettage, or desiccation, but all these techniques cause scarring. Radiotherapy has been discussed as an alternative for many years, but most trials were pre-1990. To see whether recent advances in radiotherapy would have an impact on scarring, Michael Heinrich Seegenschmiedt and his team in Essen conducted a retrospective study of 99 patients with 127 BCC lesions treated between 1986 and 1999 (Strahlenther Onkol 2001; 177: 240–46). Most tumours were on the face and neck and all were treated with externalbeam (orthovoltage) radiation.
Complete responses were seen in 126 lesions (99%) after 3 months and only two patients had local relapse after long-term follow-up (average 3 years). Also, 98% of patients were happy with the cosmetic outcome despite the mild-to-moderate sideeffects of radiation, including reversible problems with wound healing. Only 3% of patients suffered longterm side-effects such as atrophy, fibrosis, and telangiectasia. Dermatologist Suzanne Olbricht (Harvard Medical School, MA, USA) argues that recurrences after radiotherapy are larger and more difficult than after surgery, and at 15 years, patients are at risk of developing a second skin cancer because of the radiation. She says: “Radiation scars mature poorly. They look worse at 10 years than they do at 2 years, but surgical scars look better.” Seegenschmiedt warns against dismissing radiotherapy on these grounds, “there are no randomised trials that directly compare the outcome after surgery with the outcome after radiotherapy”, he says. Martina Habeck
THE LANCET Oncology Vol 2 June 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
men who did not fight in the Vietnam war”. A third study was carried out by the US Children’s Cancer Study Group, (Buckley JD et al. Cancer Res 1989; 49: 4030–37). The paper states that there was “a 2.7-fold increased risk of AML in the children of men with self-reported exposure of more than US plane sprays defoliants on dense jungle growth during the 1000 days to pesticides Vietnam War or weed killers”. The IOM is expected to release a a report every 2 years on the health final report on Agent Orange and it’s effects of Agent Orange. The health effects in 2002, following the Environmental Agents Service of the recent publication of another report Veterans’ Administration estimates linking Agent Orange and type 2 that up to 1000 children in the USA diabetes in veterans. In 1991, an Act of suffer from AML. Georgina Kenyon Congress instructed the IOM to issue
© AP Photo/Department of Defense
Link revealed between AML and Agent Orange
Good results with radiotherapy for BCCs What is the best approach for treating basal cell carcinomas (BCCs) in areas such as the nose, lips, and eyes? Recent research by radiation oncologists at the Alfried Krupp Krankenhaus (Essen, Germany) suggests that radiotherapy effectively prevents recurrences and yields “good to excellent” cosmetic results. BCCs occur mostly in the elderly; the tumours rarely metastasise, but are often locally invasive and destructive. Effective methods for treatment include excision, micrographic surgery, curettage, or desiccation, but all these techniques cause scarring. Radiotherapy has been discussed as an alternative for many years, but most trials were pre-1990. To see whether recent advances in radiotherapy would have an impact on scarring, Michael Heinrich Seegenschmiedt and his team in Essen conducted a retrospective study of 99 patients with 127 BCC lesions treated between 1986 and 1999 (Strahlenther Onkol 2001; 177: 240–46). Most tumours were on the face and neck and all were treated with externalbeam (orthovoltage) radiation.
Complete responses were seen in 126 lesions (99%) after 3 months and only two patients had local relapse after long-term follow-up (average 3 years). Also, 98% of patients were happy with the cosmetic outcome despite the mild-to-moderate sideeffects of radiation, including reversible problems with wound healing. Only 3% of patients suffered longterm side-effects such as atrophy, fibrosis, and telangiectasia. Dermatologist Suzanne Olbricht (Harvard Medical School, MA, USA) argues that recurrences after radiotherapy are larger and more difficult than after surgery, and at 15 years, patients are at risk of developing a second skin cancer because of the radiation. She says: “Radiation scars mature poorly. They look worse at 10 years than they do at 2 years, but surgical scars look better.” Seegenschmiedt warns against dismissing radiotherapy on these grounds, “there are no randomised trials that directly compare the outcome after surgery with the outcome after radiotherapy”, he says. Martina Habeck
THE LANCET Oncology Vol 2 June 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.