, combustion products, and hydrazines and nitric acid -- components of the propellant used for Scud and other missiles -- for any evidence of links to specific cancers, neurological effects, or other health problems that persist after exposure. More than 600 oil-well fires were ignited in Kuwait by retreating Iraqi troops during the Gulf War conflict, sending up large plumes of smoke that occasionally remained low to the ground. Troops also may have been exposed to combustion products through vehicle exhaust, heaters in poorly ventilated tents, and cooking stoves. Military personnel may have had contact with hydrazines and nitric acid when they disarmed or disposed of Scud missiles or were downwind of a missile explosion. They also may have come into contact with fuels when refueling ground vehicles, aircraft, and equipment.

Of the approximately 800 studies reviewed in detail for this report, most involved individuals who were exposed to these agents in occupational settings over long periods of time. Only a small number actually studied veterans who may have been exposed while serving in the Persian Gulf. The committee carefully assessed the quality, limitations, and relevance of each epidemiologic study, and used five categories to describe the strength of the evidence.

SUFFICIENT EVIDENCE OF A CAUSAL RELATIONSHIP, the strongest level of evidence, means that many studies have established a clear link between exposure to an agent and a health outcome. Among the other requirements, there must be a plausible biological explanation for the relationship. None of the compounds evaluated in this report met these criteria.

Evidence that establishes a link between exposures and a health outcome with reasonable certainty, but fails to meet the higher standard of proof needed for causality, is characterized as SUFFICIENT EVIDENCE OF AN ASSOCIATION. The evidence for an association between lung cancer and combustion products falls into this
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Contact: Christine Stencel or Chris Dobbins
news@nas.edu
202-334-2138
The National Academies
20-Dec-2004

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