The available evidence is too sparse or of insufficient quality to determine whether the majority of health problems that may be experienced by Gulf War veterans could be associated with exposures to fuels for military vehicles, propellents in Scud missiles, or substances given off by combustion sources such as oil-well fires, exhausts, and tent heaters, according to the latest report on the Gulf War and health from the Institute of Medicine of the National Academies.
However, data from studies of occupational and environmental exposures to air pollution, vehicle exhaust, and other combustion products led the committee that wrote the report to conclude that exposure to such substances is associated with an increased risk of lung cancer.
"Studies of people exposed to air pollution, vehicle exhaust, and burning of coal or other heating and cooking fuels consistently show that such exposures are linked to an increased risk for developing lung cancer," said committee chair Lynn Goldman, professor, Bloomberg School of Public Health, Johns Hopkins University, Baltimore. "This provides sufficient evidence that exposure to combustion products during the Gulf War could be associated with lung cancer in some veterans." Military personnel may have encountered combustion products from diesel-fueled heaters in poorly ventilated tents, cooking stoves, vehicle exhaust systems, and oil-well fires. "It should be emphasized that smoking is the major culprit for lung cancer, accounting for 80 percent of all cases, according to the American Cancer Society," Goldman added.
The committee also found some evidence that exposure to combustion products is linked to asthma and cancers of the nose, mouth, throat, and bladder, as well as to low birth weight and premature births in women exposed while pregnant; the data were weaker in these cases, however. The data on whether the majority of cancers, neurological problems, and other health problems are associated with exposure to fuels, propellants, or combustion products were inadequate to draw conclusions. "While we would like to have more definitive answers to questions about the specific diseases that may be associated with these substances, in most cases the evidence simply is not strong enough or does not exist," Goldman said.
Because scant information exists on actual exposure levels experienced by individual service members -- a critical factor when assessing health effects -- the committee could not draw specific conclusions about Gulf War veterans' chances of developing lung cancer or any other health problems as a result of exposures. No systematic monitoring of air contamination from oil-well fires was conducted in the Persian Gulf region until May 1991, and this monitoring did not measure levels of contamination produced by other combustion sources, such as heaters or engines. Moreover, no data are available that would allow comparisons between levels of exposure to air contaminants during the Gulf War and exposures to similar contaminants in civilian occupational and environmental settings.
Veterans who have experienced chronic health problems following their service in the Persian Gulf region are asking whether exposure to various chemical, biological, or environmental agents might be responsible. This IOM report is the third in a series that responds to requests from the U.S. Department of Veterans Affairs and Congress to examine the health effects of potentially harmful agents to which Gulf War veterans might have been exposed. The first report focused on potential health effects from depleted uranium, pyridostigmine bromide, sarin, and vaccines; the second centered on insecticides and solvents. These reports did not directly assess whether health effects could occur as a result of service in the Gulf War.