Statement Submitted by the Lung Cancer Alliance
to the House Committee on Veterans’ Affairs
Subcommittee on Investigations and Oversight Hearing
Gulf War and Health Vol. 10
February 23, 2016
Lung Cancer Alliance (LCA) thanks the chairman and the committee
for allowing the submission of the following comments for the record of this
hearing.
LCA, the leading national lung cancer policy, advocacy and
patient support organization, is deeply concerned by the lack of updated
disease specific incidence and mortality data from the Department of Veterans
Affairs in the Gulf War and Health Volume 10 Report.
Without this critical information, the Vol. 10 report, perforce, had to conclude:
“...that there is insufficient/adequate
evidence to determine whether an association exists between deployment to the
Gulf War and any form of cancer, including lung cancer and brain cancer.”
The Vol.8 report indicated that at that point in time, only lung
cancer showed a statistically relevant excess between Gulf War deployed
veterans and non-deployed veterans, based on a published 2010 study by Young et
al which linked Defense Manpower Data
Center datasets with files from 28 state cancer registries and the Department
of Veterans Affairs Central Cancer Registry.
The study concluded that the 15% excess of lung cancer diagnoses
in deployed veterans over the years 1991-2006 warranted additional follow-up
studies. Indeed, the Vol.10 report concluded that additional follow-up was
necessary.
The Vol.10 report gives no indication that this was done. In
fact, on page 102, the Vol. 10 Report states:
Because cancer incidence in the past 10
years has not been reported, additional follow-up
is needed.
Many cancers have long latency periods, 20-30 years in the case
of lung cancer as both Vol. 8 and 10 accurately report. The median age for a cancer diagnosis in the
United States is 65 (70 for lung cancer) and the median age of Gulf War
veterans in 1991 was 28. Thus, the impact of Gulf War deployment on cancer
incidence and mortality cannot be accurately evaluated without long term
follow-up and accurate incidence and mortality statistics.
Updating the 2010 Young study would have been the most logical,
cost-effective and statistically significant resource in preparing for Vol.10.
The only other Primary study cited in Vol.10 was the 2015 update
(Sim et al.) on the Australian Gulf War veterans which did not show elevated
cancer incidence or mortality rates. However, while the survey included all
1,871 Australia Gulf war veterans, 84% were Navy, not deployed ground forces,
and 87% were under the age of 55 at the time of the update.
The Vol. 10 report conceded that telephone/web surveys of U.S.
Gulf War veterans by committee member (Dursa et al., 2015) and the VA showing
no disparity of impact did not qualify as primary studies and were not
sufficiently powered or cross-checked with actual mortality and incidence data
to be considered statistically significant.
When queried by LCA, the committee staff indicated that they did
not ask the VA for disease-specific mortality data. Clearly this has to be
done.
Lung cancer is the leading cause of all cancer deaths. Its annual
mortality is equivalent to all deaths from breast, prostate, colon and
pancreatic cancers combined. Veterans,
especially those who served in combat, are at highest risk due to the
combination of smoking rates and exposure to carcinogens.
CT screening for a defined high risk population ages 55-80 has
been validated by one of the largest randomized controlled trials ever carried
out by the National Cancer Institute, given a B recommendation by the U.S.
Preventive Services Task Force, a required preventive service covered by
commercial insurance and Medicare with no co-pays, deductibles or co-insurance.
Yet the VA , whose population is at highest risk, still refuses
to implement this life-saving benefit system-wide.
Since the median age of Gulf War veterans is now the mid-50’s,
LCA would urge the committee to require the VA to immediately implement CT lung
cancer screening. Indeed, CT screening will provide more concrete and
accurate data on lung cancer, as well as
data on heart disease and other lung diseases, than the $500,000,000, 18-year
Gulf War study has to date.
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