Cancers Linked to Toxic Drinking Water at Camp Lejeune
Numerous types of cancers have been linked to the toxic drinking water at Camp Lejeune, including leukemia, non-Hodgkin’s lymphoma, and kidney cancer.
Between 1953 and 1987, Marines, family members, reservists, National Guard members, and civilians who lived and worked at the base were exposed to contaminated bath and drinking water. This water contained over 70 chemicals, including industrial and dry-cleaning solvents. These potentially hazardous chemicals were found at concentrations that were 240 to 3,400 times permitted safety levels.
The main contaminants found in the water at two of the water treatment systems are trichloroethylene (TCE), perchloroethylene/tetrachloroethylene (PCE), benzene, and vinyl chloride, which have been linked to increased risk for certain cancers.
VA Presumptive Service Connection
In 2017, the Department of Veterans Affairs finalized a rule for presumptive service connection for entitlement of VA benefits, applying only to veterans and former reservists, and former National Guard members.
The VA limited consideration to trichloroethylene, perchloroethylene, benzene, and vinyl chloride. The list includes adult leukemia, non-Hodgkin’s lymphoma, multiple myeloma, kidney cancer, liver cancer, and bladder cancer.
ATSDR Review
The Agency for Toxic Substances and Disease Registry completed an epidemiological study to assess whether Marines, Navy personnel, and civilians who lived and worked at Camp Lejeune were at an increased risk for cancer and other health issues because of exposure to water contaminated with volatile organic compounds.
Epidemiological studies look at the distribution of diseases through observation of measures of disease (incidence) or death (mortality). The ATSDR reviewed multiple observational research studies to assess risk.
Classification of Evidence
ATSDR applied classifications used in scientific research to assess how strong the evidence was to connect the contaminant to cancer or health issues and whether additional research is needed. These classifications are:
Sufficient: There is sufficient evidence to conclude a causal relationship exists or that the chemical can cause cancer. (Not all people who are exposed to these contaminants will develop cancer and not all cancer is caused by a particular carcinogenic substance.)
Equipoise and Above (As Likely as Not): Evidence is sufficient to conclude that a causal relationship is as likely as not to exist. However, there is not enough evidence to conclude definitively that a causal relationship exists.
Below Equipoise: Evidence is not sufficient to conclude a causal relationship is at least more likely than not to exist.
Against: Evidence suggests there is no causal relationship.
ATSDR Epidemiological Study Results
The ATSDR epidemiological study concludes the following assessment of the cancer risks associated with Camp Lejeune contaminants.
Kidney Cancer
TCE: Sufficient Evidence for Causation
The International Agency for Cancer Research, Environmental Protection Agency, and the National Toxicology Program of the U.S. Department of Health and Human Services all conclude that there is sufficient evidence to show a causal relationship between tetrachloroethylene and kidney cancer.
PCE: Below Equipoise Evidence for Causation
Based on the results of several studies at the Environmental Protection Agency and National Cancer Institute, ATSDR concludes there is below equipoise evidence for causation for PCE and kidney cancer due to inconsistent findings.
Non-Hodgkin’s Lymphoma
TCE: Sufficient Evidence for Causation
The EPA Toxicological Review of TCE concluded, “The human evidence from epidemiological studies of TCE exposure is strong for non-Hodgkin’s lymphoma but less convincing than for kidney cancer. The IARC review concluded a positive association.
PCE: Equipoise and Above Evidence for Causation
Based on an NCI Study, there is sufficient evidence for causation for PCE and non-Hodgkin’s lymphoma.
Benzene: Sufficient Evidence for Causation
ATSDR concluded there was sufficient evidence for causation for benzene and NHL based on recent epidemiological studies and supporting evidence from mechanistic and animal studies.
Multiple Myeloma
TCE: Equipose and Above Evidence for Causation
ATSDR concludes that combing epidemiological evidence with mechanistic evidence alone is sufficient to reach equipoise and above. Evidence from animal studies suggests that TCE exposure causes certain autoimmune diseases which have been associated with multiple myeloma.
PCE: Below Equipoise Evidence for Causation
ATSDR concluded that epidemiological evidence has mixed results and is not adequate to determine a causal relationship between PCE and multiple myeloma. There is also not enough animal or mechanistic information.
Benzene: Equipoise and Above Evidence for Causation
Based on the results of a meta-analysis and a study involving Norwegian offshore oil industry workers, ATSDR concluded that there is equipoise and above evidence for causation for benzene and multiple myeloma.
Adult Leukemia
TCE: Equipoise and Above Evidence for Causation
ATSDR concludes there is equipoise and above evidence for causation for TCE and all adult leukemias, including acute myeloid leukemia, acute lymphocytic leukemia, chronic myeloid leukemia, and chronic lymphocytic leukemia. This assessment is based on epidemiological evidence, the link between immune disorders associated with TCE, and evidence that TCE affects lymphoid cells.
PCE: Below Equipoise Evidence for Causation
Epidemiological studies are limited. Studies of dry-cleaning workers who are likely to have the highest PCE exposure had mixed results. Therefore, ATSDR concludes that evidence for causation for PCE and leukemias is below equipoise.
Benzene: Sufficient Evidence for Causation
An IARC review concluded that “benzene causes acute myeloid leukemia, acute nonlymphocytic leukemia. Also, a positive association has been observed between exposure to benzene and acute lymphocytic leukemia, chronic lymphocytic leukemia, multiple myeloma, and non-Hodgkin’s lymphoma.”
ATSDR concludes there is sufficient evidence for causation for benzene and all leukemia types based on the results of meta-analyses, as well as cohort studies and the findings that occupational exposure is associated with reductions in lymphoid and myeloid cells.
Vinyl Chloride: Below Equipoise Evidence for Causation
A study of polyvinyl chloride workers observed excess mortality. However, a meta-analysis showed no elevation of risk. Therefore, ATSDR concluded that there is below equipoise evidence.
Bladder Cancer
PCE: Sufficient Evidence for Causation
Although no animal or mechanistic data definitely supports epidemiological findings, the ATSDR position is that epidemiological studies show sufficient evidence for causation for PCE and bladder cancer.
TCE: Below Equipoise Evidence for Causation
Benzene and Vinyl Chloride: Below Equipoise Evidence
Due to the limited number of epidemiological studies, ATSDR concludes there is insufficient information to determine if there is an association between benzene and vinyl chloride and bladder cancer.
Liver Cancer
TCE: Equipoise and Above Evidence for Causation
An EPA meta-analysis showed an elevated risk for TCE and liver cancer. However, the analysis was limited due to the small number of highly exposed cases. Several subsequent studies conducted had serious limitations, including low exposure and biases. ATSDR concluded that the epidemiological evidence with supporting evidence from animal studies and supporting mechanistic information meets equipoise and above for causation.
PCE: Below Equipoise Evidence for Causation
No meta-analysis has been conducted for PCE exposure and liver cancer. A limited number of epidemiological studies have been conducted. Occupational studies in dry cleaning and other areas have been inconclusive. Therefore, ATSDR concludes there is below equipoise evidence.
Benzene: Below Equipoise Evidence for Causation
Only one study has evaluated occupational benzene exposure and liver cancer. Epidemiological evidence is insufficient. Therefore, ATSDR concluded evidence for causation for benzene and liver cancer is below equipoise.
Vinyl Chloride: Sufficient Evidence for Causation
An IARC review concluded that there is convincing evidence that vinyl chloride exposure causes hepatocellular carcinoma and angiosarcoma of the liver. Two large cohort studies showed convincing evidence that vinyl chloride causes hepatocellular carcinoma and angiosarcoma of the liver. In addition, observational studies have shown that vinyl chloride increases the risk of liver cirrhosis, a known risk factor for angiosarcoma of the liver. ATSDR concludes there is sufficient evidence for causation.
Cancers with at Least One Study Associated with TCE/PCE Exposure
Due to the low number of studies, more research is needed. Therefore, the ATSDR characterizes these associations as below equipoise for causation.
- Breast cancer
- Cervical cancer
- Esophageal cancer
- Lung cancer
- Hodgkin’s disease
- Ovarian cancer
- Prostate cancer
- Rectal cancer
Cancers with Positive Findings in at Least One Study that Evaluated Vinyl Chloride
The low number of studies indicates more research is needed; therefore, ATSDR categorizes these associations as below equipoise for causation.
- Brain cancer
- Lung cancer
- Soft tissue cancer
The contaminants in Camp Lejeune drinking water are associated with various types of cancer. Evidence varies, based on research results. In many cases, additional research is needed.