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###  Agent Orange Brief

**Prepared by the Environmental Agents Service (131)**

C2 VA Central Office, Washington, DC 20420 Aug. 2002

## 

##  

> **AGENT ORANGE AND VIETNAM RELATED RESEARCH**

**VA EFFORTS**

**Vietnam Veterans Mortality Study
([Proportionate Mortality Study of Army]{.underline}
[and Marine Corps Veterans of the Vietnam War]{.underline})** -- The
results of this study were released in September 1987. Patterns of
mortality among 24,235 Army and Marine Corps Vietnam veterans were
compared with that of 25,685 non-Vietnam veterans using standardized
proportional mortality ratios. The study subjects were a random sample
of deceased Vietnam era veterans identified in a VA computerized benefit
file. Military service information was obtained from military personnel
records, and cause of death information from death certificates.

Statistically significant excess deaths were observed among Army Vietnam
veterans for motor vehicle accidents, non-motor vehicle accidents and
accidental poisonings. Similar findings have been reported in other
studies of Vietnam veterans. Suicides were not elevated among Vietnam
veterans. Marine Corps Vietnam veterans appeared to have an increased
mortality from lung cancer and non-Hodgkin's lymphomas compared to
Marines who did not serve in Vietnam. The study did not investigate
possible causes of these findings. The study was published in the
[Journal of Occupational Medicine]{.underline} in May 1988.

**Follow-up Proportionate Mortality Study of Army and Marine Corps
Veterans of the Vietnam War** -- This updates the Vietnam Veterans
Mortality Study. The initial effort included Vietnam-era veterans who
died during the 1965-82 period. The updates include deaths through 1984.

Compared to non-Vietnam veterans, soldiers and Marines who served in
Vietnam had a small but statistically significant excess of deaths from
external causes. Army Vietnam veterans had small excesses of laryngeal
cancer and lung cancer, but the role of such known causes as smoking
could not be determined. The study was published in the [Journal of
Occupational Medicine]{.underline} in July 1991.

**Proportionate Mortality Among US Army Vietnam Veterans Who Served in I
Corps** -- This study was designed to determine whether Army veterans,
who were stationed in the same geographical area in Vietnam as Marine
veterans, experienced mortality patterns similar to these Marines. The
post-service mortality experience of 6,668 Army veterans who served in
Military Region I, also known as "I Corps," was compared to that of
27,917 Army non-Vietnam veterans.

Statistically significant excesses of deaths were observed for motor
vehicle accidents and accidental poisonings. Deaths due to other major
disease categories, including malignant neoplasms, and suicides were no
more frequent among Army I Corps veterans than their counterparts. No
significant excess of deaths due to non-Hodgkin's lymphomas or lung
cancer was observed. The study results were published in the [American
Journal of Epidemiology]{.underline} in October 1990. This was a
follow-up research project in response to results of the Vietnam
Veterans Mortality Study.

**Soft Tissue Sarcoma Study
([Soft Tissue Sarcoma and Military Service in]{.underline}
[Vietnam:  A Case Control Study]{.underline})** -- This study was
conducted of men who were of draftable age during the Vietnam conflict
to examine the association of soft tissue sarcomas with military service
in Vietnam as well as other environmental risk factors. A total of 217
soft tissue sarcoma cases selected from the Armed Forces Institute of
Pathology were compared to 599 controls for Vietnam service occupational
and non-occupational exposure to various chemicals, occupational
history, medical history, and life-style (smoking, alcohol, coffee,
etc.).

The results of the study indicate that Vietnam veterans did not have an
increased risk of soft tissue sarcomas when compared to those men who
had never been in Vietnam. The study was published in the
[Journal of the National Cancer Institute]{.underline} in October 1987.

**Soft Tissue Sarcoma Review
([Soft Tissue Sarcomas and Military Service in]{.underline}
[Vietnam:  A Case Comparison Group Analysis of Hospital Patients]{.underline})**
-- This study reviewed soft tissue sarcoma cases among Vietnam era
veterans who were admitted to VA medical centers during the period
1969-1983. This effort compared location, histopathology and relative
frequency of soft tissue sarcomas between Vietnam veterans and
non-Vietnam veterans.

The study showed that for this group of veterans, service in Vietnam did
not increase the risk of developing this type of cancer. The VA's Office
of Environmental Epidemiology, now known as the Environmental
Epidemiology Service, worked with the VA's Pathology Service on this
research. The findings were published in the [Journal of Occupational
Medicine]{.underline} in December 1986.

**Adipose Tissue Study
([Dioxins and Dibenzofurans in Adipose Tissue of U.S.]{.underline}
[Vietnam Veterans and Controls]{.underline})** -- VA, in collaboration
with the Environmental Protection Agency (EPA), completed a very
detailed analysis of adipose tissue specimens from 195 men of the
Vietnam era age group. The specimens were analyzed for 2,3,7,8-TCDD, the
contaminant found in one of the ingredients of Agent Orange, and sixteen
other related dioxins and dibenzofurans. Researchers used adipose tissue
collected for the EPA's National Human Adipose Tissue Survey. A total of
36 Vietnam veterans, 79 veterans who did not serve in Vietnam, and 80
civilians were selected and their archived tissues were analyzed.

Investigators found that the average level of 2,3,7,8-TCDD in adipose
tissue of Vietnam veterans was not significantly different from that of
the non-Vietnam veterans or the civilians. This was the case both with
and without adjustment for several demographic variables. Furthermore,
the results showed no association between TCDD levels and Agent Orange
exposure opportunity estimations based on military records. The study
was published in the [American Journal of Public Health]{.underline} in
March 1991.

**National Vietnam Veterans Readjustment Study** -- This study found
that a majority of Vietnam theater veterans have made a successful
re-entry to civilian life and currently experience few symptoms of
post-traumatic stress disorder (PTSD) or other readjustment problems.
Although in general, male Vietnam theater veterans do not differ greatly
in their current life adjustment from their era veteran counterparts,
there is some evidence that female theater veterans currently experience
more readjustment problems than other Vietnam era veteran women of
similar age and military occupation. The study found that 15.2 percent
of all male Vietnam veterans and 8.5 percent of Vietnam veteran women
currently suffer from PTSD. The study also indicated that PTSD in the
Vietnam veteran population is associated with significant levels of
morbidity, reflected in higher levels of unemployment, family and
educational difficulties. The rates of PTSD are higher for black and
Hispanic veterans than among white veterans.

**Combat Experience and Postservice Psychosocial Status as Predictors of
Suicide in Vietnam Veterans** -- Potential risk factors for suicide
among 38 Vietnam veterans were examined using Vietnam veterans who died
from motor vehicle accidents as a comparison group. Veterans were
selected from Los Angeles County Medical Examiner's files.

No military service factor was associated with suicide. The
characteristics of Vietnam veterans suicide cases were not substantially
different from non-Vietnam veterans suicides with respect to known
demographic risk factors. The psychological profile for Vietnam veteran
suicide cases was also similar to non-Vietnam veteran suicide cases in
most instances. Symptoms related to PTSD were observed more frequently
among suicide cases than accident cases. However, suicides were not
associated with specific combat experiences or military occupation. The
extent of combat experience in Vietnam per se as measured in this study
was not a good predictor of suicide death. These results were published
in the [Journal of Nervous and Mental Disease]{.underline} in January
1990.

**Army Chemical Corps Study** -- This study examined health effects of
chemical exposures during military service in Vietnam among men assigned
to Army chemical units, which were responsible for detecting and
counteracting enemy chemical warfare by using riot control agents and
for defoliating vegetation using phenoxy herbicides. Because they were
involved in the mixing and application of these chemicals, these men
were likely to have had heavier exposure than ground troops. The U.S.
Army and Joint Services Environmental Support Group identified nearly
1,000 men who served in Army chemical units in Vietnam between 1965 and
1971 from unit morning reports. Fifty-three deaths were observed through
December 1987. Based on rates for U.S. men adjusted for race, age, and
calendar period, there were statistically significant excesses of
digestive disease deaths, primarily due to alcohol-related diseases, and
from motor vehicle accidents. Two deaths were observed from leukemia
(with 0.5 expected) and two from brain cancer (0.4 expected). A total of
257 of the veterans had received VA inpatient care and/or the VA Agent
Orange Registry medical examinations during the study period. Two
veterans had confirmed diagnoses of Hodgkin's disease (0.7 expected).

Because of the small study group size and the lack of specificity of
information regarding exposure, these results cannot be attributed to
any single chemical agent. The study results were published in the
[American Journal of Industrial Medicine]{.underline} in December 1990.

**Non-Hodgkin's Lymphoma Among Vietnam-era Veterans** -- This was a
hospital-

based case-control study undertaken to examine the association between
military service in Vietnam and non-Hodgkin's lymphomas. The case group
of about 201 Vietnam-era veterans who were treated in VA medical centers
between 1969 and 1985 with diagnoses of non-Hodgkin's lymphomas was
compared with 358 Vietnam-era veterans with diagnoses other than
malignant lymphomas.

Military service in Vietnam did not increase the risk of non-Hodgkin's
lymphomas either in general or with increased latency period, defined as
the duration in years from the first service in Vietnam to hospital
discharge. Service in a specific military branch, a specific region of
Vietnam, or combat role (as determined by military occupational
specialty) was not associated with any increased risk of non-Hodgkin's
lymphomas. The study was published in the [Journal of Occupational
Medicine]{.underline} in July 1991.

**A Case Control Analysis of Post-Traumatic Stress Disorder Among
Vietnam Veterans in the Agent Orange Registry** -- This case control
study compared demographic and military variables of 374 Vietnam
veterans with PTSD diagnoses with a similar number of Vietnam veterans
who did not have PTSD. All of these veterans were selected from the VA
Agent Orange Registry, a computerized database of about 220,000 Vietnam
veterans who voluntarily reported to a VA health care facility for a
medical examination. (For more information about the VA Agent Orange
Registry, see **Agent Orange Brief, B1.**) Cases and controls were
matched by age, year of Agent Orange Registry examination, and race.

Investigators confirmed that being wounded in Vietnam and having a
combat job in Vietnam were risk factors for PTSD. Data analysis also
revealed that those who had noncombat jobs but were wounded had the
highest risk of PTSD. The study was published in the
[Annals of Epidemiology]{.underline} in November 1991.

**Women Vietnam Veterans Mortality Study** -- Approximately 4,500 women
Vietnam veterans and 6,500 women veterans who never served in Vietnam
were identified from military records and followed for vital status on
December 31, 1987. Investigators found that women Vietnam veterans had
lower than expected mortality from all causes compared to U.S. women
non-Vietnam veterans. Suicide rates were about the same in both groups.
There was a slight excess of mortality from external causes among women
Vietnam veterans compared with non-Vietnam veterans, primarily due to an
excess of motor vehicle accidents. In comparison to U.S. women,
mortality from cancers of the pancreas and uterine corpus was elevated
among women Vietnam veterans but the increase was not statistically
significant. The study results were published in the
[American Journal of Epidemiology]{.underline} in November 1991. This
study was updated by extending the follow-up period of vital status to
December 31, 1991. The results, which are consistent with the earlier
findings, were published in the [Journal of
Occupational Medicine]{.underline} in March 1995.

**Hodgkin's Disease and Vietnam Service** -- This hospital-based
case-control study examined the association between military service in
Vietnam and several histologic types of malignant lymphomas. Earlier
studies that showed an association between exposure to phenoxy
herbicides and the risk of malignant lymphomas sparked concerns among
Vietnam veterans about Agent Orange exposure. This is a report of 283
Vietnam-era veteran patients with a diagnosis of Hodgkin's disease who
were treated in one of the 172 VA hospitals from 1969 to 1985. The
controls consisted of 405 Vietnam-era veterans with a diagnosis other
than malignant lymphoma.

Military service information was obtained from a review of veterans'
military personnel records. Cases and controls were compared with
respect to service in Vietnam and surrogate measures of potential Agent
Orange exposure. Investigators found that service in Vietnam was not
associated with any significant increase in the risk of Hodgkin's
disease. Furthermore, surrogate measures of potential Agent Orange
exposure, such as service in a specific military branch, in a certain
region within Vietnam, in a combat role, or extended Vietnam service
time, were not associated with any significant increased risk of
Hodgkin's disease. The results were published in the [Annals of
Epidemiology]{.underline} in September 1995.

**Military Service in Vietnam and the Risk of Death from Trauma and
Selected Cancers** -- This study compared the postservice mortality of
10,716 U.S. Marine veterans who served in Vietnam with that of 9,346
Marine veterans who did not serve in Vietnam. There was a significant
excess of death for Vietnam Marines from all causes (combined) and all
external causes (combined). After adjustments for age and rank in
military, overall mortality continued to be statistically significant
for Vietnam Marines compared to non-Vietnam Marines. The excess overall
mortality was mainly due to excess deaths from external causes.

The risks for several site-specific cancers were elevated but not
statistically significant. Investigators suggested that follow-up of
this Marine cohort continue to determine whether there are statistically
significant differences in the mortality patterns of Marine Vietnam and
non-Vietnam veterans, especially for cancers. The results were published
in the [Annuals of Epidemiology]{.underline} in September 1995.

**A Review of NVVRS Data for Women Vietnam Veterans** -- VA, by means of
a contract with the Research Triangle Institute (RTI), completed the
National Vietnam Veterans Readjustment Study (NVVRS). The 3,106 study
subjects included 950 women (431 Vietnam veterans, 304 non-Vietnam
veterans, and 215 civilians). In addition to a 3-5 hour interview, some
Vietnam and non-Vietnam veterans underwent a follow-up clinical
interview with an expert mental health clinician. There were 86 women
Vietnam veterans and 35 women non-Vietnam veterans in the group that
received the follow-up interview. There is already an extensive report
on the study design, statistical methods, and results by the RTI.

This follow-up analysis is focusing on women veterans. They are being
evaluated by military service characteristics, such as occupation (nurse
vs. non-nurse), length of service, branch, rank, and career status.
Other characteristics, including age, race, substance abuse, and family
history of violence are being considered and adjusted for in the
analysis. All the data files, analysis files, and documentation
necessary for the project have been obtained from the RTI.

An abstract was completed and sent to the House and Senate Committees on
Veterans' Affairs on October 29, 1996. The analysis confirmed findings
from the NVVRS of an increased risk of developing PTSD, depressive
episodes, and alcohol abuse among women who served in Vietnam compared
to women who served elsewhere. However, nurses serving in Vietnam were
not at any higher risk than non-nurses in Vietnam for developing any of
these three post war psychological problems other than depressive
episodes which showed an elevated but non-significant risk associated
with nursing in Vietnam.

**Mortality Patterns among Vietnam Veterans -- A 24-Year Retrospective
Analysis** -- This project is the second update of the Vietnam Veterans
Mortality Study. The mortality experience of 33,833 U.S. Army and Marine
Corps Vietnam veterans who died during 1965-1988 was compared with that
of 36,797 deceased non-Vietnam veterans using proportionate mortality
ratios (PMR). Military service information was abstracted from military
personnel records and cause of death information recorded from death
certificates.

Army Vietnam veterans had statistically significant excesses of deaths
from laryngeal cancer and lung cancer. There was an excess of external
causes, including motor vehicle accidents and accidental poisonings. In
contrast to Army veterans, the results for Marine Vietnam veterans
varied according to the referent population used. When compared with
non-Vietnam veterans, Marine Vietnam veterans had significantly elevated
PMRs for lung cancer and skin cancer. There was also a significant
excess of external causes of death, accidental poisonings and homicides
compared with all non-Vietnam veterans. The results were published in
the [Journal of Occupational Medicine]{.underline} in March 1996.

**Army Chemical Corps Vietnam Veterans Study Update** -- This study is
an update of an investigation published in the
[American Journal of Industrial Medicine]{.underline} in December 1990.
The original mortality study was expanded to include Army Vietnam-era
veterans who were identified by the Defense Manpower Data Center with a
chemical primary military occupational specialty or MOS code and by
class rosters (1965-72) obtained from the Army Chemical School of Ft.
McClellan.

These additional study subjects increase the size of the original
Vietnam chemical cohort and provided a comparison group of Army Chemical
Corps veterans who never served in Vietnam. The study results were
published in the [American Journal of Industrial Medicine]{.underline}
in early 1997. The results of the analysis comparing the Vietnam cohort
support the earlier study's finding of a significant excess of deaths
from digestive diseases primarily due to liver cirrhosis.
Non-significant elevated relative risks were observed for all cancers
combined, digestive and respiratory systems cancer, skin cancer,
lymphopoietic cancers, and respiratory system diseases. Compared to the
mortality rates in the general population, the non-Vietnam Army Chemical
Corps Chemical Corps veterans had a statistically significant deficit in
mortality from all causes combined, which is consistent with a "healthy
selection bias" seen among military populations.

**Army Chemical Corps Vietnam Veterans Health Study** -- In July 1997,
VA announced a research initiative designed to determine whether it is
possible to conduct a large-scale study of the long-term health effects
of exposure to Agent Orange (and other herbicides used in Vietnam) on
Army Chemical Corps Vietnam veterans. The feasibility study is expected
to take a minimum of twelve months. If subsequent analysis of response
rates, availability of medical records to validate veterans-reported
health history, and other study requirements show that a large-scale
study is feasible, that may take another three years to complete.

In July 1997, in response to NAS recommendations, VA announced an
additional research initiative designed to determine whether it is
possible to conduct a large-scale study of the long-term health effects
of exposure to Agent Orange (and other herbicides used in Vietnam) on
Army Chemical Corps Vietnam veterans.

For a pilot study, letters were sent to 500 randomly selected veterans
inviting them to participate in this investigation. (Researchers
selected study participants carefully to ensure that possible biases are
minimized, if not eliminated. Study participants could not recruit or
volunteer themselves.) Half of the letters were sent to Vietnam
veterans, and half were sent to Vietnam era veterans who did not serve
in Vietnam.

The results of the 405 telephonic interviews and 95 serum dioxin
measurements conducted during the pilot study were presented to the
study oversight committee in October 1998. The pilot study demonstrated
that the Army Chemical Corps Vietnam era veterans could be located and
were willing to participate in this telephone health interview.

The overall completion rate was 83%. The data also confirmed the fact
that these men, often with assistance from their wives, were able to
provide considerable detail on the reproductive details for pregnancies
of offspring they had fathered. Serum concentrations of dioxins were
found to be significantly correlated with the self-reported history by
the veteran that he actually participated in the spraying of herbicides
during their Vietnam service. Based on these findings the advisory
committee voted to have the investigators proceed with the main study.
The main study, which began in February 1999, includes approximately
2,500 Vietnam and 2,500 non-Vietnam veterans who served in the Army
Chemical Corps. The main phase is expected to take 30 months to
complete.

**Agent Orange Registry Review for Testicular Cancer** -- All men who
had their initial Agent Orange Registry examination between 1983 and
1987, and who had a confirmed diagnosis of testicular cancer were
potential candidates for this project. Controls were selected from the
Agent Orange Registry group matched to the case group by age, year of
initial examination, and race. Military records were sought for all
cases and controls and abstracted to obtain information on dates of
military service, dates served in Vietnam, unit addresses, and military
occupations in Vietnam.

Case-control analyses examined the relationship between specific Vietnam
service characteristics and testicular cancer. The study results are not
consistent with the hypothesis that Agent Orange may be a risk factor
for testicular cancer among Vietnam veterans. The study results were
published in the [Annals of Epidemiology]{.underline} in January 1994.

**The Risk of Suicide among Wounded Vietnam Veterans** -- This study was
undertaken to determine whether an association exists between combat
trauma and risk of

postservice suicide among Vietnam veterans. The risk of suicide for
34,534 veterans who were wounded in Vietnam was evaluated for severity
of wound and the number of times wounded. Investigators found that there
was a trend of increasing risk of suicide with increased occurrence of
combat trauma. The highest relative risk was observed for those veterans
who were wounded more than once and hospitalized for a wound.

In comparison with the U.S. male general population, veterans
hospitalized because of a combat wound or wounded more than once had a
significantly increased risk of suicide. Those wounded more than once
and hospitalized had the highest increased risk of suicide. The study
results were published in the [American Journal of Public
Health]{.underline} in May 1996.

**A Case-Control Study of Lung Cancer Among Vietnam Veterans** --
Because of concerns about Agent Orange exposure, VA conducted a series
of studies of specific cancers among Vietnam veterans. Lung cancer was
the topic of investigation in this report.

The VA's Patient Treatment File (PTF) was used to identify 329 Vietnam
era veterans with a diagnosis of lung cancer made between 1983 and 1990.
The PTF is a computerized hospitalized database of inpatient records,
including patient's demographic data, and diagnoses. A record is created
for each inpatient discharged from all VA medical centers. Variables
abstracted from the military record include education, race, branch of
service, Military Occupational Specialty Code, rank, and units served
within Vietnam. Two hundred sixty-nine controls were randomly selected
from the PTF file of men hospitalized for a reason other than cancer. A
second control (or comparison)

group of 111 patients with colon cancer was also selected from the PTF.
Data were also gathered on exposure to Agent Orange through the location
of each individual ground troop veteran's unit in relation to an area
sprayed and the time elapsed since the area was sprayed. Researchers
found increased lung cancer mortality in Vietnam veterans. This study
was published in the [Journal of Occupational and Environmental
Medicine]{.underline} in August 1997.

**Posttraumatic Stress Disorder and the Risk of Traumatic Deaths Among
Vietnam Veterans** -- This study evaluated whether an association exists
between posttraumatic stress disorder (PTSD) and traumatic deaths among
Vietnam veterans. Mortality risk of 4,247 Vietnam veterans from the VA
Agent Orange Registry (AOR) with a diagnosis of PTSD relative to that of
12,010 Vietnam veterans from the AOR with no diagnosis of PTSD was
calculated. Mortality experience of both groups was also compared with
U.S. males.

The veterans with PTSD were more likely than non-PTSD veterans to die
from suicide and from accidental poisoning. Among Vietnam veterans on
the AOR, PTSD is associated with a significant increased risk for
suicide and accidental poisoning. The study results were published in
the [Journal of Nervous and Mental Disease]{.underline} in November
1994.

**Women Vietnam Veterans Reproductive Health Study** -- Studies of
reproductive outcomes among male veterans have been mostly negative in
that service in Vietnam was not associated with the risk of fathering a
child with birth

defects. Although the results of male Vietnam veterans health studies
are useful in assessing the general health of women Vietnam veterans,
further

investigation may be necessary in the areas of gender specific health
outcomes of women and of the birth outcomes of their children. It is
generally accepted that maternal exposures are more commonly associated
with adverse reproductive outcomes than paternal exposures.

This research compared the reproductive health outcomes of 4140 women
Vietnam veterans with those of an equal number of women veterans who did
not serve in Vietnam. Information on exposure was collected from
telephone interviews and supplemented with and validated by military
personnel records. Data on the birth outcomes were collected from
telephone interviews and validated by reviews of medical and hospital
records.

Although 8% of the women Vietnam veterans and 7.1% of the non-Vietnam
veterans reported that they had a cancer of the reproductive organs,
namely, breast, ovaries, uterus, or cervix, the difference was not
statistically significant, either for the individual sites or for the
reproductive organs as a group. There were no statistical differences
between the two groups in the proportion of pregnancies resulting in
miscarriage or stillbirth, low birth weight, pre-term delivery, or
infant death.

Women Vietnam veterans, however, reported significantly more babies with
birth defects and with severe birth defects. Over-reporting by women
Vietnam veterans is not considered a likely explanation for these
findings.

**Where can a veteran obtain additional information on VA Agent Orange
research and studies on related matters?**

Information on these subjects can be obtained at the VA medical center
libraries, from the Registry Physicians or Agent Orange Coordinator at
every VA medical center, or from the Environmental Agents Service (131),
Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC
20420.

Where is additional information on Agent Orange --related issues
available?

The following Agent Orange fact sheets (including the one you are
reading) are available on the World Wide Web at
[www.va.gov/agentorange](http://www.va.gov/agentorange). Hard copies can
be obtained from local VA medical centers or from the VA Central Office
at the Environmental Agents Service (131), Department of Veterans
Affairs, 810 Vermont Avenue N.W., Washington, DC 20420. The briefs are
A1 -- General Information, A2 - Class Action Lawsuit, B1 -- Registry, B2
-- Health Care Eligibility, B3 -- VA Disability Compensation, B4 -- VA
Information on Agent Orange and Related Matters, C1 -- The Problems
Encountered in Research, C3 -- Vietnam Related Research - Non-VA
Efforts, D1 -- Birth Defects, D2 -- Chloracne, D3 -- Non--Hodgkin's
Lymphoma, D4 -- Soft Tissue Sarcomas, D5 -- Peripheral Neuropathy, D6 --
Hodgkin's Disease, D7 -- Porphyria Cutanea Tarda, D8 -- Multiple
Myeloma, D9 -- Respiratory Cancers, D10 -- Prostate Cancer, D11 -- Spina
Bifida, and D12 -- Diabetes.

This fact sheet was updated in early July 2002 and does not include any
subsequent developments.