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Veterans and Agent Orange: Update 2010 (2012)

Chapter: Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers

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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×

Appendix C

Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers

In response to a request from the Department of Veterans Affairs, the committee responsible for Update 2006 prepared Table C-1 to demonstrate how conclusions provided for the full range of cancer types and to clarify into which groupings any specific cancer diagnosis falls. The committee for Update 2010 notes that it reframed its overview of lymphohematopoietic neoplasms according to the World Health Organization classification system (WHO, 2008), which partitions these disorders first according to the lymphoid or myeloid lineage of the transformed cells rather than as lymphomas or leukemias; this emphasizes the close etiologic relationship of chronic lymphocytic leukemia and hairy-cell leukemia with Hodgkin and non-Hodgkin lymphomas and with the neoplasm multiple myeloma and its related condition AL amyloidosis.

The major portion of evidence compiled for review in the Veterans and Agent Orange (VAO) series comes from cohort studies, primarily of mortality but some of incidence. Other data have been generated by case–control studies, which follow the only design amenable to studying very infrequent or very specific health outcomes. How researchers are able to group, analyze, and report their findings is influenced by the distribution of cases that they observe, so the data that VAO committees have had available for review reflect mortality experience at a level of specificity concordant with statistical analysis.

The International Classification of Diseases (ICD) system is used by physicians and researchers around the world to group related diseases and procedures so that morbidity and mortality information can be classified for statistical purposes in a standard form amenable to data storage and retrieval. It is a comprehensive hierarchic system that permits great detail but can be collapsed into broad categories. Codes mentioned in VAO reports are stated in terms of ICD,

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×

TABLE C-1 Mapping of Groupings of Malignant Neoplasms That Are the Subjects of Conclusions in the Veterans and Agent Orange Series with ICD-9 Codes

NIOSH Category for Cause of Death
Major Minor NIOSH Groupings of Cancer Sites "VAO Characterization of Grouping"a
Suhsites
ICD-9 Codes
02 Buccal cavity and pharynx "Oral, nasal, and pharyngeal"
004 Lip 140
005 Tongue 141
006 Other parts of buccal cavity
Salivary glands
Floor of mouth
Gum and other mouth

142
144
143,145
007 Pharynx
Oropharynx
Tonsil
Nasopharynx
Hypo pharynx
Other buccal cavity and pharynx

146
146.0-146.2
147
148
149
(160 = nasal below)
03 Digestive organs and peritoneum
008 Esophagus "Esophagus" 150
009 Stomach "Stomach" 151
010 Intestine except rectum "Colorectal"
Small intestine
Colon (large intestine)

152
153
154
011 Rectum
012 Biliary passages, liver, and gall bladder "Hepatobiliary"
Liver and intrahepatic bile ducts
Gallbladder and extrahepatic bile ducts

155
156
013 Pancreas 157
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
NIOSH Category for Cause of Death
Major Minor NIOSH Groupings of Cancer Sites "VAO Characterization of Grouping"a
Suhsites
ICD-9 Codes
014 Retroperitoneum and other and unspecified digestive organs 158-159
04 Respirator system "Respiratory"
015 Larynx "Larynx" 161
016 Trachea, bronchus, and lung "Lung"
Trachea
Lung and bronchus
162
162.0 (there is no ICD 162.1)
162.2-162.9
017 Pleura 163
018 Other respiratory Nasal cavity, middle ear, and accessory sinuses
Thymus, heart, and mediastinum
Other respiratory, unspecified


(160, above with oral and pharyngeal)
164 (164.0, below with endocrine; 164.1,
below with soft tissue sarcoma) 165
(discontinuity with ICD codes)
05 019 Breast (male and female) "Breast" 174, 175
06 Female genital organs "Female reproductive"
020 Cervix uteri 180
021 Other unspecified parts of uterus
Uterus, parts unspecified
Placenta
Body of uterus

179, 181, 182
179
181
182
022 Ovary, fallopian tube, and broad ligament Ovary
Fallopian tube and other uterine adnexa
183
183.0 (there is no ICD 183.1)
183.2-183.9
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
NIOSH Category for Cause of Death
Major Minor NIOSH Groupings of Cancer Sites "VAO Characterization of Grouping"a
Suhsites
ICD-9 Codes
023 Other female genital organs 184
07 Male genital system 185, 186
024 Prostate "Prostate" 185
025 Testis "Testicular" 186
Penis and other male genital organs [for NIOSH in minor group 036] 187
08 Urinary system
026 Kidney (including renal pelvis and ureter) "Renal" 189.0-189.2
027 Bladder and other urinary organs "Urinary bladder"
Bladder
Urethra, paraurethral glands, other and unspecified urinary
188, 189.3-189.9
188
189.3-189.9
(discontinuity with ICD codes)
09 Other and unspecified sites
028 Bone ("and articular cartilage" in ICD nomenclature) "Bone and joint" 170
029 Melanoma "Melanoma" 172
030 Other malignant skin neoplasm "Non-melanoma skin" 173
031 Mesothelioma No codes (new minor code, above with lung)
032 Connective ("and other soft" in ICD nomenclature) tissue "Soft-tissue sarcoma"
(heart)
171
(164.1)
033 Brain and other parts of nervous system (ICD "soft tissue" includes peripheral nerves and autonomic nervous system) "Brain" 191-192
034 Eye 190
035 Thyroid (thymus) 193
164.0
036 Other and unspecified sites Other endocrine cancers
Other and ill-defined sites
Staled or assumed to be secondary of specified sites
194
195
196-198
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
NIOSH Category for Cause of Death
Major Minor NIOSH Groupings of Cancer Sites "VAO Characterization of Grouping"a
Suhsites
ICD-9 Codes
Site unspecified 199
10 Lymphatic and hematopoietic tissue Lymphoma
037 Hodgkin disease 201
038 Non-Hodgkin lymphoma 200, 202 (excluding 202.4), 273.3
039 Multiple myeloma 203 (excluding 203.1)
040 Leukemia and aleukemia "Leukemia (other than chronic B-cell leukemias)" 204-208
Lymphocytic (primary grouping now with other neoplasms of lymphocytic origin, lymphomas and multiple myeloma)
Acute lymphocytic 204.0
"Chronic lymphocytic (including hairy cell leukemia)" 204.1
Other lymphocytic 202.4; 204.2-204.9
Myeloid (granulocytic)
Acute 205.0
Acute erythremia and erythroleukemia 207.0
Megakaryocyte leukemia 207.2
Chronic myeloid 205.1
Other myeloid 205.2-205.3, 205.8-205.9
Monocytic
Acute monocytic 206.0
Chronic monocytic 206.1
Other monocytic 206.2-206.9
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
Other leukemia
Other acute 208.0
Other chronic 207.1,208.1
Aleukemic, subleukemic and "not 203.1,207.2,207.8,208.2-208.9
otherwise specified"

aBoldface cancer (sub)site: most comprehensive grouping for which a conclusion has been drawn.

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×

Version 9 (ICD-9). ICD-7, ICD-8, and ICD-9 were in effect for deaths that occurred in 1960–1967, 1968–1978, and 1979–1998, respectively; the differences among them are fairly subtle. Although ICD-10, which went into effect for coding causes of deaths that occurred from 1999 on, appears radically different from the earlier versions, it corresponds in large part to basically the same disease entities (see Table C-2). To date, most published epidemiologic studies considered in the VAO series have been related to health outcomes that occurred and were encoded before ICD-10 went into effect.

Since 1983, the National Institute for Occupational Safety and Health (NIOSH) has maintained software for generating standardized expectations, as derived from US mortality data assembled by the National Center for Health Statistics, for ICD-encoded mortality datasets. An article by Robinson et al. (2006) discusses revisions to that standard software to incorporate deaths coded according to ICD-10 and includes conversions and equivalencies between ICD-7, -8, -9, and -10 for 119 exhaustive categories for cause of death. Codes for malignant neoplasms span the ICD-9 range 140.0–208.9, NIOSH’s major categories 02–10, or NIOSH’s more specific minor categories 004–040.

The NIOSH death codes for neoplasms provide comprehensive scaffolding for organizing the committee’s reviews and conclusions by cancer type that is somewhat simpler than ICD classifications, but maps completely to the ICD system as it has evolved. Because the NIOSH system has been used to mediate analysis of many sets of cohort data, its groupings correspond quite closely with the published research findings available for review by VAO committees. In general cohort studies, one is unlikely to encounter results on more specific groupings than NIOSH’s minor categories.

As discussed in Chapter 2, this committee has not framed its conclusions strictly in terms of ICD codes, but the ICD system has been a valuable tool for the work of VAO committees. There can be coding errors on hospital records or death certificates, but when researchers present their results labeled with ICD codes, there can be little ambiguity about what they intended. When their most definitive indication is something like “respiratory cancers,” however, there can be uncertainty about where the evidence should be considered. In such cases, the committee has done its best to follow the hierarchy laid out in Table C-1.

As indicated above, many of the studies reviewed by the committee use or were written at a time when ICD-9 was in place. Accordingly, ICD references in this report use that scheme. ICD-10 began to be implemented in the United States in 1999. It differs from ICD-9 in level of detail (about 8,000 categories vs about 5,000 in ICD-9) and nomenclature (alphanumeric vs the numeric codes of ICD-9); additions and modifications were also made with regard to some coding rules and the rules for selecting an underlying cause of death (Anderson et al., 2001). Table C-2 lists the ICD-9 and ICD-10 codes for the various forms of malignant neoplasm addressed in this report. In situ neoplasms, benign neoplasms,

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×

TABLE C-2 Surveillance, Epidemiology, and End Results (SEER) Program Malignant Neoplasm Site Groupings for ICD-9 and ICD-10

Cancer Site ICD-9 Codes ICD-10 Codes
Buccal cavity and pharynx
Lip 140.0-140.9 COO.O-C00.9
Tongue 141.0-141.9 COI.C02.I-C02.9
Salivary glands 142.0-142.9 C07, CO8.O-C08.9
Floor of moulh 144.0-144.9 C04.0-C04.9
Gum and other mouth 143.0-143.9,145.0-145.6, CO3.O-C03.9, C05.0-C05.9,
145.8-145.9 C06.0-C06.9
Nasopharynx 147.0-147.9 CILI-CIL9
Tonsil 146.0-146.2 C09.0-C09.9
Oropharynx 146.3-146.9 C10.1-C 10.9
Hypopharynx 148.0-148.9 CI2,CI3.0-CI3.9
Other buccal cavity and pharynx 149.0-149.9 CI4.0-CI4.9
Digestive system
Esophagus 150.0-150.9 CI5.0-CI5.9
Stomach 151.0-151.9 CI6.0-CI6.9
Small intestine 152.0-152.9 CI7.0-CI7.9
Colon excluding rectum 153.0-153.9,159.0 CI8.0-CI8.9,C26.0
Rectum and rectosigmoid junction 154.0-154.1 C19,C20
Anus, anal canal, and anorectum 154.2-154.3,154.8 C21.0-C2I.9
Liver and intrahepatic bile duct
Liver 155.0,155.2 C22.0, C22.2-C22.4, C22.7-C22.9
Intrahepatic bile duct 155.1 C22.1
Gallbladder 156.0 C23
Other biliary 156.1-156.9 C24.0-C24.9
Pancreas 157.0-157.9 C25.0-C25.9
Retroperitoneum 158.0 C48.0
Peritoneum, omentum, and 158.8-158.9 C48.1-C48.2
mesentery
Other digestive organs 159.8-159.9 C26.S-26.9, C48.8
Respiratory system
Nasal cavity, middle ear, and 160.0-160.9 C30.0,C30.1.C3I.0-C3L9
accessory sinuses
Larynx 161.0-161.9 C32.0-C32.9
Lung and bronchus 162.2-162.9 C34.0-C34.9
Pleura 163.0-163.9 C38.4
Trachea, mediastinum, and other 162.0, 164.2-165.9 C33.C38.I-C38.3.C38.8.
respiratory organs C39
Bones and joints 170.0-170.9 C40.0-C40.9, C41.0-C41.9
Soft tissue (including heart) 171.0-171.9,164.1 C38.0, C47.0-C47.9, C49.0-C49.9
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
Cancer Site ICD-9 Codes ICD-10 Codes
Skin
Malignant melanomas 172.0-172.9 C43.0-C43.9
Other malignant skin neoplasms 173.0-173.9 C44.0-C44.9
Breast (male and female) 174.0-174.9,175 C50.O-C50.9
Female genital system
Cervix 180.0-180.9 C53.0-C53.9
Corpus 182.0-182.1,182.8 C54.0-C54.9
Uterus, not otherwise specified 179 C55
Ovary 183.0 C56.0-C56.9
Vagina 184.0 C52
Vulva 184.1-184.4 C5I.0-C51.9
Other female genital organs 181, 183.2-183.9, 184.8, C57.0-C57.9, C58
184.9
Male genital system
Prostate 185 C61
Testis 186.0-186.9 C62.0-C62.9
Penis 187.1-187.4 C60.0-C60.9
Other male genital organs 187.5-187.9 C63.0-C63.9
Urinary system
Urinary bladder 188.0-188.9 C67.0-C67.9
Kidney and renal pelvis 189.0, 189.1 C64.0-C64.9, C65.0-C65.9
Ureter 189.2 C66.0-C66.9
Other urinary organs 189.3-189.4,189.8-189.9 C68.0-C68.9
Eye and orbit 190.0-190.9 C69.0-C69.9
Brain and other nervous system
Brain 191.0-191.9 C71.0-C7I.9
Meninges 192.1 C70.O-C70.9
Other nervous systema 192.0, 192.2-192.9 C72.0-C72.9
Kndocrine system
Thyroid 193 C73
Other endocrine (including 164.0, 194.0-194.9 C37, C74.00-C74.92,
thymus) C75.0-C75.9
Lymphomas
Hodgkin's disease 201.0-201.9 C81.0-81.9
Non-Hodgkin's lymphomas 200.0-200.8,202.0-202.2, C82.0-C82.9, C83.0-C83.9,
202.8-202.9 C84.0-C84.5, C85.0-
C85.9, C96.3
Multiple myeloma 203.0,238.6 C90.0, C90.2
Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
Cancer Site ICD-9 Codes ICD-10 Codes
Leukemias
Lymphocytic
Acute lymphocytic 204.0 C9I.0
Chronic lymphocytic 204.1 C9I.I
Other lymphocytic 202.4,204.2-204.9 C91.2-C9I.4,C9I.7,C91.9
Myeloid (granulocytic)
Acute myeloid 205.0,207.0, 207.2 C92.0, C92.4-C92.5, C94.0, C94.2
Chronic myeloid 205.1 C92.1
Other myeloid 205.2-205.3, 205.8-205.9 C92.2-C92.3. C92.7, C92.9
Monocytic
Acute monocytic 206.0 C93.0
Chronic monocytic 206.1 C93.I
Other monocytic 2O6.2-206.9 C93.2, C93.7, C93.9
Other leukemia
Other acute 208.0 C94.4, C94.5, C95.0
Other chronic 207.1,208.1 C94.I,C95.I
Aleukemic, subleukemic and 203.1,207.2,207.8, C90.1,C9I.5,C94.3,C94.7,
"not otherwise specified" 208.2-208.9 C95.2, C95.7, C95.9
Miscellaneous malignant neoplasms 159.1, 195.0-195.8, C26.I, C76.0-C76.8, C77.0-
196.0-196.9, C77.9, C78.0-C78.8,
199.0-199.1,202.3, C79.0-C79.8, C80,
202.5-202.6. C88.0-C88.9, C96.0-
203.8 C96.2. C96.7. C96.9, C97

aCancers of the peripheral nerves and the autonomic nervous system are classified as “soft tissue” in ICD.
SOURCE: Adapted from Ries et al. (2003), Table A-4.

neoplasms of uncertain behavior, and neoplasms of unspecified behavior have separate codes in both schemes.

REFERENCES

Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. 2001. Comparability of cause of death between ICD-9 and ICD-10: preliminary estimates. National Vital Statistics Reports 49(2):1–32.

Ries LAG, Eisner MP, Kosary CL, Hankey BF, Miller BA, Clegg L, Mariotto A, Fay MP, Feuer EJ, Edwards BK (eds). 2003. SEER Cancer Statistics Review, 1975–2000, Bethesda, MD: National Cancer Institute.

Robinson CF, Schnorr TM, Cassinelli RT, Calvert GM, Steenland K, Gersic CM, Schubauer-Berigan MK. 2006. Tenth revision U.S. mortality rates for use with the NIOSH Life Table Analysis System. Journal of Occupational and Environmental Medicine 48(7):662–667.

WHO (World Health Organization). 2008. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissue (4th edition). Lyon, France: World Health Organization.

Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Suggested Citation:"Appendix C: Clarification of Cancer Groupings Used in Reporting Results, with Correspondence to NIOSH Cause-of-Death Codes and ICD Codes for Cancers." Institute of Medicine. 2012. Veterans and Agent Orange: Update 2010. Washington, DC: The National Academies Press. doi: 10.17226/13166.
×
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Next: Appendix D: Biographies of Committee to Review the Health Effects in Vietnam Veterans of Exposure to Herbicides (Eighth Biennial Update) and Staff »
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Because of continuing uncertainty about the long-term health effects of the sprayed herbicides on Vietnam veterans, Congress passed the Agent Orange Act of 1991. The legislation directed the Secretary of Veterans Affairs (VA) to request the Institite of Medicine to perform a comprehensive evaluation of scientific and medical information regarding the health effects of exposure to Agent Orange and other herbicides used in Vietnam to be followed by biennial updates. The 2010 update recommends further research of links between Vietnam service and specific health outcomes, most importantly COPD, tonsil cancer, melanoma, brain cancer, Alzheimer's disease, and paternally transmitted effects to offspring.

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