Vietnam vets face dangers decades later

     By Marla Cone
     Editor in Chief
     Environmental Health News
     Published Sept. 15, 2008

Jim McKasson thought he was safe when he returned, seemingly unscathed, from the Vietnam War in 1969.

But the war may claim him after all.

Nearly 40 years later, McKasson is battling a life-threatening, highly malignant prostate cancer.

“I guess they could have stuck me out in the jungle, where I could have been shot,” said McKasson, now 62. “But it turns out that there was something a lot worse brewing.”

  soldiers in vietnam

Vietnam veterans exposed to the defoliant Agent Orange are twice as likely to contract prostate cancer as unexposed veterans, according to a study of 13,000 Northern California veterans conducted by University of California at Davis researchers. Worse, the cancer will likely be an aggressive, deadlier version that strikes earlier and spreads more readily to other organs.

About 20 million gallons of Agent Orange, which contained carcinogenic dioxins, were sprayed between 1962 and 1971 to defoliate the jungles of Vietnam, Laos, Cambodia and Thailand.

As a 21-year-old aircraft mechanic, McKasson helped load drums of Agent Orange aboard planes at a base in Thailand’s Ubon Ratchathani province, a frontline facility for the U.S. Air Force.

Only now, as Vietnam War veterans reach their 60s, is the full toll on American soldiers becoming clear.

McKasson, diagnosed with prostate cancer last year, was one of the 13,144 men whose medical records were analyzed by the research team from UC Davis and the Dept. of Veteran Affairs Northern California Health Care System.

Dr. Lars Ellison, former chief of urology at the VA in Northern California, said he and the other researchers had suspected from treating veterans that the men exposed to Agent Orange had more severe forms of prostate cancer.

“But I did not expect to see such a large effect of exposure.  It was really quite startling when the analysis of the data was complete,” Ellison said in an email interview from Iraq, where he is serving as a major in the U.S. Army Reserve.

The study, published in the Sept. 15 edition of the journal Cancer, is the largest to date of Vietnam veterans and prostate cancer, said Dr. Karim Chamie, the study’s lead author and resident physician at the UC Davis Dept. of Urology and the Northern California VA health care system.

Prostate cancer strikes one out of every six American men; it is their second leading cause of cancer death.

The UC Davis researchers said doctors should classify Vietnam veterans as “high risk” and rigorously screen them and perform biopsies more often.

Because they now are reaching their 60s, when many cancers develop, “it is only with the passing of age that the true risk has come into focus,” they wrote.

“Nobody knows how bad these herbicides are until many years later, when the cancer sort of spreads its wings and takes over,” Chamie said in an interview.

The Agent Orange cases buttress a trend doctors and scientists have noticed with other synthetic chemicals: Brief exposure early in life – or even before birth – can predispose the body to disease decades later.

In the study, Northern California veterans exposed to Agent Orange developed prostate cancer at twice the rate of unexposed veterans. Among 6,214 exposed men, 239 were diagnosed, compared with 124 out of 6,930 unexposed men.

But even more importantly, exposed veterans had more than three times the rate of metastasized cancer--which means it spread to their bones and lymph nodes and is often lethal--and a two-fold increase in high scores ranking the tumors’ malignancy. They also were diagnosed with cancer at the average age of 59.7 years, compared with 62.2 years for veterans unexposed to Agent Orange.

Chamie said Agent Orange is “accelerating the cancer. When it spreads beyond the prostate, survival goes down substantially. It’s a huge hit on their quality of life, too, because traditional treatments don’t work.”

More than a decade ago, U.S. government research did not find a high rate of prostate cancer among Vietnam veterans. But the numbers of men studied were small and they were too young to look for cancer, the UC Davis researchers said.

Dr. William Aronson, a UCLA School of Medicine professor of urology, said the new findings reveal detailed and useful information on the rate and severity of the disease. He said he is particularly concerned about the higher incidence of metastasized cancer and the high scores ranking their malignancies.

“That’s an extremely important finding and one that needs to be understood by practitioners,” said Aronson, staff urologist at the VA’s Greater Los Angeles Health Care System. He was not involved in the study.  “These cancers are more likely to metastasize and fail curative therapy, and patients are more likely to die.”

Aronson added that he “would treat these patients like I would any other high risk patient and start more aggressive screening at age 40.”

But many veterans and their doctors are unaware of the link between the Vietnam War and prostate cancer, so their screening procedures and treatments are often no more extensive than other men’s.

“Two thirds or more of those who have prostate cancer now or had it in the past had no clue that it had anything to do with their service in Vietnam,” said Rick Weidman, executive director of policy and government affairs for Vietnam Veterans of America.

Weidman said the VA has done a poor job of educating Vietnam veterans about their high risks of prostate cancer, diabetes and other diseases, and has failed to conduct studies that might document other health problems, such as testicular cancer.

The UC Davis researchers reported that the “long-term effects of Agent Orange may never be known” because the U.S. government is no longer funding health studies of Operation Ranch Hand, the veterans who sprayed 95% of Agent Orange.

Called Agent Orange because of the color of the bands around the 55-gallon drums, the defoliant contained dioxins, a by-product of the manufacture of the chlorinated herbicides 2,4-D and 2,4,5-T. Dioxins, classified as a human carcinogen, build up and persist in tissues for years, even decades.

Many Vietnam veterans also were exposed to an array of other carcinogens, including PCBs and trichloroethylene, used on military engines and equipment.

“It was a toxic soup in which we lived and fought,” Weidman said.

About three million veterans fought in Southeast Asia during the Vietnam War, and about 300,000 of them have undergone exams under the federal government’s Agent Orange Registry. Nearly 100,000 have filed claims alleging that the herbicide harmed their health. 

Vietnamese people also were highly exposed, and the government there estimates that about three million people have died or been stricken with cancer or birth defects.

“As a defoliant, Agent Orange is quite toxic. There are a number of other malignancies that have a definite association with exposure,” said Ellison, the study’s senior author.

McKasson was one of the veterans with the highly aggressive cancer that spread into his lymph nodes. It ranked high in malignancy—a score of nine out of 10.  But it was caught fairly early, and his prostate and lymph nodes were removed. He still is undergoing intensive hormone therapy.

“If I would have waited another six months or so, I might not even be here today,” said McKasson, who lives in the Northern California town of Paradise.

Before his diagnosis after a routine exam, he had no idea that he was high risk for prostate cancer and other diseases due to his exposure to Agent Orange.

His advice to fellow veterans: “Go get tested.” He spreads the word to other veterans because, he said, most aren’t going in for annual medical exams.

McKasson said while serving two years in Southeast Asia as a staff sergeant with the 8th Fighter Wing, he “didn’t have a clue” what chemicals he and others were being exposed to or what might happen to their health.

“These planes were dripping this stuff,” McKasson said. “We’d walk on it and the drums would leak and it would get on our hands. We didn’t have any protective clothing or anything.”

Now, with his life threatened four decades later, “in some ways, you feel a little bit betrayed,” McKasson said. “I did my job and I’m proud of what I did, but it was a waste of time, a waste of lives.”