Health Studies in Adults
ATSDR is conducting studies about Camp Lejeune because people were exposed to chemicals shown to be associated with several cancers and other chronic conditions.
Cancer Incidence Study
Evaluation of Cancer Incidence Among Marines and Navy Personnel and Civilian Workers Exposed to Contaminated Drinking Water at USMC Base Camp Lejeune: A Cohort Study
To read the study’s findings, visit http://medrxiv.org/content/early/2024/01/29/2024.01.27.24301873. CDC/ATSDR has published this study on a preprint server. In addition to scientific review at CDC/ATSDR, the study has also been externally peer reviewed as part of standard manuscript preparation at CDC/ATSDR prior to its posting on a preprint server. The paper has also been submitted for publication in a peer-reviewed publication.
Study Purpose
The cancer incidence study of Camp Lejeune Marines and Navy personnel, as well as civilian workers, was designed to investigate whether exposure to contaminated water at Camp Lejeune increased cancer risk.
What Was Studied
Cancer incidence among Marines and Navy personnel, as well as civilian workers, who were stationed at or worked at Camp Lejeune between the mid-1970s and mid-1980s, (population size=154,821) was compared to Marines and Navy personnel and civilian workers at Camp Pendleton, California (population size=163,484) during the same period.
The Camp Lejeune and Camp Pendleton cohorts were similar in their demographics, socioeconomic status, training activities, and civilian employee occupations. However, in contrast to Camp Lejeune, Camp Pendleton drinking water was not known to be contaminated prior to 1986.
Features of this Study
This is one of the largest studies of this type conducted in the United States, having used cancer registry data from all 50 states, the District of Columbia, Puerto Rico, the Pacific Islands, the U.S. Department of Defense, and the U.S. Department of Veterans Affairs.
Conclusions and Key Results
Increased risk of several cancers was observed among Marines and civilian workers exposed to contaminated drinking water at Camp Lejeune compared to personnel at Camp Pendleton.
In Marines and Navy personnel, increased risk was found for some types of leukemia and lymphoma, as well as for cancers of the lung, breast, larynx, esophagus, thyroid, and soft tissues.
Among civilian workers, increased risk was observed for myeloid cancers and some cancers of the breast and lung.
Testing/Treatment
ATSDR recommends that those who think they may be affected have regular medical check-ups to monitor their health. ATSDR also encourages those affected to discuss their exposure with their medical provider, who can advise them on their personal health questions.
Health Survey
Health Survey Information
View more information about the study »
- Why did you develop the health survey?
On January 28, 2008, President Bush signed the 2008 National Defense Authorization Act. This required ATSDR to develop a health survey of persons possibly exposed to contaminated drinking water at Camp Lejeune.
- Who was eligible for the survey?
Anyone who lived or worked at Camp Lejeune during the period of drinking water contamination was eligible for the survey. ATSDR couldn’t identify all of these people from available records, so we sent the survey to the people we could identify.
People who received the survey included:
- former active-duty marines and sailors who were stationed at Camp Lejeune anytime between April 1975 and December 1985
- civilian employees who worked at the base anytime between October 1972 and December 1985
- People who took part in ATSDR’s 1999-2002 survey
- a sample of former active duty and civilian workers from Camp Pendleton
- people who requested a health survey by registering with the United States Marine Corps before June 30, 2011
- Why did you survey former active duty and civilian workers from Camp Pendleton?
Active duty and civilians who worked at Camp Pendleton and Camp Lejeune are similar except for their exposures to chemicals in drinking water. The information from those who lived at Camp Pendleton allows us to compare the health experiences between these two groups. This will help us determine if contaminated drinking water at Camp Lejeune affected people’s health.
- What conditions did the health survey ask about?
The health survey asked questions about more than twenty different cancers and other diseases. People also had space to report other diseases not mentioned in the survey.
- When was the survey sent?
The surveys were mailed from June 2011 through June 2012.
- Why didn’t I get a survey?
You may not have received a survey because you are not part of one of the groups included in the health survey. The following groups were included in the health survey:
- former active-duty marines and sailors who were stationed at Camp Lejeune anytime during April 1975 and December 1985
- civilian employees who worked at the base anytime during October 1972 to December 1985
- people who took part in ATSDR’s 1999-2002 survey
- a sample of former active duty and civilian workers from Camp Pendleton
- people who requested a health survey by registering with the USMC by June 30, 2011
Even if you did not receive a survey, if you lived or worked at one of the bases during this time, the results will apply to you.
- What did you find?
Compared to Camp Pendleton, the Camp Lejeune group had higher mortality rates for the following causes of death:
- Cancers of the cervix, esophagus, kidney, liver, lung, pancreas, prostate, rectum, and soft tissue
- Hodgkin’s lymphoma
- Leukemias
- Multiple myeloma
- Multiple sclerosis
The higher rates for kidney cancer, cervical cancer, Hodgkin’s lymphoma, leukemias, multiple myeloma, and lung cancer were mainly among those with higher cumulative exposures to the contaminants. However, the precision of the estimated rates of many of these conditions was low.
The findings for the smoking-related causes of death such as stomach cancer, cardiovascular disease, and (COPD) suggested that smoking would have only a slight impact on the associations between causes of death and exposure to the drinking water contaminants at Camp Lejeune.
Male Breast Cancer Results
Evaluation of contaminated drinking water and male breast cancer at Marine Corps Base Camp Lejeune, North Carolina: a case control study
Study Purpose
Some residents who lived at Camp Lejeune from the 1950s through 1985 were exposed to contaminated drinking water.
The purpose of this study was to determine if Marines who were exposed to contaminated drinking water at Camp Lejeune were more likely to have male breast cancer.
Drinking water at Camp Lejeune was contaminated with volatile organic compounds (VOCs), including trichloroethylene (TCE), tetrachloroethylene (PCE), benzene, 1,2-dichloroethylene (DCE), and vinyl chloride.
What Was Studied
The study included 71 men with breast cancer (called “cases”) and 373 men who had other types of cancer (called “controls”). ATSDR used the Department of Veterans Affairs (VA) cancer registry to identify these cases and controls. ATSDR selected the controls from cancers that are not associated with solvent exposure; this included 270 men with skin cancer, 71 with mesothelioma, and 32 with bone cancer.
The VA cancer registry maintains information from eligible veterans who were diagnosed with or treated for cancer at a VA clinic. Eligible study members were male Marines born before January 1, 1969, and diagnosed with cancer or treated for cancer at a VA medical facility from January 1, 1995, (the start of the VAcancer registry) to May 5, 2013 (the latest date that complete medical records were available). Marines born after January 1, 1969, were not old enough to serve during the period of contamination at Camp Lejeune (i.e., they were younger than 17 years of age by the end of 1985 when the contamination ended).
Features of this Study
Because of the lack of existing information, ATSDR used extensive water modeling to reconstruct exposures before 1987. The water modeling identified where and when certain areas at Camp Lejeune received contaminated drinking water. ATSDR used the water modeling results to determine which Marines were exposed to contaminated water during their service.
ATSDR combined the water modeling results with additional information from personnel records, base family housing records, and records that indicated where Marine units were barracked. ATSDR used all of this information to estimate contaminant-specific residential exposure levels for each of the cases and controls in the study who were stationed at Camp Lejeune.
Conclusion and Key Results
ATSDR’s study results suggested possible associations between exposure to PCE, DCE, and vinyl chloride at Camp Lejeune and male breast cancer. These results took into account age at diagnosis, race, and service in Vietnam. For PCE, risk increased slightly with increasing levels of exposure.
Exposures to TCE, PCE, DCE, and vinyl chloride were also observed to possibly accelerate the onset of male breast cancer.
The study did not find evidence suggesting associations between male breast cancer and exposures to benzene.
The results of this study add to the scientific literature on the health effects of exposures to these chemicals in drinking water. However, these findings were based on small numbers of exposed cases.
ATSDR evaluated male breast cancer in a cancer incidence study that involved state cancer registries nationwide as well as federal cancer registries.
Additional Resources
Mortality Study of Civilian Employees Exposed to Contaminated Drinking Water at USMC Base Camp Lejeune: A Retrospective Cohort Study
Download as PDF [PDF – 416 KB]
Study Purpose
The purpose of the study was to determine whether potential exposures to the drinking water contaminants at Camp Lejeune are associated with increased risk of death from specific cancers and other chronic diseases among those who were employed at the base. The contaminants included trichloroethylene (TCE), tetrachloroethlylene (also known as perchloroethylene or PCE), benzene, and two contaminants that are formed when TCE or PCE degrade in ground water: 1,2-dichloroethylene and vinyl chloride.
What Was Studied
The study evaluated specific causes of death in 4,647 full-time workers who were employed at Camp Lejeune during 1973-19851 . ATSDR also evaluated a comparison group of 4,690 full-time workers who were employed at Camp Pendleton during 1973-1985 but were not employed at Camp Lejeune during this period. The Camp Pendleton workers were not exposed to contaminated drinking water.
Cause of death data from 1979-2008 were used to study the Camp Lejeune and Camp Pendleton cohorts. Information on causes of death was obtained from the National Death Index (NDI) of the National Center for Health Statistics. The study included all underlying causes of death that other studies have shown to be associated with one or more of the chemicals found in the drinking water at Camp Lejeune. Causes of death were selected based on literature reviews conducted by the U.S. Environmental Protection Agency (EPA), the National Toxicology Program (NTP), the International Agency for Research on Cancer (IARC), and Agency for Toxic Substances and Disease Registry (ATSDR).
The causes of death that were studied include:
- Amyotrophic lateral sclerosis (ALS)
- Cancers of the bladder, brain, cervix, colon, esophagus, female breast, kidney, larynx, liver, lung, oral cavity, pancreas, prostate, rectum, and soft tissue
- Hematopoietic cancers
- Hodgkin’s Lymphoma
- Leukemias
- Multiple myeloma
- Non-Hodgkin’s lymphoma
- Non-cancerous kidney diseases
- Non-cancerous liver diseases
- Multiple sclerosis
- Parkinson’s disease
The study also included three causes of death known to be caused by cigarette smoking but not known to be associated with the drinking water contaminants: cardiovascular disease, chronic obstructive pulmonary disease (COPD), and stomach cancer. These causes of death were included to assess the possible impact of smoking on the findings because ATSDR did not have information on smoking status for study subjects.
Features of this Study
The study looked at the Camp Lejeune civilian workers and a comparison civilian worker population from Camp Pendleton. Camp Pendleton did not have a contaminated drinking water supply.
The cumulative exposure of each Camp Lejeune worker was based on the workplace location, duration of employment, and the monthly average estimates of the contaminants in the drinking water serving the workplace. Monthly contaminant levels in the drinking water were estimated by modeling the movement of the contaminants from the source of pollution through the ground water and into the water distribution system.
Key Results
During 1979-2008, there were 654 deaths in the Camp Lejeune group of civilian workers and 869 deaths in the Camp Pendleton group. The median ages in 2008 for the Camp Lejeune and Camp Pendleton cohorts were 58 years and 60 years, respectively.
Compared with the Camp Pendleton workers, the Camp Lejeune workers had higher mortality rates for the following causes of death:
- Cancers of the female breast, kidney, lung, oral cavity, prostate, and rectum
- Kidney diseases
- Leukemias
- Multiple myeloma
- Parkinson’s disease
The higher rates of cancers of the kidney, prostate and rectum, leukemias, and Parkinson’s disease were mainly among the Camp Lejeune civilian workers with higher cumulative exposures to the contaminants.
When those with higher exposures at Camp Lejeune were compared to those with lower exposures at Camp Lejeune, higher cumulative exposures to the contaminants were associated with increased risks for cancers of the kidney, esophagus, prostate, and rectum, leukemias, and Parkinson’s disease.
The findings for the smoking-related causes of death, such as stomach cancer, cardiovascular disease, and chronic obstructive pulmonary disease suggested that smoking would have only a minor impact on any association between cause of death and exposure to the drinking water contaminants at Camp Lejeune.
Conclusion
The study found elevated risks in the Camp Lejeune civilian workers for several causes of death, including kidney cancer, leukemia’s, prostate cancer, rectal cancer and Parkinson’s disease. Because only 14% of the Camp Lejeune group had died by the end of the study, the numbers of cause-specific deaths were small, resulting in wide confidence intervals. Wide confidence intervals indicate considerable uncertainty about the actual risk (it could be higher or lower). Note: ATSDR published a mortality study of Marines and Navy personnel at Camp Lejeune. Several cancers with elevated risk in that study were also elevated among the civilian employees: cancers of the kidney, prostate, lung and rectum, leukemias, and multiple myeloma: http://www.atsdr.cdc.gov/sites/lejeune/mortalitystudy.html.
Additional Resources
A Retrospective Cohort Study
Evaluation of mortality among Marines and Navy personnel exposed to contaminated drinking water at USMC Base Camp Lejeune: A retrospective cohort study
Study Purpose
The purpose of this study was to determine whether residential exposures of Marines and Navy personnel to contaminated drinking water at Camp Lejeune increased risk of mortality from cancers and other chronic diseases.
What Was Studied
The study evaluated specific causes of death in 154,932 Marines and Navy personnel who began service during 1975-19851 and were stationed at Camp Lejeune anytime during this period. ATSDR also evaluated a comparison group of 154,969 Marines and Navy personnel from Camp Pendleton. The Camp Pendleton group was not exposed to contaminated drinking water but was otherwise similar to the Camp Lejeune group.
Cause of death data from 1979-2008 was used to study the Camp Lejeune and Camp Pendleton cohorts. Information on causes of death was obtained from the National Center for Health Statistics National Death Index (NDI). The study included all underlying causes of death that other studies have shown associations with one or more of the chemicals found in the drinking water at Camp Lejeune. Causes of death were selected based on literature reviews conducted by the U.S. Environmental Protection Agency (EPA), the National Toxicology Program (NTP), the International Agency for Research on Cancer (IARC), and the Agency for Toxic Substances and Disease Registry (ATSDR).
The causes of death studied include:
- Amyotrophic lateral sclerosis (ALS)
- Cancers of the bladder, brain, cervix, colon, esophagus, female breast, kidney, larynx, liver, lung, oral cavity, pancreas, prostate, rectum, and soft tissue
- Hematopoietic cancers
- Hodgkin’s Lymphoma
- Leukemias
- Multiple myeloma
- Non-Hodgkin’s lymphoma
- Non-cancerous kidney diseases
- Non-cancerous liver diseases
- Multiple sclerosis
Also included in the study were three causes of death that are known to be caused by cigarette smoking but are not known to be associated with the drinking water contaminants: cardiovascular disease, chronic obstructive pulmonary disease (COPD), and stomach cancer. These causes of death were included to assess the possible impact of smoking on the findings because ATSDR did not have information on smoking status for study subjects.
Features of this Study
The study included a comparison population from Camp Pendleton that was similar to the Camp Lejeune cohort on risk factors such as military training, occupations, and smoking. Camp Pendleton did not have a contaminated drinking water supply.
Residential cumulative exposure to each contaminant was based on results from the water modeling and the location and duration of residence.
Key Results
Compared to Camp Pendleton, the Camp Lejeune group had higher mortality rates for the following causes of death:
- Cancers of the cervix, esophagus, kidney, liver, lung, pancreas, prostate, rectum, and soft tissue
- Hodgkin’s lymphoma
- Leukemias
- Multiple myeloma
- Multiple sclerosis
The higher rates for kidney cancer, cervical cancer, Hodgkin’s lymphoma, leukemias, multiple myeloma, and lung cancer were mainly among those with higher cumulative exposures to the contaminants. However, the precision of the estimated rates of many of these conditions was low.
The findings for the smoking-related causes of death such as stomach cancer, cardiovascular disease, and COPD suggested that smoking would have only a slight impact on the associations between causes of death and exposure to the drinking water contaminants at Camp Lejeune.
Conclusion
The study found increased risk of death in the Camp Lejeune cohort for several causes including cancers of the cervix, esophagus, kidney, and liver, Hodgkin’s lymphoma, and multiple myeloma. This study makes an important contribution to the body of evidence about harm caused by these chemicals. However, due to its limitations it did not provide definitive evidence for causality, nor can it answer the question whether an individual has been affected by these exposures at Camp Lejeune.
Additional Resources
Morbidity Study of Former Marines, Employees, and Dependents Potentially Exposed to Contaminated Drinking Water at USMC Base Camp Lejeune: A Summary of Agency for Toxic Substances and Disease Registry (ATSDR) Study Design and Results
Study Purpose
Some residents and civilian employees who lived or worked at Camp Lejeune from the 1950s through 1985 were exposed to drinking water contaminated with volatile organic compounds.
The purpose of this study was to determine whether there is a link between exposure to contaminated drinking water at Camp Lejeune and selected cancers or other diseases in former service men and women, their families, and civilian workers.
Drinking water at Camp Lejeune was contaminated with volatile organic compounds (VOCs), including trichloroethylene (TCE), tetrachloroethylene (PCE), benzene, trans-1,2-dichloroethylene (DCE), and vinyl chloride.
What Was Studied
Health surveys were mailed to over 247,000 study participants or their next of kin. Over 76,000 surveys were completed, collecting information about cancers and other diseases, including type of disease and age of diagnosis, as well as factors that affect health like age, race, education, smoking, and alcohol use.
Features of this Study
This study looked at military personnel, their families, and civilian employees at Camp Lejeune who may have been exposed to contaminated drinking water and compared some specific health problems with military personnel and civilian employees at Camp Pendleton who were not exposed to the water. Using a comparison group with a similar population who was not exposed helps assess if there is a link between exposure to the water and diseases.
In addition, the researchers conducted an ‘internal’ analyses (looking at the exposed populations within Camp Lejeune only) to see if increasing levels of exposure to the contaminants in the drinking water resulted in increased risk of disease.
Conclusion and Key Results
This study shows that contaminated drinking water at Camp Lejeune was linked to increased risk for bladder cancer, kidney cancer, and kidney disease.
- Exposure to both TCE and PCE was associated with an increased risk for kidney cancer in both Marines and civilian employees
- Exposure to both TCE and PCE was associated with increased risk for bladder cancer and kidney disease in civilian employees
- Exposure to PCE was associated with increased risk for bladder cancer and kidney disease in Marines
Risk increased with increasing levels of exposure to the contaminants for kidney cancer (TCE and PCE in Marines and TCE/PCE in civilian employees) and kidney disease (PCE in Marines and TCE/PCE in civilian employees).
These results are consistent with results found in previous studies.
Next Steps
The results of this study add to the scientific literature on the risk of cancer and other diseases associated with TCE and PCE in drinking water. ATSDR followed up on these findings in a cancer incidence study that involved state cancer registries nationwide, as well as federal cancer registries.
For More Information
This study can be accessed online at https://www.atsdr.cdc.gov/sites/lejeune/docs/health_survey_report-508.pdf pdf icon[PDF – 2 MB].
More information about the mortality studies is available at https://www.atsdr.cdc.gov/sites/lejeune/mortalitystudy.html and https://www.atsdr.cdc.gov/sites/lejeune/civilianmortalitystudy.html.
Other Camp Lejeune public health activities can be found online at https://www.atsdr.cdc.gov/sites/lejeune/activities.html.
For more information about ATSDR’s work on Camp Lejeune, visit www.atsdr.cdc.gov/sites/lejeune
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