Beyond Skin-Deep

A recent study out of the United States has found that Vietnam war veterans previously exposed to the herbicide Agent Orange may be at higher risk for certain types of skin cancer. The latest findings may have resonance here in Canada, where military and public-service workers used herbicides containing Agent Orange to clear trees and brush across the country from 1950 to 1980.

Findings of the pilot study, Association between Agent Orange Exposure and Nonmelanotic Invasive Skin Cancer, released in February, add to previous research suggesting that the risk of nonmelanotic invasive skin cancer (NMISC) could be increased even decades after exposure to Agent Orange, with at least some exposed veterans having unusually aggressive nonmelanotic skin cancers.

The pilot study reviewed the medical records of 100 men with light skin tones between 56 and 80 years old, who had enrolled in the United States’ Agent Orange registry from 2009 to 2010. Results show a 51 per cent higher incidence of NMISC in veterans, compared to the national incidence rate of 23.8 per cent among the same age group. Among the 43 per cent of veterans who had chloracne — a skin condition that looks similar to severe acne and is caused by exposure to dioxins — the rate of NMISC was more than 80 per cent.

Agent Orange, a herbicide made of one part 2,4,5-Trichlorophenoxyacetic acid (2,4,5-T) and one part 2,4-Dichlorophenoxyacetic acid (2,4-D), was used widely by the American military as a defoliant during the Vietnam War. The toxic dioxin — 2,3,7,8-Tetrachlorodibenzodioxin (TCDD) — created as an unintentional by-product of 2,4,5-T, “is among the most carcinogenic compounds ever to undergo widespread use in the environment,” says co-author of the pilot study Dr. Mark W. Clemens, a surgeon at the University of Texas M. D. Anderson Cancer Center’s department of plastic surgery in Houston.

The International Association for Research on Cancer in Lyon, France classifies TCDD as “known to be carcinogenic to humans” and describes phenoxy herbicides 2,4-D and 2,4,5-T as “possibly carcinogenic to humans”.

TOO CLOSE

The federal government in Canada banned Agent Orange in 1985, but prior to the ban, provincial and municipal workers used 2,4,5-T from the ’50s to the ’80s to clear power lines in Ontario. Military workers at Canadian Forces Base Gagetown (CFB Gagetown) in New Brunswick and hydro workers in British Columbia were also exposed to the toxic chemical.

Carol Brown Parker, co-president of Agent Orange Association of Canada Inc. in Westfield, New Brunswick, lived near CFB Gagetown in Oromucto as a child when her father was stationed there. She says she knows many veterans who have skin cancer and chloracne. Parker recalls that from 1956 to 1967, military workers sprayed Agent Orange along with 25 other toxic herbicides without proper protective gear to clear the area of trees and brush and to test the herbicide for use by the American military. “They told us we could drink it, it was that safe,” she says.

In 2007, the federal government announced that they would issue ex-gratia payments of $20,000 to each person who worked, lived or trained at CFB Gagetown or resided in a community within five kilometres of the base and had been diagnosed with any one of 12 associated health conditions.

For veterans who suffer from multiple illnesses, Parker says this one-time payment “is a drop in the bucket when you figure out all the medicine that you need.” She cites an 82-year-old veteran who was diagnosed with two kinds of skin cancer, lung cancer, prostate cancer and diabetes. He applied for a medical pension three times, but was turned down. Not many people have been successful at getting medical pensions, Parker says. “It can take you several years to get through the process, and once you get a third denial, that’s it.”

Tony Merchant, former politician and a class-action lawyer at Merchant Law Group LLP, agrees that the compensation does not go far enough. “When government makes a political gesture, one can accept that they only have a limited amount of money to give,” Merchant says from Regina. “But rather than giving $300,000 to some people who deserved a million and a half and giving $2,000 to those who deserved $15,000, they just gave everybody the same $20,000. So for some people, it was probably all they would have ever received. For the people who were severely wronged, it was just a pittance.”

Paul Demers, PhD, director of the Occupational Cancer Research Centre steering committee in Toronto, says the topic of the study “is a good thing to look at,” but highlights its limitations. For one, the participants who registered themselves with the Agent Orange registry did so because of health problems, “so you can’t really compare them then to the general population.” As well, the fact that the study was conducted by plastic surgeons — not by cancer or occupational-health researchers — limits their ability to do follow-up research.

Demers points out that cancers other than skin cancer — such as non-Hodgkin’s lymphoma and soft-tissue sarcoma — have a higher body of evidence supporting association with TCDD. “Dioxins overall appear to be associated with an overall increase in a number of different types of cancers, with lung cancer being of particular concern,” he says.

The authors also acknowledge other limitations in the report, which include participants’ recall bias of events that occurred decades earlier; the inability to measure the levels of TCDD accurately at this point in time; and the inability to control for sun exposure in tropical environments.

Nevertheless, the study recommends service personnel with prior exposure to TCDD to seek counselling on skin cancer. “Patients involved directly with spraying the agent and those with light eye and skin colours may be most susceptible to the development of nonmelanotic invasive skin cancer,” the study concludes.

SEEKING REDRESS

While Merchant suggests that the report alone presents sufficient evidence to proceed with a lawsuit, he believes that there are not enough veterans with skin cancer to pursue a class action suit against the government in Canada.

“You can’t take them to court over a person who has lymphoma as a result of Agent Orange, because if they want to fight the long fight, then it will cost a million dollars to do that and you won’t get a million dollars in damages,” he notes.

In 2005, Merchant Law launched a suit against the federal government with a group of soldiers who had developed health problems following exposure to Agent Orange in CFB Gagetown. The court accepted that the probability of health problems had increased significantly and certified the action, but it was overturned at the appeals court due to the sheer diversity of the group being represented — the veterans had 26 types of lymphomas and various kinds of cancers. The court ruled that Merchant Law would have to take each individual group separately.

Seeking compensation through other means is not likely to be any easier. While the probability of causation may have gone up in cases like the Gagetown veterans, Merchant says workers’ compensation boards often argue that the cause of adverse health effects cannot be proven beyond doubt.

While skin cancer was not cited as one of the associated health effects in the Ontario Independent Fact-Finding Panel on Herbicide 2,4,5-T — released last June to investigate the use of the chemical spray by government workers — the Workers Safety and Insurance Board of Ontario (WSIB) will review and consider new studies and scientific evidence as they emerge, says Christine Arnott, spokesperson for the WSIB in Toronto.

Following the report’s publication, the WSIB has moved forward with the adjudication process, and some workers have since received compensation. “For workers whose claims have been allowed, recognizing their direct exposure to 2,4,5-T and high levels of TCDD, the WSIB provides a broad range of benefits, which can include full healthcare coverage, loss of earnings benefits [and] benefits related to the degree of a worker’s permanent impairment,” Arnott says. The board has also set up an occupational-disease information line on which concerned workers can leave a message.

But adjudication in occupational disease claims remains a complex matter. “In each case, we review the individual’s work activities and exposures, along with expert scientific and medical evidence regarding the worker’s condition and its relation to the workplace exposure,” Arnott says. 

Carmelle Wolfson is assistant editor of OHS CANADA.

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