(The following is
the transcript of the webcast
presentation)
ATSDR Camp Lejeune
Survey of Childhood Cancers and Birth Defects
A Progress Report
on the Survey of Childhood Cancers and Birth Defects Among Children
Whose Mothers Were Pregnant While Living at U.S. Marine Corps Base
Camp Lejeune, North Carolina, 1968-1985.
Good day. My name
is Dr. Wendy Kaye.
I'm an epidemiologist
at the Agency for Toxic Substances and Disease Registry, also known
as ATSDR. Today I'd like to give you an overview of our Camp Lejeune
survey.
ATSDR is a public health
agency responsible for evaluating toxic substances in the environment
and how they affect people. We do assessments on all superfund and
other hazardous waste sites.
As part of this process,
we identified the drinking water problem at Camp Lejeune that needed
further study. Some of the water at Camp Lejeune was found to
be contaminated with volatile organic compounds used for degreasing
and dry cleaning, trichloroethylene - TCE and perchloroethylene
- PCE. Three water distribution systems that served family base
housing, Hadnot Point, Hospital Point, and Tarawa Terrace, were
affected.
Volatile organic compounds
were found in the drinking water in 1982. We don't know exactly
when the contamination got into the water; it could have been many
years earlier. There were no drinking water standards available
in 1982 to determine if the level of the contamination was a problem.
Additional sampling was done in 1984 and the wells were closed in
1985. Currently and since 1985 the water has been fine
ATSDR's assessment indicated
that the major health concerns for exposure to the drinking water
were adverse birth outcomes and cancer in children who were exposed
to these compounds in utero, that is while the child was in the
mother's womb. This group was thought to be the was most sensitive
to the exposures. ATSDR recommended that studies be done of the
relationship between the drinking water exposures and specific birth
defects and childhood cancers.
The first step in conducting
the study was to identify children with the specific birth defects
and childhood cancers. We were concerned about those children who
were conceived or carried in utero while their mothers lived in
on-base housing at Camp Lejeune between 1968 and 1985. 1968 was
chosen as the start of the study period because it was the first
year that birth certificates were computerized in the state of North
Carolina. The year 1985 was chosen as the end date of the study
because the contaminated wells were shut down in February of 1985.
Eligible children included
those whose mothers lived in base housing at the time of their
birth. There were approximately 12,500 of these births. The others
had mothers who were pregnant while living in base housing but born
after they were transferred from Camp Lejeune. We estimated there
were about 4,000 of these births.
We used a variety of
ways to find people to ask them to take part in the survey. We used
information from the birth certificates and the Marine Corps to
help us find the current addresses. We used a mass media campaign
to alert parents to call us. We decided to focus the study on specific
birth defects and childhood cancers because previous studies had
identified an association between these conditions and exposure
to drinking water contaminated with TCE and PCE. Additionally, these
conditions could be identified through a survey. The specific conditions
are neural tube defects - spina bifida and anencephaly; oral clefts
- cleft lip and cleft palate; and childhood cancers - Acute Lymphocytic
Leukemia and Non-Hodgkin's Lymphoma.
The survey took place
between September 1999 and January 2002. The survey asked questions
about the mother's date of pregnancy and where she lived while she
was pregnant. She was also asked about the child-- whether the child
had had any birth defects or childhood cancers diagnosed by a doctor
before the age of 20. The total number of children included
in the survey was 12,598. We were able to interview about 80% of
the parents whose children were born while they lived in on-base
housing. We were also able to interview between 64 and 73% of the
parents who were no longer at Camp Lejeune when their children were
born. The overall participation rate was close to 80%.
The survey cast a very
broad net to make sure that we didn't miss anyone with a condition
we wanted to study. We identified 103 children who possibly had
the specific birth defects and childhood cancers we are studying.
We have obtained the medical records for 46 of them, or about 45%.
We are still in the process of verifying these records and will
make every attempt to contact the other 57 people and obtain permission
to review the medical records. The specific numbers of childhood
birth defects and cancer reported among those who completed the
survey are 33 neural tube defects, 41 oral clefts, 22 with leukemia,
and 7 with childhood lymphoma.
However, what the survey
could not tell us is whether these birth defects or cancers are
in any way associated with the mother's using the contaminated water.
An epidemiologic study
is necessary to determine whether exposure during pregnancy to drinking
water contaminated with PCE and TCE at Camp Lejeune is associated
with an increased risk of specific birth defects and childhood cancers.
The survey was only the first step in conducting this study. It
was necessary to do the survey to find and identify people with
specific birth defects and childhood cancers.
There are additional
steps that need to be done as part of the study. We need to complete
confirming the birth defects and childhood cancers that were reported
to us, do an interview, and model the water distribution system
at Camp Lejeune. The people who will be included in this study are
all the children who had the childhood outcomes of interest born
to mothers who resided at Camp Lejeune during their pregnancies.
All of them will be contacted and asked to take part in the study.
We will also ask a sample of mothers who completed the survey and
whose children did not have any of the outcomes we are studying
to be in the study as a comparison group.
The study will consist
of an in-depth telephone interview asking where people lived, their
medical histories, what water they consumed during their pregnancies,
and information on their occupations. We will also do extensive
modeling of the water distribution systems at Camp Lejeune so that
we can see which water went to which base housing. In order to do
the study, we must develop a scientific protocol. This is already
started and in fact is almost complete. Once the protocol
is completed, it must go through a series of reviews. This includes
scientific peer review, a review by the Office of Management and
Budget, and Human Subjects Review. We expect these reviews to begin
within the next few weeks and to be completed by the end of the
calendar year. A few months after we have obtained all the needed
clearances, we will begin contacting people to ask them if they
would be willing to take part in the study.
I want to thank you
again for your interest in ATSDR's work at Camp Lejeune. For information
or questions, you can contact ATSDR or the Marine Corps at the numbers
and e-mails provided. Thank you.
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