Summary of All 2014 ATSDR Studies and Impact

The following four studies were released in recent years and, when put together, offer a good overview of the extent of Camp Lejeune toxic water contamination. Thanks to officials at the CDC for this great summary to share.

Overview of ATSDR Water Modeling and Epidemiological Study Findings for Camp Lejeune Water Contamination

Over the past 2 years, the Agency for Toxic Substances and Disease Registry (ATSDR) has completed
and published four epidemiological studies to determine if people residing and working on U.S. Marine
Corps Base Camp Lejeune (Camp Lejeune), NC, or their offspring were at increased risk for certain
health effects as a result of exposure to water contaminated with volatile organic compounds (VOCs).

These studies make an important contribution to the body of evidence about harm caused by these
chemicals.

Brief Site Background:

During the early 1980s, high concentrations of VOCs were discovered in groundwater and drinking-
water serving some areas at Camp Lejeune. Sources of contamination included a privately owned dry
cleaning facility (ABC One-Hour Cleaners) adjacent to Camp Lejeune and base activities releasing fuel
and chlorinated solvents. Base and dry-cleaner operations began in 1942 and 1953, respectively.

Maximum measured concentrations of selected contaminants at water treatment plants included:

• . 215ppb of tetrachloroethylene (PCE) in drinking water at the Tarawa Terrace water treatment
  plants (February 1985)
• . 1,400ppb of trichloroethylene (TCE) in drinking water at the Hadnot Point water treatment
  plants (May 1982)
• . 720ppb of benzene in a Hadnot Point water treatment plants supply well (December 1984)

In 1989, Camp Lejeune and the off-base dry cleaner were placed on the U.S. Environmental Protection
Agency’s (EPA) National Priorities List (NPL) of hazardous waste sites. ATSDR is required to gather
information and data to assess human health impacts from exposures at NPL sites.

Historical Reconstruction of Groundwater Flow, Contaminant Fate and Transport,
and Distribution of Drinking Water

Tarawa Terrace, Hadnot Point and Holcomb Boulevard Water Distribution Systems

Water Modeling Purpose

To identify where and when certain areas at Camp Lejeune received drinking water contaminated with
volatile organic compounds (VOC), and help determine which people were exposed to contaminated
drinking water.

What Was Modeled

ATSDR reconstructed monthly levels of contaminants in water supply wells and drinking water from
1942 to 1987 for two drinking water systems where specific VOCs were detected. Contaminants
included TCE, PCE, benzene, 1,2-dichloroethylene (DCE) and vinyl chloride.

• Tarawa Terrace was primarily contaminated with PCE which is probably carcinogenic to
  humans¹. It served family housing.

¹ Agents Classified by the IARC Monographs, Volumes 1–111 (http://monographs.iarc.fr/ENG/Classification/index.php, accessed Jan. 2015)

• Hadnot Point was primarily contaminated with TCE which is carcinogenic to humans1 . The
  treatment plant served family housing, barracks, an officer quarters, a hospital, training areas,
  workplaces, and retail establishments.
• A third water system, Holcomb Boulevard was primarily uncontaminated except when
  intermittently supplied by contaminated Hadnot Point drinking water during the dry
  spring and summer months of 1972–1985. Hadnot Point also supplied Holcomb
  Boulevard’s drinking-water system when its plant was shut down during January 27-
  Febraury 7, 1985. The primary VOC that exceeded its drinking-water maximum
  contaminant level (MCL) during this period was TCE.

Key Results

• Tarawa Terrace:
  • Maximum level of PCE detected in drinking water was 215 parts per billion (ppb) in
    February 1985.
  • Water modeling estimated that drinking water exceeded the current EPA MCL for PCE of
    5 ppb for 346 months during November 1957-February 1987.
• Hadnot Point
  • Maximum level of TCE detected in drinking water was 1,400 ppb in May 1982. Other
    contaminants detected included PCE, DCE, vinyl chloride and benzene.
  • ATSDR estimates that drinking water exceeded the current MCL for one or more VOCs
    from August 1953 through January 1985.
  • TCE (current MCL is 5 ppb) – Exceeded MCL from August 1953-January 1985 and
    reached maximum level of 783 ppb during November 1983.
• PCE (current MCL is 5 ppb) – Exceeded MCL from August 1974-January 1985 and
  reached a maximum level of 39 ppb in November 1983.
• 1,2-tDCE (current MCL is 100 ppb) – Exceeded MCL from November 1972-January
  1985 and reached a maximum level of 435 ppb during November 1983.
• Vinyl Chloride (current MCL is 2 ppb) – Exceeded MCL from November 1972-
  January 1985 and reached maximum level of 67 ppb during November 1983.
• Benzene – (current MCL is 5 ppb) – Exceeded MCL from January 1979-January
  1985 and reached maximum level of 12 ppb during April 1984.

Conclusion

ATSDR concludes that former Marines and their families served by the Tarawa Terrace Water
Treatment Plant from November 1957 through February 1987 received drinking water contaminated
with PCE at levels that exceeded the current MCL of 5 ppb.

ATSDR concludes that former Marines and their families served by the Hadnot Point Water Treatment
Plant from August 1953 through January 1985 received drinking water contaminated with one or more
VOCs at levels that exceeded current MCLs.

Mortality Among Marines and Navy Personnel

Evaluation of mortality among Marines and Navy personnel exposed to contaminated
drinking water at UMSC Base Camp Lejeune: A retrospective study

Study Purpose

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 a cohort of 154,932 Marines and Navy personnel who
began service during 1975-1985 and were stationed at Camp Lejeune anytime during this period. We
also evaluated a similar comparison cohort of 154,969 Marines and Navy personnel from Camp
Pendleton who were not exposed to contaminated drinking water.

Key Results

Compared to Camp Pendleton, the Camp Lejeune cohort had higher mortality rates for the following
causes of death:

• All cancers combined, cancers of the cervix, esophagus, kidney, liver, lung, pancreas, prostate,
  rectum, and soft tissue
• Hodgkin lymphoma
• Leukemias
• Multiple myeloma
• Multiple sclerosis

Findings are consistent with a New Jersey drinking water study, meta-analyses of TCE workers and
cancers of the kidney, liver, Hodgkin lymphoma, multiple myeloma, leukemias, and pancreas
conducted by National Cancer Institute, EPA, and International Agency for Research on Cancer, and
other occupational studies.
With Camp Pendleton as the reference group and the Camp Lejeune cohort split into two exposure
groupings (no/low cumulative exposure and medium/high cumulative exposure to trichloroethylene),
an exposure-response was observed for kidney cancer, liver cancer, lung cancer, rectal cancer, cervical
cancer, multiple myeloma, Hodgkin lymphoma, and leukemias.
The findings for the smoking-related causes of death, such as stomach cancer, cardiovascular disease,
and chronic obstructive pulmonary disease (COPD) 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

Compared to Camp Pendleton, the study found increased risk of death in the Camp Lejeune cohort for
all cancers combined, kidney cancer, liver cancer, esophageal cancer, pancreatic cancer, rectal cancer,
soft tissue cancers, lung cancer, cervical cancer, prostate cancer, leukemias, Hodgkin lymphoma, multiple myeloma and multiple sclerosis. Because less than 6% of the Camp Lejeune cohort had died
by the end of the study, the numbers of some of the cause-specific deaths were small, resulting in wide
confidence intervals. Wide confidence intervals indicate uncertainty about the actual risk (it could be
higher or lower).

Mortality Among Civilian Employees

Mortality study of civilian employees exposed to contaminated drinking water at USMC
Base Camp Lejeune: A retrospective study

Study Purpose

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
civilians who were employed at the base.

What Was Studied

The study evaluated specific causes of death in 4,647 full-time workers who were employed at Camp
Lejeune during 1973-1985. We 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.

Key Results

Compared with the Camp Pendleton workers, the Camp Lejeune workers had higher mortality rates for
the following causes of death:

• All cancers combined, cancers of the female breast, kidney, lung, oral cavity, prostate, and
  rectum
• Kidney diseases
• Leukemias
• Multiple myeloma
• Parkinson’s disease

Findings are consistent with the New Jersey drinking water study, meta-analyses of TCE workers and
cancers of the kidney, multiple myeloma, and leukemias, other occupational studies, and a twin-study
of TCE and Parkinson disease (as well as case reports of TCE workers and Parkinson’s disease).

The higher rates of cancers of the kidney, prostate and rectum, leukemia’s, and Parkinson’s disease
were mainly among the Camp Lejeune civilian workers with higher cumulative exposures to the
contaminants.

Within the Camp Lejeune cohort, comparing those with below the median cumulative exposure to
those at or above the median cumulative exposure, elevated risks were observed for kidney cancer,
esophageal cancer, leukemias, rectal cancer, oral cancers, female breast cancer, prostate cancer, and
Parkinson’s disease.

The findings for the smoking-related causes of death, such as stomach cancer, cardiovascular disease,
and COPD 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

Compared to Camp Pendleton, the study found elevated risks in the Camp Lejeune civilian workers for
several causes of death, including all cancers combined, kidney cancer, leukemias, multiple myeloma,
lung cancer, oral cavity cancers, female breast cancer, prostate cancer, rectal cancer, Parkinson’s
disease and kidney diseases. 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 uncertainty about the actual risk (it could be higher or lower).

Summary of the Two Mortality Studies

Consistent findings between the two mortality studies:

Elevated risks for all cancers and cancers of the kidney, rectum, lung, prostate, multiple
myeloma and leukemias.
(Note: Due to small numbers, the following could not be evaluated: Hodgkin lymphoma, and
cancers of the soft tissue and cervix among civilian workers; Parkinson’s disease among
Marines/Navy personnel; and male breast cancer in both studies.)

Some confidence intervals for specific causes of death were wide because of small numbers of deaths
due to:

• The young ages of the Camp Lejeune Marines/Navy personnel and civilian worker cohorts by
  the end of the study (12/31/2008).

• Marines: 97% were <55 years of age, and <6% had died.
• Civilian workers: median age = 58 years; 72% were <65 years of age; and 14% had died

• The “healthy veteran effect” and the “healthy worker effect”: veterans and workers have a
  lower risk of mortality compared to the general population.
• Advances in treatments that increase the survivability of certain cancers and other diseases.
  Diseases with relatively long survival rates include:

• Non-Hodgkin lymphoma, cancers of the kidney, bladder, colon, rectum, breast, prostate,
  and soft tissue, and Parkinson’s disease.
• Latency periods for some cancers can be as long as 30 years or more after exposure.

Birth Defects and Childhood Cancers Study

Exposure to Contaminated Drinking Water and Specific Birth Defects and Childhood Cancers at Marine Corps Base Camp Lejeune, North Carolina

Study Purpose

To determine if maternal exposures to the drinking water contaminants at Camp Lejeune increased the
risk of neural tube defects (NTDs), oral clefts, and childhood hematopoietic cancers. This study also
examined whether children exposed to contaminated drinking water during the first year of life had an
increased risk of childhood cancers.

What Was Studied

ATSDR analyzed survey results from parents of 12,598 children to identify potential cases of birth
defects and childhood cancers. ATSDR asked parents if their child had a birth defect or developed a
childhood cancer. To be eligible for the survey, the mother had to reside on base some time during her
pregnancy and children had to be born between 1968 and 1985.

Conclusion and Key Results

• Exposure to TCE and benzene was associated with NTDs.
  • During the first trimester of pregnancy, the risk of a NTD increased with increasing levels
    of exposure to TCE. This finding is consistent with previous drinking water studies in
    New Jersey and Woburn, MA.
  • First trimester exposure to benzene was associated with NTDs. ATSDR was unable to
    evaluate whether increasing levels of exposure to benzene were associated with
    increased risk of NTDs because of small numbers of exposed cases.
• First trimester exposure to PCE, vinyl chloride, and 1,2- DCE showed weaker associations to childhood hematopoietic cancers such as leukemia.
  • These associations are weaker than those found for NTDs.
  • Researchers did not observe an increased risk for these cancers with increasing levels of exposure to the chemicals.
  • A Woburn, MA study found an elevated risk of childhood leukemia. However, the primary contaminant was TCE, although PCE was also present at levels above its maximum contaminant level.
• No evidence was found for other associations between outcomes and exposures.
  • For childhood cancers, ATSDR also looked at exposures during the second and third trimesters, the entire pregnancy as a whole, and exposures in the first year of life. The investigators did not see any associations between these chemicals with these time periods.
  • Exposure to contaminants in Camp Lejeune drinking water did not increase the risk of oral clefts.

These findings also apply to women who gave birth before 1968 if they were exposed to similar levels
of VOCs-contaminated drinking water.

The birth defects and childhood cancer study findings were based on small numbers of cases which
resulted in low precision (wide confidence intervals) for the odds ratios. Wide confidence intervals
indicate uncertainty about the actual risk (it could be higher or lower).

Adverse Birth Outcomes Study

Evaluation of contaminated drinking water and preterm birth, small for gestational age, and birth weight at Marine Corps Base Camp Lejeune, North Carolina: A cross-sectional study

Study Purpose

To determine if maternal exposures to contaminants in drinking water at Camp Lejeune were
associated with preterm birth and small for gestational age (i.e., low weight given the length of the
pregnancy).

This study is a reanalysis of a previous study that incorporates recent information obtained from the
historical reconstruction of monthly levels of the contaminants in the drinking water systems serving
family housing at the base. The previous study incorrectly categorized as “unexposed” some maternal
exposures before June 1972, because of incomplete information concerning the drinking water
systems that was available at the time the study was conducted.

What Was Studied

The study included 11,896 live singleton births 28-47 weeks gestation weighing 500 grams or more.
The births occurred between 1968 and 1985 to women who resided on base for at least one week
before giving birth.

Conclusion and Key Results

The following effects were seen in births from 1968-1985 to women exposed to contaminated drinking
water at Camp Lejeune. These findings also apply to women who gave birth before 1968 if they were
exposed to similar levels of VOCs-contaminated drinking water.

• Maternal exposure to PCE was associated with preterm birth (before 37 weeks of pregnancy).
  • For PCE and preterm birth, the strongest association was seen for exposures during the 2nd trimester (4th to 6th months).
• Maternal exposure to TCE was associated with small for gestational age (SGA), term low birth weight (TLBW) and reduced mean birth weight.
  • The risk of TLBW increased with increasing levels of exposure to TCE during the 2nd trimester.
  • The finding for TLBW is consistent with a study in NJ.
  • The finding for SGA is consistent with findings from a previous study conducted in Woburn, MA.
• Maternal exposure to benzene was associated with TLBW.
  • The risk of TLBW increased with increasing levels of exposure to benzene throughout the pregnancy.

Citations

Water Modeling:

Maslia et al.: Analyses of Groundwater Flow, Contaminant Fate and Transport, and Distribution of
Drinking Water at Tarawa Terrace and Vicinity, U.S. Marine Corps Base Camp Lejeune, North Carolina:
Historical Reconstruction and Present-Day Conditions. Atlanta, GA: Agency for Toxic Substances and
Disease Registry; 2007.

http://www.atsdr.cdc.gov/sites/lejeune/tarawaterrace.html

Maslia et al.: Analyses and Historical Reconstruction of Groundwater Flow, Contaminant Fate and
Transport, and Distribution of Drinking Water Within the Service Areas of the Hadnot Point and
Holcomb Boulevard Water Treatment Plants and Vicinities, U.S. Marine Corps Base Camp Lejeune,
North Carolina. Atlanta, GA: Agency for Toxic Substances and Disease Registry; 2013.

http://www.atsdr.cdc.gov/sites/lejeune/hadnotpoint.html

Health Studies:

Bove et al.: Evaluation of mortality among marines and navy personnel exposed to contaminated
drinking water at USMC base Camp Lejeune: a retrospective cohort study. Environmental Health 2014
13:10.

http://www.ehjournal.net/content/pdf/1476-069X-13-10.pdf

Bove et al.: Mortality study of civilian employees exposed to contaminated drinking water at USMC
Base Camp Lejeune: a retrospective cohort study. Environmental Health 2014 13:68.

http://www.ehjournal.net/content/pdf/1476-069X-13-68.pdf

Ruckart et al.: Evaluation of exposure to contaminated drinking water and specific birth defects and
childhood cancers at Marine Corps Base Camp Lejeune, North Carolina: a case–control study.
Environmental Health 2013 12:104.

http://www.ehjournal.net/content/pdf/1476-069X-12-104.pdf

Ruckart et al.: Evaluation of contaminated drinking water and preterm birth, small for gestational age,
and birth weight at Marine Corps Base Camp Lejeune, North Carolina: a cross-sectional study.
Environmental Health 2014 13:99.

http://www.ehjournal.net/content/pdf/1476-069X-13-99.pdf

Courtesy of the ATSDR