How burning fireplaces may have increased the risk of rare cancers and respiratory diseases in veterans

A bipartisan measure to expand medical coverage for millions of Iraqi and Afghan veterans exposed to toxic fires was blocked on Thursday, after 25 Republican senators who backed the bill last month reversed their position.

This decision prevented the legislation from reaching President Biden’s desk. The bill has already passed the House and an earlier version was passed in the Senate last month, before some changes were made. Proponents of the measure were surprised that the current version did not return.

The problem is how military bases in Iraq and Afghanistan disposed of waste between around 2010 and 2015: by dumping it in a pit and setting it on fire in the open.

Many veterans attribute later health problems, such as cancer and respiratory disease, to exposure to chemicals released into the air from these fires. The smoke carried a range of harmful substances, including lead, mercury, benzene, hydrocarbons, dioxins and volatile organic compounds.

“Those deployed to bases where fire pits were used clearly were exposed to agents known to be harmful,” said David Savitz, professor of epidemiology at Brown University School of Public Health.

The legislation would have expanded access to healthcare for more than 3.5 million veterans who were exposed to toxins while serving in the military after 9/11. It would also have added 23 illnesses , including several cancers, to the list of conditions eligible for federal health care coverage.

Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of 2022 – or PACT Act, as it is known – was named after an American veteran who attributed his lung cancer to exposure to the pit burning. Robinson died of complications from his illness in 2020.

Savitz and other experts said burning trash the way the military did could certainly increase disease risk, but more research is needed to find out if the conditions reported by veterans were directly caused by burning fireplaces. . Either way, they think veterans should be able to get the care they want.

“The legislation was very important to provide health benefits to veterans with these types of lung diseases and a presumptive diagnosis of rare cancer and to provide them with care,” said Steven Coughlin, professor of epidemiology at the Augusta University. “Hopefully they get back on track.”

Why the fireplaces turned out to be so poisonous

Savitz said fire pits began to be gradually replaced by incinerators around 2010. But before that, the military set fires to all sorts of trash in the open.

“They were burning everything they had – everything from garbage, food waste, medical waste, water bottles,” he said.

Coughlin said the list included plastics, cardboard, heavy metals and vehicle parts.

“They poured kerosene on it to ignite it, and they burned those piles of garbage day and night,” he said.

Burns were frequently located near barracks, so combatants “often breathed in this filth daily with substantial exposure,” Coughlin said.

Exposure to hearth burns during military service has since been linked to certain respiratory and cardiovascular conditions, including asthma, bronchitis, and chronic obstructive pulmonary disease. A small 2011 study also identified cases of constrictive bronchiolitis – a rare but life-threatening lung condition – among previously healthy soldiers who served in Iraq and Afghanistan.

A potential association with cancer is more tenuous, the two experts said, because Iraqi and Afghan veterans have been exposed to burn outbreaks for the past two decades or so, and some cancers are not diagnosed until longer after exposure. to a carcinogen.

“There have been many reports of veterans with rare cancers,” Coughlin said. But “it can take decades – 30, 40, 50 years – before certain chronic diseases manifest themselves”.

The PACT Act proposes to add lung, brain, kidney, gastrointestinal and other cancers to the list of diseases eligible for expanded health coverage.

Veterans Affairs Secretary Denis McDonough expressed support for the PACT Act in May.

“The bipartisan bill will help us advance one of the department’s top priorities: getting more veterans into VA care,” McDonough said in a statement. “President Biden has also been clear on his commitment to providing more VA health care to veterans impacted by toxic exposures, which is why we need Congress to send the PACT Act to his desk.”

Biden’s son Beau died of a brain tumor in 2015 and served in Iraq on military bases that used fire pits.

Coughlin said that of the various compounds soldiers were exposed to, dioxins are of particular concern because of a link to respiratory cancer.

“Humans weren’t designed to deal with dioxin exposure,” he said. “There is no safe exposure limit.”

However, linking occasional combustion outbreaks to disease can be difficult, Savitz said, because the exposures were not well documented by the military. He is currently investigating whether people with respiratory or cardiovascular conditions were previously stationed at bases that used burning fireplaces.

At this time, Savitz said, “it has not been directly shown that those who were exposed to combustion fireplaces during military service actually have elevated long-term disease rates.”

But he and Coughlin said the government shouldn’t wait to offer health care to veterans until scientists fully understand all the risks of exposure to the burn pit.

“It’s important to make sure these veterans get proper care and not wait for the epidemiology to catch up,” Coughlin said.

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