Health Studies in Adults

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 https://www.researchsquare.com/article/rs-4171975/v1. 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.

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Health Survey Information

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1. 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.

2. 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

3. 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.

4. 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.

5. When was the survey sent?

The surveys were mailed from June 2011 through June 2012.

6. 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.

7. 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.

Frequently Asked Questions

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

• Journal Article

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Frequently Asked Questions

Study Purpose

The purpose of this cohort study of Camp Lejeune Marines/Navy personnel and civilian workers was to determine if being stationed or employed at Camp Lejeune between 1975 and 1985 (Marines/Navy personnel) or between October 1972 and December 1985 (civilian workers), a portion of the period when the drinking water was contaminated, increased the risk of specific causes of death during the follow-up period between 1979 and 2018 compared to being stationed or employed at Camp Pendleton.

What Was Studied

The Camp Lejeune Mortality Cohort Study was conducted of Marines and Navy personnel who, between 1975 and 1985, began service and were stationed at Camp Lejeune, North Carolina or Camp Pendleton, California and civilian workers employed at Camp Lejeune or Camp Pendleton between October 1972 and December 1985.

Camp Pendleton Marines/Navy personnel and civilian workers were chosen as the comparison groups in this study because the base’s finished drinking water was not known to be contaminated prior to 1986. Additionally, Camp Pendleton’s Marines/Navy personnel and civilian workers were similar to Camp Lejeune in terms of demographics, socioeconomic factors, training activities, personnel trained, and types of civilian employee occupations.

Features of this Study

Few studies have evaluated drinking water exposures to trichloroethylene (TCE), tetrachloroethylene (PCE), vinyl chloride, or benzene and the risk of specific causes of death. ATSDR previously conducted cohort Mortality Studies comparing Marines/Navy personnel and civilian workers stationed or employed at Camp Lejeune from 1975 to 1985 and 1972 to 1985, respectively, with similar cohorts over the same periods stationed or employed at USMC Base Camp Pendleton, California. The follow-up period for both of the previous Camp Lejeune mortality studies was between 1979 and 2008. The current cohort mortality study extends the follow-up period to 2018.

Conclusion and Key Results

Drinking water at U.S. Marine Corps Base Camp Lejeune, North Carolina was contaminated with TCE and other industrial solvents from 1953 to 1985. Increased risk of several causes of death was observed among Marines and civilian workers exposed to contaminated drinking water at Camp Lejeune compared to personnel at Camp Pendleton, which is not known to have similar drinking water contamination.

• In Marines and Navy personnel, increased risk of causes of death was observed for kidney, esophageal, and female breast cancer.
• Among civilian workers, increased risk of causes of death was observed for chronic kidney disease, Parkinson disease, and female breast cancer.

ATSDR Testing/Treatment Recommendations

This work is an update to the previous mortality studies published in 2014. It contributes to what is known about exposures to contaminated drinking water and health impacts. There are no specific medical tests that are recommended for these exposures. Instead, ATSDR recommends that individuals who think they may have been exposed to contaminated drinking water at Camp Lejeune monitor their health by having regular medical check-ups. We also encourage those persons to discuss this information with their physician, who can advise them on their personal health questions.

Additional Resources

• Journal Article (provisional)

Download as PDF [PDF, 217 KB]

Frequently Asked Questions

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

• Journal Article (provisional)

Download as PDF

Frequently Asked Questions

Study Purpose

The purpose of this cohort study of Camp Lejeune Marines/Navy personnel and civilian workers was to determine if being stationed or employed at Camp Lejeune between 1975 and 1985 (Marines/Navy personnel) or between October 1972 and December 1985 (civilian workers), a portion of the period when the drinking water was contaminated, increased the risk of specific causes of death during the follow-up period between 1979 and 2018 compared to being stationed or employed at Camp Pendleton.

What Was Studied

The Camp Lejeune Mortality Cohort Study was conducted of Marines and Navy personnel who, between 1975 and 1985, began service and were stationed at Camp Lejeune, North Carolina or Camp Pendleton, California and civilian workers employed at Camp Lejeune or Camp Pendleton between October 1972 and December 1985.

Camp Pendleton Marines/Navy personnel and civilian workers were chosen as the comparison groups in this study because the base’s finished drinking water was not known to be contaminated prior to 1986. Additionally, Camp Pendleton’s Marines/Navy personnel and civilian workers were similar to Camp Lejeune in terms of demographics, socioeconomic factors, training activities, personnel trained, and types of civilian employee occupations.

Features of this Study

Few studies have evaluated drinking water exposures to trichloroethylene (TCE), tetrachloroethylene (PCE), vinyl chloride, or benzene and the risk of specific causes of death. ATSDR previously conducted cohort Mortality Studies comparing Marines/Navy personnel and civilian workers stationed or employed at Camp Lejeune from 1975 to 1985 and 1972 to 1985, respectively, with similar cohorts over the same periods stationed or employed at USMC Base Camp Pendleton, California. The follow-up period for both of the previous Camp Lejeune mortality studies was between 1979 and 2008. The current cohort mortality study extends the follow-up period to 2018.

Conclusion and Key Results

Drinking water at U.S. Marine Corps Base Camp Lejeune, North Carolina was contaminated with TCE and other industrial solvents from 1953 to 1985. Increased risk of several causes of death was observed among Marines and civilian workers exposed to contaminated drinking water at Camp Lejeune compared to personnel at Camp Pendleton, which is not known to have similar drinking water contamination.

• In Marines and Navy personnel, increased risk of causes of death was observed for kidney, esophageal, and female breast cancer.
• Among civilian workers, increased risk of causes of death was observed for chronic kidney disease, Parkinson disease, and female breast cancer.

ATSDR Testing/Treatment Recommendations

This work is an update to the previous mortality studies published in 2014. It contributes to what is known about exposures to contaminated drinking water and health impacts. There are no specific medical tests that are recommended for these exposures. Instead, ATSDR recommends that individuals who think they may have been exposed to contaminated drinking water at Camp Lejeune monitor their health by having regular medical check-ups. We also encourage those persons to discuss this information with their physician, who can advise them on their personal health questions.

Additional Resources

• Journal Article (provisional)

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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