![]() ![]() ![]() This study was approved by the institutional review boards at the Durham VA Medical Center, The University of Texas Medical Branch, and the US Army Medical Research and Development Command Human Research Protection Office. Key to this proposal is the fact that all data from all VA sites are integrated into a common electronic medical record collated in VINCI. Using inpatient and outpatient data and fee-based or community care claims (ie, care provided outside the VA system for which the VA paid), we queried data from the VA Informatics and Computing Infrastructure (VINCI) to identify all veterans seen at any VA health system site from January 1, 2001, to December 31, 2019. To address these issues, we examined bladder cancer according to Agent Orange exposure using data from the largest integrated health system in the country, the VA health system. However, to our knowledge, such a comprehensive analysis of Agent Orange and bladder cancer has not been done to date, mainly due to the small numbers of exposed cases, the lack of ability to identify Agent Orange exposure, and the lack of an ability to control for known confounders, particularly smoking, a major bladder cancer risk factor. 6, 14 To provide a true measure of aggressive bladder cancer, it is crucial to study not just the diagnosis of bladder cancer but the aggressiveness of disease when diagnosed. 6 Based on this and the aforementioned studies, the US Department of Veterans Affairs (VA) recently designated bladder cancer as a cancer caused by Agent Orange exposure. 6, 7, 8, 9, 10, 11, 12, 13 The Institute of Medicine concluded that the association between Agent Orange exposure and bladder cancer outcomes is an area of needed research. To our knowledge, only limited data exist regarding the association of Agent Orange with bladder cancer risk and mortality, to date. One factor recently implicated is Agent Orange. 4, 5 However, many bladder cancer cases cannot be explained by the known risk factors, leading to a need to identify new risk factors. 3Īlthough smoking is one of the strongest bladder cancer risk factors, other risk factors include older age, male sex, and exposure to carcinogens, such as aromatic amines, inorganic arsenic, and polycyclic aromatic hydrocarbons. ![]() 1 Although most patients with bladder cancer receive a diagnosis of non–muscle-invasive disease (clinical stage T1 or less), 2 approximately 20% to 40% of patients either present with or later develop muscle-invasive disease. ![]() There will be an estimated 81 180 new cases of bladder cancer and 17 100 deaths from bladder cancer in the US in 2022. Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study collection, management, analysis, and interpretation of the data preparation, review, or approval of the manuscript and decision to submit the manuscript for publication.ĭisclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the US Department of Defense or US Department of Veterans Affairs.ĭata Sharing Statement: See Supplement 2. No other disclosures were reported.įunding/Support: This study was supported by grant W81XWH1710576 from the US Department of Defense Peer Reviewed Cancer Research Program (Dr Williams, Ms De Hoedt). Ms De Hoedt reported receiving grants from Janssen and Photocure outside the submitted work. Supervision: Williams, De Hoedt, Terris, Freedland.Ĭonflict of Interest Disclosures: Dr Williams reported receiving personal fees from Merck, Janssen, Photocure, Valar Labs, and Digital Media outside the submitted work. Obtained funding: Williams, Tyler, Freedland.Īdministrative, technical, or material support: Williams, De Hoedt, Tyler. Statistical analysis: Janes, Howard, Baillargeon. Williams, MD, MBA, MS, Division of Urology, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555 ( Contributions: Dr Williams had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.Ĭoncept and design: Williams, Janes, Yang, Baillargeon, Kuo, Tyler, Terris, Freedland.Īcquisition, analysis, or interpretation of data: Williams, Janes, Howard, De Hoedt, Baillargeon, Kuo, Terris, Freedland.ĭrafting of the manuscript: Williams, Janes, Yang, Baillargeon, Freedland.Ĭritical revision of the manuscript for important intellectual content: Williams, Janes, Howard, De Hoedt, Baillargeon, Kuo, Tyler, Terris, Freedland. ![]()
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