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Health effects linked with trichloroethylene (TCE), tetrachloroethylene (PCE), benzene, and vinyl chloride exposure

The effects of exposure to any chemical depend on—

  • When you are exposed (during pregnancy, in infancy, etc),
  • How much you are exposed to,
  • How long you are exposed,
  • How you are exposed (breathing, drinking), and
  • What your personal traits and habits are.

Therefore, not everyone who is exposed to trichloroethylene (TCE), tetrachloroethylene (PCE), benzene, or vinyl chloride exposure will develop a health problem.

ATSDR assessed 16 diseases in its document ATSDR Assessment of the Evidence for the Drinking Water Contaminants at Camp Lejeune and Specific Cancers and Other Diseases. This document combined the findings from ATSDR’s Camp Lejeune studies with findings from studies of other populations exposed occupationally or environmentally to TCE, PCE, vinyl chloride and benzene.

Listed below are the health effects where there is sufficient evidence for causation in people exposed occupationally or environmentally to the chemicals detected in the drinking water at Camp Lejeune. Evidence is considered sufficient for causation if there is 1) sufficient evidence from human studies in which chance and biases (including confounding) can be ruled out with reasonable confidence or 2) less than sufficient evidence from human studies but sufficient evidence in animal studies and strong evidence that the chemical acts through a relevant mechanism in humans.

Health effects with sufficient evidence for causation for TCE

  • Kidney cancer
  • Non-Hodgkin lymphoma
  • Cardiac defects

Health effects with sufficient evidence for causation for PCE:

  • Bladder cancer

Health effects with sufficient evidence for causation for benzene:

  • Leukemias
  • Non-Hodgkin lymphoma

Health effects with sufficient evidence for causation for vinyl chloride:

  • Liver cancer

Listed below are the health effects where the evidence is sufficient to conclude that a causal relationship is at least as likely as not, but not sufficient to conclude that a causal relationship exists (“equipoise and above”) in people exposed occupationally or environmentally to the chemicals detected in the drinking water at Camp Lejeune. In other words, equipoise and above means that there is enough research to support a link between the health effect and the exposure, but there is not enough research to definitively conclude that exposure causes the health effect. More research is needed to clearly show that the exposure causes the health effect.

Health effects with evidence that is equipoise and above for causation for TCE:

  • Leukemia
  • Liver cancer
  • Multiple myeloma
  • End-stage renal disease
  • Parkinson disease
  • Scleroderma

Health effects with evidence that is equipoise and above for causation for PCE:

  • non-Hodgkin lymphoma
  • End-stage renal disease

Health effects with evidence that is equipoise and above for causation for benzene:

  • Multiple myeloma

Additionally, listed below are other health effects that have been linked to TCE, PCE, benzene, and/or vinyl chloride in populations other than Camp Lejeune who worked with and/or drank water contaminated with these chemicals. These links are based on studies with positive associations between exposures to these chemicals and development of health effects.

Health effects with positive findings in at least one study that evaluated exposure to TCE and/or PCE:

  • Chonal atresia (nasal passages blocked with bone or tissue) (1, 2)
  • Eye defects (1, 2)
  • Low birth weight (3, 4)
  • Fetal death (1, 3, 5)
  • Major malformations (6)
  • Miscarriage (7, 8)
  • Neural tube defects (1, 2, 3)
  • Oral cleft defects (including cleft lip) (1, 2, 3)
  • Small for gestational age (1)
  • Breast cancer (9)
  • Cervical cancer (10)
  • Esophageal cancer (11, 12, 13)
  • Lung cancer (14)
  • Hodgkins disease (10)
  • Ovarian cancer (10)
  • Prostate cancer (10)
  • Rectal cancer (13)
  • Impaired immune system function (15)
  • Neurological effects (delayed reaction times problems with short-term memory, visual perception, attention, and color vision) (8)
  • Neurobehavioral performance deficits (i.e., delayed recall and deficits in visual perception), decreased blink reflex, and mood effects (i.e., confusion, depression and tension) (15, 16)
  • Severe, generalized hypersensitivity skin disorder (an autoimmune-related disease) (17)

Health effects with positive findings in at least one study that evaluated exposure to benzene:

  • Aplastic anemia (18)
  • Myelodysplastic syndromes (19)
  • Miscarriage (18)

Health effects with positive findings in at least one study that evaluated exposure to vinyl chloride:

  • Brain cancer (20)
  • Lung cancer (21)
  • Soft tissue cancer (20)
  • Liver cirrhosis (22)

Findings from ATSDR’s health studies at Camp Lejeune are available at https://www.atsdr.cdc.gov/sites/lejeune/activities.html.

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References

1. Massachusetts Department of Public Health, Centers for Disease Control and Prevention, Massachusetts Health Research Institute. 1996. Final report of the Woburn environmental and birth study. Boston, Massachusetts: Massachusetts Department of Public Health.

2. Bove F, Shim Y, Zeitz P. 2002. Drinking water contaminants and adverse pregnancy outcomes: a Review. Environ Health Perspect 110(S): 61-73.

3. Bove FJ, Fulcomer MC, Klotz JB, Esmart J, et al. 1995. Public drinking water contamination and birth outcomes. Am J Epidemiol 141:850-62.

4. Rodenbeck SE, Sanderson LM, Rene A. 2000. Maternal exposure to trichloroethylene in drinking water and birthweight outcomes. Arch Environ Health 55:188–194.

5. Bove FJ, Fulcomer MC, Klotz JB, Esmart J, et al. 1995. Public drinking water contamination and birth outcomes. Am J Epidemiol 141:850-62.

6. Khattak S, K-Moghtader G, McMartin K, Barrera M, et al. 1999. Pregnancy outcome following gestational exposure to organic solvents: a prospective controlled study. JAMA 281(12): 1106-09.

7. Pesticide and Environmental Toxicology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency. 1999. Public health goal for trichloroethylene in drinking water. Sacramento, California.

8. Pesticide and Environmental Toxicology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency. 2001. Public health goal for tetrachloroethylene in drinking water. Sacramento, California.

9. Aschengrau A, Rogers S, Ozonoff D. 2003. Perchloroethylene-contaminated drinking water and the risk of breast cancer: additional results from Cape Cod, Massachusetts, USA. Environ Health Perspect 111(2):167-73.

10. Wartenberg D, Reyner D, Scott CS. 2000. Trichloroethylene and cancer: epidemiologic evidence. Environ Health Perspect 108(S2):161-176.

11. National Toxicology Program (NTP). Report on carcinogens. 14th edition. Research Triangle Park, NC: US Department of Health and Human Services; 2016.

12. Mundt KA, Birk T, Burch MT. 2003. Critical review of the epidemiological literature on occupational exposure to perchloroethylene and cancer. Int Arch Occup Environ Health. 76:473-91.

13. Paulu C, Aschengrau A, Ozonoff D. 1999. Tetrachloroethylene-contaminated drinking water in Massachusetts and the risk of colon-rectum, lung, and other cancers. Environ Health Perspect 107(4):265-71.

14. Chiu WA, Jinot J, Scott CS, Makris SL et al. 2013. Human health effects of trichloroethylene: key findings and scientific issues. Environ Health Perspect 121:303-311.

15. Reif JS, Burch JB, Nuckols JR, Metzgar L, et al. 2003. Neurobehavioral effects of exposure to trichloroethylene through a municipal water supply. Environ Res 93:248-258

16. Feldman RG, Chirico-Post J, Proctor SP. 1988. Blink reflex latency after exposure to trichloroethylene in well water. Environ Health 43: 143-148.

17. Cooper GS, Makris SL, Nietert PJ, Jinot J. 2009. Evidence of Autoimmune-Related Effects of Trichloroethylene Exposure from Studies in Mice and Humans. Environ Health Perspect 117:696–702.

18. Khan HA. 2007. Short Review: Benzene's toxicity: a consolidated short review of human and animal studies. Hum Exp Toxicol. 26; 677-685.

19. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol 97: 1,3-Butadiene, Ethylene Oxide and Vinyl Halides (Vinyl Fluoride, Vinyl Chloride and Vinyl Bromide). Lyon, France 2008.

20. Bofetta P, Matisane L, Mundt KA, Dell LD. 2003. Meta-analysis of studies of occupational exposure to vinyl chloride in relation to cancer mortality. Scand J Work Environ Health. 29:220-229.

21. Scelo G, Constantinescu V, Csiki I, Zaridze D, et al. 2004. Occupational exposure to vinyl chloride, acrylonitrile and styrene and lung cancer risk (Europe). Cancer Causes Control. 15:445-452.

22. Grosse Y, Baan R, Straif K, Secretan B, et al. 2007. Carcinogenicity of 1,3-butadiene, ethylene oxide, vinyl chloride, vinyl fluoride, and vinyl bromide. Oncology: The Lancet. 8:679-680.

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