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Part A: Medical History

Question A1
Question A2
Question A3
Question A4
Question A5
Question A6
Question A7
Question A8
Question A9
Question A10
Question A11
Question A12

 

Question A1 Have you suffered from any of the following medical conditions which you feel may be related to your service in Vietnam?

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Question A1.1 -- Hearing

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Hearing or Ear Problems	40 (18%)	27b	26-29
	32-48a

a 95% confidence interval for number of veterans reporting condition
b Expected based on Australian estimates of age- and sex-specific prevalence of long term conditions. Calculated using National Health Survey (NHS) data. First results ABS catalogue No 4392.0 ²

Comment on Comparison

The ranges indicate an excess of this condition for female Vietnam veterans. The expected numbers are based on prevalence of long term complete or partial deafness which are probably much more restrictive criteria than used by the veterans in responding to this question. The rate reported by female veterans (18%) was substantially less than the rate reported by male veterans (55%).

Conclusion

There is a statistically significant excess of hearing and ear problems among female veterans.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A1.2 -- Haemorrhoids

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Haemorrhoids	21 (9%)	11b	10-13
	15-27a

a 95% confidence interval for number of veterans reporting condition
b Expected based on Australian estimates of age- and sex-specific prevalence of long term conditions Calculated using NHS 1995 First results: ABS catalogue No 4392.0 ²

Comment on Comparison

The ranges indicate an excess of this condition for female Vietnam veterans. The reported occurrence of haemorrhoids among female veterans is approximately one third of that reported amongst male veterans (9% vs 28%). As noted in the report on male veterans, direct comparison with the National Health Survey (NHS) should only be made with caution due to possible under-reporting in the NHS.

Conclusion

There is a statistically significant excess of this condition when compared to the general population.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A1.3 -- Panic Attacks

Condition	Number of Veterans Reporting Condition	Expected Number
Panic Attacks	30 (13%)	4b
	22-38a

a 95% confidence interval for number of veterans reporting condition
b Expected based on sex-specific annual prevalence estimate of panic disorders in ABS Mental Health and Wellbeing: Profile of Adults. Catalogue no. 4328.0, 1997³

Comment on Comparison

The prevalence of panic attacks reported by veterans appears high but this may be due to the fact that the ABS survey is estimating 12 month prevalence, not adult lifetime prevalence, as in the veterans survey.

In addition, because clinical definitions were not provided with the veterans survey, respondents may have included general anxiety disorders in this question while the NHS offered a more precise definition of panic disorder.

Consequently, the prevalence of panic attacks reported by veterans should be considered in conjunction with other psychological indicators such as anxiety, depression and post traumatic stress disorders, which are discussed in questions A1.5, A1.6, and A2.5. The rate reported by female veterans (13%) was substantially less than the rate reported by male veterans (30%).

Conclusion

There is a statistically significant excess of panic attacks reported by female veterans.

The male Vietnam veterans study report recommended that:

• the level and type of treatment and counselling resources available to treat panic attacks and other mental health conditions experienced by veterans should be reviewed for adequacy;
• while recognising the importance of PTSD, there be a broader diagnostic and treatment focus on other mental health conditions common in veterans; and
• the survey results should be referred to the RMA as evidence of the need to establish a specific Statement of Principle (SoP).

The findings of the female survey on psychological conditions reinforce this recommendation.

Question A1.4 -- Migraine

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Migraine	25 (11%)	6b	5-7
	18-32a	42c	40-44

a 95% confidence interval for number of veterans reporting condition
b Calculated using NHS 1995 First results: ABS catalogue no. 4392.0 using Recent Migraine²
c Calculated using NHS 1995 First results: ABS catalogue no. 4392.0 using Recent Headache²

Comment on Comparisons

Migraine is a particular type of headache with specific clinically recognised symptoms. People experiencing severe headaches may assume they are suffering from a migraine when they do not in fact have the symptoms necessary for a clinical diagnosis.

In the veterans survey there was no opportunity to report on the occurrence of headaches, nor was a definition of migraine given. It is therefore reasonable to assume a degree of misclassification may have occurred. Because of this the NHS data on recent migraine alone and recent migraine and recent headache have been used for comparison. It should also be noted that the NHS survey does not seek specific information about migraine or headache, but draws this information from questions about general health and service utilisation.

Conclusion

Given the problems associated with diagnosis and misclassification, a difference in migraine prevalence between the female veterans and the general population remains uncertain.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A1.5 -- Anxiety Disorders

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Anxiety Disorders	38 (17%)	30b	25-34
	30-46a	25c

a 95% confidence interval for number of veterans reporting condition
b Using prevalence estimates from a sample of patients at Sydney GPs, derived from Harris⁴
c Expected based on sex- and age-specific 12 month prevalence from ABS Mental health and wellbeing: Profile of adults³

Comment on Comparisons

As Harris does not present prevalence rates according to sex, the rates calculated in this comparison assume equal prevalence in the males and females. This assumption is only made with caution, as there are many possible reasons for a gender difference.

The expected figures based on the ABS survey are for a 12 month prevalence among women and the definition includes panic disorder, agoraphobia, social phobia, and generalised anxiety disorders.

Conclusion

The prevalence of anxiety disorders reported by female veterans is less than half that reported by male veterans. Although it is higher than the prevalence in the comparison groups it falls within the confidence interval and is not, therefore, statistically significant.

Nevertheless, the conclusion on the provision of a wider range of support for psychological conditions, which was reached under the question on Panic Attacks, (Question 1.3 above) should be noted.

Question A1.6 -- Depression

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Depression	39 (17%)	19b	15-22
	31-47a	22c	13-31
		14d

a 95% confidence interval for number of veterans reporting condition
b Using prevalence estimates derived from Harris⁴
c Expected based on prevalence of specific diagnostic criteria of depressive disorders in patients in a rural primary care setting in the USA, derived from Barrett⁵
d Expected based on sex- and age-specific 12 month prevalence of affective disorders (depression and dysthymia) in ABS Mental health and wellbeing: Profile of adults³

Comment on Comparisons

The comparison studies capture the difficulties (such as regional variations) in defining depression. Harris reported a general prevalence of depression in Sydney general practice patients of approximately 7.5% based on an abnormal score on a general health questionnaire ⁴. The ABS estimate is based on age-specific prevalence for Australian women in a national survey over a twelve month period, rather than adult lifetime prevalence as reported by female veterans. Barrett found a general prevalence of specific depressive disorders of 10%, but identifies an additional 11% prevalence of other significant symptoms of depression⁵.

As indicated for the condition of anxiety above, the expected number and range are based on the assumption of equal prevalence in males and females, however Barrett identified a higher prevalence of certain disorders among women and among those who had never married. Adjustment of the expected range to take account of this was not possible. It suggests, however, that the difference between the confidence interval for the number of veterans reporting the condition and the expected ranges may be less than the statistically significant difference indicated in the table. The rate reported by female veterans (17%) was substantially less than the rate reported by male veterans (45%).

Conclusion

There appears to be a statistically significant excess of depression among female veterans. This may be due to the time periods and definitions used in the comparisons.

The conclusion on the provision of a wider range of support for psychological conditions reached under the question on Panic Attacks, (Question 1.3 above) is relevant to this finding.

Question A1.7 -- Alcohol and Drug Abuse

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Alcohol and Drug Abuse	19 (9%)	14b	13-15
	13-25a	12c	9-14
		4d

a 95% confidence interval for number of veterans reporting condition
b Using prevalence estimates for medium-high risk drinking from NHS 1995 First results ABS Catalogue no. 4392.0²
c Using prevalence estimates for intermediate- to very high- risk from National Heart Foundation Prevalence Study 1989⁶
d Using 12 month prevalence of substance abuse (alcohol / drugs) from ABS Mental health and wellbeing: Profile of adults³

Comment on Comparisons

The expected numbers and ranges generated for this question provide only approximate comparisons. This is because the veterans survey reports on alcohol or drug abuse while the National Heart Foundation (NHF) and the NHS surveys specify 'risk behaviour' for alcohol consumption and do not consider drug abuse. Further, the NHF survey defines risk according to number of drinks taken per week (with an average of 5-8 standard drinks daily constituting high risk) while the NHS assigns risk according to volume of alcohol consumed (where greater than 50mls daily consumption constitutes high risk).

In each instance the high risk groups for alcohol consumption were taken as the best available comparisons. As a result, the expected numbers at b and c and their corresponding ranges do not include drug use. There may be an underestimate of community prevalence of drug use in these data, as it has also been established that 2.3% of women aged 40-54 report weekly use of cannabis⁷. The expected figure d, based on both alcohol and/or drug abuse, is considerably lower than the number of veterans reporting this condition. This may be due to the limitations of using twelve month prevalence.

Conclusion

Because of the different questions asked in the various surveys, no definitive comparison with the community can be made. The possible slight excess in the prevalence of alcohol and drug abuse among female veterans is not statistically significant.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A1.8 -- Insomnia and Sleep Disturbance

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Insomnia and Sleep	50 (22%)	7b	6-8
Disturbance	41-59a	135c	126-144

a 95% confidence interval for number of veterans reporting condition
b Using prevalence estimates for recent insomnia from NHS 1995 First results ABS Catalogue no. 4392.0²
c Using prevalence estimates for current insomnia derived from Bixler⁸

Comment on Comparisons

The differences between the prevalence estimates for insomnia are the result of the definitions used in the different studies. The definitions used by Bixler did not specify a reference period or offer a definition of insomnia (using instead difficulty falling asleep, difficulty staying asleep, or early final awakening). Because of this, Bixler's study is likely to overestimate the prevalence of insomnia in the community. The NHS data probably under-represents insomnia and sleeping disorders, as that survey did not specifically ask about insomnia but drew its conclusions from health-seeking actions of respondents and the figures are only based on recent insomnia.

Conclusion

Caution should be exercised when considering these community data because the divergent definitions and reference periods used in the different studies make comparisons difficult.

Recognising these limitations, there does not appear to be an excess of this condition among female veterans.

Question A1.9 -- Not Suffered from Any of the Conditions in Question A1

A total of 135 of the respondents (61%) reported they had not suffered from any of the conditions listed in this question, or did not believe they were linked to their service in Vietnam. This is considerably larger than the corresponding percentage for male veterans (20%).

 

Question A2 Since your first day of service in Vietnam, have you ever been told by a doctor that you have any of the following medical conditions?

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Question A2.1 -- Gastric Reflux

Condition	Number of Veterans Reporting Condition	Expected Number
Gastric Reflux	56 (25%)	11 (5%)b
	46-66a	33 (15%)c

a 95% confidence interval for number of veterans reporting condition
b Calculated using estimates for oesophagitis among people over 55 years of age⁹
c Calculated using estimates for heartburn⁹

Comment on Comparisons

The female veterans survey did not offer a diagnostic definition of gastric reflux, which may reflect the fact that it is difficult to distinguish gastric reflux disease and oesophagitis based on symptoms alone. Pregnancy, the symptoms of oesophagitis and heartburn, and disorders of the hiatus hernia and lower oesophageal sphincter, all contribute to gastric reflux which is a very common ailment⁹.

The community comparison used was based on a study of hospital employees in the United States and found that for the duration of the study, 7% of subjects experienced heartburn daily, 15% experienced heartburn monthly, and 5% of people over 55 suffered from oesophagitis⁹. As veterans were asked to report on gastric reflux since their first day of service in Vietnam, their prevalence of this condition is likely to be somewhat higher than the prevalence reported by Kahrilas⁹. The comparison study was not sufficiently detailed to allow for the calculation of an expected range.

The rate reported by female veterans (25%) was less than the rate reported by male veterans (30%).

Conclusion

There is an apparent excess of this condition, however because of the lack of precision defining this condition in both the survey population and the community comparison, this finding should be interpreted with caution.

Question A2.2 and A2.3 -- Ulcer (Stomach or Duodenal)

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Stomach ulcer	15 (7%)
	8-22a
Duodenal	9 (4%)
	3-15a
Stomach or Duodenal	22 (10%)	17b	15-18
	15-29a

a 95% confidence interval for number of veterans reporting condition
b Calculated using prevalence of recent and long term conditions, NHS 1995 First results: ABS catalogue no. 4392.0²

Comment on Comparison

Separate expected numbers and ranges for stomach and duodenal ulcers could not be obtained from the NHS. Because the expected prevalence combines recent and long-term conditions, some double counting of ulcers may have occurred. Despite this possible double counting, the NHS may still underestimate adult lifetime prevalence since ulcers are treatable and the NHS only reports a 12 month prevalence.

In the survey, veterans were asked to report stomach or duodenal ulcers since their first day of service in Vietnam regardless of the effects of treatment. Veterans may also have reported symptomatic gastritis and oesophagitis as ulcers.

Conclusion

The reported prevalence of ulcers is not markedly different from the prevalence in the community.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A2.4 -- Cirrhosis of the Liver

Comment on Comparisons

One case (<1%) of cirrhosis of the liver was reported in the study population. The prevalence of this condition is affected by environmental exposures, most notably alcohol consumption and exposure to hepatitis. In turn, these factors are affected by cultural practices, gender and international patterns of infectious disease¹⁰.

Statistical comparisons between different populations should therefore only be made with caution and have not been made in this instance, as the prevalence among female veterans was low. The community comparisons used in the male Vietnam veterans study looked at cirrhosis among men and were therefore not applicable for this study. No alternative comparisons could be located.

Conclusion

One case does not represent an excess.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A2.5 -- Post Traumatic Stress Disorder

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Post Traumatic Stress	27 (12%)	22b	10-34
Disorder (PTSD)	20-34a

a 95% confidence interval for number of veterans reporting condition
b Calculated using female age- and marital status-specific lifetime prevalence estimates derived from a US national survey ¹¹

Comment on Comparison

This condition can be caused by any number of traumatic events. Because no comparable Australian data exist, the expected range is calculated from a slightly younger US comparison population. Although there is potential for underestimation of the prevalence of PTSD due to the possibility that some cases may be misclassified as panic attacks or anxiety disorder, the comparison indicates that an excess in the female veterans is unlikely.

The prevalence of PTSD in females is less than half that among male veterans (12% vs 31%).

Conclusion

PTSD does not appear to be excessive among female veterans.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment. Nevertheless, the conclusion on the provision of a wider range of support for psychological conditions which was reached under the question on Panic Attacks, (Question 1.3 above) should be noted.

Question A2.6 -- High Blood Pressure

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
High Blood Pressure	52 (23%)	53b	51-55
	43-61a	66c	61-71

---

a 95% confidence interval for number of veterans reporting condition
b Calculated using NHS 1995 First results: ABS catalogue no 4392.0² using long-term hypertension (self-reported health service utilisation)
c Calculated using National Heart Foundation Risk Factor Prevalence Study 1989⁶ using prevalence of hypertension, determined by objective measurement

Conclusion

The prevalence of high blood pressure among female Vietnam veterans is commensurate with that in the general community. This contrasts with the excess of high blood pressure reported by male veterans.

Question A2.7 -- Allergies

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Allergies	39 (17%)	32b	30-33
	31-47a	46c	44-48

a 95% confidence interval for number of veterans reporting condition
b Calculated using NHS 1995 First results: ABS catalogue no 4392.0² using Hayfever (long-term)
c Calculated using NHS 1995 First results: ABS catalogue no 4392.0² combining Hayfever and unspecified allergies (long-term)

Comment on Comparisons

Veterans were not asked to specify the allergies they suffered from. Two expected numbers were calculated, using firstly data for hayfever, and secondly, hayfever and unspecified allergies. This may have resulted in an overestimation of community prevalence as double counting may have occurred.

Conclusion

The rate of allergies among female veterans does not appear to exceed levels in the general population.

Question A2.8 -- Asthma

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Asthma	30 (13%)	19b	17-20
	22-38a	12c	11-14

a 95% confidence interval for number of veterans reporting condition
b Calculated using NHS 1995 First results: ABS catalogue no 4392.0² using asthma (long-term)
c Calculated using NHS 1995 First results: ABS catalogue no 4392.0² using asthma (recent)

Comment on Comparisons

Asthma is a common problem in the Australian population. The prevalence of asthma reported by female veterans exceeded expectations based on NHS data, and was higher than the rate reported by male veterans (10%).

Conclusion

There is a statistically significant excess in the number of female veterans reporting asthma.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment. However, it is recommended that this finding be referred to the RMA for information.

Question A2.9 -- Other Respiratory Disorders

Twenty-four (11%) of the veterans reported other (unspecified) respiratory conditions. As the nature of these conditions was not revealed, community comparisons could not be made.

Question A2.10 -- None of the conditions listed in A2

One hundred and three (46%) of the veterans did not report any of the conditions listed. This is higher than the corresponding percentage for the male veterans (29%).

 

Question A3 Since your first day of service in Vietnam, have you been told by a doctor that you have any of the following medical conditions:

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Question A3.1 -- Hepatitis

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Hepatitis	17 (8%)
	11-23a
Hepatitis A	9 (4%)	1b	1-1
	5-13a
Hepatitis B	4 (2%)	0b	0-0
	1-10a
Hepatitis C	2 (1%)	1b	0-1
	0-7a	3c	1-4

a 95% confidence interval for number of veterans reporting condition
b Calculated using national annual disease notification rate, 1996¹²
c Calculated using prevalence from a survey of pregnant women in South Australia¹³

Comment on Comparisons

There are a number of types of hepatitis, some of which can be accurately determined by blood tests, while diagnostic techniques for others are unreliable. The notification rates were assumed constant across thirty years to calculate adult lifetime prevalence. As not all cases of hepatitis are reported, the notification rates are likely to provide an underestimation of these conditions in the community. Relevant comparison studies from occupational groups, including the lifetime prevalence of hepatitis related to needle-stick injuries in Australian nurses, were not available. The rate reported by female veterans (8% overall) was higher than the rate reported by male veterans (4% overall).

Conclusion

There is a statistically significant excess in the prevalence of hepatitis A (4%) and hepatitis B (2%) among female veterans when compared with expected rates among Australian women of a similar age.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment. However, it is recommended that this finding be referred to the RMA for information.

Question A3.2 -- Malaria

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Malaria	6 (3%)	0b	0-0
	2-10a

a 95% confidence interval for number of veterans reporting condition
b Calculated using national annual disease notification rate, 1996¹²

Comment on Comparison

The prevalence of malaria in female veterans (3%) is higher than expected for the general community but lower than the prevalence reported among male veterans (8%). The occurrence of malaria during and occasionally after service might be expected, given the geo-climatic conditions in Vietnam. However, it is also noted that armed service veterans at least, were subject to an imposed prevention regime.

Conclusion

There is a statistically significant excess of this condition among female veterans.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A3.3 -- Strongyloides Worm Infection

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Strongyloides Worm Infection	2 (1%)	no community comparison available	0-9b
	0-7a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Mahmoud¹⁴

Comment on Comparison

The prevalence reported by veterans was within Mahmoud's range estimates of 0-4% for the south-eastern United States¹⁴. No expected number could be given since the comparison population prevalence was given as a range rather than a point estimate.

Conclusion

There does not appear to be an excess of this condition among female veterans.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment. However, as noted in the male veterans study, strongyloides is a condition that can be aggravated by treatments used to contain cancer. As female veterans reported an elevated risk of developing cancer (See Question A6) the recommendation made in the male veterans morbidity study that DVA notify oncologists that Vietnam veterans are a high risk group for strongyloides is reinforced.

Question A3.4 -- Motor Neurone Disease

Condition	Number of Veterans Reporting Condition	Expected Number
Motor Neurone	0 (0%)	0b
	0-4a

a 95% confidence interval for number of veterans reporting condition
b Calculated using an estimated average annual incidence rate for US white females¹⁵

Conclusion

Motor neurone disease is a rare condition. That no cases were identified is consistent with the prevalence rate of 5 per 100 000 reported by Kurtzke¹⁵. There was an unexpectedly high number of male Vietnam veterans reporting this condition and validation of those responses is to occur.

Question A3.5 -- Multiple Sclerosis

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Multiple Sclerosis	1 (<1%)	0b	0-0
	0-6a

a 95% confidence interval for number of veterans reporting condition
b Calculated using crude population prevalence for Australian females aged 20 and over ¹⁶

Comment on Comparison

Hammond et al. report on rates of multiple sclerosis according to socio-economic factors including educational status¹⁶. They found that there was a statistically significant association between level of education and the occurrence of multiple sclerosis, with age-adjusted prevalence rates for women over the age of twenty ranging between 24.8 cases per 100 000 women with trade or technical certificates, 164.1 cases per 100 000 women with a diploma, and 102.2 cases per 100 000 women with university degrees. The number of women involved in the veterans study was too small to allow meaningful comparison with those data.

Conclusion

There is not a statistically significant excess of multiple sclerosis reported by female veterans. However, it is noted that the prevalence of multiple sclerosis reported in the male study was higher than expected and validation of these responses is to occur. It is recommended that the one reported case in female veterans be considered alongside the results of the male validation study.

Question A3.6 -- Ischaemic Heart Disease

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Ischaemic Heart Disease	25 (11%)	9b	8-10
	16-34a	6c	5-7
		15d	14-17

a 95% confidence interval for number of veterans reporting condition
b Expected calculated using heart disease (long-term), using NHS 1995 First results: ABS catalogue no 4392.0²
c Expected calculated using heart disease (recent), using NHS 1995 First results: ABS catalogue no 4392.0²
d Calculated using heart disease (Long-term and recent), using NHS 1995 First results: ABS catalogue no 4392.0²

Comment on Comparisons

Heart disease is defined differently in the NHS and the veterans survey. Veterans may have included conditions such as high blood pressure or high cholesterol which are not part of a clinical definition of ischaemic heart disease, yet contribute to heart problems. The Vietnam Veterans Mortality Study¹⁷ indicated that the rate of mortality from heart disease was higher than expected among male veterans, however women were not included in that study. The rate reported by female veterans (11%) was somewhat less than the rate reported by male veterans (15%) in Volume I of this study.

Conclusion

Two of the comparisons tabulated indicate a statistically significant difference between the prevalence reported by veterans and the prevalence expected in the community. Therefore, there may be a statistically significant excess of ischaemic heart disease among female veterans.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

Question A3.7 -- Not suffered from any of the conditions in Question A3

One hundred and seventy-six (79%) of the female Vietnam veterans indicated they had not suffered from the conditions or diseases listed in question A3. Due to the unspecified nature of this question no comparable community data were sought.

This percentage is similar to the corresponding figure for the male veterans (75%).

 

Question A4 Since your first day of service in Vietnam, have you been told by a doctor that you have diabetes?

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Question	Number of Veterans Reporting Condition	Expected Number	Expected Range
Since your first day of service in Vietnam, have you been told by a doctor that you have diabetes?	5 (2%)	10b	9-11
	2-11a

a 95% confidence interval for number of veterans reporting condition
b Based on age- and sex-specific prevalence of long term conditions using NHS 1995: ABS catalogue 4392.0²

Comment on Comparison

This condition was not defined in the questionnaire, thereby allowing the possibility that veterans may have interpreted a single high sugar value as diabetes. These conditions are separated in the NHS, wherein most cases reported would be non-insulin-dependent diabetes mellitus. The latter condition is relevant to a comparison with the veterans, among whom insulin-dependent diabetes, usually of juvenile onset, would be very unlikely.

Conclusion

The reported prevalence of diabetes amongst female Vietnam veterans does not exceed the level reported in the general population.

The VEA allows that following diagnosis and acceptance of a claim for this condition, eligible veterans will be entitled to compensation and or treatment.

 

Question A5 Since your first day of service in Vietnam, have you had a hysterectomy?

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Question	Number of Veterans Reporting Condition	Expected Number	Expected Range
Since your first day of service in Vietnam, have you had a hysterectomy?	61 (28%)	62b	60-64
	51-71a

a 95% confidence interval for number of veterans reporting condition
b Calculated using NHS First results: ABS catalogue no. 4392.0²

Comment on Comparison

The expected number was calculated using age-specific incidence rates from the NHS. These data provide a reliable community comparison.

The veterans' response may have been affected by the sampling bias introduced by the failure to locate a larger proportion of the total cohort of female veterans and the possible under-representation of married veterans.

Conclusion

On the data available, the proportion of veterans who have had a hysterectomy is much the same as might be expected in Australian women in a similar age group.

 

Question A6 Since your first day of service in Vietnam, have you been told by a doctor that you have cancer?

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Question	Number of Veterans Reporting Condition	Expected Number
Since your first day of service in Vietnam, have you been told by a doctor that you have cancer?	67 (30%)a	no comparative data availablec
	57-77b

a Total number of cancers reported by veterans
b 95% confidence interval for number of veterans reporting condition
c Cancer accounted for 24% of female deaths in Australia in 1990³⁵; the lifetime prevalence of cancer would exceed this figure, consistent with the 30% reported by veterans here.

Comment

A total of 67 (30%) of the respondents reported they had been diagnosed with cancer since their first day of service in Vietnam. These 67 veterans reported a total of 91 cancers.
Three veterans reported three cancers, 18 reported two cancers, and the remaining 46 veterans reported one cancer each.

The comparison implied at note c above needs to be interpreted with caution. Cancer Registry data exclude non-melanocytic skin cancers, whereas the veterans survey included this condition.

 

Question A7 What type of cancer?

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General

With the exception of cancer of the fallopian tubes and hydatidiform mole, the age-specific prevalence estimate for each cancer listed below, and the approximate 95% confidence interval for this estimate, is calculated using Australian Institute of Health and Welfare and Australasian Association of Cancer Registries data¹⁸ . The International Classification of Diseases (ICD) code has also been listed for each cancer.

Estimates of the numbers of people living with cancer were calculated by determining the prevalence of each cancer, then subtracting the expected number of deaths. Approximate prevalence estimates were obtained by a similar method to that used in the male veterans survey: the number of veterans in each 5-year age cohort was multiplied by the 5-year age-specific risk for the incidence of the cancer. As the cancer registry data reports lifetime prevalence but veterans were asked about the occurrence of cancers since their service in Vietnam, the 5-year age-specific mortality from cancer from the age of 20 to the current age was subtracted from this total.

SoPs exist for those cancers surveyed in the questionnaire with the exception of hydatidiform mole. These SoPs allow veterans to claim compensation if they are suffering from cancer. Treatment for cancer is also provided, separately from the compensation regime.

Overall, the responses to Questions A7-1 to A7-16 given below indicate that female veterans have a statistically significant increased risk of developing cancer of any type (all cancers considered together) when compared to the community. Because of the small number of women participating in the survey this increase was not statistically significant for most cancers considered by individual type. This increase should be viewed alongside the excess of cancers reported in the Male Vietnam Veterans Morbidity Study and the rates of cancer deaths reported in the Vietnam Veterans Mortality Study¹⁷.

The responses to the male survey are to be validated to establish the reliability of the results. Because of the low numbers of female responses to cancers, and because of the potential to cause distress for no solid evidentiary purpose, it is not recommended that the female results to cancer be validated. However, it is recommended that the female results be considered alongside the results of the male veterans validation study.

Question A7.1 -- Melanoma

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Melanoma	7 (3%)	3b	1-8
	3-14a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 172

Conclusion

The prevalence of melanomas reported in the female veterans study is similar to the prevalence in the general population. The slight excess of melanomas reported by female veterans was not statistically significant.

Question A7.2 -- Other Skin Cancer (Basal Cell Carcinoma or Squamous Cell Carcinoma)

Non-melanocytic skin cancers were reported by 37 veterans (17%). These skin lesions are often removed without pathological confirmation and their prevalence is not monitored by cancer registries, so proper comparisons are not calculable.

Question A7.3 -- Cancer of the Head and Neck

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Cancer of the Head and Neck	5 (2%)	1b	0-5
	2-11a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 146-148, 161, 191-193

Conclusion

Cancers are usually diagnosed as being organ based. As this question asked about the occurrence of cancers in the region of the head and neck rather than in specific organs, cancers other than thyroid, larynx and pharynx may have been included. For the purposes of comparison we have considered cancers of the oropharynx, nasopharynx, hypopharynx, larynx, brain and nervous system and thyroid. The difference between the veterans and the community is not statistically significant.

Question A7.4 -- Leukaemia

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Leukaemia	1 (<1%)	0b	0-4
	0-6a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 204-208

Conclusion

The small numbers involved in this survey reduce the reliability of statistical comparisons. While the reported prevalence of leukaemia does not appear to be higher than expected for this population, the finding above should be considered alongside the results of the male veterans morbidity validation study.

Question A7.5 -- Non-Hodgkin's Lymphoma

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Non-Hodgkin's Lymphoma	2 (1%)	0b	0-4
	0-7a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 200, 202

Comment on Comparison

In a population as small as the female veteran study, one would not expect to find cases of non-Hodgkin's lymphoma. The finding of two cases was not a statistically significant excess, however it should be noted that an apparent excess of this condition was reported among male Vietnam veterans.

Conclusion

While there was no statistically significant excess of this cancer, the finding above should be considered alongside the results of the male veterans morbidity validation study.

Question A7.6 -- Soft Tissue Sarcoma

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Soft Tissue Sarcoma	2 (1%)	0b	0-4
	0-7a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 171

Comment on Comparison

One would not expect to find any cases of soft tissue sarcoma in a group the size of the female veteran population. The two cases that have occurred can be accounted for within the range of expected responses.

Conclusion

While there was no statistically significant excess of this cancer, the finding above should be considered alongside the results of the male veterans validation study.

Question A7.7 -- Cancer of the Colon

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Cancer of the Colon	1 (<1%)	1b	0-5
	0-6a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 153

Conclusion

The reported prevalence of colon cancer among female veterans corresponds to expected community rates.

Question A7.8 -- Cancer of the Ovaries (including other uterine adnexa)

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Cancer of the Ovaries	1 (<1%)	0b	0-4
	0-6a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 183

Conclusion

The reported cumulative prevalence of ovarian cancer does not exceed the rate expected in a group of Australian women matched for age.

Question A7.9 -- Breast Cancer

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Breast Cancer	17 (8%)	5b	2-11
	11-23a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Australian Cancer registry data¹⁸ ICD 174-175

Comment on Comparison

Risk of breast cancer is associated with a number of factors including low number of pregnancies, childlessness or mothers giving birth to their first children at an older age¹⁹. The method used to contact female veterans probably contributed towards an under-representation of married respondents to the survey. Responses to Question B1 indicate that, of those who did respond, there was a lower than expected number who had ever married and a lower than expected number of children born to survey participants.

Conclusion

There is a statistically significant excess of breast cancer in the study population.

The implication of this is difficult to judge given the probable existence of the non-war-related risk factors for breast cancer, as explained above. However, contributory environmental exposures in Vietnam cannot be ruled out.

This finding should be considered alongside the results of the male veterans validation study for cancers as a whole.

Question A7.10 -- Cancer of the Fallopian Tubes

There were no cases of cancer of the fallopian tubes reported by female Vietnam veterans. This is an extremely rare condition and is not separately tabulated in the standard cancer incidence reports. A reported rate of 3.6 cases per million indicates that none would be expected in the study population^{20, 42}.

Question A7.11 -- Endometrial (Uterine) Cancer

Condition	Number of Veterans Reporting Condition	Expected Number	Expected Range
Endometrial (Uterine) Cancer	4 (2%)	1b	0-5
	1-10a

a 95% confidence interval for number of veterans reporting condition
b Calculated using Lawton^{20, 42}. ICD 179, 182

Conclusion

The apparent excess of endometrial cancer among female veterans was not statistically significant.

Question A7.12 -- Cancer of the Cervix

Condition

Number of Veterans Reporting Condition

Expected Number

E