Cohort study of the association of exposure to Agent Orange and hepatocellular carcinoma among US military personnel

Incidence and mortality of hepatocellular carcinoma (HCC) are increasing. Viral hepatitis and alcohol use are known risk factors; however, other risk factors are less defined, including Agent Orange (AO), an herbicide linked to several cancers. A retrospective cohort study of 296,505 Vietnam veterans, who served between 1966 and 1975, found no association between AO exposure and incident HCC. Among these veterans viral hepatitis, nonalcoholic fatty liver disease, and alcohol and tobacco use were the most important clinical risk factors for HCC, which were further modified by cirrhosis status.