AFGSC, USAFSAM hold Missile Community Cancer Study virtual town hall Published March 13, 2024 By Col. Brus E. Vidal Air Force Global Strike Command Public Affairs BARKSDALE AIR FORCE BASE, La. -- Air Force Global Strike Command (AFGSC) Commander, Gen. Thomas A. Bussiere, held a virtual town hall Feb. 23 with current and former missile community members currently serving throughout several organizations to provide updates on environmental sampling results, Polychlorinated Biphenyls (PCBs) mitigation efforts, and the results from the first phase of the epidemiologic cancer study. A team comprised of experts and leaders from both the AFGSC Surgeon General’s Office, and the U.S. Air Force School of Aerospace Medicine (USAFSAM) began the virtual town hall by providing results from environmental sampling of all 45 Missile Alert Facilities (MAFs) at the three active Intercontinental Ballistic Missile (ICBM) wings. The results were the second of three seasonal rounds of testing, with 2,400 samples taken at each base. All air, water and soil samples were below laboratory limits of detection or were within acceptable regulatory levels for any chemicals or hazards, according to AFGSC Surgeon General, Col. Gregory A. Coleman. A graphic created in Adobe Illustrator, published on DVIDS April 11, 2024, is a revised version of the first iteration of the graphic which originally depicted the MCCS timeline as it began around Dec 2022; which was initially released via the AFGSC website March 13, 2024. The purpose of publishing this updated version April 11, 2024, on the AFGSC website and DVIDS was to provide corrections and clarity on some text statements that were written in the initial March 13 version. The changes made to the first version that are reflected in this second version are as follows. The end of the first sentence under “June – July 2023” was altered to combine it with the second, now showing, “…within AFGSC; begins combing…”; the word “PCB” in the headline title “PCB Identified & Mitigation Efforts Completed” was changed to “PCBs” to make the word plural and therefore more scientifically accurate; the date of “June 2024” was changed to “Summer 2024” for accuracy; the end half of the sentence under “June 2024” that said, “…a virtual pool of supplemental state and territory registries of cancer diagnoses.” Was replaced with, “…other cancer registries.” for accuracy and clarity; and lastly, the version date listed as “Current as of 13 March 2024” was changed to reflect the changes made between the initially released graphic and this revised version by having this statement be changed to say, “Current as of 20 March 2024”. The updates reflected in this second version (and now most current version) were requested by subject matter experts within the MCCS leadership team and were carried out with the guidance, outlined processes, and release authority of the AFGSC Public Affairs Office, and in alignment as required with the DoD Visual Information Style Guide; DoDI 5040.02, Visual Information (VI); DoDI 5040.07, Visual Information (VI) Productions; and AFI 35-101, Public Affairs Procedures. (U.S. Air Force graphic by Staff Sgt. Shelby Thurman) Photo Details / Download Hi-Res Additionally, PCBs were not detected at any of the six Missile Procedures Trainers (two per base), including individual air samples at each of the six trainers, and 108 total surface swipe samples collected. James M. Miller, Deputy Director, AFGSC Logistics and Engineering Directorate (A4), noted PCB cleaning efforts continue. A team of medical and bioenvironmental experts partnered with the AFGSC A4 Directorate, Twentieth Air Force A4 Directorate, the Minuteman III Special Program Office, and USAFSAM to develop iterative protocols to address potential future samples above the U.S. Environmental Protection Agency (EPA) standards, after four such samples were found during the first round of sampling. So far, two of the three MAFs have been cleaned to now be below EPA standards and re-opened for duty. Coleman and Miller discussed additional mitigation efforts in Launch Control Centers (LCCs), including: further verification of PCB-containing materials, environmental space upgrades, deep cleaning of LCCs, and establishing a recurring PCB-cleaning contract. Coleman said the next steps include creating standard PCB response procedures for any areas of concerns that may be identified in the future, establishing or updating Maintenance Technical Orders, establishing or updating bioenvironmental response checklists, establishing or updating Civil Engineering manuals, and refining Launch Facility (LF) sampling plans. Miller also noted that additional deep cleaning operations will be conducted as a separate effort from the establishment of the PCB-cleaning contract. This deep cleaning will be conducted systematically and incrementally over time to assure work centers are routinely cleaned to appropriate levels to assure overall cleanliness in order to prevent buildup of dirt, monitor for mold, and overall improve the living conditions and safety for the missileers performing 24-hour shifts at the sites. Col. Tory W. Woodard, USAFSAM Commander, announced that USAFSAM recently finished sampling at multiple operations and maintenance areas at Vandenberg Space Force Base, California, to include launch facilities- noting the results will ensure the safety of officers and maintainers working and training at Vanderberg SFB, and will also be used inform future LF testing across the ICBM wings. Moving to the Epidemiology Review, Woodard stated that Phase 1A of the study process is complete. In it, they have aggregated data from electronic military records from 2001-2020; including persons diagnosed with cancer who have utilized the military healthcare system and/or Tricare. The Epidemiology Review considers all core Air Force Specialty Codes working in MAFs and LFs. Woodard cautioned that comparing cancer rate data from Phase 1A to the general population is difficult at this time due to the limited breadth of the data reviewed thus far. USAFSAM will evaluate data across multiple overlapping databases as this review was only from one of them. He reported the initial data available at this time appears to show trends suggesting a potential increased incidence for breast and prostate cancer in the missile community. He did specifically note that this initial data did not show an increased incidence of Non-Hodgkin’s Lymphoma in Phase 1A. However, they will continue to analyze all data throughout the added subsequent phases to assure a thorough investigation is completed. Concerns about increased rates of Non-Hodgkins’s Lymphoma were the initial driver for the start of AFGSC’s study, which began one year ago as of this month. “This actually mirrors some other nationally published data reviewing cancer incidence in the U.S. military, which also suggests higher rates of breast and prostate cancer in service members,” Woodard noted. “What we don’t know is whether these rates specifically for breast and prostate are due to increased screening, or access to care, or whether these are due to unique miliary exposures. There is medical research that suggests increased access to care—i.e. free lifetime care—results in earlier cancer diagnosis and better outcomes.” Woodard and Coleman emphasized the Epidemiology Review is a multi-phase process involving studies across numerous databases, records and registries; Phases 1B, 1C and Phase 2 are still forthcoming. “We have five other data sets to study, and each additional data set will build our knowledge base and help to shape the larger picture,” Woodard said. “That picture will not be complete until we complete all phases of this Epidemiology Review.” Future phases will examine data obtained from the DoD Cancer Registry, the Veterans Affairs Cancer Registry, the National Death Index, and other pooled registries that pull data from across individual State cancer registries. This complex study will thus assure optimal capture of cancer cases and in-depth study of the cancer rates for those members who currently serve or previously served in the Missile Community. This look will also capture those who previously served at bases in the past that no longer have an active nuclear missile mission, such as Ellsworth Air Force Base, South Dakota; and Grand Forks AFB, North Dakota; among other locations. The way forward was also discussed. An important next step is ensuring appropriate hazard documentation for all missile-related personnel currently serving, in or out of the ICBM mission, by way of standardizing the records documentation process that uses a service member’s Individual Longitudinal Exposure Record (ILER). USAFSAM is working with the Defense Health Agency to identify solutions to improve the speed and thoroughness of documentation, including looking at a process for those who previously served. A process is still in development for those who previously served. Standardizing the records documentation is a process that will take time and one that will also improve over time, Woodard and Coleman said. USAFSAM is in the process of loading more than 70,000 data points obtained from their environmental sampling efforts into occupational exposure records, for example. Woodard and Coleman said the team recognizes there are specific women’s health concerns and are reviewing pregnancy profiling protocols “to ensure we are advising our missile operators appropriately.” They added that MCCS results will inform whether a deeper study of reproductive health concerns is needed. Woodard and Coleman also highlighted their continued stakeholder engagement continue, including discussions held in January with White House officials and PACT Act representatives to keep them appraised of the study’s progress. Monthly coordination meetings between members from USAFSAM, the AFGSC Surgeon General’s Office, the USAF Surgeon General’s Office, and the VA are continuing as well to ensure information is consistently shared among all entities. With Phase 1B of the Epidemiology Review underway and the third round of environmental sampling set for this Spring, Bussiere reinforced his long-standing personal pledge to transparency throughout the process. “Your safety and health are still my priority. My leadership team, our Air Force leaders and I take the responsibility to protect Airmen and Guardians extremely seriously,” Bussiere said during the virtual town hall. “I vow to maintain an open dialogue with you, your families, and the missile community past and present throughout this process.” “It’s also important to emphasize that nothing has changed regarding the level of support behind this effort from our senior leaders,” he added. “There remains a significant level of interest and engagement.” Bussiere closed by stating he knows there are likely more questions than time allowed during the town hall and encouraged anyone with a question to please ask. Questions can be submitted on the Missile Community Cancer Study website, through the QR code, and links on AFGSC and Air Force Surgeon General websites and social media. He also said missile community members can submit their question directly to him, AFGSC Deputy Commander Lt. Gen. Mike Lutton, Col. Coleman, or Col. Woodard. Additional questions can be submitted through the “Ask the Commander” portion on the AFGSC website’s Contact Us subpage form by clicking the drop-down menu and choosing “AFGSC Commander” as the intended recipient. To close out the virtual town hall, Bussiere continued to address the missile community members when he said, "Our team is doing a fantastic job with this study, and they are also laser-focused on addressing issues and concerns … there should be no obstacles to communication on this very important issue. I ask that you be persistent in highlighting areas that need to be highlighted to help us to get things right, but that you also be patient because there is still a lot to be done.” U.S. Air Force Logo Editor's Note: This article was updated on April 11, 2024, at 6:38pm CST. The revisions that occurred were that the accompanying graphic originally titled "Missile Community Cancer Study Current Timeline" was replaced with an updated version and this Editor's Note was added. The previous version of the graphic is still located in the top photo slideshow on this article, on the AFGSC website here, and on DVIDS for archival purposes. A graphic created in Adobe Illustrator, published on DVIDS and https://www.afgsc.af.mil/ April 11, 2024, is a revised version of the first iteration of the graphic (DVIDS Photo ID: 8294964/VIRIN: 240313-F-FG097-1001) which originally depicted the Missile Community Cancer Study’s timeline as it began around December 2022; which was initially released online via the Air Force Global Strike Command website on March 13, 2024, with the intention of accompanying the latest news article from AFGSC’s Public Affairs Office regarding the recent updates on the MCCS by way of a virtual town hall held Feb. 23, 2024, by AFGSC commander, Gen. Thomas A. Bussiere, with other senior Air Force leaders from the U.S. Air Force School of Aerospace Medicine and the AFGSC Surgeon General’s Office. The purpose of publishing this updated version April 11, 2024, on the AFGSC website and DVIDS was to provide corrections and clarity on some text statements that were written in the initial March 13 version (DVIDS Photo ID: 8294964/VIRIN: 240313-F-FG097-1001). The changes made to the first version that are reflected in this second version are as follows. The end of the first sentence under “June – July 2023” was altered to combine it with the second, now showing, “…within AFGSC; begins combing…”; the word “PCB” in the headline title “PCB Identified & Mitigation Efforts Completed” was changed to “PCBs” to make the word plural and therefore more scientifically accurate; the date of “June 2024” was changed to “Summer 2024” for accuracy; the end half of the sentence under “June 2024” that said, “…a virtual pool of supplemental state and territory registries of cancer diagnoses.” Was replaced with, “…other cancer registries.” for accuracy and clarity; and lastly, the version date listed as “Current as of 13 March 2024” was changed to reflect the changes made between the initially released graphic and this revised version by having this statement be changed to say, “Current as of 20 March 2024”. The updates reflected in this second version (and now most current version) were requested by subject matter experts within the MCCS leadership team and were carried out with the guidance, outlined processes, and release authority of the AFGSC Public Affairs Office, and in alignment as required with the DoD Visual Information Style Guide; DoDI 5040.02, Visual Information (VI); DoDI 5040.07, Visual Information (VI) Productions; and AFI 35-101, Public Affairs Procedures.