U.S. Air Force School of Aerospace Medicine (USAFAM) completed a review of Malmstrom cancer concerns in 2001 showing no increased rates of non-Hodgkin lymphoma among missileers. The evaluation included record reviews encompassing 1991-2000, and it included site sampling. However, we acknowledge time has passed and have the responsibility to investigate any potential service-related risks to Airmen, Guardians or their dependents’ health. We take this responsibility seriously.

The USAF continues to employ significant resources to ensure the safety of force and family.  For example, each installation maintains a bio-environmental engineering team that routinely samples air, water, and workplace safety as well as a public health safety team that remains committed to the safety of force and family.  The USAF is also committed to a worldclass work environment. Consequently, when the chain of command heard of this matter, General Thomas A. Bussiere, Commander, Air Force Global Strike Command, approved a comprehensive study design by USAFSAM to conduct a formal assessment that addresses specific cancer concerns raised by missile community members across related career fields and also examines the possibility of clusters of non-Hodgkin's lymphoma (NHL) at intercontinental ballistic missile bases.

There is no screening test for NHL. Current and former Service members and their dependents that are concerned or have questions can always speak with their health care provider about personal risk factors and a health care plan.

Bone marrow and lymph node biopsies, in concert with CT scans, are used to diagnose NHL when a person has symptom or signs of illness. These tests are not screening tests.

One of the most common symptoms is an enlarged lymph node, causing a lump or bump under the skin, which is usually not painful. This is most often on the side of the neck or in the armpit or groin.

Other symptoms can include fever, chills, night sweats, weight loss, feeling tired, and swelling in the abdomen. If an individual believes they have symptoms of NHL they should consult their health care provider.

There is no screening test for NHL. Current and former Service members and their dependents that are concerned or have questions can always speak with their health care provider about personal risk factors and a health care plan. HIPAA requires physicians to protect patient’s health information by using safeguards to ensure confidentiality, integrity and security of the information. Additionally, military members' information is only provided to command on an as needed basis if mission readiness is affected and only in general.

Treatment for any cancer is complex. Individuals diagnosed with NHL should work with their health care providers to identify the best treatment plan for their specific cancer. Medical treatment is based on an individuals medical history, risks and comorbidities, and is individualized by the health care team along with the patient. There are different types and subtypes of NHL, with different risk factors and treatments.

Safety is a precondition for every operation we conduct on base and in the missile complex. The Air Force takes the welfare of its personnel seriously and USAFSAM is reviewing the concerns. Our Airmen are also empowered to make the safety decisions in the field and base support agencies are postured to support them to ensure a safe operating environment.

Lastly, if a Service member does not feel well or is concerned, they should seek medical care. If a Service member is under treatment for a condition, their health care team can help determine duty status to ensure their safety, in accordance with the Personnel Reliability Assurance Program and other programs.

Different types of NHL have different risk factors, including genetic and autoimmune predisposition. Depending on the type risk factors include (not all-inclusive): Age; obesity (BMI>30); diets rich in saturated and monounsaturated fats; high intake of red meat / chicken / beef / pork / lamb; infection with: H. pylori, Hepatitis C, HIV (Human Immunodeficiency Virus), EBV (Epstein-Barr Virus).

Listings that may be circulating on social media are not all-inclusive and are not official. The study underway by USAFSAM will address specific cancer concerns raised by missile field members across related career fields and examine the possibility of clusters of NHL at intercontinental ballistic missile bases.

While prostate cancer is much more common overall, it is quite rare to have a diagnosis of prostate cancer in males under age 40. In contrast, there were more than 4000 NHL cases in people under 40 in the general U.S. population in 2020.

In the MCCS, the expected number of each cancer type in the missile community was calculated and adjusted for age, sex, and race. The missile community is markedly younger than the U.S. population as a whole, so the expected number of NHL cases is greater than the expected number of prostate cancers. As a reminder, this study is still in progress, and both the case counts and expected counts are likely to change as we include additional data sources and refine our analytic methods.

The potential hazardous materials exposure at the missile silos extends to all three missile bases. The equipment in the launch control center and launch control equipment buildings were identical, hence the reason missileers were trained and used identical technical orders to fulfill the mission.

The scope of this study is intentionally broad, going back as far as the 1970’s, examining multiple locations, and the missileer and associated career fields with similar exposure risks. Data is being pulled from multiple databases to gather as much information as possible.

The group conducted the initial visit to each base for an orientation of missile operations and base facilities. Visits to the operational wings will help the team develop strategies for assessing the presence of potential occupational exposure hazards in work environments associated with the missile operations and maintenance. The visits specifically included base tours, tours of missile alert facilities and LCCs, and weapons maintenance facilities to broaden the team’s understanding of ICBM operations.

The scope of this study is intentionally broad, going back as far as the 1970’s, examining multiple locations, and the missileer and associated career fields with similar exposure risks. Data is being pulled from multiple databases to gather as much information as possible.

The group conducted the initial visit to each base for an orientation of missile operations and base facilities. Visits to the operational wings will help the team develop strategies for assessing the presence of potential occupational exposure hazards in work environments associated with the missile operations and maintenance. The visits specifically included base tours, tours of missile alert facilities and LCCs, and weapons maintenance facilities to broaden the team’s understanding of ICBM operations.

At the time of the 2001 study, they did consider PCBs exposures. Based on their review at that time and inspection of the LCCs, the team did not identify a significant exposure pathway history that would have indicated specific testing was required. Without a known physical exposure or reported leakage, the contaminant chain would not be present to suggest a need for specific PCB sampling. The team at the time did perform extensive environmental testing based on the information they had at that time, to included sampling air, soil, and water for a variety of other hazards.

For this current study we are certainly considering potential PCB exposures as an occupational hazard. We are working with the SPOs and leadership to determine the timeframe of PCB removal activities to better pinpoint potential timeframes of risk. Once we can fully review the inputs from the SPO, talk further with past/current crews and workers, and review current medical literature, we will then determine whether PCB testing would be recommended at this time.

Data is currently being pulled from multiple databases to gather as much information as possible. In the event that the study finds evidence of increased cancer risk within the missile community, additional studies will be considered and/or a registry may be created. Please reference the Missile Community Cancer Study webpage where information will be updated regularly.

Yes, the comparisons of cumulative incidence (total number of cases over the study period) to the general population will be adjusted for age, sex, and race. These factors are known to influence the risk of developing cancer.

While designing the MCCS, researchers expanded the study to include a broad range of career fields that work in the missile fields. The change increases the statistical power of the study and includes people in other career fields who have similar exposures within the ICBM community. Working with Air Force Global Strike Command and 20^th Air Force historians, the research team identified nearly 100 current and historical AFSCs as being part of the larger missile community. Therefore, the research includes approximately 84,000 personnel in the missile community during the study timeframe. This includes missile maintainers, technicians, facilities personnel, specific security forces and food services personnel, among others. Of the 84,000 in the missile community, approximately 8,000 personnel are identified as Missile Combat Crew or Missile Operations Staff Officers. The final MCCS analysis will include a stratified risk assessment by job location, including this population of 8,000.

The study follow-up period ends Dec. 31, 2020, due to the availability of data. When we started this study in 2023, the datasets available to us ended in 2020, as it takes over three years for National Cancer Institute and others to release their yearly data.

The epidemiology study pulls AFPC records by AFSC and captures former and current Missile Community members who served on Active Duty from 1976-2010. Cancer development associated with an environmental exposure usually takes years to develop, which is why cancer studies generally use a 10-year follow-up period after a possible exposure to ensure adequate time is included for cancers to develop. For the MCCS, the latest data available from the National Cancer Institute is from 2020. Therefore, because we are concerned with a potential exposure, the study includes personnel who served from 1976-2010 to include an adequate follow-up period. We worked with NIH/National Cancer Institute when designing our study and we set this time at 10 years, consistent with their advice and other national cancer studies.

For our current study, if someone entered service after 2010, their cancer would not be included in our data. While we want to know about all cancer cases, in performing a rigorous, scientific retrospective study, we have to draw lines and use the data available to us at the time. We anticipate our current study may be used to drive further studies looking at additional populations/timeframes in the future, if indicated.

It will be important to monitor the Missile Community going forward, so that we can push for additional resources where required. If missile community members feel they have developed adverse health conditions due to an exposure during their service, they should seek advice and an evaluation from their primary care team. Active duty members should follow-up with their local Military Treatment Facility (on base clinic or hospital). Members should also share their concerns during their Separation History & Physical Exam (SHPE) prior to separating or retiring to ensure documentation. Recently Retired or Separated members should contact a Veterans Affairs healthcare facility.

The DAF contracted a project to design a water treatment system so personnel in the missile field would have water comparable to the local area, in this case, the city of Great Falls, Montana. Initiated in 2015, the design contract is not related to the MCCS or prior findings of PCBs at the Missile Alert Facilities (MAFs). It was directed to address hardness, pH, and palatable concerns generally related to sediment in the well water.

Out of 15 MAF locations, 12 have dedicated water wells. The other three locations receive water from a local municipal water source, piped into their pumphouses. Currently, eight of the 12 locations with dedicated wells have water treatment systems installed, which include reverse osmosis systems. The overall goal is to provide consistent water quality for each location by allowing engineers configuration control as much as possible.  Local base agencies will continue to test water routinely (as required by federal law) to assure water quality meets appropriate standards.

No, cadmium was not sampled and is not considered part of the MCCS. Cadmium is captured in the maintenance technical data procedures highlighting exposure and personnel safety during operations. The base Bioenvironmental Engineering (BE) shops are aware of cadmium existence and have documented cadmium as a hazard based on their knowledge of missile maintenance operations. Control measures to include PPE established by local BE should be used when handling cadmium. As AFGSC continues to implement Similar Exposure Groups (SEGs) Standardization, we can expect greater fidelity on the existence of cadmium hazards, which SEGs are exposed to cadmium during their occupational duties.

The Minuteman weapon system has components that contain cadmium in various locations within the system. Personnel performing maintenance are aware of the presence of cadmium by the technical data safety precautions (see below). Additionally, personnel that would be involved with direct maintenance actions on cadmium parts would follow the applicable safety precautions and outlined technical data while performing the applicable maintenance.     

Technical Data Safety Precautions

Cadmium Dust Precautions/Requirements

• Operations on cadmium coated/plated materials may produce cadmium dust which is toxic and a confirmed human carcinogen.
• Operations that involve maintenance activities on metals with cadmium coatings shall be coordinated through the base Bioenvironmental Engineering office to ensure all provisions and guidelines within the OSHA regulation 29 CFR 1910.1027 are followed.

Seven Launch Control Centers (LCC) at Malmstrom Air Force Base, Montana, had detectable levels of Polychlorinated biphenyls (PCB) above zero.

The following items had detectable levels of PCBs: visual display screen, console keyboard, circuit breaker, LCDB panel, Oxygen Regeneration Unit, power supply, wall and floor below Electromagnetic Interface Filter, Receiver Digital Data, battery access charger, DC power switch, and LCC ceiling.

Swipe samples from the underside of two LCC LCDB panels contained the concentrations of PCBs above the Code of Federal Regulations, Title 40, Part 761.

The equipment and surfaces that people commonly touched had detectable PCBs, but the levels fell below the standards found in the Toxic Substances Control Act and 40 CFR part 761, containing requirements for the use, disposal, and marking of PCBs. The two LCDB panels (underside) that tested above the standard is in an area people don’t commonly touch.

For those areas which tested above standards found in 40 CFR Subpart D, the U.S. Air Force will remediate and retest. While there is not a federal requirement for cleanup of detectable PCBs for areas below 40 CFR 761, the U.S. Air Force is developing long-term plans for testing and remediation.

Immediate measures to limit exposure have been taken at the two facilities above the EPA cleanup standard. For all other areas, subject matter experts recommend routine cleaning and general sanitation on/around workspaces. Additionally, personnel are recommended to use soap and water to wash hands prior to eating, drinking, or smoking.

For those areas above the EPA 40 CFR 761 cleanup standards, remediation and retesting is being coordinated.

EPA standards vary depending on the type of spill, waste, or product, where the spill, waste, or product is located, and the potential for human exposure. Specific standards can be found in 40 CFR 761, Subpart D and Subpart G. The EPA sets standards considering human health impacts, to include the potential for inhalation and skin contact.

The CDC says the general population’s primary exposure to PCBs in through eating contaminated high-fat foods, mainly seafood and dairy. Occupational exposure to PCBs occurs mainly via breathing them in and when the skin is exposed to maintenance or repair of equipment manufactured before 1977, or as a result of accidents involving such equipment.

Missile Alert Facility and Launch Control Center water is tested quarterly by Bio-Environmental following EPA regulations, similar to water testing on any military installation. Missile Alert Facility Managers also test water weekly to ensure water filtration systems are operating. All Missile Alert Facility kitchens and food preparation areas are inspected by Public Health at least annually. Missile Alert Facility Managers do routine kitchen cleanliness inspections as well.

PCBs were banned in the United States in 1977 and thus new construction materials and electrical components for the Sentinel modernization program will not contain PCBs.

The USAFSAM team worked with the Minuteman System Program Office (SPO) and 20 AF to determine which locations should be swiped for PCBs, based on equipment historically known to contain PCBs as well as commonly touched areas to look for unintentional transfer of PCB contamination from one location to another (cross-contamination). The PCB sampling strategy intentionally shifted from Round 1 to Round 3, as the team adjusted to returning results and new information.  In Round 1, the team swiped more than 20 sites in each MAF. In Round 2, the team sampled the trainers were sampled, as well as sites at Vandenberg SFB, including Launch Facilities (LFs). Round 3 will include LF sampling at the three missile wings. Researchers did no resample the same sites as the persistent nature of PCBs does not change seasonally and cleaning efforts are still underway, but the information from the MCCS will help guide future testing efforts.

Important to note, the MCCS has not found any PCBs or other hazards in the air, water, or soil, only on surfaces inside the LCCs. The study found three LCCs with surface PCBs above the thresholds found in 40 CFR Subpart D. Of those, two have been successfully cleaned to below that level, and the last has been mitigated. Equipment containing PCB components has been clearly marked with warning labels so members wear appropriate PPE (latex gloves) when accessing those components for maintenance purposes, which are then disposed of following appropriate HazMat protocols.

In addition, AFGSC is developing a contract to deep clean all Missile Alert Facilities, which we expect to be in place by late summer 2024. This contract will include provisions to further execute PCB cleaning and testing to validate effectiveness.

People can be exposed to contaminants in these ways:

• Inhalation (by breathing)
• Ingestion (by eating or drinking)
• Absorption (through skin or eyes)
• Exposure to Radiation

The first two rounds of the MCCS have not found any contaminants in the air, water, or soil; and, radon levels (a form of natural radiation from bedrock) have been well below the intervention threshold. The only hazards documented to date are surface PCBs. Potential exposure to surface PCBs could occur through absorption if someone touched a contaminated surface with the PCBs on their skin for a period of time or through ingestion if someone touched a contaminated surface and then touched their mouth, food, or drink. Hand washing with regular soap and water removes PCBs easily; this is an important step in preventing exposure to many contaminants.

The Agency for Toxic Substances and Disease Registry, available through the CDC, has further information on exposure pathways.