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 hear 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.

If a Service member is concerned with a workplace exposure, they should inform their health care provider who will document the concern in the medical record additionally contact your bio-environmental engineer flight that maintains, by Service member, the workplace hazards you have been exposed to throughout your career.

Workplace hazards are monitored in accordance with the Occupational Safety and Health Administration. Medical and civil engineering / facilities meet monthly during the Occupational and Environmental Health Working Group to discuss shops with potential exposure that require surveillance. Service members and supervisors are trained that if a Service member is injured on the job, they should fill out an AF Form 978, notify their supervisor, and seek medical attention, if warranted.

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.

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.

Yes, we have engaged various organizations. It’s important we use the connecting organizations and agencies around us to share information across as many spaces as possible so Airmen, former Airmen, retirees, reservists, guardsmen and families are aware of updates. We will continue to engage and stay open to suggestions on how to reach other organizations, forums, groups or audiences.

1. More information on military exposures

2. Expanded VA health care and benefits eligibility under PACT Act

3. How to file a VA disability claim

4. VA benefits available to family members/survivors

5. VA benefits available to the service member

6. VA resource to stay current on the VA's Million Veteran Program, a national research program analyzing military experiences affect health and wellness of Veterans

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.

Updates will be provided in a transparent way when there is significant information to share. It’s not possible to project when, during the course of the study, USAFSAM will have updates to share.

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.

This suggests PCBs were not transmitted within workspaces.

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, Subpart G (40 CFR 761) standard for PCB cleanup following a previous spill.

The equipment and surfaces that people commonly touched had detectable PCBs, but the levels fell below the 40 CFR 761 Subpart G standard for PCB cleanup. The two LCDB panels (underside) that tested above the standard is in an area people don’t commonly touch.

The areas detectable but not at zero are akin to levels one unknowingly encounters in the everyday environment. For those areas which tested above the 40 CFR 761 Subpart G, 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 will work with the appropriate agencies to determine cleanup / remediation and follow-on actions. 

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 standard, remediation and retesting is being coordinated. While there is not a federal requirement for cleanup of detectable PCBs for areas below this standard, clean-up and remediation actions are being coordinated. 

The EPA set the 10 microgram (µg) / 100 cm² clean up standard considering human health impacts from inhalation and skin contact. This standard of 10 microgram / 100 cm² assumes unprotected exposure 24 hours a day, 7 days a week for a high occupancy scenario on a nonporous surface. 

• 10 micrograms: If you slice one regular sized paper clip into a million pieces, each slice would weigh one microgram.
• 100 cm²: This is approx. a 4x4 inch square, about the size of the palm of your hand.

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.

Data is currently being pulled from multiple databases to gather as much information as possible. In the event the study moves to a phase II, a registry may be created. Please reference the Missile Community Cancer Study webpage where information will be updated regularly.