
DATE: Wednesday, June 18, 1997              TAG: 9706180539

SECTION: FRONT                   PAGE: A1   EDITION: FINAL 

SOURCE: BY DEBRA GORDON, STAFF WRITER 

                                            LENGTH:  130 lines

ABOARD CARRIERS, A MEDICAL MYSTERY STUDY LINKS THE SHIPS TO RARE LUNG DISEASE

Somewhere in the Navy's aircraft carriers may lurk the key to understanding a rare lung disease that doctors know little about.

Though no one knows why, enlisted men and women serving aboard carriers have half again as much chance of getting the illness than people not serving on the ships, according to a Centers for Disease Control and Prevention study published last week in the Mortality and Morbidity Weekly Report.

Doctors don't know what causes the disease, called sarcoidosis, although they suspect it may involve an allergic reaction to something a person breathes or touches.

What they do know is that it can cause accumulations of inflammatory cells, called granulomas, nearly everywhere in the body - the skin, eyes, liver, spleen, bones, salivary glands, heart and central nervous system.

They know, too, that in nine cases out of 10, sarcoidosis involves the lungs, according to the Mayo Foundation for Education and Research. That it is rarely fatal. That about half the people who develop it eventually recover completely or have only minor lasting effects.

It is usually treated with the steroid prednisone. But it can return after treatment, and it can damage the eyes and other organs, such as the heart or lungs.

So what does all this have to do with aircraft carriers?

In 1974, a 21-year-old enlisted man serving on an aircraft carrier got sarcoidosis. He had a history of shortness of breath, coughing, and chest and joint pain, which he attributed to his job of grinding antiskid materials from aircraft carrier decks during the preceding two years.

He received a medical discharge a year later.

In 1987, he was diagnosed with another lung disease, called pneumoconiosis. It results from mineral deposits - such as asbestos - in the lungs.

In this man's case, a lung biopsy identified mineral-dust deposits attributed to his work aboard the aircraft carrier.

In 1992, the man asked the Navy to have the National Institute for Occupational Safety and Health, or NIOSH, part of the CDC, investigate whether his and other cases of sarcoidosis diagnosed in people with whom he had served may have been associated with environmental exposures.

That's how Dr. Tom Hodous, a medical epidemiologist with the division of respiratory disease studies in Morgantown, W.Va., got involved.

Using a database maintained by the Naval Health Research Center, Hodous and his staff studied 1,121 sarcoidosis cases among sailors diagnosed between 1965 and 1993. They then looked at whether those patients had served on ships and, if so, at the type of ships on which they had served.

Their research revealed several things:

The incidence of sarcoidosis in the Navy overall is significantly lower than shown in one of the few studies on the disease conducted on the general population.

In that study, conducted in Detroit, 30 out of 100,000 black people developed the disease, compared to 10 out of 100,000 whites. The incidence was the same for men and women within the categories. Doctors have no idea why the disease is more prevalent in the black population.

But in the Navy population, the rate of the illness's appearance is closer to 16 in 100,000 for enlisted black males, and 2.5 in 100,000 for enlisted white males.

Sailors with sarcoidosis had served in the Navy about twice as long as those without sarcoidosis. Seventy percent of the Navy's patients had served on ships.

The overall incidence of black men in the Navy with sarcoidosis dropped sharply between 1971 and 1993.

Between 1971 and 1993 - the only years for which ship data was available - one-fourth of the Navy patients who had served on ships had been on aircraft carriers. That equates to a statistically significant increased risk - 1 1/2 times the normal rate - of developing the disease for those serving on carriers.

About 5,500 people, including air crews, serve on each of the Navy's carriers. Five of the ships are based in Norfolk.

No figures are available on how many cases have been reported locally.

What does this all mean?

Hodous and his team have more questions than answers.

They have no idea why fewer men in the Navy get the rare disease than in the general population, no idea why the rates for black men in the Navy dropped during the years studied.

It could be, Hodous hypothesized, that rates in the general population are also dropping. Or that there may have been occupational exposure in the past that increased Navy men's risk, which had since been eliminated.

And the higher risk for enlisted men serving aboard carriers?

``We don't have any clear answers to those questions,'' Hodous said.

The Navy downplayed the study, saying that the ``results are not really conclusive.''

``The Navy is committed to providing a safe and healthy work environment for our people,'' said Cmdr. Mark C. Olesen, occupational medicine physician with the Navy's Environmental Health Center in Norfolk.

``Today, and for the past 20 years, there has been a consistent emphasis on assuring a safe and healthful working environment for all our employees, both in and out of uniform,'' he said. ``This includes widespread use of personal protective equipment and strict tracking and monitoring of an individual's work environment.''

The next step, Hodous said, is to consider contacting a sample of those studied to confirm the initial diagnosis and to see if their sarcoidosis is typical or if there is something unusual about it.

The Navy will also monitor the results of a large, ongoing study through the National Heart, Lung and Blood Institute on sarcoidosis in the general population, Olesen said.

``We are very concerned about the health of our people and are constantly looking for ways to promote health by increasing our understanding of medical conditions.'' ILLUSTRATION: Associated Press/File photo

WHAT IS SARCOIDOSIS?

Its symptoms: It has a wide range, often making diagnosis

difficult. They include:

flu-like symptoms,

rash on the lower legs,

coughing and shortness of breath with exercise.

Its effect: Some people recover with no problems, without even

realizing they had it. Others may go on to have chronic lung

disease, in which their lung capacity is reduced. A tiny minority

may develop more severe lung problems.

Its impact: The disease has been known for nearly a century,

Numbers aren't clear, but one study said it affects between 0.0025