Head of ICBM Cancer Study Says the Air Force Is ‘Fully Invested’

The Air Force’s study into possible cancer risks associated with work on intercontinental ballistic missiles will be a comprehensive review—and will not favor the service over evidence, medical officials leading the effort insisted.

“We need our solutions to be driven by science and data,” Col. Tory Woodard, the commander of the U.S. Air Force School of Aerospace Medicine (USAFSAM), told Air & Space Forces Magazine in a recent interview alongside a cadre of other experts.

Long-held concerns of former missileers and other personnel that supported the Air Force’s ICBM mission came to the fore earlier this year after a presentation detailing cases of non-Hodgkin lymphoma, a blood cancer, at Malmstrom Air Force Base, Mont. appeared online. Gen. Thomas A. Bussiere, head of Air Force Global Strike Command, which is in charge of the nation’s ICBM fleet, soon ordered a review of the issue, which led to the Missile Community Cancer Study designed by USAFSAM. The study has two parts: environmental sampling and an epidemiological study, which will take 12-14 months to complete, to assess cancer rates.

“This epidemiologic study that we’re focused on is very complex,” Woodard said. “It has a lot of layers, a lot of different time periods, risk assessment, and things that factor into this.”

When embarking on the study, the study team conducted initial site visits to active ICBM bases in late February and early March. The visits flagged some acute issues, such as signage denoting the presence of polychlorinated biphenyls, a banned hazardous chemical that was supposedly removed. But the purpose of the visit was to orient the medical personnel with ICBM operations. Officials said visits helped the study team realize their examination, both environmental and epidemiological, should not be confined to the missileers in underground bunkers in 24-48 hour shifts, but also include a wide array of people that work on the bases, which stretch out over silos fields in five states anchored at three bases—Malmstrom, F.E. Warren Air Force Base, Wyo., and Minot Air Force Base, N.D.

“We certainly changed our thought process on some of the hazards and things that were there,” Woodard said. “We also expanded our population of interest based on interviewing and seeing” the layout of the ICBM bases.

That population, comprising both current and former service members, includes those who work in underground launch control centers and top-side missile alert facilities, but also maintainers, food service personnel, and security forces, among others. The Air Force often does not own the land around launch facilities, and unknown exposure to agricultural chemicals has been cited as a possible issue by service officials.

“We wanted to assess the base environment as a whole,” Woodard said. “We learned and this was just simply because we were a part of that environment.”

The expanding study population presents a challenge: not putting those at highest risk into a large pool that artificially dilutes concerning data.

“We really developed two populations that we are studying in parallel,” Woodard said. “The first is just the missileers. The missileers were the ones who lived down below ground, they pulled the 24-hour shifts down in the [Launch Control Centers]. Then the other is the associated personnel. We will look at those two groups separately, so we get the cancer rate within the missileers and the cancer rate within the missile-associated career fields.”

However, the Air Force has investigated the issue before and found nothing of concern, to the skepticism of some current and former service members and their families.

Concerns are most prominent at Malmstrom, which was subject to an initial study of the increased rates of cancer in 2001 and another review in 2005, as well as the recent presentation that spurred the current study. 

“The study previously was on a much smaller scale and did not have the support that it does now—Air Force Global Strike, the Air Force Surgeon General’s office, Air Force leadership is fully invested,” Woodard said.

The issue has drawn the scrutiny of Congress, with Sen. Jon Tester (D-Mont.) raising the issue with the Air Force and Veterans Administration, according to his office. In April, Tester visited Malmstrom with Secretary of the Air Force Frank Kendall.

“The Air Force has been transparent with the public about their findings through the Global Strike Command website,” Eli Cousin, a spokesperson for Tester, told Air & Space Forces Magazine.

However, Cousin said Tester would continue to “press to make sure every potentially impacted individual is made aware of this situation, receives the appropriate health assessment, and is offered the appropriate care he or she needs.”

Air Force Global Strike Command and the U.S. Air Force School of Aerospace Medicine, while not finding any specific faults with earlier studies, say there are better positioned than prior medical teams to draw accurate conclusions.

“It would be unfair for me to really answer questions about how it was done 20 years ago, except to assess that the environment is different now—our knowledge of the disease, our knowledge of occupational hazards is much different,” Woodard said. “We have access to databases and we have technology that we didn’t have then.”

Woodard also credited AFGSC with giving medical officials better access to facilities and clearing personnel and equipment.

It is “easier and quicker for us to bring a larger range of environmental sampling equipment into the restricted areas, which will allow us to better assess the current—and future—environment,” Woodard said.

However, while different commands are involved, ultimately the Air Force is investigating itself. 

“We do not set our own standards,” Woodard said when asked whether the Air Force has less stringent standards for hazardous material than other entities.

“Things that we knew about occupational hazards and occupational exposures and have certainly progressed,” Woodard said. “That has significantly changed the way that our population and the way that our individuals manage their occupational hazards and the way that we inform our military people.”

USAFSAM has done large-scale studies before, such as a review of cancer cases among pilots, which found an elevated risk. Woodard said USAFSAM’s position inside the Air Force was helpful in getting access to and collecting data, which is being mined from military and state cancer registries among other sources.

“We already have pre-existing relationships with some of the DOD and other entities that allow us the data pull,” Woodard said. “If an outside entity tried to come in and do this study, they would have significant delays.”

But USAFSAM officials acknowledged the Air Force needed some outside input.

“We’re in continued and early collaboration with the VA and the National Cancer Institute,” Woodard said.

There are some gaps in the population the Air Force is studying. The service has cited better access to medical electronic medical records, but as the medical officials have acknowledged, the USAF did not consider certain elements hazardous in the past or had higher tolerances for hazardous material. Some former missileers and their family members have expressed concern that the Air Force will never fully account for hazards that existed further back into the 1960s and 1970s, as complete records may not have been kept or may no longer exist. Officials said the planned environmental monitoring is extensive—roughly 2,000 samples per base, according to Woodard—but only the three active facilities are covered.

“We’re also involved with Global Strike historians and researchers in trying to develop the backstory to help us provide the data to do this study,” Woodard said. “Really our focus right now is let’s focus on the epidemiologic study so we know what the cancer risks may be so that we can address those. The exposures that were done in the past, we will evaluate those when the time comes, but I want to protect today’s people.”

The team recently started environmental sampling at Malmstrom.

Woodard said the service wants to ensure that if there are any problems with the current environment or equipment, they’re resolved before the aging Minuteman III missiles are soon replaced with the new Sentinel ICBMs.

“We want to make sure that we don’t make the same mistakes or any potential mistakes,” with the Sentinel, Woodard said.

Top officials at USAFSAM, AFGSC, and the Space Force, which counts over 400 former missleers among its ranks, have engaged in town halls to address the issue, and the running updates online reflect a desire to inform the community, they say.

“As we get information, we will publicize that information,” Woodard said. “We’re not just going to say call us in 14 months and we’ll let you know what happened.”