The JFES Study followed on from earlier work by the Air Force Advocates Office (WOFF Peter Hind OAM. and David Janik CSM.) as part of a team that was instrumental in early research studies and support work focussed on the health issues affecting F111 Deseal/Reseal workers. While this is a new study (Recommendation 18 of the 2008/9 Parliamentary Inquiry into RAAF F-111 Deseal/Reseal workers and their families), their work over many years towards good outcomes for F111 workers is greatly appreciated.
The purpose of the Jet Fuel Exposure Syndrome (JFES) study was to investigate whether any changes in cell biology could be found that might help explain some of the health effects in former F-111 deseal/reseal workers. The $3 million JFES study was commissioned and funded by the Department of Defence and undertaken by Prof Frank Bowling and his team at the Mater Medical Research Institute in Brisbane. The study utilised the latest university and medical research technologies into molecular and genetic aspects of cell biology.
The study found adverse cellular effects from JP8 fuel, predominantly from the kerosene component. These findings were consistent with other recently reported studies. However, the clinical significance and the relationship between the amount of exposure and cellular changes could not be determined. The specific deseal/reseal solvents (SR51 and SR51A) demonstrated significantly lesser toxicity than jet fuel components.
The study did not find any evidence of genetic or chromosomal damage in cells exposed to JP8 fuel or the deseal/reseal solvents. Exposed veterans should be reassured that the changes to cellular functions detected are not expected to have immediate or adverse effects on their health. Defence will continue to implement practical measures, such as safe systems of work and the use of protective equipment, to minimise exposure to JP8 fuel and its components. Defence will consider long term health monitoring of its members who are, or have been, occupationally exposed to fuels and solvents. The Department of Defence has now released the Jet Fuel Exposure Syndrome Study Report. The JFES Study Report, a short 3 page Summary, a Fact Sheet and the Defence Press Release are available on the Air Force website or at the following links:
- JFES Study report (PDF 4.3 MB)
- JFES Study Summary Link (PDF 35 KB)
JFES Study Summary Link (DOC 34 KB)
- JFES Study Defence Fact Sheet (PDF 28 KB)
JFES Study Defence Fact Sheet (DOCX 14 KB)
DVA and Defence will now consider the implications of this Report in relation to other persons occupationally exposed to fuels and solvents while working on maintenance of other aircraft types. Enquiries about the JFES Study Report can be sent by email to: JFES.Study@defence.gov.au
In the interim, if you believe you have a diagnosed condition related to your military service, please lodge a claim to DVA.
In 2001 the Study of Health Outcomes in Aircraft Maintenance Personnel (SHOAMP) was commissioned as a response to the Board of Inquiry. The University of Newcastle’s SHOAMP study* examined members of the four formal deseal/reseal programs, and two comparison groups. The study reported its findings in 2004.
The study found that the incidence of cancer in the F-111 DSRS, group was “higher than expected” with an increase of around 40-50% incidence, relative to both the Amberley and Richmond comparison groups.
While it found this cancer incidence in the deseal/ reseal group to be “not statistically significant”, it also found that deseal/reseal workers reported nearly twice the number of poor health symptoms than comparison groups, and significantly poorer quality of life on both physical and mental component scores.
While not attributing causality, the study found that:
“the results point to an association between F-111 DS/RS involvement and a lower quality of life, greater incidences of: erectile dysfunction, depression, anxiety and subjective memory impairment. There is also evidence, albeit less compelling, of an association between DSRS and dermatitis, obstructive lung disease (ie. bronchitis and emphysema), and neuropsychological deficits.”
15 December 2010 Serum Management Committee
In 2005 the Department of Veterans’ Affairs commissioned a study into the desealant chemical SR51. This study was undertaken by the Chemical Hazard Assessment Laboratory, University of Sydney (CHALUS). The study found that SR51 was unlikely to be mutagenic (ie it did not cause DNA damage), but that it did have the potential to produce mitochondrial damage.
The study also found that toxicity increased with increased temperature and produced greater damage when heated. The study found that SR51 produced a very strong smell, and that this smell is detectable at levels over 1,000 times below the levels that are thought safe.
The study noted that “SR51 and its major solvent components produce toxic effects on the mitochondrial particles used in this test”. The university conducted tests in vitro (in their laboratory) and noted that, “It is not known whether similar results of toxicity would result for living mammals”. The SR51 study concluded that SR51 was “unlikely”’ to cause cancer. (Page 28 of the Parliamentary Inquiry" refers).
In 2004 Professor Frank Bowling was commissioned by the Chief of Air Force to conduct a pilot study into the possible effects on the mitochondria of personnel who were exposed to chemicals involved in the F-111 deseal/reseal programs. The purpose of Professor Bowling’s work was to “identify abnormalities of mitochondria in exposed individuals, both to understand the nature of cell injury following exposure, and to identify a possible marker of cell injury.”
The pilot study found:
- “changes in mitochondrial proteins in peripheral blood samples in individuals exposed to fuel solvents…;
- data suggest involvement of immature blood cells (stem cells) in the protein changes seen following fuel exposure….the mitochondrial changes seen in these pilot studies are an indication of disruption of stem cells in the bone marrow, and possibly in other tissues”.
(Page 30 of the Parliamentary Inquiry refers)
The results of the pilot study were examined by the Defence Work Health and Safety Branch and will be considered as part of the wider Jet Fuel Exposure Syndrome Study (JFES Study) into the health implications of working with aviation turbine fuels.
In 2006 Dr Leonie Coxon from Murdoch University carried out a study on the psychological effects on spouses of deseal/reseal workers was completed. This study found that spouses of deseal/reseal workers were more likely to have somatic complaints, anxiety, depression and higher levels of stress. These findings indicated that “there are significant deleterious effects on the psychological functioning of spouses of individuals involved in the F-111 deseal/reseal programs as a result of the program itself.” (Page 33 of the Parliamentary Inquiry refers)
The Defence Science and Technology Organisation’s Mr Stefan Danek was commissioned by the 2001 BOI, to summarise the BOI’s volumes of scientific reports from various experts. These included a toxicological assessment of deseal-reseal chemicals; the resistance of personal protective equipment, such as gloves and overalls, to various selected chemicals; the monitoring of airborne contaminants during specific processes associated with the deseal-reseal programs; and, the modelling of potential exposure or potential airborne contaminants of these same chemicals. The subsequent summary is known as the Danek Report. (Page 34 of the Parliamentary Inquiry refers)
The fourth data Study of Mortality and Cancer Incidence in F-111 DSRS fuel tank maintenance workers who were involved in the F-111 aircraft DSRS programs during 1977-2000 is well into the analysis stage.
The Fourth Mortality and Cancer Incidence Study examines the incidence of mortality and cancer in F-111 DSRS personnel against relevant comparison groups, including a matched group of personnel who served at RAAF Base Amberley and RAAF Base Richmond.
The study is expected to be completed late 2015 and published early to mid 2016 and follows three previous studies completed in 2003, 2004 and 2009 as part of a broader SHOAMP.
The Australian Institute of Health and Welfare is undertaking data analysis utilising more recently updated data than the previous studies, with an additional eight years of mortality data and an additional seven years of cancer data. The study group was increased to include personnel identified through the current tier classifications. The Fourth Study is a statistical data analysis study and no individuals will be identified in the results.
The study will provide a better understanding of the rate of the cancer and mortality of F-111 DSRS program maintenance workers compared to their RAAF peers and the general community.
Compensation, ex gratia payments, health care and counselling continues to be available for eligible F-111 DSRS workers. Counselling is also available to immediate family members of F-111 DSRS workers.
More information about the Fourth Mortality and Cancer Incidence Study can be obtained by contacting:
- F-111 hotline – Free call 1800 728 007
- Email: email@example.com
Questions and Answers
What is the Fourth Mortality and Cancer Incidence Study?
- DVA commissioned the fourth in a series of studies on the mortality and cancer incidence of F-111 Aircraft Maintenance workers who were involved in the Deseal/Reseal (DSRS) programs during 1977-2000.
- The Fourth Mortality and Cancer Incidence Study will examine the incidence of mortality and cancer in F-111 Deseal/Reseal personnel against relevant comparison groups, including a matched group of personnel who served at RAAF Base Amberley and RAAF Base Richmond, as well as the general Australian population.
- This study is a continuation of three previous studies completed in 2003, 2004 and 2006 as part of the broader Study into the Health Outcomes of Aircraft Maintenance Personnel known as the SHOAMP Study.
Why is DVA undertaking a fourth study?
- The Fourth Study will provide a better understanding of the rates of cancer and mortality for those who participated in F-111 Deseal/Reseal work between 1977 and 2000.
- The passage of time and an expanded study group has provided an opportunity to improve on the previous studies.
- Health issues can take a long time to develop. This statistical study will ensure we have a more accurate picture of the cancer and mortality of these personnel compared to their RAAF peers and the general community.
How will the study be conducted?
- The Fourth Study will use updated results with an additional eight years of mortality data (1980-2013) and an additional seven years of cancer data (1982-2010) on the previous studies. The updated data will be sourced from the National Death Index and the Australian Cancer Database.
- The study group now includes personnel identified through the current tier classifications.
- The study involves data analysis only. It does not involve direct involvement of participants.
Who is conducting the study?
- DVA has commissioned the Australian Institute of Health and Welfare to undertake the data matching and analysis.
When will the study be completed and will the results be publicly available?
- The study is expected to be completed and published early to mid 2016.
Who do I talk to about the study?
You may contact the:
- F-111 Hotline - Free call 1800 728 007
- email: firstname.lastname@example.org
What if I am not happy about my details being data matched?
No individuals will be identified in the study results, however if you wish to make a complaint about this study, you may contact the DVA Human Research Ethics Committee on (02) 6225 4659 or email: email@example.com.
Can I obtain my own individual results?
No. In order to protect the privacy of study participants, the results will not produce any personal information.
How can people take part in the study?
- No action from the F-111 community is required – this is a data analysis study only, using data from the previous studies, the National Death Index and the Australian Cancer Database.
- There will be no participant involvement in this study.
How are personnel details protected?
The Australian Institute of Health and Welfare is conducting the analysis under strict privacy and data matching protocols to ensure the protection of individual personal information.
Has ethical approval been obtained?
Ethics approvals have been obtained from all relevant State and Territory Human Research Ethics Committees and Cancer Registries.
Will there be a peer review of the study?
An Independent Scientific Advisory Committee has been established to provide expert scientific advice in relation to the conduct of the study.
What compensation/support is available for those suffering health issues as a result of their F-111 Deseal/Reseal work?
- Compensation, health care and counselling is available for eligible F-111 Deseal/Reseal participants.
- Counselling is also available to immediate family members of those who carried out Deseal/Reseal and associated work.
- More information is available on the compensation page.
How does this study relate to the Jet Fuel Exposure Syndrome Study?
The Fourth Mortality and Cancer Incidence Study is a data matching exercise by DVA investigating only those who participated in F-111 Deseal/Reseal fuel tank maintenance and other associated work.
The Jet Fuel Exposure Syndrome Study was a separate piece of work commissioned by the Department of Defence investigating genetic factors that may contribute to adverse health outcomes among some former Deseal/Reseal personnel.
The Australian Institute of Health and Welfare (AIHW) released the Third Study of Mortality and Cancer Incidence in Aircraft Maintenance Personnel: A Continuing Study of F-111 Deseal/Reseal Personnel (2009). The first and second studies were made as part of the SHOAMP study. Comparisons were made with the general Australian male population, as well as groups from RAAF Base Amberley and RAAF Base Richmond.
The AIHW study made several findings. Among them:
- Overall cancer incidence in male personnel who were involved in DSRS programs was elevated by 44%, when compared with the Australian male population. However the very small number of people involved means that this result is not statistically significant.
- Lip cancer incidence in DSRS personnel was four times as high as in the general Australian male population. This result is statistically significant, but is based on only four cases.
- Overall mortality for the two comparison groups was lower than that that found in the Australian male population; these results are statistically significant. Cancer incidence in personnel in the two comparison groups (RAAF Base Richmond in New South Wales and RAAF Base Amberley in Queensland) was similar to that of the Australian male population.
- Comparing the exposed groups (the DSRS personnel) with Amberley personnel showed no significant differences in mortality or cancer incidence.
- Comparing the exposed groups (the DSRS personnel) with Richmond personnel showed increased cancer incidence which is statistically significant.
View the Third Study of Mortality and Cancer Incidence on the AIHW website
- Third Study of Mortality and Cancer Incidence in Aircraft Maintenance Personnel (PDF 1.4 MB)
- Third Study of Mortality and Cancer Incidence in Aircraft Maintenance Personnel (RTF 1.8 MB)
The University of Newcastle Research Associates (TUNRA) Ltd and Hunter Medical Research Institute released the Second Study of Mortality and Cancer Incidence in Aircraft Maintenance Personnel (2004) as Phase 2 of the SHOAMP study. Comparisons were made with the general Australian male population, as well as groups from RAAF Base Amberley and RAAF Base Richmond.
The TUNRA study made several findings. Among them:
- A higher than expected incidence of cancer in the F-111 DSRS group, with an increase of around 40-50% in the incidence of cancer relative to both the Amberley and Richmond comparison groups, although selection bias (i.e. those with cancer in the exposed group preferentially participated in the study), or diagnostic suspicion bias (those in the exposed group presented more readily to medical attention and had their cancers diagnosed earlier) cannot be ruled out. The Standardised Cancer Incidence Ratio for the exposed group is of borderline statistical significance.
- Mortality for the exposed group was significantly lower than for both comparison groups, likely due to survivor bias in the exposed group.
The University of Newcastle Research Associates (TUNRA) Ltd and Hunter Medical Research Institute released the Second Study of Mortality and Cancer Incidence in Aircraft Maintenance Personnel (2003) as Phase 2 of the SHOAMP study. Comparisons were made with the general Australian male population, as well as groups from RAAF Base Amberley and RAAF Base Richmond.
The TUNRA study made several findings. Among them:
- A slightly higher cancer rate in the exposed group relative to either comparison group. However, the results are not statistically significant.
- A slightly lower mortality in the exposed group relative to either comparison group. However, the results are not significant.
- The conflicting trends in cancer and mortality may reflect the uncertainty in the data and lack of statistical power. In addition, there are many issues concerning the quality of the data, various sources of bias, and limited power, which limit the confidence in these results.