Association for Public Policy Analysis & Management

Participating in the United States military may increase the risk of developing cancer. A cancer diagnosis has been shown to be associated with long-term effects on physical, mental, and psychosocial well-being. Prior research on the link between military service and cancer have focused on specific exposures, branches, or assignments (e.g. Operation Ranch Hand responsible for spraying Agent orange over Southeast Asia from 1962-1971, and pilots during the Gulf War Veterans with significant exposure to aviation fuels and higher risk for testicular cancer). Limited research exists on the overall association between service and cancer considering all branches of military and any/all solid-organ and skin cancers.

The Behavioral Risk Factor Surveillance Survey (BRFSS) is a cross sectional telephone survey of non-institutionalized adults (≥ 18 years old) living in households in the US. It uses complex survey design involving stratification and multistage sampling to yield nationally representative estimates. Using data from 2013 (n=491,773) a cross-sectional analysis was used to determine the association between veteran status (members of any branch of the US armed forces) and a history of any/all cancers. Observations with missing data on exposure or outcome were excluded (n=2,917, <1%). Chi square tests were used to test for differences between veterans and non-veterans with respect to demographic characteristics. Odds ratios (OR) and 95% confidence intervals (CI) were used to describe associations between veteran status and cancer diagnosis, adjusting for potential confounders.

The final sample consisted of 488,856 participants. Among those, 12.53% were veterans (n=61,505) and 11% had a diagnosis of any/all cancers (n=82,275). Unadjusted rates of cancer diagnosis were higher among veterans (20%) compared to non-veterans/civilians (10%, P < 0.001). In a multivariable logistic regression model controlling for age, sex, ethnicity, smoking status, and access to a primary care doctor, veteran status was associated with 45% increased odds of cancer diagnosis (OR 1.45, 95% CI 1.38, 1.52).

Additional prospective, as well as retrospective, studies are necessary to determine direction of this association between veteran status and cancer. Furthermore, general physicians and internists encountering veteran patients, particularly within the Veteran Affairs (VA) system may consider particular attention to cancer screening for this population.