Cancer
Military service exposures and the incidence of gynecologic cancers among younger women Veterans from post-9/11 era conflicts Christine Ramsey* Christine Ramsey Erica Abel Allison Gaffey Kathleen Agun Melissa Skanderson Lori Bastian Cynthia Brandt Bevanne Bean-Newberry
Objectives: To examine military service-related risk factors for a new diagnosis of a gynecological cancer among younger women Veterans receiving care in Veterans Affairs (VA) medical centers.
Methods: In a retrospective cohort study of 713,767 women Veterans who entered VA care from 2001–2021 prior to age 50, the primary outcome was a diagnosis of uterine, ovarian, cervical, or other gynecological cancer after entering VA care. The primary exposures were post-9/11-era service vs. participation in other service eras and experiencing military sexual trauma (MST). Poisson models were used to evaluate the associations of post-9/11-era military service, MST, smoking, and body mass index (BMI) and incidence of gynecologic cancers, controlling for demographics (i.e., age, race, and ethnicity).
Results: Overall, 0.7% were diagnosed with a gynecological cancer (N=4,366). Mean age was 33.5 ± 8.9 years at first VA care, mean follow up was 10.7 ± 7.5 years; 21.5% served in the post-9/11 era. Post-9/11 era women were younger (31.0 vs. 34.2 years), less likely current or former smokers (40% vs. 43%), to have a BMI in the obese category (28.1% vs. 35.2%), or to report experiencing MST (31.9% vs. 35.3%) than women from other service ears. In multivariable models adjusting for age, demographics, BMI category and service era, post-9/11 era was associated with 27% less likely diagnosis of a gynecological cancer than women who served in other eras (OR:0.73, CI: 0.66, 0.80). Yet, women who experienced MST were 9% more likely to be diagnosed with a gynecological cancer (CI: 1.02, 1.15) vs. those without MST history. However, there was no significant interaction between service-era and MST on risk of a gynecological cancer diagnosis. Current smoking and having a BMI in the underweight or obese categories were also associated with greater odds of a gynecological cancer diagnosis.
Conclusions: Among women Veterans who began using VA health service before age 50, risk of gynecologic cancers was lower for post-9/11 era Veterans and higher for women who experienced MST.
Impacts: Identifying service era and deployment-related risk factors for gynecologic cancer can improve targeted preventive healthcare for women Veterans.