There is a potential link between toxic exposures during military service and the prevalence of lung cancer among veterans, according to a study presented at the International Association for the Study of Lung Cancer (IASLC)’s 2024 World Conference on Lung Cancer, held recently in San Diego, California.
Led by researchers from Vanderbilt University and presented at the meeting, the study highlights the need for veteran-specific screening guidelines that extend somewhat beyond looking at more traditional risk factors including advanced age and tobacco use.
Researchers used electronic health records from the Veterans Affairs Informatics and Computing Infrustructure (VINCI) and the Department of Defense (DAVINCI) to gather data on tobacco use and military exposures. The study included veterans who received care between January 1, 2022, and December 31, 2023, and included toxic exposures involving Agent Orange, Camp Lejeune, Gulf War, radiation, airborne hazard/burn pit, and other unspecified exposures.
Veterans were categorized based on their tobacco use as having ever, never, or unknown, and then self-reported toxic exposures. Those who declined toxic exposure screening were excluded from the study. The researchers then stratified patients by toxic exposure status, tobacco use status, and age, and investigated the association between service branch and exposure. Logistic regression modeling was used to adjust for age, tobacco use status, and exposure status.
Of 7,031,577 veterans who completed the toxic exposure screening, 2,132,015 (29.8%) screened positive for toxic exposure. The unadjusted prevalence of lung cancer was 1.6% in the overall cohort, with a slightly higher rate of 1.7% among veterans with any toxic exposure compared with 1.5% among those with no exposure.
The study researchers noted significant variations in lung cancer prevalence based on the type of toxic exposure. For instance, veterans exposed to Agent Orange had a lung cancer prevalence of 3.6%, while those exposed to Gulf War toxins had a prevalence of 0.9%. The median age also varied markedly across different exposure types. Marine veterans exposed to Agent Orange had the highest lung cancer prevalence at 3.8%, while Coast Guard veterans with Gulf War exposures had the lowest at 0.3%.
The findings underscore the critical role of considering toxic exposure in lung cancer risk assessments for veterans. The study suggests that many veterans’ lung cancer risks exceed the PLCO (Prostate, Lung, Colorectal, and Ovarian) Cancer Screening Trial’s 1.6% cutoff, indicating a need for more comprehensive screening guidelines tailored to veterans’ unique risk profiles.
The researchers concluded that their findings not only shed light on the heightened cancer risks faced by veterans but also call for immediate action to update screening protocols to better serve this important patient population.1
Reference
- Meyers P, Perkins A, Patel B, et al. Evaluating the relationship between veteran toxic exposure status and lung cancer prevalence. Presented at the 2024 World Conference on Lung Cancer; September 7-10, 2024; San Diego, CA. Abstract P3.01.F.01. https://cattendee.abstractsonline.com/meeting/20598/Session/225
