SAN DIEGO — Non-Hispanic Black veterans and servicemembers had almost twofold greater lung cancer mortality risk compared with those who are non-Hispanic white, according to a recent study.
Lung cancer also was the only fatal malignancy that was more likely in enlisted military personnel than officers.
Researchers from the Naval Health Research Center and the VA Puget Sound Health Care System in Seattle reached those conclusions after analyzing 661 cancer deaths. The data came from the Millennium Cohort Study, the largest and longest-running health study in the U.S. military; the cancer deaths occurred between 2001 and 2018 among 194,689 servicemembers and veterans.
The report in Cancer Epidemiology, Biomarkers & Prevention noted that, among the 661 cancer-related deaths, 121 identified lung cancer as the cause of death.1
In terms of other demographic factors, being single was associated with greater lung cancer mortality risk compared with those who reported being married. Lung cancer mortality risk also was greater for former military personnel with a high school degree or less, compared with those with an associate’s or bachelor’s degree.
As for military characteristics, the researchers reported that those who had served as enlisted personnel showed almost threefold greater lung cancer mortality risk than officers.
“Although deployment was associated with lung cancer mortality in unadjusted and demographically adjusted models, this effect was no longer significant after adjusting for health-related characteristics,” the study advised. “Service component, service branch, and military occupation were not associated with lung cancer mortality in unadjusted or adjusted models.”
Having experienced 1 or 2+ life stressors caused study subjects to have greater lung cancer mortality risk than those who reported none. Surprisingly, veterans reporting obesity had lower lung cancer mortality risk compared with those never classified as obese.
As expected, however, veterans ever identified as smokers had more than 4 times the likelihood of lung cancer mortality than nonsmokers. On the other hand, probable depression and post-concussion syndrome were associated with lung cancer mortality risk in unadjusted models, but not adjusted models. Risky drinking, long sleep duration and probable post-traumatic stress disorder (PTSD) also were not significantly associated with lung cancer mortality in unadjusted or adjusted models.
“The aim of the current study was to explore the association between military service characteristics and cancer mortality in a large, population-based sample of OIF/OEF service members and veterans,” the authors explained. “We found that non-deployed individuals had greater risk of overall cancer mortality and early cancer mortality compared with those who were deployed with no combat. In addition, no difference was found between those who deployed with or without combat, suggesting that the lower f risk of cancer mortality associated with deployment was present regardless of combat experiences.”
The finding was said to be consistent with the healthy soldier effect “where military populations are found to be healthier than the general population, which may be partially attributable to the initial barriers to entry into military service (i.e., physical screenings), physical health requirements necessary to remain in military service and increased access to housing and healthcare benefits received during military service.”
The study also pointed out that military servicemembers are more likely to undergo regular cancer screenings because of the universal availability of healthcare provided by the MHS. “This may potentially lead to earlier detection of cancer and therefore, reduce risk of cancer-related deaths within the active duty military population,” the authors wrote.
Only with lung cancer in both adjusted and unadjusted models was military rank associated with overall cancer mortality. “Consistent with prior research linking lower military rank and worse health outcomes, enlisted individuals had elevated risk of lung cancer mortality compared with officers. This may be due in part to greater frequency of cigarette smoking, an established risk factor for lung cancer. For instance, in a longitudinal study, noncommissioned officers were less likely to start smoking and were more likely to quit smoking compared with those in the junior enlisted rank.”
Even after adjustment for smoking in the current study, however, the elevated risk of death due to lung cancer among enlisted personnel remained, which suggested other occupational risk factors may exist. One theory is that enlisted servicemembers perform tasks that more frequently expose them to occupational hazards (e.g., carbon monoxide, respiratory carcinogens, and other toxicants) compared with officers. Those exposures could lead to poorer respiratory health (e.g., sarcoidosis and asthma incidence.).
Other military characteristics, specifically military occupation, service branch, and service component, were not associated with cancer mortality in the current study, however, the study said.
- Sharifian N, Carey FR, Seay JS, Castaneda SF, Boyko EJ, Rull RP. Risk and Protective Factors for Cancer Mortality Among United States Service Members and Veterans (2001-2018). Cancer Epidemiol Biomarkers Prev. 2023 Mar 7:EPI-22-0943. doi: 10.1158/1055-9965.EPI-22-0943. Epub ahead of print. PMID: 36880966.