Click to Enlarge: Geographic region of women with breast and gynecologic cancer. Source: Women’s Health
DURHAM, NC — As more women veterans turn to the VA for their healthcare, clinicians are seeing a shift in the types of cancers treated within the system, particularly breast and gynecologic cancers. But little is known about how women receiving cancer care in the VA compare to women with similar cancers in the general population. A new study has provided some answers.
Researchers conducted a retrospective, cross-sectional study using data from the VA’s Breast and Gynecologic Oncology System of Excellence (BGSoE) dashboard, a national VA clinical data system that tracks diagnosis, treatment and outcomes for women veterans with breast and gynecologic cancers, between Jan. 1, 2021, and March 12, 2024, and compared those findings with Surveillance, Epidemiology, and End Results (SEER) data, a population-based cancer registry program maintained by the National Cancer Institute. The analysis included 6,555 women veterans diagnosed with breast or gynecologic cancers. The median age at diagnosis was 59 for breast cancer and 58 for gynecologic cancers.1
What stood out was how those ages compared with national data, said Leah Zullig, PhD, an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Health Care System. “Compared to women in the general US population (e.g., SEER registry data), we found that women veterans were diagnosed at considerably younger ages.” But this finding was not entirely unexpected, she said. “This is consistent with what our clinician team members reported from their own clinical experience.”
While the study did not include data on hereditary risk factors or menopausal status, Zullig pointed to several possible contributors to the younger age at diagnosis. “In addition to age, there are many risk factors for breast and gynecologic cancers,” she said, adding that “there is data to suggest that women veterans may have an increased risk of developing breast cancer based on prior military service-related exposures.”
Screening practices within the VA might also be influencing when cancers are detected. “We also know that women veterans receiving VA healthcare in the VA have a high rate of receipt of cancer screening,” Zullig said. Citing recent research, she noted that “75% of women veterans were up to date for breast cancer screening and 72% for cervical cancer screening.”
Taken together, these factors may help explain the findings. “A combination of increased risk and earlier detection through screening might be contributing to the younger ages,” she said.
Despite differences in age at diagnosis, the racial composition of women veterans diagnosed with breast and gynecologic cancers closely resembled that of women in the general U.S. population. Non-Hispanic white women accounted for the largest share of diagnoses, followed by non-Hispanic Black women and Hispanic women, with similar proportions observed in SEER data.
A major strength of the study, published in Women’s Health, was its use of the BGSoE dashboard, which captures cancer care delivered both inside the VA and through community providers, Zullig said.
“The dashboard is a stellar example of VA’s incredible data infrastructure and how data can be leveraged to optimize care for veterans,” she told U.S. Medicine, noting that it offered “a much more sophisticated approach than our traditional methods of relying on diagnostic codes.”
At the same time, she cautioned that the dashboard was designed for clinical care rather than long-term historical analysis. “It is not intended as a historical database,” she said.
For clinicians and policymakers, Zullig emphasized that the study’s message is one of inclusivity rather than differentiation. “All women veterans are important,” she said. “Screening recommendations and policy decisions should be applied widely to all women veterans of cancer screening age.”
She and her colleagues see this analysis as a starting point rather than a final word. “In future research, it will be important to consider geographic differences,” Zullig said, including differences between urban and rural veterans and distance from care sites.
She also highlighted the VA’s leadership in tele-oncology. “The VA is also a leader in the provision of tele-oncology,” she said, noting its potential “to enhance the reach of cancer care services and improve access.”
As more women veterans enter the VA system, Zullig said she hopes these findings will help guide planning and resource allocation, explaining, “The VA has made a substantive commitment to women veterans and has emphasized providing comprehensive, personalized and trauma-informed care in respectful spaces. As the population of women veterans continues to grow, I hope that there will be a continued commitment to these pillars and that there will be a focus on thoughtfully scaling-up services to meet women veterans in ways are accessible to them.”
- Zullig LL, Shepherd-Banigan M, Cummin GL, Berkowitz TS, et al. Characteristics of women Veterans with incident breast and gynecologic cancers in the Veterans Health Administration. Women’s Health (Lond). 2025 Jan-Dec;21:17455057251399013. doi: 10.1177/17455057251399013. Epub 2025 Dec 24. PMID: 41442402; PMCID: PMC12744018.