Under the SERVICE Act, mammography screening is expanded for certain military populations. However, many patients don’t know about it.
Women comprise more and more of the population in the U.S. military, both active duty and veterans. In 2000, only about 4% of veterans identified as female; however, that number is expected to grow to 18% by 2040, making them the fastest growing demographic of veterans. Yet these women also represent another growing statistic: breast cancer incidences.
Military women have higher rates of breast cancer compared to the general population. A retrospective cohort study from 2011 to 2022 found that within the 3.4-million-member cohort of active-duty service members, 1,064 were diagnosed with breast cancer (18.23%), with higher incidence rates among Black and non-Hispanic service members. In comparison, the lifetime risk of breast cancer among civilian women is 12.5 percent. In 2010, breast cancer represented 30% of cancers diagnosed in female veterans.
Why are the rates so much higher for ADSMs and veterans? “It’s multifactorial,” says David Traynor, MD, internal medicine physician and chief medical officer at the Palatka Community-Based Outpatient Clinic Veterans Affairs (VA) Medical Center. Traynor, a veteran himself, also served as a toxic exposure screening navigator for the VA health system in Georgia and Florida.
Lifestyle and reproductive factors contribute — many ADSMs delay family building due to their careers, and tobacco and nicotine use is also higher among military members. And there are occupational factors. “Although we don’t have the data yet to know for sure, there is concern regarding the impact of occupational exposure to toxins, often as a result of burn pits,” says Jasmine Locklin, MD, radiologist at the Washington, D.C., VA Medical Center and member of the ACR Veterans Affairs Committee.
“Many of the things being burned had carcinogenic properties such as benzene or polycyclic aromatic hydrocarbons,” says Traynor. “There was also exposure to depleted uranium during the Gulf War,” he adds, noting, “We’re seeing similar rises in cancer among Iraqi women who were exposed around the same time, so although we don’t have the mechanism to say ‘This is the exact reason,’ we can definitely draw some inferences.”
If more of the women who are affected by burn pits and other toxic exposures are screened, they can help create a body of evidence determining whether these are in fact risk factors.
In response to these growing numbers, Congress enacted the Dr. Kate Hendricks Thomas Supporting Expanded Review for Veterans in Combat (SERVICE) Act in 2022. Although the VA usually advises screening according to the U.S. Preventive Services Task Force (USPSTF) recommendations, the SERVICE Act gives veterans who were deployed in specifically listed international military operations during certain time periods the ability to receive breast cancer assessment and clinically appropriate screening mammography under the age of 40, expanding access to younger women.
“Despite this being out there, many veterans and ADSMs do not know about their eligibility, nor do a lot of physicians,” says Locklin. Traynor adds, “They know the USPSTF guidelines but don’t realize not only that they are at a greater risk but also that screening is available to them.” What’s more, there is a concern that veterans and ADSMs seeking care may be turned away by providers outside of the military health system who do not realize this change in guidelines, Locklin says.
That’s why it’s important to get the word out among physicians, patients and the general population. “By helping inform more people, we’re not only ensuring that patients receive timely care, but we’re also helping future generations. If more of the women who are affected by burn pits and other toxic exposures are screened, they can help create a body of evidence determining whether these are in fact risk factors,” says Locklin.
Both Locklin and Traynor have been involved in campaigns to help veterans and ADSMs understand the new screening recommendations. The VA has released several fliers, including this one, that explains both the risk factors and the recommendations. Traynor has been involved with a grassroots campaign to help inform women in his area. “It was particularly important because we have rural communities that likely had no idea,” he says. Traynor cold-called veterans who were qualified and helped educate them on the new guidelines as well as the reasons for mammography in general. “There’s no substitute for conversation, even with all the technology we have. Veterans are frequently in contact with one another, and even with my own buddies. When I talk to one, they think of someone else who could use the knowledge and share it with them,” he says.
As part of the calls, Traynor helped order mammograms when needed and followed up with results. His team also set up booths at veteran outreach events and displayed educational posters. “Of the mammograms I ordered, we did catch several breast cancers in younger women that weren’t normally eligible by civilian guidelines,” Traynor says.
Whether it’s pamphlets, posters, emails or even just a conversation, helping spread the word is important for physicians and patients, Traynor says. “The more educated a patient is, the better. And as physicians — both primary care and radiologists — we play an important role in that education.”
By Meghan Edwards, freelance writer, ACR Bulletin.
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