Breast Cancer and Women in our Military

In doing research this past week, I came across a press release issued by Congressman Leonard Boswell’s office concerning the high incidence of breast cancer diagnoses in women on active duty in our military forces.

An excerpt from the May 24, 2011 release reads as follows:

Washington, DC – Today, Congressman Leonard Boswell submitted an amendment to the House Rules Committee for the National Defense Authorization Act that would commission a study on the incidence of breast cancer in members of the Armed Forces and veterans, and analyze contributing factors. The Rules Committee will consider the amendment tonight.

“There is significant anecdotal evidence that men and women who are serving or have served their country bravely are being diagnosed with breast cancer at an alarming rate, especially for their age,” said Boswell, who introduced legislation on this issue in the 111th Congress. “This Act would require the Department of Defense and VA to take the first step to determining if breast cancer is service-connected.

This press release got me wondering what research had been done to date that studied the incidence of breast cancer diagnoses in women in the military. My first stop…the Department of Defense (DOD)for an overview of facts on our women in the military:

The majority (>90%) of women in active military service are < 40 years of age. The Department of Defense (DOD) with its high percentage of young women and its commitment to health care is particularly concerned about breast cancer. When discovered at a later stage, treatment of breast cancer is expensive, aggressive and results in considerable disruption to the woman’s ability to contribute to society. Cost and disruption to life are considerably less when the carcinoma is discovered at an earlier stage. Furthermore, the DOD has a high percentage of African-American (~40%) and Hispanic (~10%) women. Death rates from breast cancer tend to be particularly high in these ethnic groups owing in part to later stage of detection and to the more aggressive nature of breast cancer in these groups.

The active duty military force is approximately 20% female. Most of these service members are in the age range (30-40 years) where routine screening for breast cancer consists only of clinical breast examination. Both mammography and clinical breast examination have a very poor accuracy in the young active duty force in determining which breast abnormalities require treatment, and which are benign and can be left alone. The immense scale and impact of this problem for the military can be assessed by the fact that there were over 2,000 cases of breast cancer diagnosed in active duty service members over the last ten years (source: ACTURS DoD Tumor Registry data).

Furthermore, there were over 8,000 unnecessary breast biopsies done on active duty women during this time because it takes 4 breast biopsies of normal non-cancerous lesions to find each individual breast cancer. Hence, women often need to take lengthy amounts of time off from duty in order to undergo multiple tests leading up to the biopsy as well as time off from duty because of the biopsy itself.

This translates into approximately 10,000 weeks, or 30 person-years, of time lost in the evaluation of normal, benign breast lesions in active duty service members. This would be unacceptable for any other healthcare issue, and should be so for this one. Unfortunately, at the present time there is absolutely no screening tool currently available to diagnose breast cancer in the early, curable stages for women under the age of 40, who make up the vast majority of women in military uniform.

I also found several references to a June 2009  article in Cancer Epidemiology Biomarkers and Prevention. What follows are excerpts that address breast cancer in U. S. service women on active duty. The study found that:

  • The incidence rates of breast cancers were significantly higher in the military among Whites and Blacks. (Zhu,K et.al. Cancer Incidence in the U.S. Military Population: Comparison with Rates from the SEER Program,18(6). June 2009)
  • The potential differences in screening practices between the military and general populations, variations in some risk factors may have contributed to the higher breast cancer rates in the military.
  • With respect to breast cancer, military women may differ from those in the general population in reproductive history such as age at first birth and use of contraceptives.
  • Military women may be more likely to use oral contraceptive pills  As shown in our recent analysis, 34% of active-duty women and 29% of women in the general population used OC pills in the preceding twelve months. Oral contraceptive pill use has been demonstrated to increase the risk of breast cancer, particularly in younger women.
  • Military women are also more likely to be engaged in industrial jobs than females in the general population and hence potentially more likely to be exposed to chemicals that may be related to breast cancer
  • A study in military women showed that those aged 34 or younger had higher age-specific incidence rates of breast cancer than women in the general population and the incidence was higher among military women with a moderate to high exposure to volatile organic chemicals than those with low or no exposure

We can only hope that Congressman Boswell of Iowa is successful in getting his study on the high incidence of breast cancer in our military approved !

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