Cancer screening among veterans compared to civilians: A cross-sectional analysis of the Behavioral Risk Factor Surveillance System

Background: A 2009 study found that cancer rates among active-duty military personnel were lower for all cancers except breast and prostate. Rates of cancer screenings also differ among veterans based on which insurance was used to cover healthcare costs. Veterans using veteran-status related health care such as TRICARE, military health insurance for active duty and veteran personnel, were more likely to report being screened for colorectal cancer via colonoscopy than veterans using private insurance. However, no study has compared rates of screening for cancer between veteran and civilian populations in the United States; thus, the purpose of this study is to compare differences in screening rates for colorectal, lung, breast, and cervical cancers between veteran and civilian populations.

Methods: A cross-sectional analysis of the 2018 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) was performed to assess the rates of cancer screening among Veterans compared to civilians. Respondents were classified as having been screened for cancer if they answered “yes” or “no” to the corresponding screening questions. Other data extracted included sociodemographics and comorbid conditions. In accordance with the U.S. Preventive Services Task Force Grade guidelines, persons greater than 24 years of age were included in the cervical cancer screening, 50 years of age for colon cancer screening, and 40 years of age for the breast cancer screening— the latter based on the recommendations from the American Cancer Society. To determine the adjusted risk ratios (ARR) of veterans receiving screening compared to civilians, multivariate logistic regression models were constructed. ARRs were adjusted for the following variables: age, gender, race, education, and healthcare coverage.

Results: Among the women-focused analyses, only 2.6% and 2.2% of respondents were veterans for cervical cancer and breast cancer, respectively. Approximately 10% were veterans for skin and lung cancer screening evaluation and nearly 15% were veterans in the CRC analysis. Prevalence of screening was higher for veterans among all types of cancer with the exception of cervical breast cancer. When controlling for age, race, education, and healthcare coverage, veterans were statistically more likely to be screened for CRC (ARR: 1.05; 95%CI: 1.04-1.07), skin cancer (ARR: 1.28; 95%CI: 1.24-1.32), and lung cancer (ARR: 1.32; 95%CI: 1.15-1.52; Table 3). The odds of having completed a cervical or breast cancer was not significantly different between veterans and civilians.

Conclusion: Our study showed that veterans were more likely to complete colorectal, skin, and lung cancer screenings than the civilian population. Although veterans were equally or more likely to receive cancer screenings, improvements can still be made to increase screening usage in this population. These solutions should be multifactorial and address occupational exposures during service as well as personal, organizational, and societal barriers. Examples include client reminders, physician audits, and one-on-one patient education, all of which have been shown to be efficacious in reducing personal barriers to cancer screenings.