Background: Cancer diagnoses in the Veterans Affairs (VA) Health Care System (HCS) account for approximately 3% of all US cancer diagnoses each year. Certain cancer types disproportionately affect veterans. Many factors contribute to changes in cancer incidence and survival among veterans, including screening guidelines and practices, treatment advances, as well as changing demographics of the veteran population and VA HCS users.
Purpose: The specific objectives of this analysis were to evaluate trends in cancer incidence and 5-year overall and cancer-specific survival among veterans.
Methods: We conducted a retrospective analysis of patients diagnosed with 15 select cancers between 2002 and 2014 that were identified in the VA Central Cancer Registry. Age-adjusted incidence rates were calculated based on the US 2000 population estimates and VHA user population. 5-year survival was calculated using the Kaplan-Meier method.
Results: Of the 15 selected cancers, overall decreases in incidence were noted for the following cancers: bladder, brain, colorectal, esophageal, head & neck, leukemia, lung, lymphoma, melanoma, and prostate. Most pronounced changes were observed for colorectal, lung, and prostate cancers. Relatively small net increases in incidence were observed for breast, kidney, liver, myeloma, and pancreas cancers. Among these 15 select cancers, the highest 5-year overall survival (OS) rates were observed for melanoma, prostate, and breast cancers (all > 70%), whereas the lowest OS rates were noted for pancreas, brain, esophagus, lung, and liver cancers (all 20%). Between 2002-2014, OS rates improved for all cancers except for the following that remained relatively stable: brain (11%), leukemia (47%), and melanoma (72%). OS rates improved the most for head & neck cancer (37% to 47%) and myeloma (32% to 40%).
Conclusions: For the 15 cancers evaluated in this report among veterans, between 2002-2014 most cancer incidence rates have decreased and survival rates for most cancers have improved over time.
