Study Finds Skin Cancer Risk Increased in US Veterans

TOPLINE:

Compared with nonveterans, US veterans show a higher prevalence of and risk for skin cancer, sunburn, and certain dermatologic conditions, according to a study.

METHODOLOGY:

• Researchers analyzed the prevalence and likelihood of skin cancer and other dermatologic conditions between veterans and nonveterans using national representative NHANES data collected over two decades (1999-2018).
• They included 61,307 participants, with 54,554 nonveterans (42.76% men; 65.78% non-Hispanic White individuals) and 6753 veterans (92.74% men; 80.42% non-Hispanic White individuals).
• A total of 54,991 participants (48,278 nonveterans and 6713 veterans) answered questions about their cancer history.

TAKEAWAY:

• Veterans had a higher prevalence of any skin cancer than nonveterans (9% vs 2.9%; P < .001). Specifically, the prevalence of melanoma (2.2% vs 0.6%), nonmelanoma skin cancer (5.1% vs 1.6%), and skin cancer of unknown subtype (2.2% vs 0.8%) was significantly higher in veterans (P < .001, for all).
• Veterans showed elevated risks for any skin cancer (odds ratio [OR], 1.72; 95% CI, 1.23-2.40), melanoma (OR, 2.27; 95% CI, 1.17-4.39), and nonmelanoma skin cancer (OR, 1.80; 95% CI, 1.17-2.78) after adjusting for demographic factors.
• Veterans also had a higher risk for psoriasis (OR, 1.61; 95% CI, 1.05-2.46), but not for eczema/dermatitis/inflamed rash in the previous 30 days anywhere on the body, although risk was significantly increased when localized to the arms.
• Veterans were more likely to spend time outdoors on workdays (OR, 1.22; 95% CI, 1.04-2.25) but their status did not differ significantly from that of nonveterans in sunscreen use or other sun protection behaviors. However, veterans had a 44%-45% (P < .05) increased risk for severe sunburn after brief sun exposure.

IN PRACTICE:

“Public health measures seeking to address veteran healthcare differences could emphasize primary preventive strategies to mitigate risk and early detection of dermatologic conditions through regular skin examinations,” the study authors concluded. An accompanying editorial noted that “dermatologists should be aware that veterans face higher skin cancer risks even after adjusting for demographic differences, potentially due at least in part, to occupational exposures.” In addition, the editorial authors wrote, “additional research is needed to identify and quantify the effects of UV and military toxic exposures on skin cancer risk among active duty service members.”

SOURCE:

The study was led by Shawheen J. Rezaei, MPhil, from the Department of Dermatology, Stanford University School of Medicine, Stanford, California, and was published online on September 4 in JAMA Dermatology. The authors of the editorial are from the Departments of Dermatology at Brigham and Women’s Hospital, Boston, and Vanderbilt University, Nashville, Tennessee.

LIMITATIONS: 

Skin cancer, psoriasis, and eczema/dermatitis were self-reported, and the predominance of older White men limited the generalizability of the findings.

DISCLOSURES:

The study was supported by Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, and Providence VA Medical Center, Providence, Rhode Island. The authors had no disclosures. The authors of the editorial disclosed receiving grants from the VA; one author’s disclosures included receiving personal fees from and being a scientific officer for Evereden, receiving grants and research funding from DermaSensor, and consulting for Oasis Pharmaceuticals and Almirall.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.