ASPO Abstracts
The Impact of Veterans' Cancer on State Cancer Incidence Rates
Category: Cancer Health Disparities
Conference Year: 2020
Abstract Body:
Purpose: Quantifying the impact of incomplete ascertainment of Veterans Affairs (VA) cancer cases on state
cancer registry's statistics. Methods: State and federal cancer registries, including the Ohio Cancer Incidence Surveillance System (OCISS), reported cancer cases among veterans until approximately 2009. However, due to changes in data sharing policies, VA cancer cases are excluded in many state cancer registries, including Ohio. To quantify the impact of VA exclusion from OCISS, average cancer age-adjusted incidence rates were compared between 1996-2008 and 2009-2016. Given the primarily male composition of the Ohio Veteran population and the
prevalence of risk factors (e.g. smoking), we also conducted the analysis separately for prostate cancer and
lung cancer, stratified by sex.Results: The overall age-adjusted cancer incidence rate (reported as per 100,000) in males during the time of VA reporting in OCISS (1996-2008) was 560. It decreased to 515/100,000 in the period without VA reporting (2009-2016). Across the same time periods of 1996-2008 and 2009-2016, incidence rates decreased by 23% and 16% for prostate (from 150 to 115) and male lung cancers (from 100 to 84), respectively. Conversely, the
average age-adjusted incidence rate of lung cancer in females during VA reporting (1996-2008) was 59/100,000, and remained stable after discontinuation of VA reporting (60/100,000 2009-2016). A similar trend was observed in the incidence rate of female breast cancer (127/100,000 1996-2008 and 126/100,000 2009-2016).Conclusions: Analyzing trends in OCISS data showed male overall cancer, prostate, and lung age-adjusted cancer incidence rates have measurably decreased, while female breast and lung cancer rates remained unchanged. These trends coincide the timeline and demographic changes expected from underreporting of the Veteran population. By failing to include VA cases, biases that mask true trends are introduced into the cancer registry. This will impact states with a large Veteran population, such as Ohio where the adult population is ~10% Veterans. Investigation will be conducted to quantify the impact of VA underreporting across other state and federal cancer registries, and to evaluate generalizability and validity of national cancer statistics.
Keywords: cancer surveillance, state cancer registry