November 11 is designated each year as Veterans Day, and all of us here at LynxDx would like to express our gratitude to everyone who has sacrificed so much to serve and defend our country. We’d also like to take the opportunity to advocate for veteran health and discuss a serious health issue affecting the men who have served in the military.
Our nation’s veterans are at a higher risk of prostate cancer than any other subgroup. About one in five male veterans will be diagnosed with the disease, a rate that is nearly twice as high as the general population and higher even than the rate for Black men.
Prostate cancer is the most common type of cancer diagnosed by the Veterans Health Administration, or VHA, at 30% of all new cancer diagnoses. Each year roughly 15,000 veterans are diagnosed with the condition. Of the 9 million vets who receive care from the VHA, nearly 500,000 have prostate cancer.
One major contributing factor is exposure to Agent Orange, a defoliant herbicide containing dioxin that was used during the wars in Korea and Vietnam and is, thankfully, no longer in production. Various studies over the years, including a 1996 report from the National Academy of Sciences, Engineering and Medicine, have established a link between the compound and prostate cancer. In 2013 a study found that veterans exposed to Agent Orange while serving in Vietnam or Korea are not only at higher risk for prostate cancer, they’re more likely to have an aggressive form of it.
Other suspected risk factors include exposure to burn pits and the various toxic compounds found on military bases or in their water supplies — including PFAS or PFOA “forever chemicals,” which are commonly used in firefighting foams. More study is needed to establish more definitive links.
What’s being done
Fortunately, there is much work underway to help veterans diagnosed with prostate cancer.
In 2016, the Department of Veterans Affairs partnered with the Prostate Cancer Foundation, which committed $50 million to establish the Precision Oncology Program for Cancer of the Prostate. The program aims to use genetic information to develop individualized treatment regimens for veterans who have advanced forms of the disease. It offers access to genetic testing and counseling, clinical trials and FDA-approved drugs that target specific cancer mutations.
The VA has also established a nationwide network of Precision Oncology Prostate Cancer Centers of Excellence as part of the initiative where much of the important work is underway.
One example is a collaboration between New York-Presbyterian, Columbia University Irving Medical Center and the James J. Peters VA Medical Center in The Bronx. There, researchers are using precision medicine to study advanced prostate cancer and running a clinical trial to identify mutations in patients’ prostate cancer tumors and look for existing drugs that may be a good fit. Of special interest is mutations in the BRCA gene, which increases the risk of developing prostate cancer for men but also breast and ovarian cancers in women.
As it turns out, the VA is an excellent place to conduct research that may help advance scientific understanding of prostate cancer.
As the largest integrated healthcare system in the nation, with nearly 1,300 facilities, including 171 medical centers, the VA also offers the largest and longest-standing electronic medical record in the country and other rich research informatics. That makes it a “gold mine for clinical researchers … based on the enormous number of patients served, the tremendous diversity of these patients, and the amount of data collected,” according to a whitepaper from Harvard Business School.
In another initiative that is recruiting patients, the group Veterans Prostate Cancer Awareness is teaming up with Baylor University, Harvard Medical School and other organizations to study why military aviator veterans are at especially high risk of getting the disease.
A significant development came in late 2022 when President Biden signed the Veterans Prostate Cancer Treatment and Research Act into law, the culmination of several years of efforts by advocates to champion legislation.
The new law creates a registry and research program focused on veterans who get their care from the VHA. It also requires the creation of a clinical pathway, updated annually, to guide best practices and ensure that veterans across the country have equal access to screening, treatment and survivorship services.
Another form of service
Taken together, these initiatives are hugely encouraging, comprising some of the most important and cutting-edge research taking place anywhere into prostate cancer causes, behaviors and treatment regimens.
Our veterans made enormous sacrifices for their country. Many have paid steep prices in terms of their personal health, and they deserve nothing but the very best in prostate cancer treatment.
We cannot undo the damage that’s already been done to veterans who’ve been diagnosed with prostate cancer. But in helping advance the scientific understanding of this disease, they may just be doing another great service to the whole world.