Skip to main content

Military Health System

Brief Report: Phase I Results Using the Virtual Pooled Registry Cancer Linkage System (VPR-CLS) for Military Cancer Surveillance.

Image of A patient at Naval Hospital Pensacola prepares to have a low-dose computed tomography test done to screen for lung cancer. Lung cancer is the leading cause of cancer-related deaths among men and women. Early detection can lower the risk of dying from this disease. (U.S. Navy photo by Jason Bortz). A patient at Naval Hospital Pensacola prepares to have a low-dose computed tomography test done to screen for lung cancer. Lung cancer is the leading cause of cancer-related deaths among men and women. Early detection can lower the risk of dying from this disease. (U.S. Navy photo by Jason Bortz)

Recommended Content:

Medical Surveillance Monthly Report

The Armed Forces Health Surveillance Division, as part of its surveillance mission, periodically conducts studies of cancer incidence among U.S. military service members. However, service members are likely lost to follow-up from the Department of Defense cancer registry and Military Health System data sets after leaving service and during periods of time not on active duty.

Therefore, an ongoing cancer surveillance study sought linkage with civilian state cancer registries through the Virtual Pooled Registry Cancer Linkage System (VPR-CLS) supported by the North American Association of Central Cancer Registries (NAACCR) and funded by the National Cancer Institute. These civilian state registries require the inclusion of all malignant or in situ neoplasms classified by the International Classification of Diseases for Oncology, Third Edition (ICD-O-3), with the exception of carcinoma in situ of the CervixThe cervix is the lower, narrow end of the uterus (womb).  The cervix connects the uterus to the vagina (birth canal).cervix and squamous/basal cell carcinomas of the skin.

Since 2004, non-malignant benign/borderline primary tumors of the brain and central nervous system (CNS) have also been included as reportable cancers.1 The VPR-CLS performs a Phase I and Phase II linkage process to identify members of the study population who have been diagnosed with a reportable cancer. In Phase I, an aggregate total of matched cancer cases are provided by each state cancer registry after performing the linkage behind their respective firewalls. In Phase II, after approval of additional applications and data use agreements, line-level data on each of the cancer cases can be provided. This report describes the Phase I linkage results.

Methods

A roster of over 10.9 million current and former service members was provided to the VPR-CLS to facilitate the Phase I linkage after Defense Health Agency (DHA) Institutional Review Board (IRB) study approval as a public health surveillance activity. The roster included current and former members of the Army, Navy, Air Force, and Marine Corps who had a duty military occupation specialty code contained in the Defense Medical Surveillance System. This included active, reserve, and guard component members serving at any period through 2017, beginning in 1985 for Army members and 1990 for members of all other services. Individuals who joined service after 2017 were not included. Cancer case counts were quantified as high-quality matches defined by a probabilistic linkage algorithm to identify matched pairs above a certain threshold when matched according to various combinations of SSN, name, sex, and date of birth. The case counts provided by the Phase I match results include all reportable cancers, as defined by the respective civilian state registry standards.1 Furthermore, individuals with multiple primary cancers are counted for each primary cancer and for each state of residence at diagnosis, according to tumor inclusion and reportability standards.1

Results 

At the time of this report, Phase I match results were available for 44 out of 46 states in the VPR-CLS. Cases were identified as early as 1973 for some state cancer registries, and up through the most recently available data (2020 for most states). A total of 539,983 cases were identified among current and former military service members (Table). Not surprisingly, the highest numbers of cases were identified in the some of the most highly populated states, including Texas, Florida, and California (Table, Figure).

Editorial Comment

Most previous military cancer surveillance studies have relied on data from the DoD cancer registry, the VA central cancer registry, TRICARE medical billing data, or a combination of these sources.2–5 Similar to the DoD cancer registry, the VPR-CLS contains information about tumor staging, patient demographics, treatment, and vital status. The primary advantages of VPRCLS for military cancer surveillance are its potential for enabling more complete surveillance among personnel who are diagnosed and treated in civilian facilities and that it is more likely to include former service members no longer on active duty. In addition, all state registries are certified annually by NAACCR for compliance with quality standards of completeness, timeliness, and accuracy.6 Phase I counts allow investigators to determine the number of cancers identified in each state prior to completing the more intensive application and review processes for Phase II.

Limitations to the VPR-CLS include a lag in data availability, as cancer registries generally make their data available 24 months after the close of a diagnosis year in order to provide the most complete and consolidated data. In addition, although the VPR-CLS provides a systematic process for linkage with multiple civilian state cancer registries, 8 states in the VPR-CLS currently require separate applications and 20 require separate data use agreements for Phase II. Finally, it should be noted that the numbers presented in this report may not include cancers diagnosed in individuals who are receiving care exclusively at military treatment facilities. At the time of this report, only 4 states had completed the requirements and agreements for DoD cancer registry data sharing. Given the large number of high-quality matches identified via the Phase I linkage process, this system serves as a promising tool for future military cancer studies. More information about the VPR-CLS can be found at: https://www.naaccr.org/about-vpr-cls/.

Author affiliations

Defense Health Agency, Public Health Directorate, Silver Spring, MD (Dr. Stahlman, CAPT Wells); North American Association of Central Cancer Registries, Springfield, IL (Ms. Clerkin, Ms. Kohler); Information Management Services, Inc., Rockville, MD (Mr. Howe); National Institute of Health/National Cancer Institute, Bethesda, MD (Dr. Cronin).

References

  1. North American Association of Central Cancer Registries (NAACCR). Chapter III: Standards for Tumor Inclusion and Reportability. Accessed June 17, 2022. Accessed 24 June 2022. http://datadictionary.naaccr.org/default.aspx?c=3&Version=22
  2. Zhu K, Devesa SS, Wu H, et al. Cancer incidence in the U.S. military population: comparison with rates from the SEER program. Cancer Epidemiol Biomarkers Prev. 2009;18(6):1740–1745.
  3. Robbins AS, Pathak SR, Webber BJ, et al. Malignancy in U.S. Air Force fighter pilots and other officers, 1986-2017: A retrospective cohort study. PLoS One. 2020;15(9):e0239437.
  4. Webber BJ, Tacke CD, Wolff GG, et al. Cancer Incidence and Mortality Among Fighter Aviators in the United States Air Force. J Occup Environ Med. 2022;64(1):71–78.
  5. Lee T, Williams VF, Clark LL. Incident diagnoses of cancers in the active component and cancer- related deaths in the active and reserve components, U.S. Armed Forces, 2005–2014. MSMR. 2016;23(7):23–31.
  6. North American Association of Central Cancer Registries (NAACCR). Certification Criteria. Accessed 24 June 2022. https://www.naaccr.org/certification-criteria/

 

Current and former U.S. military service member cancer cases identified from the Phase I VPR-CLS linkage for AFHSD surveillance study

Current and former U.S. military service member cancer cases identified from the Phase I VPR-CLS linkage for AFHSD surveillance study.

You also may be interested in...

Update: Mental Health Disorders and Mental Health Problems, Active Component, U.S. Armed Forces, 2016–2020

Article
8/1/2021

Update: Mental Health Disorders and Mental Health Problems, Active Component, U.S. Armed Forces, 2016–2020

Recommended Content:

Medical Surveillance Monthly Report

Surveillance of Mental and Behavioral Health Care Utilization and Use of Telehealth, Active Component, U.S. Armed Forces, 1 January 2019–30 September 2020

Article
8/1/2021

Recommended Content:

Medical Surveillance Monthly Report

Mental Health Disorders, Behavioral Health Problems, Fatigue and Sleep Outcomes in Remotely Piloted Aircraft/Manned Aircraft Pilots, and Remotely Piloted Aircraft Crew, U.S. Air Force, 1 October 2003–30 June 2019

Article
8/1/2021

Recommended Content:

Medical Surveillance Monthly Report

Long-Acting Reversible Contraceptive Use, Active Component Service Women, U.S. Armed Forces, 2016–2020

Article
7/1/2021
Hands holding an intrauterine device

Long-Acting Reversible Contraceptive Use, Active Component Service Women, U.S. Armed Forces, 2016–2020

Recommended Content:

Medical Surveillance Monthly Report

Oral Cavity and Pharynx Cancers, Active Component, U.S. Armed Forces, 2007–2019

Article
7/1/2021
Two hands holding chewing tobacco

Oral Cavity and Pharynx Cancers, Active Component, U.S. Armed Forces, 2007–2019

Recommended Content:

Medical Surveillance Monthly Report

The Evolution of Military Health Surveillance Reporting: A Historical Review

Article
7/1/2021
Screenshot of the inaugural issue of the Medical Surveillance Monthly Report

The Evolution of Military Health Surveillance Reporting: A Historical Review

Recommended Content:

Medical Surveillance Monthly Report

Department of Defense Mid-Season Vaccine Effectiveness Estimates for the 2019– 2020 Influenza Season

Article
6/1/2021
201019-N-PC065-1062 NORFOLK (Oct. 19, 2020) Hospital Corpsman 2nd Class Sashee Robinson, assigned to amphibious transport dock ship USS Arlington (LPD 24), administers an influenza vaccine to Machinery Repairman 2nd Class Hannah Swearingen in medical aboard the Arlington. Influenza vaccines are an annual medical readiness requirement throughout the Department of Defense. (U.S. Navy photo by Mass Communication Specialist 2nd Class John Bellino/Released)

Department of Defense Mid-Season Vaccine Effectiveness Estimates for the 2019– 2020 Influenza Season

Recommended Content:

Medical Surveillance Monthly Report

The Cost of Lower Extremity Fractures Among Active Duty U.S. Army Soldiers, 2017

Article
6/1/2021
X-ray image of a fractured tibia.

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Medical Encounters for Snakebite Envenomation, Active and Reserve Components, U.S. Armed Forces, 2016–2020

Article
6/1/2021
Masters of camouflage, the Sidewinder Rattlesnakes are out and about aboard Marine Corps Logistics Base Barstow, California, May 11. Watch where you put your hands and feet, and observe children and pets at all times, as this is the natural habitat for these venomous snakes and a bite can cause serious medical problems. Notice the sharp arrow-shaped head with pronounced jaws, and the raised eye sockets, as well as the telltale rattles. Keep in mind, however, that rattles can be broken or lost, so you may or may not hear a rattle before they strike to protect themselves.

Brief Report: Medical Encounters for Snakebite Envenomation, Active and Reserve Components, U.S. Armed Forces, 2016–2020

Recommended Content:

Medical Surveillance Monthly Report

Early Identification of SARS-CoV-2 Emergence in the Department of Defense via Retrospective Analysis of 2019–2020 Upper Respiratory Illness Samples

Article
6/1/2021
Army Maj. Raymond Nagley, S-3 officer assigned to the 50th Regional Support Group (RSG), receives a nasal swab to screen for COVID-19 at Fort Hood, Texas, on Feb. 5, 2021, from Spc. Yoali Muniz, a lab tech assigned to the 7406th Troop Medical Clinic, based in Columbia, Missouri. The 50th RSG, a Florida Guard unit based in Homestead, Florida, is preparing for deployment to Poland. (U.S. Army Guard photo by Sgt. 1st Class Shane Klestinski)

Early Identification of SARS-CoV-2 Emergence in the Department of Defense via Retrospective Analysis of 2019–2020 Upper Respiratory Illness Samples

Recommended Content:

Medical Surveillance Monthly Report

Medical Evacuations out of the U.S. Central Command, Active and Reserve Components, U.S. Armed Forces, 2020

Article
5/1/2021
U.S. Army Soldiers from the 115th Brigade Support Battalion, 1st Armored Brigade Combat Team, evacuate casualties onto waiting HH-60M MEDEVAC Blackhawk helicopters from Charlie Company, 6th Battalion, 101st Combat Aviation Brigade during Combined Resolve XV, Feb. 27, 2021, at Hohenfels Training Area. Combined Resolve XV is a Headquarters Department of the Army directed Multinational exercise designed to build 1st Armored Brigade Combat Team, 1st Cavalry Division’s readiness and enhance interoperability with allied forces and partner nations to fight and win against any adversary.(U.S. Army photo by Sgt. 1st Class Garrick W. Morgenweck)

Medical Evacuations out of the U.S. Central Command, Active and Reserve Components, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2020

Article
5/1/2021
MAYPORT, Fla. (Sept. 18, 2020) – Cmdr. Mary Gracia, a pediatric nurse practitioner at Naval Branch Health Clinic Mayport, checks five-year-old Gabriella’s ears. Gracia, a native of McAllen, Texas, says, “It's been an honor and a privilege to impart my expertise to the children of our active duty members who are graciously serving our country. These children, our future leaders, prayers lifted and bountiful blessings for each one. And to the children I've helped during overseas deployments, prayers continued.” (U.S. Navy photo by Jacob Sippel, Naval Hospital Jacksonville/Released).

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Non-service Member Beneficiaries of the Military Health System, 2020

Recommended Content:

Medical Surveillance Monthly Report

Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2020

Article
5/1/2021
Navy Lt. James E. Lamb, left, and Sgt. Ryan Eskandary exercise aboard USS Pearl Harbor

Morbidity Burdens Attributable to Various Illnesses and Injuries, Deployed Active and Reserve Component Service Members, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2020

Article
5/1/2021
U.S. Air Force Capt. Sean Wilson, a native of Winston-Salem, N.C., and a physical therapist with the 59th Orthopedic and Rehabilitation Squadron, teaches a patient some home exercises that he can perform on his own at the Craig Joint-Theater Hospital, Jan. 23, 2012. (U.S. Air Force photo by Spc.Cody Barber, Bagram Air Field, Afghanistan/Released)

Absolute and Relative Morbidity Burdens Attributable to Various Illnesses and Injuries, Active Component, U.S. Armed Forces, 2020

Recommended Content:

Medical Surveillance Monthly Report

Ambulatory Visits, Active Component, U.S. Armed Forces, 2020

Article
5/1/2021
Tech. Sgt. Kimberly Weaver, 606th Air Control Squadron noncommissioned officer in charge of medical readiness, measures an Airman’s blood pressure at Aviano Air Base, Italy, May 10, 2021.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 61 - 75 Page 5 of 14
Refine your search
Last Updated: October 11, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery