Active Military Service Veterans are at Risk for Skin Cancers

Skin Cancer Rates Among Veterans: A Closer Look at the Growing Health Risk

Skin cancer is more common among U.S. veterans compared with nonveterans, according to a recent report in JAMA Dermatology. The data suggested melanoma, nonmelanoma, and skin cancers of any type have increasing odds of developing in veterans as they age.

The news is alarming because veterans are more likely to present with late-stage skin cancers, which are associated with poorer outcomes. Veterans also have an elevated risk for depression, posttraumatic stress disorder, and substance use disorder, and they have more service-related disabilities than nonveterans.

Among veterans, 9.0% reported having had a medical issue associated with any subtype of skin cancer. Among nonveterans asked the same question, only 2.9% reported a problem. Veterans report having more exposure to the sun outdoors during active military service.

The highest occurrence of skin cancer reported was nonmelanoma skin cancer among veterans (5.1%) versus nonveterans (1.6%). Melanoma incidence was also higher among veterans (2.2%) versus nonveterans (0.6%).

The lines depicted here connect the average number of each of four groups of ages. Group 1 is the average of 20-39 year olds. Group 2 is the average of 40-59 year olds. Group 3 is the average of 60-79 year olds. Group 4 is the average of those 80 and above. The lines split after 40-59 years of age. The figure is from the article, “Skin Cancer and Other Dermatologic Conditions Among US Veterans” by Shawheen J. Rezaei, et al.

The gaps in the occurrence of skin cancer widen with increasing age. Whereas the numbers overlap between the groups when they are in their 40s or midlife, the numbers increase dramatically more for veterans as they age. By the time veterans have reached 80 years of age, they have significantly more skin cancers than nonveterans, averaging 1.5 to 2.0 times as many.

Regarding outdoor behaviors related to the sun, more veterans (77.67%) reported working outdoors between 9 a.m. to 5 p.m. than nonveterans (68.5%). This work was frequently reported as being performed without sunscreen, shade, or wearing sun-protective long sleeves.

In addition, veterans were associated with a 44-45% increased risk of severe sunburn after 30 minutes in the sun. However, the percentage of responders reporting a severe sunburn with blisters was nearly the same between groups.

The study had 54,991 participants, including veterans (n=6,713) and nonveterans (n=48,278). The data came from the National Health and Nutrition Examination Survey between 1999 and 2018.

Unfortunately, federal agencies have not adopted standardizations for sunscreen ingredients or use, or measures to protect workers from sun exposure. Although the U.S. Surgeon General does recommend sun-protective behaviors, there is no standard messaging on sunscreen use.

Public health measures could modify the risks for veterans in active military service. Strategies, clothing, and topical sunscreen could be recommended for active military personnel. Increasing education about current studies could also help to reduce exposure to ultraviolet radiation (UV).

While the study highlights a public health problem for veterans, it has limitations that caution over-interpretation. For example, the results are from self-reported data on diagnosis. Older white males also predominantly comprise the veteran population, and this group is at higher risk of skin cancer, which could skew the data. More studies are needed to confirm these findings.

This summary is based on the article “Skin Cancer and Other Dermatologic Conditions Among US Veterans” by Shawheen J. Rezaei, Jiyeong Kim, Sonia Onyeka, et al. published in JAMA Dermatology on October 1, 2024. (doi: 10.1001/jamadermatol.2024.3043)