Abstract
Objective
Women are the fastest growing demographic within the military-Veteran population in the United States. Our objective was to characterize gynecologic cancer occurrence, and trends over time, in Veterans and service members compared to non-veterans.
Methods
We performed a retrospective cohort study using National Cancer database comparing cancer occurrence, age at diagnosis, histology, and survival among veterans and service members compared to non-veterans from 2004 to 2021.
Results
Annual new gynecologic cancer diagnoses increased among Veterans from 301 in 2004 to 883 in 2021. Veterans now account for 1% of gynecologic cancer diagnoses nationwide. Veterans were diagnosed with gynecologic cancers at younger ages and earlier stages than non-veterans. Cancer histologies differed from non-veterans with endometrioid uterine cancer, germ cell ovarian cancer, and cervical adenocarcinoma being more common in Veterans. Overall survival was similar among Veterans and non-Veterans.
Conclusions
As the proportion of women in the military has grown, gynecologic cancer diagnoses and survivorship among service members and Veterans are increasing. Further work is needed to understand the epidemiology of gynecologic cancer and optimize gynecologic cancer prevention and care delivery for service members and Veterans.
1. Introduction
Women are the fastest growing demographic with the U.S. military-Veteran population, accounting for approximately 18% of the active-duty military (Facts and Statistics - Women Veterans Health Care. https://www.womenshealth.va.gov/materials-and-resources/facts-and-statistics.asp. Accessed 20 October 2025). There is limited research on the gynecologic cancer burden among military service members and Veterans (Pace, 2024). Risk factors for uterine and cervical cancer differ among veterans and non-Veterans: Veterans have lower rates of obesity, but may have higher rates of smoking than non-veterans (LaCroix, 2016, Finnegan and Salem, 2024). Our objective was to characterize gynecologic cancer occurrence, and trends over time, in Veterans and service members compared to non-veterans.
Methods
The University of Pennsylvania Institutional Review Board reviewed and exempted this study, given use of de-identified publicly available data. We used the National Cancer Database to identify newly diagnosed gynecologic cancers from 2004 to 2021. We identified Veterans and active-duty service members through their primary payor (Tricare, military, Veterans Health Administration (VHA)), hereafter referred to as Veterans. Since the NCDB misclassifies Indian Health Service as a VHA payor, we excluded individuals who identified as Native American and had gynecologic cancer from analysis (n = 5,479). We report the numbers of newly diagnosed women with gynecologic cancer overall and by cancer type and compared patient and cancer characteristics among Veterans and non-veterans using chi-squared tests.
2. Results
Annual new gynecologic cancer diagnoses increased among Veterans from 301 in 2004 to 883 in 2021, increasing from 0.5% to 1% of all new gynecologic cancers diagnosed in the US (Fig. 1). There were 13,359 diagnoses of gynecologic cancer among Veterans during the study period. As of 2020, there were at least 5,767 Veterans alive with a history of gynecologic cancer, the majority of whom had had uterine cancer (67%, 3,852). Uterine cancer was the most common gynecologic cancer in both groups, accounting for 55% of new diagnoses among Veterans and non-veterans in 2021. Endometrioid uterine cancer was more frequent among Veterans than non-veterans (79.6% vs. 76.9% of uterine cancers, p < 0.001). Ovarian cancer was the next most common, accounting for 17% among Veterans and 18% among non-veterans. Germ cell ovarian cancer was more frequent among Veterans than non-veterans (3.1% vs. 1.8% of all ovarian cancers, p < 0.001). Among patients with cervical cancer, adenocarcinoma was more frequent among Veterans than non-veterans (26.3% vs. 23.3%, p < 0.002).
Fig. 1.
Annual gynecolgic cancer diagnoses among veterans vs. non-veterans, 2004–2021.
Veterans were significantly younger at gynecologic cancer diagnosis than non-veterans (median age 58 vs. 62 years, p < 0.001). Across cancer types, Veterans were more likely to be diagnosed with early-stage disease (67% vs. 63% non-veterans, p < 0.001), despite traveling further for care and living in lower-income areas than non-veterans (Supplemental Tables 1-2). Overall survival was similar among Veterans and non-veterans within gynecologic cancer type, when adjusted for age, histology, and stage at diagnosis.
3. Discussion
As the proportion of women in the military has grown, gynecologic cancer diagnoses and survivorship among service members and Veterans are increasing. In our national study, Veterans were diagnosed with gynecologic cancers at younger ages and earlier stages than non-veterans, and cancer histologies differed from non-veterans. Gynecologic cancer diagnoses have continued to increase since the study period with 1,597 gynecologic cancers diagnosed among women insured by the VHA from 2021 to 2024, the majority of who received cancer treatment outside the VA Health System (Shepherd-Banigan, 2025). After breast cancer, cervical cancer is the second most common cancer among female Veterans ages 18–39 years who deployed to Iraq and Afghanistan (Young et al., 2025).
The study has limitations. While the NCDBC identify veterans who received oncologic cancer outside the VHA or military with their VHA or military insurance, the NCDB cannot identify Veterans who do not use military or VHA insurance. In 2023, more than 95% of eligible service members enrolled in Tricare, and around 50% of female veterans used VHA health care, thus these estimates likely undercount gynecologic cancer in veterans (TRICARE by the Numbers - DHA.mil, 2026). Data completeness may improve as female enrollment in VHA insurance increases, and the NCDB is the most complete data source at this time. We are unable to differentiate cancer burden among active service members and Veterans, although we anticipate most diagnoses are among Veterans due to age. A small number of cancer cases may be in family members of service members insured through TRICARE. The trend to earlier age at diagnosis in veterans may reflect earlier disease detection in a fully-insured population. Similarly, the difference in germ cell tumors could be due to improved access to care among young veterans than the general population. Further work is needed to understand the epidemiology and burden of gynecologic cancer in Veterans.
With the major expansion of VHA insurance to Gulf, Iraq, and Afghanistan war veterans in 2024, more patients with gynecologic cancer will use the VA health system for gynecologic cancer work-up, cancer, and survivorship care. These findings provide insights to optimize cancer prevention and care delivery to Veterans with gynecologic cancers.
CRediT authorship contribution statement
Anna Jo Bodurtha Smith: Writing – original draft, Methodology, Investigation, Funding acquisition, Data curation, Conceptualization. D’Nyla Dean: Writing – review & editing, Writing – original draft, Investigation, Data curation. Xingmei Wang: Writing – review & editing, Software, Investigation, Data curation. Leah L. Zullig: Writing – review & editing, Validation, Investigation, Conceptualization. Haley Moss: Writing – review & editing, Visualization, Methodology, Funding acquisition, Conceptualization.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.gore.2026.102100.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
Supplemental Table 1. Characteristics of Veterans and Non-Veterans with Gynecologic Cancer, 2004-2021. Supplemental Table 2. Stage at Diagnosis Overall and by Veteran Status.
References
- Facts and Statistics - Women Veterans Health Care. https://www.womenshealth.va.gov/materials-and-resources/facts-and-statistics.asp. Accessed 20 October 2025.
- Pace R., et al. The landscape of care for women veterans with cancer: an evidence map. J. Gen. Intern. Med. 2024;39:2300–2316. doi: 10.1007/s11606-024-08903-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- LaCroix A.Z., et al. Aging well among women veterans compared with non-veterans in the women’s health initiative. Gerontologist. 2016;56:S14. doi: 10.1093/geront/gnv124. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Finnegan A., Salem K. Comparative study of hypertension, diabetes, dementia and smoking in military veterans and non-veterans: a quantitative study using primary healthcare data. BMJ Mil. Health. 2024 doi: 10.1136/MILITARY-2024-002817. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shepherd-Banigan M., et al. Improving cancer care for women seeking services in the veterans health administration through the breast and gynecological oncology system of excellence. Mil. Med. 2025;190:150–153. doi: 10.1093/milmed/usae447. [DOI] [PubMed] [Google Scholar]
- TRICARE by the Numbers - DHA.mil (accessed May 6, 2026) https://www.womenshealth.va.gov/materials-and-resources/facts-and-statistics.asp (accessed May 6, 2026).
- Young R.W.C., Duncan J.E., Sohn V.Y. Supporting the PACT Act: top cancers diagnosed in young veterans who deployed to Iraq and Afghanistan. Surgical Oncol. Insight. 2025;2 [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Supplemental Table 1. Characteristics of Veterans and Non-Veterans with Gynecologic Cancer, 2004-2021. Supplemental Table 2. Stage at Diagnosis Overall and by Veteran Status.