The Missile Community Cancer Study: Initial Report on Cancer Incidence and Mortality.
Congress, the United States Department of the Air Force (DAF) leadership, and other individuals frequently request military-specific cancer cluster investigations as concerns over cancer clusters within the military community continues to be a public health topic. The Intercontinental Ballistic Missile (ICBM) missile community is involved in the operation and maintenance of long-range ballistic missiles that have the capability to deliver nuclear warheads as part of the U.S. nuclear deterrence mission. They experience unique working conditions that are demanding and highly regulated due to the sensitive and critical nature of their work. The purpose of this study is to further evaluate cancer incidence and cancer mortality among missile community (MC) members serving from 1976 to 2010 utilizing multiple data sources from the Department of Defense (DoD) electronic health record, the Veteran's Administration (VA) electronic health record, both the DoD and VA cancer registries, and National Death Index data.
For both incidence and mortality, an internal comparison (MC compared to DAF non-missile community [non-MC]) and an external comparison (MC compared to the U.S. general population) were conducted. For the internal comparisons, regression analyses were adjusted for sex, age, race, and rank (officer vs. enlisted). Incidence rate ratios (IRRs) and mortality rate ratios and corresponding 95% confidence intervals were estimated using the log link function, with individual person-years accounted for using the offset option. For the external comparisons, standardized incidence ratios and standardized mortality ratios were adjusted for age, sex, race, and year of death and were generated for the MC as compared to the U.S. general population for each of the 14 cancers individually and collectively.
Males accounted for 92.92% of the MC, compared to 84.10% of the non-MC. Most individuals in both groups were White, accounting for 84.41% in the MC and 80.25% in the non-MC. Prostate cancer was the most common type among both the MC (n = 577, 31.38%) and non-MC (n = 16,845, 31.55%). Cancer incidence in the MC was statistically similar or lower compared to both the U.S. general population and the non-MC. Likewise, cancer mortality in the MC was statistically similar or lower compared to both comparison groups.
Although this study did not find an increased risk of cancer incidence or mortality in the MC, additional analysis is planned using data from the Virtual Pooled Registry. Not only does this study provide a more comprehensive and reliable assessment of cancer risks in this military population than previous investigations, but it also informs important decisions about the design of future cancer epidemiology studies in military populations.
For both incidence and mortality, an internal comparison (MC compared to DAF non-missile community [non-MC]) and an external comparison (MC compared to the U.S. general population) were conducted. For the internal comparisons, regression analyses were adjusted for sex, age, race, and rank (officer vs. enlisted). Incidence rate ratios (IRRs) and mortality rate ratios and corresponding 95% confidence intervals were estimated using the log link function, with individual person-years accounted for using the offset option. For the external comparisons, standardized incidence ratios and standardized mortality ratios were adjusted for age, sex, race, and year of death and were generated for the MC as compared to the U.S. general population for each of the 14 cancers individually and collectively.
Males accounted for 92.92% of the MC, compared to 84.10% of the non-MC. Most individuals in both groups were White, accounting for 84.41% in the MC and 80.25% in the non-MC. Prostate cancer was the most common type among both the MC (n = 577, 31.38%) and non-MC (n = 16,845, 31.55%). Cancer incidence in the MC was statistically similar or lower compared to both the U.S. general population and the non-MC. Likewise, cancer mortality in the MC was statistically similar or lower compared to both comparison groups.
Although this study did not find an increased risk of cancer incidence or mortality in the MC, additional analysis is planned using data from the Virtual Pooled Registry. Not only does this study provide a more comprehensive and reliable assessment of cancer risks in this military population than previous investigations, but it also informs important decisions about the design of future cancer epidemiology studies in military populations.
Authors
Beam Beam, Wolff Wolff, Fryman-Wynkoop Fryman-Wynkoop, Crawford Crawford, Khalil Khalil, Smith Smith, Ruiz Ruiz, Guinn Guinn, Kelly Kelly, Ramsey Ramsey, Escobar Escobar, Simon Simon, Adkins Adkins, Britt Britt
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