DIHE: Save A Life: Ask If She’s Served | Caitlin “Cat” Russell, PhD, MBE, CRNP, WHNP-BC
Caitlin “Cat” Russell, PhD, MBE, CRNP, WHNP-BC
I was a 22-year-old brand new lieutenant when I received my first PAP smear. The civilian contractor rolled her eyes when I told her I wasn’t sexually active (“You all say that!”) and then commented about how sheltered and ignorant I must be when she realized I wasn’t lying. A few years later, my male PCP tried to bully me into having a PAP without a female chaperone present, but as a captain, I had enough rank to shut him down.
These are only two of the women’s health experiences I had while serving in the U.S. Army that shaped my decision to become a women’s health nurse practitioner. My experiences were not unique or even considered “that bad” for women serving in the military.
There are approximately two million women veterans in the U.S. but fewer than 50% receive care through the Veterans Health Administration (VA).1,2 I am among those who exclusively see non-VA healthcare providers because why would I trust another government healthcare system when the first resulted in so much medical mistrust?
As a woman, I am an invisible veteran. When most people think of veterans, they do not think of the young woman sporting the latest trends, or the exhausted mother trying to quiet her children or the elderly woman sitting in the waiting room. For this reason, I implore you to start screening your patients for veteran status with the simple question “Have you ever served in the military?” This creates an inclusive care environment and allows you to start a conversation about the gynecological cancer risks associated with military service.
Although not nearly enough studies have been performed in this space, some findings indicate that women veterans have a higher risk of gynecological cancers when compared to civilians.3 Women veterans report higher risk factors at higher rates than civilians, such as previous sexual assault, smoking, identifying as a Black woman or living in the South.3 Black women living in the South are the fastest growing veteran population and are the demographic that experiences the highest incidence and mortality rates from gynecological cancers.4,5 Identifying all potential risk factors is critical to prevention and early detection.
Over 300,000 women served in Iraq and Afghanistan and were exposed to environmental hazards such as burn pits.6 Large and small, these ubiquitous waste management fires were used to dispose of everything from computers to medical waste. The U.S. government finally acknowledged the risks these posed to the veteran population by passing the PACT Act in 2022. Under the PACT Act, women who served in Iraq or Afghanistan (or several other countries during the Global War on Terror) who develop female reproductive cancer (i.e., breast, paraurethral glands, cervical, ovarian, urethral, uterine, vaginal, vulvar cancer) are eligible for no-cost health care, free prescription medications and other benefits.7,8 In 2021, the VA established the Breast and Gynecological Oncology System of Excellence (BGSoE), which provides veterans with a cancer care navigation program and telehealth oncology services.9 Prior to 2022, many women veterans who filed for VA disability due to gynecological cancers were denied, so providing your patients with accurate, up-to-date information can help facilitate their care.
This is not to say that you should force your patients to pursue VA care. There are valid reasons the patient in front of you may not want to seek VA care, but being aware of the additional risks associated with your patients’ military service and having the ability to inform them of all possible resources available to them can help save lives.
Resources
VA PACT Act Presumptive Cancers
Military Service Screening for Clinicians
Caitlin “Cat” Russell, PhD, MBE, WHNP-BC (she/her), is a post-doctoral fellow in the National Clinician Scholars Program at the University of Pennsylvania and a 2021 Pat Tillman Foundation Scholar. She is currently pursuing a Master of Science in Health Policy Research.
Dr. Clason served in the Army from 2006 to 2013 and is interested in addressing the health inequities faced by women who are currently serving or who have previously served in the military. She is especially interested in researching reproductive health and access to care issues in this population. Her postdoctoral work seeks to explore the decision-making process of women veterans who choose not to access VA care, pregnancy loss and how it is experienced by service women and veterans, and access to abortion care in the military population.
References
1. Glowacki N. 2019 Gender and Veteran Demographics. Department of Labor Accessed September 20, 2024. https://www.dol.gov/sites/dolgov/files/VETS/files/2019-Gender-and-Veteran-Demographics-Slides.pptx
2. National Center for Veteran Analysis and Statistics. Profile of Veterans: 2017.; 2019. Accessed January 12, 2023. https://www.va.gov/vetdata/docs/SpecialReports/Profile_of_Veterans_2017.pdf
3. Danan ER, Than C, Chawla N, Hoggatt KJ, Yano EM. Abnormal cervical cancer screening results among US Veteran and non-Veteran participants in the National Health Interview Survey (NHIS). Prev Med Rep. 2023;36:102472. doi:10.1016/j.pmedr.2023.102472
4. Frayne SM, Phibbs CS, Saechao F, Friedman SA, Haskell SG. Sourcebook: Women Veterans in the Veterans Health Administration: Vol. 4. Longitudinal Trends in Sociodemo- Graphics, Utilization, Health Profile, and Geographic Distribution. U.S. Department of Veterans Affairs, Veterans Health, Women’s Health Services/Center for Innovation to Implementation, Women’s Health Evaluation Administration Initiative. https://www.womenshealth.va.gov/
5. Yoo W, Kim S, Huh WK, et al. Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States. Chang JS, ed. PLOS ONE. 2017;12(2):e0172548. doi:10.1371/journal.pone.0172548
6. Buckley M, Thompson R. Introduction: Special Issue on Women and Operation Iraqi Freedom. J Veterans Stud. 2021;7(2):1. doi:10.21061/jvs.v7i2.276
7. Department of Veteran Affairs. Service Connected Matrix. September 29, 2024. https://benefits.va.gov/benefits/derivative_sc.asp
8. Department of Veteran Affairs. Presumptive cancers related to burn pit exposure. Accessed September 29, 2024. https://www.va.gov/resources/presumptive-cancers-related-to-burn-pit-exposure/#reproductive-cancers
9. Shepherd-Banigan M, Zullig LL, Berkowitz TSZ, 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. Published online September 23, 2024:usae447. doi:10.1093/milmed/usae447