Military personnel are a unique population who may have encountered higher levels and varieties of carcinogenic agents during their service than the general population. Investigating these potential risks is essential for thoroughly understanding bladder cancer etiology, particularly among the veteran population. Such exposures include Agent Orange, an herbicide laden with the carcinogen TCDD that was used in the Vietnam War, and depleted uranium, used in tank armor and munitions in the Gulf War and later conflicts. Additionally, veterans may be exposed to asbestos, diesel exhaust, and ionizing radiation, alongside contamination from other military-specific pollutants in drinking water at deployment sites.
Given the spectrum of potential carcinogenic exposures among veterans, it is plausible that numerous other chemical agents may contribute to bladder cancer incidence. To address this, we conducted a systematic review and meta-analysis to evaluate existing literature regarding exposure to potential carcinogens and the occurrence of bladder cancer among veterans.
Meta-analysis demonstrates significant associations between exposure to Agent Orange (HR 1.17 [95% CI: 1.01-1.36], P < .00001) and depleted uranium (HR 2.13 [95% CI: 1.31-3.48], P = .002) with increased bladder cancer risk among veterans. Exposure to contaminated drinking water shows a trend towards increased risk (HR 1.25 [95% CI: 0.97-1.61], P = .08).
The significant health risks identified necessitate enhanced clinical management and preventive measures for veterans. Given the established links between these exposures and bladder cancer, future research should focus on elucidating the specific carcinogenic agents involved and the disproportionate prevalence of these exposures among veterans to inform targeted screening and healthcare strategies. This approach is crucial not only for better epidemiological understanding but also for the direct healthcare implications for veterans, who may benefit from early detection and intervention strategies tailored to their specific exposure profiles.
Written by:
- Gal Saffati, Research Fellow, Baylor College of Medicine, Houston, TX
- Shane Kronstedt, MD, Urology Resident, Scott Department of Urology, Baylor College of Medicine, Houston, TX