Data show that lung cancer is the leading cause of cancer death among men and women, accounting for about 25% of all cancer fatalities in the United States. Compared to the general population, lung cancer incidence in veterans and service members of the American military is significantly higher due to the prevalence of heavy smoking associated with the inhalation and ingestion of a large spectrum of carcinogens.

During their service, military workers have been regularly and unwittingly exposed to hazardous substances. The risk of military exposure to carcinogens can be high depending on where the service member once served or is currently serving. Exposure to asbestos, PFAS chemicals found in firefighting foam, Agent Orange, carbon monoxide in diesel exhaust, heavy smog, pesticides, and detonated or destroyed chemical weapons can all lead to lung cancer.

Lung cancer often progresses with few signs or symptoms until patients have reached an advanced stage of the disease. Unfortunately, this has a huge impact on patient mortality. The survival rate for lung cancer is 73-90% at stage 0 but decreases to fewer than 10% by stage IV.

Lung cancer is often insidious, with no obvious signs or symptoms until the illness has progressed. In approximately 7-10% of cases, lung cancer is diagnosed incidentally in asymptomatic patients after a chest X-ray was performed for other reasons. In other instances, physicians may misdiagnose the persistent cough caused by lung cancer as pneumonia or bronchitis. A general practitioner may treat what they think to be a common respiratory illness rather than sending a patient to a pulmonologist for additional testing or assessment. By the time the doctor determines that the treatment has failed, and that additional testing is required, valuable time has been lost. Suspicious findings such as lymph node enlargement or nodules may be detected on an X-ray; if these abnormal findings are not reevaluated within a short period, a lung cancer diagnosis may be missed. Long-term survival is contingent upon early and accurate diagnosis — and the Detection of Early Lung Cancer Among Military Personnel (DECAMP) initiative, a multidisciplinary and translational research program, aims to enhance lung cancer detection via noninvasive techniques and better screening.

The purpose of this program, which is being conducted by Boston University in collaboration with the American College of Radiology and is funded by the Department of Defense’s Lung Cancer Research Program, Johnson & Johnson and Novartis Biomedical Research Institutes, is to gain a better understanding of the military’s unique lung cancer risk in comparison to the general population. Scientists’ current priority is to eradicate deaths and suffering from lung cancer by finding lung cancer in people before they have any symptoms and further improving therapeutic outcomes.

Molecular biomarkers testing, used to determine the presence of particular mutations or a particular protein among patients diagnosed with advanced-stage lung cancer, is the first step in precision medicine — ensuring that based on the individual’s biomarker status, the patient gets matched to the right treatment at the right time.

A better delineation between COPD (emphysema and/or chronic bronchitis), pneumonia and tuberculosis, and lung cancer may lead to meaningful improvement in lung cancer prognosis and reduce the morbidity and mortality associated with this deadly disease. Complete copies of all of your service medical records should be considered by the pathologist when confirming or excluding lung cancer. Understanding the possible signs, symptoms and nature of pulmonary malignancy related to inhalation of a spectrum of carcinogens can reduce the time to diagnose them and potentially contribute to the improved survival rate.

In some cases, obtaining a private, professional medical opinion can mean the difference between getting veterans’ benefits for your disabilities or not. Using private medical evidence such as evidence from your family physician, or a specialist you’ve previously consulted, also establishes greater credibility for your claim, informs the Department of Veterans Affairs that you currently suffer from the claimed condition, and allows your private physician to consider possible service connection for a clinically diagnosed condition.

Remarkably, pollution at military bases is so extended and hazardous that more than two-thirds of all Superfund sites listed by the U.S. Environmental Protection Agency are military-affiliated, according to an EPA report. Dumped into pits, leaking from corroding containers, buried in unlined landfills, and left on test ranges, contaminants such as metal cleaning solvents, machining oils, metals, metalworking fluids, and chemical ingredients used in explosives have leached into groundwater, thereby causing groundwater pollution.

While the VA’s primary function is tending to badly injured soldiers during their time of service, it failed to support those exposed to hazardous chemicals and materials during their military service.

“We have to make sure that no veteran is locked out of treatment for conditions related to toxic exposure,” said then-President-elect Joe Biden in a 2020 Veterans Day speech.

A bill to reform how military personnel exposed to toxic substances in the line of duty receive treatment and benefits for illnesses linked to toxic exposure was reintroduced this year in the U.S. Senate by Sens. Thom Tillis and Maggie Hassan. The Toxic Exposure in the American Military Act would enhance eligible veterans’ access to health care by providing consultation and testing for eligible veterans through the VA.

Jonathan Sharp is the director of claims at Environmental Litigation Group P.C., a law firm in Birmingham, Ala., that focuses on advocating for veterans exposed to toxic chemicals while on active duty.

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