Military sexual trauma and the incidence of gynecologic cancers among women Veterans

Abstract:Objectives: To examine if military sexual trauma (MST) is associated with the incidence of gynecologic cancers among women Veterans who receive care in the Veterans Health Administration (VHA). Design: Data were collected from a retrospective cohort of women who initiated VHA care between 2001 and 2023 and participated for at least 6 months, completed MST screening, and did not have a previous diagnosis of cervical, uterine, or ovarian cancer. We compared women with and without a positive MST screen on demographics, health behaviors, and clinical characteristics. Unadjusted incidence rates of ovarian, uterine, and cervical cancers were calculated overall, and then by MST status. We used Cox proportional hazard models to evaluate the associations of MST and gynecological cancer after adjusting for demographics, health behaviors, and clinical variables. Participants: The dataset included 775,464 women. Main Measures: A history of MST was the primary predictor of interest. Outcomes were first VHA electronic health record documentation of cervical, uterine, and ovarian cancer diagnoses. Key Results: Women were 40.9±15.2 years old, 51.4% were non-Hispanic White, and 31.4% had a positive MST screen. Unadjusted incidence rates for the total sample were 45.5, 36.7, and 26.5 per 100,000 person-years for cervical, uterine, and ovarian cancers, respectively. After adjustment, compared to women without documented MST, those with MST had a 25% greater risk of cervical cancer (95% CI 1.17–1.33), a 17% greater risk of uterine cancer (95% CI 1.09–1.27), and a 9% greater risk of ovarian cancer (CI 1.00–1.20). Conclusions: Overall, a history of MST was associated with an increased incidence of gynecologic cancers. These findings support the need for early screening and engagement in trauma-informed gynecologic care for women Veterans following discharge from the military, and potentially for other survivors of sexual violence.