Are Veterans at increased risk of myeloproliferative neoplasms?
Abstract: Persian Gulf War-era Veterans were found to have a younger age at diagnosis and shorter overall survival (OS) for myeloproliferative neoplasms (MPNs) compared to Korean and Vietnam War-era Veterans. This disparity may result from immortal time bias, where earlier-era Veterans with MPNs likely died prior to the study's 2006 start. Despite limitations inherent to retrospective studies, findings suggest military service may elevate MPN risk, potentially influenced by factors such as stress, inflammation, and exposure to bone marrow toxins. Increased risks associated with black race, smoking, and thrombosis or bleeding in MPNs align with existing research. Complex tumorigenesis processes challenge the attribution of somatic mutations like JAK2 to specific genotoxic exposures, with evidence suggesting early-life mutation acquisition accelerated by military-related stressors or toxic exposures. The study highlights the importance of integrating clinical phenotypes into the assessment of MPNs in military populations. Recommendations from the National Academies of Sciences, Engineering, and Medicine (NASEM) emphasize leveraging cancer registries, addressing rare cancers, and considering demographic factors. Findings underscore the urgency of expanding presumed service-connected conditions to include MPNs for Veterans exposed to carcinogenic agents during service. The study also advocates for service connection as a means to enhance access to quality Veterans Health Administration (VHA) care, further supported by recent policy advancements under the PACT Act. These findings reinforce the need for data-driven policies to improve Veteran health outcomes and expand the scope of service-connected conditions for Gulf War-era Veterans.