b'UniformedServicesUniversityoftheHealth Sciences, the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. and the Uniformed Services University of the Health Sciences,allinBethesda,MD.Thisdiffer-ence was largest compared to the uninsured and Medicaid groups, while it was minimal for the SEER-insured groups.Akeydifference,accordingtotheCancer Medicine study, is that individuals, retirees and their families have free care or minimal out-of-pocket costs in the military health system (MHS). It noted that out-of-pocket costs in the United States general population can vary substantially. 4Still,lungcancerisconsideredverydanger-ous,especiallyamongveteransandmilitary servicemembers.Thecongressionally-directedLungCancer Research Program (LCRP) pointed out, Lung cancer risk for our military is significant, with 24% to as high as 38% of servicemembers smok-ing compared to 14% of civilians.The group also advised that deployments also worsensmokingratesbyabout50%. Among military veterans, it explained that lung cancer is a leading cause of cancer-related deaths, with about 15 veterans dying of lung cancer each day.Patients from the U.S. general population were iden- An estimated 900,000 veterans remain at risk due tified from the Surveillance, Epidemiology and Endto age, smoking, and other environmental exposures Results (SEER) program. 3 during and after military service, the LCRP added. Results indicated that, compared to ACTUR patientsDespite improved screening methods for lung can-withNSCLC,SEERpatientsshowedsignificantcer and advances in treatment, the 5-year survival rate worse survival. The adjusted hazard ratios (HRs) wereremains low at 28% for non-small cell lung cancer and only 7% for small cell lung cancer.1.08 [95% Confidence Interval (CI) = 1.03-1.13], 1.221 (95% CI = 1.16-1.28), 1.40 (95% CI = 1.33-1.47),Moghanaki D, Taylor J, Bryant AK, Vitzthum LK, et. Al Lung Cancer Survival Trends in the Veterans Health Administration. Clin 1.50 (95% CI = 1.41-1.59), for insured, insured/noLung Cancer. 2024 Mar 2:S1525-7304(24)00035-4. doi: 10.1016/j.specifics, Medicaid, and uninsured patients, respec- cllc.2024.02.009. Epub ahead of print. PMID: 38553325.tively.Thepatternwasconsistentlyobservedin2Howlader N, Forjaz G, Mooradian MJ, Meza R, Kong CY, Cronin subgroupanalysisbyrace,gender,age,ortumorKA, Mariotto AB, Lowy DR, Feuer EJ. The Effect of Advances in stage. Results were similar for small cell lung cancerLung-Cancer Treatment on Population Mortality. N Engl J Med. 2020 Aug 13;383(7):640-649. doi: 10.1056/NEJMoa1916623. PMID: (SCLC), although they were only borderline signifi- 32786189; PMCID: PMC8577315.cant in some subgroups, the study team advised. 3Lin J, Shriver CD, Zhu K. Survival among lung cancer patients: In another study finding that cancer patients treatedcomparison of the U.S. military health system and the surveillance, withintheMHSgenerallyreceivetheirdiagnosesepidemiology, and end results (SEER) program by health insurance earlier than members of the general U.S. populationstatus. Cancer Causes Control. 2024 Jan;35(1):21-31. doi: 10.1007/covered by employee-provided insurance, Medicaids10552-023-01765-0. Epub 2023 Aug 2. PMID: 37532916.or without insurance, the largest difference was noted4Flanary JT, Lin J, Shriver CD, Zhu K. Cancer stage at diagnosis: Comparison of insurance status in SEER to the Department of forlungcancer,accordingtotheresearchersfromDefense Cancer Registry. Cancer Med. 2023 Oct 30. doi: 10.1002/Walter Reed National Military Medical Center, thecam4.6655. Epub ahead of print. PMID: 37902129.37'