Staff at the Minneapolis VA Healthcare System show support for Breast Cancer Awareness Month last year. VA photo posted on X
ATLANTA — Breast cancer remains a significant health concern, particularly among women veterans, who face unique challenges within the Veterans Affairs (VA) healthcare system. Chief among those challenges is an utter lack of comprehensive data regarding women veterans’ breast cancer experiences.
“We identified a single report that looks at trends in patient demographics, cancer stage, and tumor characteristics of women veterans receiving breast cancer care,” noted Hayley Moss, MD, director of the VA’s Breast and Gynecologic Oncology System of Excellence, National Oncology Program, in Durham, NC, at the 2024 Association of VA Hematology/Oncology (AVAHO) annual meeting in September in Atlanta
Given that women are the fastest-growing demographic in the VA, the absence of research is particularly troubling. More than 2 million women in the U.S. served in the military, where they make up 10% of today’s fighting force. The VA cares for more than 600,000 women today, a number that has tripled in the last two decades.
Yet, Moss noted that in 24 years of data, only a single publication focused on the experiences of women veterans diagnosed with breast cancer, a paucity that severely limits the ability of healthcare providers to deliver tailored and effective care. Beyond breast cancer, only one study focused on women veterans and toxic exposures for a range of cancer types, but it did not discuss the patient experience, cancer stage or treatment.
“We don’t know enough about women veterans,” said Moss. “We don’t know anything about cancer care quality. We don’t know anything about treatment. We know nothing about survivorship, which we should know a lot about, because we have patients go for survivorship care,” said Moss.
Care Varies Across VA
Care experiences for women veterans vary significantly by geography, revealing a fragmented system. “Some veterans report positive experiences, while others face challenges that detract from their care,” Moss said. This inconsistency arises partly from lack of gender-sensitive spaces and practices within VA facilities, with waiting rooms and exam spaces that often do not meet the needs of female veterans, leading to discomfort during sensitive procedures.
Care is also fragmented across systems, with 75% of women veterans with breast cancer receiving primary care and survivorship care from the VA, while obtaining breast cancer-specific care from community providers. “Roughly a third of our patients get their care [for breast cancer entirely] in the community, while 40% experience dual care,” Moss explained; just 25% receive care entirely through the VA.
Moss noted that most women who receive their breast cancer care entirely at the VA would have breast surgery and possibly reconstruction performed by a general surgeon, not one with sub-specialty training in the field.
The communication between community providers and VA staff often falls short, leaving patients to navigate multiple facilities and protocols without the benefit of coordinated care team. This disjointed care system leaves many women veterans without a clear understanding of their treatment journey, making it essential to recruit more subspecialty surgeons and enhance coordination between VA and community providers.
In contrast, academic medical centers typically provide a multidisciplinary approach where patients see their entire care team in one visit.
Suggested Improvements
Moss outlined several areas where focus by the VA would significantly improve the care for women veterans. These included better recruitment of specialized surgeons and the establishment of designated Centers of Excellence within the VA. Partnering with local cancer centers and incorporating virtual care teams can also enhance accessibility, particularly for rural veterans who may struggle to reach specialized care.
Moss also advocated further development and greater use of the Breast and Gynecologic Oncology System of Excellence (BGSoE), a comprehensive dashboard to track veterans diagnosed with reproductive cancers, including breast, ovarian, uterine and cervical cancer across the VA system. “This tool allows us to identify which patients are receiving care and where gaps exist,” she explained.
By utilizing this data, VA healthcare providers can ensure that women veterans receive timely and effective treatment for these cancers, track female veterans at high risk of reproductive cancers and offer access to the first national breast cancer virtual peer support program for veterans undergoing treatment.