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Surveillance Snapshot: Cervical Cancer Screening Among U.S. Military Service Women in the Millennium Cohort Study, 2003–2015

Image of Lt. Cmdr. Leslye Green, staff obstetrician and gynecologist, Naval Hospital Pensacola (NHP), uses a model to discuss cervical cancer with a patient. Lt. Cmdr. Leslye Green, staff obstetrician and gynecologist, Naval Hospital Pensacola (NHP), uses a model to discuss cervical cancer with a patient at NHP. According to the Centers for Disease Control and Prevention (CDC), cervical cancer is highly preventable because screening tests for cervical cancer and vaccines to protect against human papillomavirus (HPV), which is the main cause of cervical cancer, are readily available. Cervical cancer is highly treatable and associated with long survival and good quality of life when it is detected early. (U.S. Navy photo by Mass Communication Specialist 1st Class Brannon Deugan)

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The Millennium Cohort Study is a prospective study that was initiated in 2001 and includes over 200,000 current and prior U.S. military service members.1 Questionnaires are sent to participants approximately every 3 years to collect information on service related experiences as well as mental, physical, and behavioral health. Compliance with contemporary cervical cancer screening recommendations was determined among service women enrolled in the Millennium Cohort Study during 2003–2015. Current cervical cancer screening recommendations call for a Pap smear alone every 3 years in women aged 21–65 years or for a human papillomavirus (HPV) DNA test with or without a Pap test every 5 years for women aged 30–65 years.2 Women were considered eligible for screening in a given year if they were aged 21–62 years on the last day of the year, had served in the active component (i.e., at least 9 months in active component pay and strength rosters) for the concurrent year and 2 years before, had not had a hysterectomy, and had not separated from the military. Women were considered compliant with screening recommendations between 2003–2015 if they had a medical report of a Pap smear in the year of assessment or prior 2 calendar years. Women were also considered compliant with screening recommendations in 2013–2015 if they had HPV DNA testing completed within the previous 5 years.

Overall, among U.S. service women in the Millennium Cohort Study, the compliance rate increased from 61.2% in 2003 to a peak of 83.1% in 2010 then declined to a low of 59.8% in 2015 (Figure). During the first 7 years of the study period, compliance was highest among Air Force personnel. Between 2013 and 2015, compliance was highest among Coast Guard personnel. Compliance was lowest among Navy personnel in all but 1 year (2004) of the 13-year period. Compliance was also consistently higher for service women who had initiated the HPV vaccine than for women who had not (on average 6.3% higher). No differences in compliance were observed by cigarette smoking status, which was used as a surrogate measure of other health behaviors.

Author affiliations: Deployment Health Research Department in the Military Population Health Directorate, Naval Health Research Center, San Diego, CA (Dr. Matsuno, Dr. Porter, Mr. Warner, CAPT Wells); Leidos, San Diego, CA (Dr. Matsuno, Dr. Porter, Mr. Warner).

Disclaimer: One of the authors of this work is a military service member or employee of the U.S. Government. This work was prepared as part of their official duties. Title 17, U.S.C. §105 provides that copyright protection under this title is not available for any work of the U.S. Government. Title 17, U.S.C. §101 defines a U.S. Government work as work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties. This report was supported by the Military Operational Medicine Research Program under work unit no. 60002. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

REFERENCES

1. Gray GC, Chesbrough KB, Ryan MA, et al. The Millennium Cohort Study: a 21-year prospective cohort study of 140,000 military personnel. Mil Med. 2002;167(6):483–488.

2. U.S. Preventive Services Task Force. Final recommendation statement. Cervical cancer: screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening?ds=1&s=pap. Accessed 9 April 2020.

FIGURE. Cervical screening rates among service women, by branch of service, U.S. Armed Forces, 2003–2015

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Incidence, Timing, and Seasonal Patterns of Heat Illnesses During U.S. Army Basic Combat Training, 2014–2018

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From 2003 through 2018, there were 1,579 incident diagnoses of exertional hyponatremia among active component service members, for a crude overall incidence rate of 7.2 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, females, those less than 20 years old, and recruit trainees had higher overall incidence rates of exertional hyponatremia diagnoses. The overall incidence rate during the 16-year period was highest in the Marine Corps, intermediate in the Army and Air Force, and lowest in the Navy. Overall rates during the surveillance period were highest among Asian/Pacific Islander and non-Hispanic white service members and lowest among non-Hispanic black service members. Between 2003 and 2018, crude annual incidence rates of exertional hyponatremia peaked in 2010 (12.7 per 100,000 p-yrs) and then decreased to 5.3 cases per 100,000 p-yrs in 2013 before increasing in 2014 and 2015. The crude annual rate in 2018 (6.3 per 100,000 p-yrs) represented a decrease of 26.5% from 2015. Service members and their supervisors must be knowledgeable of the dangers of excessive water consumption and the prescribed limits for water intake during prolonged physical activity (e.g., field training exercises, personal fitness training, and recreational activities) in hot, humid weather.

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During 2002–2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). In both sexes, overall rates of other disorders of adrenal gland and Cushing’s syndrome were lower than for adrenal insufficiency but higher than for hyperaldosteronism, adrenogenital disorders, and adrenomedullary hyperfunction. Crude overall rates of adrenal gland disorders among females tended to be higher than those of males, with female:male rate ratios ranging from 2.1 for adrenal insufficiency to 5.5 for androgenital disorders and Cushing’s syndrome. The highest overall rates of adrenal insufficiency for males and females were among non-Hispanic white service members. Among females, rates of Cushing’s syndrome and other disorders of adrenal gland were 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.

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