Smoking-related cancer in Scottish military veterans

Abstract

Background: Serving military personnel have been shown to be more likely to smoke, and to smoke more heavily, than civilians. Our aim was to examine whether veterans have an increased risk of smoking-related cancer compared with non-veterans. Methods: Retrospective cohort study of 57,000 veterans born 1945-1985, resident in Scotland, and 173,000 age, sex and area of residence matched non-veterans, using Cox proportional hazard models to compare risk of lung cancer and other smoking-related cancers overall, by sex and by birth cohort, adjusting for socioeconomic status. Results: Over mean 29 years follow-up, 445 (0.79%) veterans developed lung cancer compared with 1,106 (0.64%) non-veterans (adjusted hazard ratio 1.16, 95% confidence intervals 1.04-1.30, p = 0.008). Other smoking-related cancers occurred in 737 (1.31%) veterans compared with 1,883 (1.09%) non-veterans (adjusted hazard ratio 1.18, 95% confidence intervals 1.08-1.29, p < 0.001). Risk was significantly increased among veterans born 1950-1954 for lung cancer and 1945–1954 for other smoking-related cancers. Risk of lung cancer was decreased among veterans born 1960 onwards. Conclusion: Veterans living in Scotland born before 1955 were at increased risk of smoking-related cancer compared with non-veterans, but younger veterans were not. This may reflect changing patterns of smoking in military personnel as a consequence of health promotion policy, and a changing operational environment. Primary healthcare providers should be aware of the importance of providing smoking cessation support to veterans.