VA Study: Black Veterans See Similar, Better Cancer Survival Rates as Non-Black Veterans

Unlike Black individuals in the general population who experience disparities in medical care, Black veterans with several types of cancer were just as likely to survive as non-Black veterans, according to a recently published systematic review and meta-analysis. For some cancers, Black veterans reported even better survival outcomes.

The analysis, published by Drew Moghanaki, MD, MPH, Chief of Thoracic Oncology, Department of Radiation Oncology, University of California, Los Angeles, and codirector, Veterans Affairs (VA) Greater Los Angeles Lung Precision Oncology Program, et al, in JAMA Network Open, found that Black veterans had better overall survival (OS) than non-Black veterans (hazard ratio [HR], 0.93) and cancer-specific survival (CSS) (HR, 0.94).

Black veterans had better survival rates for bladder, laryngeal, lung, oropharyngeal, prostate, and plasma cell cancers.

“Once there's equal access to cancer care, we no longer see the purported biological differences that people think are linked to race,” Moghanaki said in an interview with Federal Practitioner.

General Population: Racial Gap

“We've known for decades that there are differences in cancer outcomes for Black people in the US vs non-Black people,” Moghanaki said.

While the gaps in cancer mortality rates between Blacks and Whites have decreased over the last 25 years, colorectal cancer mortality remained 21% higher among Black people than White people in 2024, according to a report from the American Association for Cancer Research.

The association also reported that overall cancer mortality is 13% higher among Black men than White men, despite only 3% higher incidence. Separately, breast cancer mortality in Black women is 35% higher than in White women, even though their incidence is 6% lower.

Research suggests these disparities exist “not so much because of biology, but instead because of the structural and socioeconomic differences that many Black Americans live with in this country,” Moghanaki said.

The VA is different, he said, because “once you’re eligible for VA health care benefits, you’re getting essentially the same health care regardless of skin color.”

For the study, the researchers sought to determine whether the advantages of the VA system were reflected in cancer survival outcomes.

Methodology: Reviewing 34 Years of Data

The authors analyzed 39 studies including 603,256 veterans treated for cancer between 1983 and 2017. Study sizes ranged from 117 to 145,678 subjects. On average, 29.0% (range, 8.9%-55.0%) of participants were Black. Some studies specifically compared Black and White veterans, but the overall meta-analysis compared Black veterans with non-Black veterans.

A total of 29 studies had sufficient data for meta-analyses, including 20 (69%) focused on prostate cancer, 2 (7%) each on non-small cell lung cancer (NSCLC) and pancreatic cancer, and 1 each (3%) on head and neck cancers, esophageal cancer, bladder cancer, breast cancer, and myeloma.

Worse Outcomes for Black Veterans Were Rare

Of the 27 studies that examined OS, most (63%) found similar survival rates between Black and non-Black veterans, with 9 reporting higher survival for Black veterans and only 1 reporting higher survival for non-Black veterans. Among the 17 studies that evaluated CSS, those numbers were 13, 3, and 1, respectively.

Among veterans with prostate cancer, the pooled HRs for Blacks vs non-Blacks were 0.94 for OS and 0.90 for CSS. For NSCLC, they were 0.92 and 0.98, respectively.

The study notes that Black veterans may represent “a positively selected subgroup with respect to health, resilience, or other unmeasured factors, a phenomenon that has been described as a ‘healthy Black veteran effect.”

Other limitations include the high number of prostate cancer studies in the meta-analysis, while several leading causes of cancer death in the US (colorectal, pancreatic, breast), were underrepresented or absent. The analysis also included few women.

The differences in outcomes by race between the VA and general population may be due to the VA’s commitment to providing access to a full range of care and support, Moghanaki said.

“Veterans who are eligible for VA health care benefits also receive housing support, transportation benefits, caregiver support, social services, and mental health services that is often important for anyone with a diagnosis of cancer,” he said, before adding, “The VA’s footprint is large and able to ensure access to care regardless of where veterans live.”

In an interview with Federal Practitioner, Electra D. Paskett, PhD, professor of cancer research and director of the Division of Cancer Prevention and Control at The Ohio State University College of Medicine, who was not involved in the study, said the findings show that “equal access to state-of-the-art care in a timely manner produces good outcomes.”

She offered this message to VA clinicians: “Keep doing what you are doing!”

Moghanaki reported relationships with Bristol Myers Squibb Foundation and Varian Medical Systems, and he was the sole recipient of funding for the study from the Stanley Iezman and Nancy Stark Endowment for Thoracic Radiation Oncology Research at the David Geffen School of Medicine/University of California, Los Angeles. Some other authors reported additional disclosures. Paskett reports no disclosures.