March 1997

VA has responded to the growing number of women veterans by targeting programs and facilities to meet their unique health-care needs. There are 1.2 million women veterans living in the United States and Puerto Rico, nearly five percent of the 25.9 million total U.S. veteran population. Today, women make up 13 percent of the active duty military force -- a dramatic growth since the beginning of the Vietnam conflict when the military capped the number of women in the armed forces at two percent.

Using National Institutes of Health criteria for identifying "women's health issues,"
VA research projects deal with diseases or conditions that are unique, more prevalent, or more serious among women. The research also may cover those diseases or conditions for which risk factors or interventions are different for women. During fiscal year 1996, VA researchers conducted a total of 189 such projects funded by VA and other federal and private organizations.

Women's Health Sciences Division

In January 1993, VA established a new division within the National Center for Post-Traumatic Stress Disorder devoted to studying the impact of military trauma on women veterans. The Women's Health Sciences Division, based at the Boston VA Medical Center, became the first of its kind in the country. Research in this division is specifically designed to address gender issues potentially linked to post-traumatic stress and closely associated disorders such as depression and substance abuse. Studies focus on women or male-female comparisons.

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The National Vietnam Veterans' Readjustment Study, published in 1988, reported that women theater veterans had high lifetime rates (26 percent) of PTSD related to their military service. However, war zone service is not the only setting in which military women experience high rates of stress; women are more likely than men to be exposed to rape, assault, harassment and gender discrimination. Studies at the Women's Health Sciences Division have investigated the effects of a range of stressful experiences on women who served during the Vietnam conflict and the Persian Gulf War. Preliminary results show that reported rates of sexual harassment and assault of women in the military are substantially higher than the national average. In addition, assaultive and violent noncombat traumas are reported frequently during peacetime service, highlighting the fact that women's military experiences may be more broadly stressful than men's.

Investigators at the Center have developed and evaluated several assessment instruments designed to measure military stressors commonly experienced by women and their reactions to stress, both traumatic and nontraumatic. They have examined the validity and utility of a new diagnostic interview to assess the effects of trauma on women. To learn more about the links among stress, trauma and health, projects are underway that involve explorations of biological stressor indicators (including autonomic, endocrinologic and immunologic measures) and associated changes following stressful occurrences. This work is currently being extended to gender comparisons, with particular attention to interpersonal stressors, emotion and biological responses to stress. This year, the Center also began a collaboration with scientific colleagues who have national expertise in biological indices related to stress and trauma. This effort should help identify the ways in which psychosocial experiences impact biological outcomes.

A major goal of the Women's Health Sciences Division is to rapidly develop treatment programs for use by military personnel working with individuals exposed to a variety of life trauma. Along with national changes in the delivery of VA health care, research is increasingly focused on assessing health service delivery, such as access, quality, satisfaction and outcome issues. One large-scale research endeavor is a national survey of women veterans' perceptions and experiences in their efforts to access VA health care services. This is the first veteran survey to involve representative samples of women users, former users and non-users of VA care, and will provide a model that more clearly specifies institutional and individual characteristics associated with access, including health outcomes. A collateral study has involved an internal and external needs assessment of the female veteran population, its demographics, and characteristics of the needs among women veterans residing in Massachusetts.

Registry of Women Veterans and Other Health Services Research

In FY 1994, VA's Health Services Research and Development Service implemented a special initiative on women's health. As a result, investigators at the Houston VA Medical Center are developing a National Registry of Women Veterans. The registry will be the first electronic database that uniquely identifies all women veterans separated from active military duty since January 1, 1942. The data will be used to promote research on the continual improvement of health care of American women veterans and all women.

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At the Hines, Ill., VA Medical Center, researchers are developing a database on long-term care use by male and female veterans to assist in identifying and meeting the long-term care needs of women veterans. In Bedford, Mass., a VA project is aimed at identifying factors that may affect the health-related quality of life of female veterans who use VA outpatient services. Researchers in Boston are studying factors that may constitute actual or perceived barriers to women's efforts to use VA health care.

Reproductive Health Outcomes Among Women Vietnam Veterans

In September 1993, VA announced approval of a project to study reproductive outcomes of women Vietnam veterans. Public Law 99-272 originally mandated a comprehensive study, which was later determined by the Office of Technology Assessment (OTA) to be not scientifically feasible. An alternative, approved by OTA and congressional staff, involved a mortality study, which has been completed; an analysis of post-traumatic stress disorder and other psychological outcomes, completed in 1996; and a study of reproductive outcomes. VA was able, in FY 1994, to select a contractor to complete the study. The first phase, or feasibility study comparing the reproductive health outcomes of women Vietnam veterans with women who did not serve in Vietnam, has been completed. The second phase, a large scale study, is underway. Information from this study will allow VA to learn more about the relationship between military service and the reproductive health of women veterans.

Breast Cancer

Of the estimated 1.2 million women veterans in the United States, about 144,000 are expected to develop breast cancer during their lives. The chance of complete recovery is better when breast cancer is found early. Researchers at the San Francisco VA Medical Center studied the efficacy of screening mammography as a means of reducing mortality from breast cancer and found that the screening significantly reduced it in women aged 50 to 74 years.

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At the Hines, Ill., and Durham, N.C., VA medical centers, investigators found that 46 percent of women veterans over age 50 had not received a mammogram in the past year. As a result, researchers suggested an urgent need to promote early breast cancer detection programs for women veterans and to further assess risks. The Durham VA Medical Center instituted a Wellness Program and Wellness Flow Sheet that provides a quick, accurate reference specifying the health promotion, diseases screening and prevention needs of women veterans.

Other VA projects are looking at new screening and diagnostic procedures. At the Gainesville, Fla., VA Medical Center, investigators are examining magnetic resonance imaging of the breast as a diagnostic tool. At the San Diego VA Medical Center, investigators are developing a direct digital imaging system that will exceed the performance of current film mammography.

For the past 17 years, investigators at the VA Medical Center in Albany, N.Y., have been studying the effects of the body's natural rhythms on surgery and chemotherapy in patients with cancer, including women with breast cancer. The researchers have shown that women with breast cancer whose surgery is performed near the time of ovulation are four to five times less likely to suffer relapse and death than those who are operated on during or nearer their menstrual period. Also under investigation is the effect of daily rhythms on the administration of chemotherapeutic agents to establish maximum anticancer and minimal cytotoxic effects of the therapy.

VA participates in clinical drug trials sponsored by the National Cancer Institute and other federal government agencies, and by private proprietary companies. These studies include adjuvant chemotherapy and hormonal therapy with hormones such as the antiestrogen tamoxifen used in postmenopausal women.

Basic research into the causes and prevention of breast cancer is also conducted by VA researchers. An investigator at the Baltimore VA Medical Center is using cultures of human breast cancer cells to look at insulin-like growth factors to determine their role as stimulators of breast cancer cells. At the New York VA Medical Center, investigators are using a rat model to study the role of insulin-like growth factor in mammary cancer. The investigator hypothesizes that growth hormone and insulin-like growth factor act together to cause mammary cancer. At the St. Louis VA Medical Center, research is progressing on the control of oncogene expression by growth factors. The investigator has found a gene that is expressed in tumor cells more than in normal cells. This gene also is present in normal cells, but decreases in old age. The investigator hypothesizes that this gene is important in cellular aging and in changing the cell from normal to tumor.

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In fiscal year 1996, VA funded six research projects on breast cancer for $396,491. Another 35 projects were supported with $989,622 from other federal agencies or private organizations.

Osteoporosis

Osteoporosis is a disorder of decreased bone mass and density resulting in fragile bones which fracture easily. It is a common condition associated with aging and occurs six times more frequently in women than in men. Investigators at the Minneapolis VA Medical Center are conducting clinical trials of oral estrogen as a treatment for osteoporosis in postmenopausal women. They also are studying a drug called diphosphonate -- which is expected to reduce the incidence of fractures in postmenopausal women ages 55 to 80. World-recognized experts in the field at the Charleston, S.C., VA Medical Center are studying the relationship of vitamin D and bone and are currently involved in clinical studies of investigational drugs for osteoporosis. Several projects at the Loma Linda, Calif., VA Medical Center are directed toward the unequal changes in the rates of bone formation and bone resorption in postmenopausal women. Information from these studies will be used in improving treatment and understanding the cause of the disease, which is still unknown.

Unlike many other diseases, there is no good animal model to use for studying osteoporosis. An investigator at the Newington, Conn., VA Medical Center is breeding special lines of mice for this purpose. These mice provide a unique experimental system to explore molecular events associated with human bone formation and remodeling in an intact animal system. Bone cells in tissue culture are being used by investigators at the Miami VA Medical Center to study how parathyroid hormone affects calcium metabolism in bone cells.

Molecular biology and various growth factors for bone cells are also being investigated by VA researchers. At the Loma Linda VA Medical Center, investigators are studying a growth factor called insulin-like growth factor II, while at VA's Southwest Texas Health Care System, researchers are directing efforts at a growth factor called transforming growth factor B.

In fiscal year 1996, VA funded 14 research projects on osteoporosis for $1.3 million. Another 49 projects were supported with $3 million in funds from other public and private institutions.

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* Related Fact Sheets Available from VA News Service

• VA Research
• VA Programs for Women Veterans
  

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