Health care provider options for military personnel may increase likelihood of regular breast and cervical cancer screenings

An interdisciplinary team of researchers including Joel Segel, associate professor of health policy and administration at Penn State, recently analyzed 2007-2019 Military Health System (MHS) data of female patients to examine individual and location factors associated with one- and two-year breast and cervical cancer screening rates. For cervical cancer screening, they examined data from women ages 21-64. For breast cancer screening, they examined data from women ages 40-64. Their findings, published in Military Medicine, showed higher rates for cervical cancer screening where more health care is delivered from civilian care providers.

The researchers’ analysis highlighted differences between breast and cervical cancer screening rates. For breast cancer screening, they found higher screening rates for older, married, more senior women (ages 50-64). For cervical cancer screening, they found higher screening rates for younger, unmarried, more junior women (ages 21-29). 

“These findings are consistent with the recommendations made by the US Preventive Services Task Force for breast and cervical cancer screening,” Segel said. “While these results did not come as a surprise, we were happy our results showed the MHS is following those health care standards.”

The researchers also found minimal differences in screening across demographic groups likely due to comprehensive coverage and broad access to care.

While the researchers looked at demographic data, they also estimated differences in screening rates based on the fraction of purchased care vs. direct care from a military provider, and average per capita spending in catchment areas – a 40-mile radius around a military medical facility.

In the military, there are two primary ways to receive health care. Individuals can go to a military medical facility on or near their base or, depending on location, can go to a hospital or facility in a civilian setting and purchase care. The researchers found higher rates for both breast and cervical cancer screening in catchment areas where more health care was delivered via purchased care in a civilian setting.

Women living in an area with a higher rate of purchased care had an increased probability of receiving a mammogram screening within one year. For every additional $1,000 in per capita spending, women had an even higher likelihood of receiving a mammogram screening within one year. Similar results were observed when looking at two-year screening rates vs. one-year screening rates.

According to Segel, these differences are likely due to a larger availability of purchased care and more options for individuals to seek care and treatment, making it easier to get appointments with health care providers.

While many of the findings may be attributed to differences in these cancer screening types, they emphasize the importance of continuing to provide timely breast and cervical cancer screening, which looks to be a success of the options afforded to military personnel through the MHS.

This work is part of a broader study Segel is working on to better understand geographic variations in health care within the MHS.

“We’ve been looking at this data more broadly to determine if differences in screening rates are partially due to placement factors in the military,” Segel said. “The Defense Health Agency is very concerned about variation. When the military relocates individuals, they want to ensure everyone has the same access to the same quality of care. We hope to ultimately have a better understanding of why certain areas are higher or lower in terms of screening rates, as well as broader patterns of variation in treatment and prevention.”

Originally published in April 2025.