Summit at Walter Reed focuses on cancer-risk mitigation across the force

By Bernard S. Little Walter Reed National Military Medical Center, Hospital Communications

As a cancer survivor, prevention of the disease is a focus “near and dear” to U.S. Navy Capt. (Dr.) Lanny Littlejohn, he recently shared.

Littlejohn, director of Walter Reed National Military Medical Center (WRNMMC), welcomed attendees to the Cancer Prevention Summit on Oct. 30 at WRNMMC. The John P. Murtha Cancer Center (MCC), the Department of War’s sole designated cancer care and research Center of Excellence (CoE), hosted the event.

The summit focused on “cancer-risk mitigation across the force with particular attention on high-risk military occupations where exposures, operational tempo and environmental conditions may increase cancer risk in ways not seen in civilian populations,” said Littlejohn. “Nearly half of my career was in these environments.”

After interning with General Surgery at Naval Medical Center San Diego, Littlejohn took an assignment as a flight surgeon with Marine Tactical Electronic Warfare Squadron 4 (VMAQ-4), at Marine Corps Air Station, Cherry Point, North Carolina. He also deployed in support of Operation Southern Watch to Saudi Arabia.

Following that assignment, Littlejohn served as a diving and undersea medical officer with Navy Explosive Ordnance Disposal Mobile Unit (EODMU) 2 at Little Creek, Virginia, before beginning his residency in emergency medicine at Naval Medical Center Portsmouth (NMCP) in 2009. After completing his residency, he deployed to Helmand Province, Afghanistan in 2010.

From 2009 to 2014, Littlejohn served as the staff physician for the emergency medicine residency program at NMCP and director of the Combat Trauma Research Group. He also served in a direct combat medical support role for U.S. Special Operations Command and deployed six times to AFRICOM and CENTCOM.

“In 2011, I returned from my first Afghanistan tour, and I was diagnosed with one of those cancers [impacting military service members at increased numbers],” Littlejohn said. He thanked those involved in his successful treatment, adding, “What you do matters.”

Littlejohn explained that recent congressionally-mandated cancer research studies by the Armed Forces Health Surveillance Division show that military aviators have a 24% increased risk of cancers compared to the general U.S. population, particularly for melanoma, with an 87% increased risk specifically for military aviators compared to the general U.S. population.

Special Operations Forces (SOF) have an 18% increased risk of cancer compared to non-SOF service members, with particular risk for melanoma and testicular cancer, Littlejohn said.

He added that ongoing studies will continue to investigate and identify the occupational and environmental risk factors that may contribute to these rates, which can also impact military readiness. “The health and ability to deploy on short notice for these individuals is critical to readiness, success in the battle space and national security.”

“The best treatment for cancer is to never get it, and that’s why prevention is so important,” agreed retired U.S. Army Col. (Dr.) Craig Shriver, director of the MCC and MCC Research Programs at the Uniformed Services University of the Health Sciences (USU). He added that more than 1,500 active duty service members are diagnosed with some form of cancer every year.

“Every human is at some risk for cancer, and some humans are at increased risk for cancer,” Shriver said. “Identifying those individuals at increased risk, which can include demographics, family history, genetics, occupational exposures, military occupational specialties, environmental toxins, and more, are critical things to identify so we can do precision-targeted prevention in high-risk populations.” He added that identifying cancer early enhances treatment and survivability.

Primary prevention

U.S. Navy Lt. Cmdr. (Dr.) Ellen Lesh, a USU preventive medicine resident, focused on primary cancer prevention, which she described as actions taken to decrease the chance of getting the disease. This includes lifestyle modifications such as avoiding tobacco use, limiting alcohol consumption, maintaining a healthy weight, exercising regularly, eating a balanced diet, and using sunscreen to block ultraviolet (UV) radiation. In addition, she said getting vaccinated against cancer-causing viruses, such as the human papillomavirus (HPV) and the Hepatitis B virus (HBV), can lower the risk of cervical, head/neck and liver cancers.

Lesh said studies show that approximately 40% of cancers worldwide may be prevented if people focused on primary cancer prevention and lifestyle modifications. The World Health Organization (WHO) estimates between 30-50% of all cancer cases are preventable “by eliminating or reducing exposure to established modifiable risk factors.

Secondary prevention

U.S. Air Force Lt. Col. (Dr.) David Garcia, also a USU preventive medicine resident, focused on secondary prevention, which includes finding cancer or precancerous conditions early, ideally before symptoms appear and when treatment is most effective. This includes routine screening, clinical and self-examinations, and removing precancerous lesions.

Lesh also explained that tertiary prevention happens after a cancer diagnosis and focuses on slowing disease progression, preventing complications, reducing disability, and stopping recurrence.

Because of the Department of War’s (DoW) “equal-access advantage” to healthcare, Garcia said military beneficiaries are often diagnosed at earlier stages across breast, prostate, colon and lung cancers.

“Folks in the military typically don’t delay healthcare because of cost,” he added. This also makes early detection more likely in the military population.

Garcia explained that the Aviator Cancer Examination Study (ACES) Act, signed into law on Aug. 14, 2025, mandates a multi-year scientific study led by the National Academies of Sciences, Engineering, and Medicine (NASEM) to investigate cancer incidence, mortality, and underlying environmental or occupational causes among military fixed-wing aviators and aircrew members. He said that as studies by NASEM ACES and [DoW] mature, the future path forward will fundamentally shift towards “individualized shared decision-making (proactive skin exams, smart MRI pathways, standard age 45 colorectal cancer screening and testicular screening) rather than blunt baseline [guidelines].”

Aviation

U.S. Navy Air Force Capt. (Dr.) Jordan Valenta, a hematology-oncology fellow, focused on aviation in discussing high-risk military occupations for cancer. He said cancer risk factors faced by military aviators and air crews include increased exposure to cosmic ionizing radiation, ultraviolet radiation, circadian rhythm disruptions and jet fuel. These factors appear to put aviators and air crews at increased risk for melanoma, thyroid, prostate, and breast cancers.

“Mortality is lower despite the higher incidence for cancers among the military population,” Valenta added. He explained that this may be attributed to the “healthy Soldier effect,” with service members being younger, healthier and more active than the general population, in addition to service members’ and their families’ free access to preventive healthcare, cancer care, and radiation-shielding equipment available within some military occupational specialties.

Special Operations Forces

Dr. Angelia Eick-Cost, senior epidemiologist with the Armed Forces Health Surveillance Division, discussed high-risk military occupations: SOF. These members may face increased exposure to toxic particulates and gunpowder residue, lead and heavy metals, burn pits and airborne toxins, explosives and breaching munitions, industrial chemicals and solvents. They may also face more deployments to austere environments with increased sun exposure.

Multi-Cancer Early Detection

U.S. Army Capt. (Dr.) Kyle Yuan, a hematology-oncology fellow at Walter Reed, explained the emerging multi-cancer early detection (MCD) technology, a single blood test that screens for several cancers simultaneously. MCD is still under research and hasn’t been approved by the Food and Drug Administration (FDA), Yuan said. It also does not replace standard cancer screenings, like mammograms and colonoscopies.

“It’s not a diagnosis, and a positive result from a MCD would still necessitate an imaging, biopsy and workup,” Yuan added. “MCD tests can find cancers we don’t screen for today with relatively few false positives, but they miss early cancers and have not been shown to save lives.”

Dr. Kristen Natale, MCCRP pathologist, explained that the Vanguard Study, a multi-site clinical trial in which Walter Reed is one of the participating sites, will explore the feasibility of using MCD tests in future randomized controlled trials.

“The plan is to look at whether the benefits of using MCD tests outweigh the harms, and whether they can detect cancer early in a way that reduces cancer-related deaths,” Natale said.

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