Optimizing Care for Veterans at Risk of Cancer From Camp Lejeune Water Exposure

From 1953 to 1985, as many as 1 million Marines, Navy personnel, civilian workers, and their families stationed at Camp Lejeune were exposed to volatile organic compounds (VOCs) through contaminated drinking and bathing water. Epidemiologic studies link VOC exposure to ≥ 10 cancers. Cohort studies have shown higher cancer incidence and mortality among Camp Lejeune personnel, with up to a 3- to 6-fold increase for some cancers compared with Camp Pendleton controls. Clinical awareness of cancers associated with Camp Lejeune water contamination remains limited. Federal primary care and internal medicine clinicians are uniquely positioned to address this gap.

Camp Lejeune VOC exposure is associated with solid tumor and hematologic cancers, which present with various symptoms, examination findings, and diagnostic considerations. Primary care and internal medicine clinicians can improve outcomes by recognizing symptom patterns, conducting thorough physical examinations, and implementing a targeted diagnostic screening panel for identified veterans who were stationed at Camp Lejeune. A proposed panel includes complete blood count with differential and peripheral smear, comprehensive metabolic panel, lactate dehydrogenase, urinalysis, low-dose chest computed tomography (CT), and CT of the abdomen and pelvis. Educating veterans and clinicians on symptom recognition, relevant physical examination findings, and the value of initial screening may help close this critical gap and reduce costs associated with advanced-stage cancer treatment.

Clinicians caring for veterans exposed to Camp Lejeune VOCs can improve outcomes and quality of life through increased awareness of exposure-associated symptoms, targeted physical examination, and timely use of cost-effective screening to support earlier cancer detection and reduce diagnostic delays and costs. Clinicians are central to early recognition, physical assessment, appropriate screening tools, and ongoing care for this high-risk veteran cohort.