Abstract Introduction Cervical cancer is preventable through human papillomavirus (HPV) vaccination, routine screening, and timely follow up of abnormal results. However, limited evidence is available regarding cervical cancer burden and screening patterns and barriers within the Canadian Armed Forces (CAF). This study describes the demographic, military, clinical, and screening characteristics of cervical neoplasia cases diagnosed among CAF Regular Force members between 2012 and 2024. Materials and Methods A retrospective descriptive case series was conducted using electronic medical records from the Canadian Forces Health Information System. The International Classification of Diseases, 10th Revision (ICD-10) codes in the clinical extract were used to identify any cervical neoplasia diagnoses from January 1, 2012 to December 31, 2024. Incident cases were confirmed based on colposcopy‑directed biopsy results. Demographic and military-specific data at diagnosis were obtained from the Master Patient Index. Variables extracted from the health record included age at diagnosis, rank, screening history, HPV vaccination status, diagnostic pathways, stage at diagnosis, referral timelines, and follow-up outcomes. Descriptive statistics were used to summarize case characteristics and identify gaps in screening participation and follow-up adherence. Results A total of 23 incident cervical neoplasia cases were confirmed during the study period. The median age at diagnosis was 37 years (range: 24-52), and 47.8% were officers. 21.8% reported smoking at diagnosis. 43.5% of cases had missed (n = 7) or delayed (n = 3) at least 1 routine cervical cancer screening before diagnosis. 39.1% experienced delayed or missed follow-up after abnormal Pap results. Reported barriers to routine screening and follow-up included pandemic-related service interruptions, deployment or domestic posting, pregnancy, and childcare challenges. 39.1% (n = 9) had an abnormal result at the first recorded Pap test in the system. HPV vaccination completion was recorded for 52.2% of cases, and among those tested for HPV (n = 19), 31.6% were positive for types 16 or 18. Invasive cancer accounted for 56.5% of diagnoses, with 92.3% of invasive cases presenting at International Federation of Gynecology and Obstetrics (FIGO) stage I. Histology included squamous cell carcinoma (69.2%) and adenocarcinoma (30.8%). The median interval from abnormal screening result to diagnosis was 3.1 months (range: 0.7-61.9). No cervical cancer–related deaths were identified. Conclusion This case series provides the first comprehensive description of cervical neoplasia among CAF Regular Force members over more than a decade. Findings highlight important opportunities to strengthen CAF prevention efforts, including improving screening participation and reducing delays in follow-up of abnormal tests. Enhanced reminder systems, reduced barriers to screening including self-testing, and targeted health promotion may reduce cervical cancer incidence and support the health and operational readiness of CAF personnel.
Abstract Established in 2000, the Warfighter Refractive Eye Surgery Program (WRESP) positioned refractive surgery at the forefront of enhancing operational readiness. With 25 years of evidence, the WRESP treats the right procedure for the right patient. Its lasting contribution is its method: testing new technology against the demands of the mission.
Abstract Introduction Biological warfare involves the deliberate use of microorganisms or toxins to cause disease and death in humans, animals, or plants, and has occurred across state warfare, bioterrorism, biocrime, and accidental laboratory release. Despite a substantial historical literature, many commonly cited events lack rigorous primary-source documentation, and secondary reviews frequently perpetuate unverified claims. This review applies explicit evidentiary criteria to distinguish well-documented incidents from contested allegations and unsubstantiated claims, using Carus’s typology to categorize events by actor and intent. Materials and Methods Following PRISMA guidelines (PROSPERO CRD42024592724), we searched PubMed, Web of Science, and Scopus up to April 4, 2024, supplemented by grey literature and expert consultation. Two reviewers applied predefined inclusion and exclusion criteria to title/abstract and full-text screening. A 3-tier evidentiary framework (well-documented, contested, and unsubstantiated), adapted from elements of ROBIS and PRISMA, was applied to 48 candidate events identified between pre-historic times and 2019, with adjudication by subject-matter experts. Quantitative analysis was restricted to the 19 well-documented events to anchor findings to corroborated evidence from primary archival sources, forensic investigations, and specialist scholarship. Results The 19 well-documented events caused at minimum 21,595 injuries and 10,079 deaths, comprising 17 deliberate uses (89.5%) and 2 major accidental releases (10.5%). Deliberate events comprised 6 biocrimes (31.6%), 5 acts of warfare (26.3%), 4 bioterrorist attacks (21.1%), and 2 State-sponsored acts (10.5%). Fourteen biological agents were employed across 31 agent instances. CDC Category B agents predominated (58.1%, n = 18), followed by Category A (35.5%, n = 11); 2 agents did not fit into the CDC classification (6.5%), and no Category C agents were identified. Bacillus anthracis was the most frequently used agent (22.6%, n = 7), followed by ricin (12.9%, n = 4) and Vibrio cholerae (9.7%, n = 3). The principal dispersal methods were contaminated food and beverages (29.2%, n = 7) and direct inoculation and infected animals or insect vectors (12.5%, n = 3), respectively. Events occurred across 9 countries, with the United States most frequently affected (31.6%, n = 6). Perpetrators originated from 10 countries, with the United States, United Kingdom, and Japan together accounting for over half of the well-documented events. Fewer than half of the events identified across the historical literature (n = 19; 39.6%) met the criteria for well-documented status, underscoring the need for consistent evidentiary standards in biosecurity research. Conclusions Biological warfare remains a significant concern given its covert nature, the accessibility of low-technology dispersal methods, and emerging risks from synthetic biology, dual-use research, and artificial intelligence. Prevention, early detection, and rapid response, supported by ethical research oversight and open-source surveillance, are essential to mitigating these threats.
