An LGBTQ Pride survey from 2021 declares that around 80% of the global population is heterosexual. The other 20% identify as lesbian, gay, bisexual, pansexual, asexual, or otherwise queer.
In terms of gender identity, the numbers are dramatically different. Only a little less than 1% of the population identifies as transgender, gender-nonconforming, or non-binary.
Because members of the LGBTQ community are biologically the same as members of the heterosexual community, some might think that they are exposed to much the same risk of cancer. However, this is not the case. In reality, members of the LGBTQ community face a unique set of challenges when it comes to cancer risk and treatment.
In this blog post, we aim to explore the cancer burden in the LGBTQ community, identify the systemic barriers to cancer care that this community faces, and provide some tips on how to lower your risk of cancer if you are an LGBTQ person.
LGBTQ CANCER BURDEN
The term ‘cancer burden’ refers to the total number of new cases of cancer diagnosed in a population in a given year and the number of deaths caused by cancer.
In the United States, the American Cancer Society estimates that around 1.9 million new cases of cancer will be diagnosed in 2022. This is the cancer burden for the entire US population.
Unfortunately, due to a number of systemic reasons, no one can say with certainty what the cancer burden is for the LGBTQ community. This is because most data on cancer incidence and mortality do not consider sexual orientation or gender identity. Not one of the national cancer registries in the US includes data on sexual orientation or gender identity.
This lack of data hampers our ability to understand the true cancer burden in the LGBTQ community. This is a problem because, without this data, it is difficult to design targeted cancer prevention and screening programs for LGBTQ people. It also makes it difficult to track progress over time.
However, despite the lack of cancer registry data, we can glean some information on the disproportionate cancer burden in the LGBTQ community from various studies.
Let’s look at these studies and the six site-specific cancers that are most commonly diagnosed in LGBTQ people.
Breast cancer incidence is similar in heterosexual and bisexual women. However, studies have shown that lesbians are more likely to develop breast cancer.
Risk factors that have been identified as increasing the risk of breast cancer in lesbians include, but are not limited to:
- Higher rates of obesity in lesbians
- Lower rates of pregnancy (pregnancy is considered a ‘protective factor‘ against breast cancer)
- Higher rates of smoking
- Higher rates of alcohol consumption
Studies that serve as a source of information about the colorectal cancer burden in the LGBTQ community are actually ecological studies looking into colorectal cancer incidence and mortality rates in counties of various sexual minority and gender identity densities.
For example, this ecological study found that counties with higher densities of sexual minority men and women had higher colorectal cancer incidence rates. The same study also concluded that there are higher mortality rates of colorectal cancer in counties with higher densities of gay and bisexual men (but not women).
Reasons for the higher incidence and mortality rates of colorectal cancer in LGBTQ people may be due to a combination of risk factors, such as higher rates of smoking, higher rates of obesity, and higher rates of alcohol consumption present in the LGBTQ community.
Ecological studies similar to those used to investigate colorectal cancer incidence and mortality rates in the LGBTQ community have also been used to study lung cancer incidence and mortality rates.
In this case, findings vary widely according to sexual orientation. For example, counties with higher densities of bisexual men have been found to have lower lung cancer incidence rates. However, the opposite has been shown for gay men.
For non-heterosexual women, counties with higher densities of lesbians have been found to have lower lung cancer incidence rates, while the opposite has been true for bisexual women.
The California Health Interview Survey did what national cancer registries have not been able to do – it took sexual orientation and gender identity into account when looking at cancer data.
This survey found that the prevalence of cervical cancer was higher in lesbian and bisexual women than it was in heterosexual women. More precisely, the prevalence of cervical cancer was 14.0% in heterosexual women, 16.5% in lesbians, and 41.2% in bisexual women.
We must emphasize that this only describes women living in California. However, it is still the only study of its kind so far and thus provides us with some valuable information.
Sources comparing endometrial cancer risk in heterosexual, lesbian, and bisexual women are extremely limited.
However, the one study that has been conducted on this topic found that lesbians have a higher risk of endometrial cancer than heterosexual women. Bisexual and heterosexual women seem to have a similar risk.
Finally, anal cancer incidence is significantly higher in gay and bisexual men than in heterosexual men.
The exact reasons for this are unknown, but it is thought to be due to HPV infection and other risk factors, such as smoking. Receptive anal sex in and of itself is also a risk factor for anal cancer.
SYSTEMIC BARRIERS TO LGBTQ CANCER CARE
Now that we’ve presented the facts about the cancer burden in the LGBTQ community, we need to address why this community is so underserved when it comes to cancer care.
The fact is that the LGBTQ population faces a number of systemic barriers when trying to access proper cancer care. Not only cancer care – LGBTQ health disparities exist in a number of different areas, ranging from mental health to HIV/AIDS.
These disparities are caused by factors such as social stigma, discrimination, and a lack of cultural competency among healthcare providers.
Let’s look at them in more detail.
The first and arguably most important barrier to LGBTQ cancer care is provider ignorance. This refers to both a lack of knowledge about how many LGBTQ patients there are and a lack of knowledge about the specific health needs of this population.
According to this survey of general practitioners, only 5% of them ask their patients about their sexual orientation.
Doctors that are aware of their patients’ sexual orientation are often not aware of the specific health needs that come with it.
This lack of awareness leads to many problems, such as misdiagnosis, delayed diagnosis, and a general lack of understanding of the patient’s needs. LGBTQ patients can feel like they’re not being taken seriously or their concerns are not being heard.
The second systemic barrier to LGBTQ cancer care is discrimination. This can take many different forms, from overt hostility to more subtle forms of bias.
For example, 1 in 5 transgender people reports being denied health care because of their transgender status.
It’s important to remember that discrimination is not only intentional – it can also be the result of unconscious bias.
Unconscious bias is a form of discrimination that happens when we have preferences or stereotypes that we are not aware of. Everyone has them, and they can lead us to make judgments about people without realizing it.
If patients feel like they’re being discriminated against, they are less likely to seek out care in the first place. And if they do seek care, they may not be as forthcoming about their symptoms or their sexual orientation and gender identity.
Research confirms that members of the LGBTQ community are more likely to experience poverty than the general population.
Poverty, unemployment, and housing insecurity are a barrier to health care.
For one, people who can’t afford health insurance are less likely to get routine screenings and preventive care. This means that they are more likely to be diagnosed with cancer at a late stage when it is more difficult to treat.
In addition, people who live in poverty are more likely to have other health problems that make it difficult to get to and from doctor’s appointments. They may also have trouble taking time off work to go to appointments or affording child care so that they can go.
All of these factors make it harder for LGBTQ people living in poverty to get the cancer care they need.
Lack of mental health care
Due to the systemic barriers we’ve just discussed, LGBTQ people are more likely to experience mental health problems such as anxiety and depression.
Such mental health problems can make it hard to access cancer care. For example, someone who is depressed may not have the energy to make appointments or follow through with treatment.
Anxiety can also lead people to avoid going to the doctor altogether out of fear of discrimination or rejection.Studies have proven time and again that LGBTQ people experience anxiety over disclosing their sexual orientation or gender identity to their health care provider.
Mental health issues can also make it hard to stick to cancer treatment regimens.
This is why it’s so important for LGBTQ people to have access to mental health care. Without it, they may never get the cancer care they need.
What can be done?
So what can be done to bridge this gap in cancer care for LGBTQ people?
For one, doctors and other health care providers need to be trained on the unique needs of this population. This includes everything from understanding the different types of cancer that LGBTQ people are at higher risk for; to being aware of the systemic barriers they face.
In addition, healthcare providers need to create a safe and welcoming environment for all patients, regardless of their sexual orientation or gender identity. This includes using the patient’s preferred name and pronouns, being respectful of their privacy, and providing culturally competent care.
Finally, more research is needed on cancer in the LGBTQ community. While there is some data out there, it is often limited. To fully understand the scope of the problem and develop targeted interventions, we need more research on cancer in LGBTQ people.
By increasing awareness, training healthcare providers, and conducting more research, we can start to reduce the health disparities faced by LGBTQ people and ensure that everyone has equal access to cancer care.
HOW TO REDUCE CANCER RISK FOR LGBTQ PEOPLE
If you are an LGBTQ person, there are a number of things you can do to lower your risk of cancer.
- Find a trustworthy health care professional
It’s easier said than done, but finding a healthcare professional that you trust is an important step in cancer prevention, if not the most important one.
A doctor who knows about your unique needs as an LGBTQ person and is supportive of your rights is more likely to provide the best possible care.
In addition, a doctor that you trust is more likely to make sure that you get the screenings and preventive care you need to catch cancer early.
- Go in for routine cancer screening
Regular cancer screenings are another cornerstone of cancer prevention.
Your chosen healthcare provider should work with you to develop a cancer screening plan tailored to your individual needs. This may include screenings for breast, cervical, and colorectal cancers and others.
What type of screening and how often you need it will depend on some factors, including your age, sexual history, family history, and personal medical history.
It’s important to remember that cancer screenings are not just for people with symptoms. They are also for people who are symptom-free but may be at higher risk for cancer due to their lifestyle or family history.
- Get vaccinated
Some vaccines can help prevent cancer, including the HPV vaccine, which can protect against certain types of cervical and anal cancer.
Other vaccines, such as the hepatitis B vaccine, can also help prevent cancer.
If you are an LGBTQ person, it’s important to talk to your healthcare provider about which vaccines are right for you and which you can get for free or at a reduced cost.
- Eat a healthy diet and exercise regularly
Eating a healthy diet and exercising are two of the best things you can do to reduce your risk of cancer and a host of other chronic diseases.
A healthy diet includes plenty of fruits, vegetables, and whole grains and limits processed meats, red meat, and sugary drinks.
As for exercise, the American Cancer Society recommends at least 150 minutes of moderate activity or 75 minutes of vigorous activity per week. (Ideally, over 300 minutes of moderate activity per week.)
But any amount of activity is better than none, so even if you can’t meet the recommended guidelines, every little bit counts.
- Limit alcohol and don’t use tobacco
Limiting alcohol and not using tobacco are two more important cancer prevention strategies.
Alcohol is linked to an increased risk of several types of cancer, including breast cancer, throat cancer, and liver cancer. People who drink alcohol should do so in moderation, which means no more than one drink per day for women and no more than two drinks per day for men.
As for tobacco, it’s best to avoid it altogether. If you feel like you cannot quit, it’s important to talk to your healthcare provider about ways to reduce your risk of cancer. They will also have resources to help you stop.
- Disclose your family history
If you have a family history of cancer, it’s important to disclose this to your healthcare provider. They may recommend additional screenings or tests to catch cancer early.
They may also refer you to a genetic counselor, who can help you understand your risks and make informed decisions about cancer prevention.
While one may assume that cancer rates would be similar across all demographics, this is unfortunately not the case. The LGBTQ community faces a disproportionate burden of cancer due in part to systemic barriers to care.
There are six site-specific cancers that affect the LGBTQ community at increased rates: anal, breast, colorectal, cervical, endometrial, and lung. These are just the ones that we have some data for. There are probably many more.
Reasons why cancer rates are higher in the LGBTQ community include:
- Stigma and discrimination, which can lead to delays in diagnosis and treatment
- Lack of access to health care due to lack of insurance or providers who are not knowledgeable about LGBTQ health needs
- Unhealthy lifestyle choices, such as smoking and drinking alcohol
- Certain viral infections, such as HPV and hepatitis B, and similar
There are actions that people in the LGBTQ community can take to reduce their risk of cancer. These include getting regularly screened for cancer, getting vaccinated, eating a healthy diet, exercising regularly, limiting alcohol, not using tobacco, and disclosing their family history to their health care provider.
At the end of the day, institutions and health care providers need to do better serving the LGBTQ community. But it is also important for members of the LGBTQ community to take their health into their own hands and advocate for themselves. Only then can we hope to see a reduction in cancer rates in this population.
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