According to a 2021 survey, approximately 80% of people worldwide identify as heterosexual. The remaining 20% identify as lesbian, gay, bisexual, asexual, pansexual, queer (LGBTQ), or are unwilling to divulge their orientation. It may seem like a small minority, but keep in mind that 20% amounts to 1 in 5 people.
In terms of gender identity, the vast majority of people (99%) identify as cisgender, meaning that their gender identity matches the sex they were assigned at birth. A much smaller portion of the population (less than 1%) identifies as transgender, non-binary, or another gender identity that doesn’t match their birth sex.
Even though the LGBTQ community only consists of a small portion of the population, they face a number of significant challenges. One such public health challenge is cancer.
In this blog post, we will discuss the disproportionate cancer disparities in the LGBTQ population. We will also discuss why LGBTQ people are more likely to develop and die of certain cancers than heterosexual individuals.
LGBTQ community cancer rates
The term “cancer burden” refers to the number of new cancer cases diagnosed and the number of cancer-related deaths in a given population.
Unfortunately, for the LGBT community in the United States, these numbers are largely unknown. None of the national cancer registries in the US currently collect data on sexual orientation and gender identity.
This lack of data makes it difficult to compare cancer rates among LGBTQ and cisgender, and heterosexual people. Even more significant than that, the lack of data makes it impossible for health care providers to pinpoint which cancer screenings, treatments, and prevention strategies are most effective for LGBTQ people. Without accurate data, it’s difficult to design and implement tailored cancer care programs for this population.
That being said, there is some epidemiological research that provides insight into the cancer burden in the LGBTQ community. Thanks to these studies, we are able to identify site-specific cancers that affect LGBTQ people at higher rates than the general population.
These site-specific cancers are:
- Anal cancer
- Breast cancer
- Cervical cancer
- Colorectal cancer
- Endometrial cancer
- Lung cancer
Let’s look at each of these cancers and how they affect LGBT individuals.
Anal cancer is a relatively rare cancer, with an expected 9,440 new cases in the US in 2022.
However, the incidence of anal cancer is higher in gay and bisexual men than in heterosexual men and even more so (up to 9 times higher!) in HIV-positive gay and bisexual men.
Most anal cancers are caused by the human papillomavirus (HPV). HPV is a sexually transmitted virus that can be passed through sexual contact, including vaginal, anal, and oral sex. However, gay and bisexual men are more likely than heterosexual men to engage in anal sex, which contributes to the higher rates of anal cancer in this population.
Not only that, but receptive anal sex in and of itself is also a risk factor for anal cancer.
Compared to anal cancer, breast cancer is much more common, with an expected 287,850 new cases of breast cancer in the US in 2022. In fact, it is the second most common cancer in women after skin cancer.
While the incidence of breast cancer is similar between heterosexual women and lesbian women, gay women have a slightly higher risk of developing breast cancer than heterosexual women.
Reasons for this are not fully understood, but contributing factors include a higher prevalence of obesity in gay women, as well as lower pregnancy rates among gay and bisexual women. Pregnancy is considered a protective factor against breast cancer.
The American Society of Clinical Oncology estimates that in 2022, around 14,100 women in the United States will be diagnosed with cervical cancer.
Thanks to the California Health Interview Survey data, we know that the prevalence of cervical cancer in heterosexual women in California is 14.0%. In comparison, the prevalence among lesbians is 16.5%, and an astounding 41.2% among bisexual women. Even though this information is related only to women in California, it provides a valuable snapshot of how this cancer affects women of different sexual orientations.
HPV, the same virus that causes anal cancer, is the most significant risk factor for cervical cancer as well. Aside from HPV, other contributing risk factors for cervical cancer include smoking and a higher body mass index, which are more common in gay and bisexual women than heterosexual women.
Colorectal cancer (colon cancer and rectal cancer combined) is the third most common type of cancer in the United States. In 2022, it is expected that there will be 106,180 new cases of colon cancer and 44,850 new cases of rectal cancer.
According to an ecological analysis of colorectal cancer incidence and mortality in relation to sexual minority density across counties, the counties with a higher density of gay, lesbian, and bisexual men and women have a higher incidence of colorectal cancer. In terms of cancer mortality, the same study finds a positive association between a higher density of gay and bisexual men and higher colorectal cancer mortality, but not in the case of women.
There are still no published studies detailing the reasons for differences in cancer risk by sexual orientation and gender identity. However, the fact that there is an increase in obesity, smoking, and alcohol consumption in the LGBTQ community compared to the heterosexual community might play a role.
Endometrial cancer is the most common type of cancer of the female reproductive organs. Approximately 65,95 new cases are expected to be diagnosed in the United States in 2022.
The number of studies comparing the incidence of endometrial cancer between heterosexual women and lesbian and bisexual women is limited at best. Only one study suggests that the risk of endometrial cancer could be higher in lesbians compared to heterosexual women due to the following reasons:
- Higher rates of nulliparity (never giving birth) in lesbians. Just as it is a protective factor against breast cancer, pregnancy is also protective against endometrial cancer.
- Higher rates of obesity in lesbians.
- Lower rates of hormone replacement therapy use in lesbians (which is a protective factor against endometrial cancer).
There is no evidence suggesting that bisexual women have a higher risk of endometrial cancer than heterosexual women. However, one analysis found that women who have never had sex with men have a decreased risk of endometrial cancer.
If we exclude skin cancer, lung cancer becomes the second most common type of cancer in the United States (right after breast cancer for women and prostate cancer for men). In 2022, it is expected that there will be 236,740 new cases of lung cancer.
Ecological analyses similar to those conducted for colorectal cancer have also been done for lung cancer. The results of these studies are varied:
- Geographical areas with a higher density of bisexual men had lower rates of lung cancer incidence than the general population.
- Areas with a higher density of gay men had slightly higher rates of lung cancer incidence (compared to the general population).
- Areas with a higher density of lesbians had lower rates of lung cancer incidence.
- And areas with a higher density of bisexual women had higher rates of lung cancer incidence.
Further research is required to draw significant conclusions at an individual level from these findings.
It is evident that data on cancer incidence and outcomes among sexual minority groups are still quite limited. More research is needed in this area to better understand how the risk factors for various types of cancer vary between heterosexuals and members of the LGBTQ community.
However, even with this limited data, it is clear that cancer takes a significant toll on LGBTQ patients. This is especially true for certain types of cancer, such as the anus, breast, colon, rectum, uterus, and lungs.
These health disparities among sexual minority groups highlight the importance of targeted cancer screening, prevention, and control efforts within the LGBTQ community. Such disease control efforts could help reduce the risk of cancer among LGBTQ individuals and improve outcomes for those already diagnosed with the disease.
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