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Cancer Comes Out

Members of LGBT community are at greater risk for some types of cancer. And those with cancer face challenges in getting the care and support they need. By Cameron Walker

 When Susan DiPronio was hospitalized with a fever during her chemotherapy treatments for stage I breast cancer in 2004, she had a bad reaction to the antibiotics she received and went into shock. As hospital staff rushed into the room, DiPronio’s girlfriend was rushed out. She wasn’t a family member, the nurses said. DiPronio, a writer, photographer and social activist in Philadelphia, recalls the unsettling feeling of being alone. During one of the scariest moments of her treatment, she says, “the person who cares about you most is not there.”

 
Smoking Among LGBT Youth
FDA campaign addresses increases in smoking.

LGBT Online Resources
Websites provide LGBT support.
Fear, doubt and isolation can be part of treatment and recovery for any cancer survivor. For those who are lesbian, gay, bisexual or transgender (LGBT), these feelings can be magnified by worries about misunderstandings or discrimination. In addition, the LGBT population may be at greater risk for several types of cancer and may have worse outcomes than heterosexuals, according to research findings.

Different Experiences, Greater Risks
While very little cancer research has focused on the LGBT community, cancer may affect this population at different rates and in different ways than their heterosexual counterparts. A 2011 study in the journal Cancer found that gay men who responded to the California Health Interview Survey were nearly twice as likely as straight men to be cancer survivors. A 2012 study of women who responded to the National Health Interview Survey found that women who lived with other women had more than three times the risk of dying from breast cancer as those who lived with men. And the experience of recovering from cancer can be quite different: A review of studies about prostate cancer in men who have sex with other men found that, while these men are diagnosed with prostate cancer at about the same rate as heterosexual men, they experience poorer sexual function and quality of life after diagnosis and treatment.

Researchers believe LGBT people have risk factors that may predispose them to higher rates of certain cancers. Gay men are more likely than straight men to be infected with human papillomavirus (HPV), putting them at greater risk for anal and oral cancers. In the study of responses to the California Health Interview Survey, researchers suggested that infection with HIV, which can be a risk factor for cancers including Hodgkin lymphoma and lung cancer, may be responsible for higher cancer rates among gay men. (See “Many Cancers in HIV-Positive Patients Go Untreated.”) Women who haven’t had children or breast-fed have a higher risk of breast cancer, and these factors are more likely to be present in lesbian and bisexual women than in heterosexual women, according to the American Cancer Society.
 
LGBT people also have higher rates of depression and anxiety than their heterosexual counterparts, which can lead to alcohol use, smoking and obesity—all risk factors for cancer (See “FDA Campaign Addresses Smoking Among LGBT Youth.”) Nearly one in four gay, lesbian and bisexual adults smoke, while only one in six heterosexual adults are cigarette smokers.

These risk factors aren’t caused by sexual orientation or gender identity, says Gwendolyn Quinn, a cancer researcher at Moffitt Cancer Center in Tampa, Florida, who studies reproductive health in at-risk populations. But they are linked to issues and situations that arise from being LGBT. In 2015, Quinn and her colleagues reviewed the available research on cancer in the LGBT population for CA: A Cancer Journal for Clinicians and found that LGBT people may be at greater risk for at least seven cancer types: anal, breast, cervical, colorectal, endometrial, lung and prostate.

Compounding the problem, LGBT people are less likely to get regular health exams, including cancer screenings. Going to the doctor may be uncomfortable—a transgender woman, for example, might put off an office visit to avoid the discomfort of having to explain she needs a prostate exam. But the reasons for less-frequent checkups go beyond what happens in the doctor’s office. Health insurance coverage is less common in the LGBT community than among heterosexuals, although the legal acceptance of same-sex marriages may start to expand access to health insurance. Employer-sponsored insurance coverage of married same-sex couples went up by more than 5 percentage points in the first 18 months after New York state passed the Marriage Equality Act in July 2011.

Getting More Data
Researchers and LGBT community members are concerned about cancer risks, but it’s not clear yet to what extent these risk factors affect the number of cancer cases among LGBT people. “We have a huge absence of data indicating potential disparities within the LGBT community,” says Jack Burkhalter, a clinical psychologist at Memorial Sloan Kettering Cancer Center in New York City, who studies cancer risk-related behavior in the LGBT community. While researchers are starting to home in on cancer risk factors among LGBT people, he says, “it’s not the same thing as knowing what the actual incidence and prevalence of cancers are in the community.”

09/26/2016
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