Upon receipt of a cancer diagnosis, bias and judgement from medical providers should not be a concern for patients.
However, research has shown that patients who identify as lesbian, gay, bisexual, transgender or queer (LGBTQ) regularly experience increased anxiety and fear discrimination in medical situations. LGBTQ cancer survivors consistently report lower satisfaction with medical care, and gay, bisexual and transgender men who survive cancer appear more likely to experience depression or relationship difficulties.
Barriers to care exist in these communities, as well.
Despite enactment of the Affordable Care Act and nationwide recognition of marriage equality, those who identify as LGBTQ are more likely than heterosexuals to lack health insurance, according to the American Cancer Society.
This may be of particular concern for cancer care. Although no specific data exist about the number of patients with cancer who identify as LGBTQ, studies suggest this population may be at increased risk for malignancy. A study published in Cancer showed gay men appeared more likely than heterosexual men to receive a cancer diagnosis (8.25% vs. 5.04%; P < .0001).
Further, data show gays and lesbians are more likely to report cancer-associated behaviors, such as smoking cigarettes, tanning, and consuming excessive alcohol and high-fat diets.
“We live in a fairly hetero-centric world,” Allison L. Diamant, MD, associate professor of general internal medicine and health services research at David Geffen School of Medicine at University of California, Los Angeles, told HemOnc Today. “The assumption by most providers — and not necessarily in a pejorative way — is that their patients are heterosexual. Educating doctors and trainees on the importance of asking questions about a patient’s sexual orientation, gender identity or sexual behavior should be key components of the patient interview when establishing care.”
HemOnc Today spoke with clinicians and researchers about the factors that influence cancer risk in the LGBTQ community, the importance of open communication about sexuality and gender identity between patients and their physicians, the issues faced by transgender patients seeking cancer care, and the need for improved and expanded cancer research in this patient population.
Although research that focuses on cancer in the LGBTQ community is limited, data suggest certain cancers may be more prevalent in these individuals.
Ulrike Boehmer, PhD, associate professor of community health sciences at Boston University’s School of Public Health, and colleagues conducted an ecological study — published in 2014 in BMJ Open — that used sexual orientation population data aggregated at the county level to determine its association with cancer incidence.
Among men, greater bisexual population density appeared linked to lower incidence of lung cancer and higher incidence of colorectal cancer. Among women, greater lesbian population density appeared associated with lower incidence of lung and colorectal cancers and higher incidence of breast cancer, whereas greater bisexual population density was linked to higher incidence of lung and colorectal cancers and lower incidence of breast cancer.
However, because SEER data and cancer registries do not collect information about sexual orientation, researchers concluded “it cannot be readily determined ... whether cancer is more prevalent among individuals with a sexual minority orientation.”
Any excess risk in the LGBTQ community may be driven by potentially actionable factors.
“Most cancers are linked to behavioral risks, such as smoking, obesity, alcohol consumption, poor diet or nutrition, and physical inactivity,” Boehmer told HemOnc Today. “From available population surveillance, we know that lesbians have a higher rate of obesity than straight women. We know that LGBTQ individuals smoke at much higher rates than straight counterparts. These are relevant to breast and lung cancers, so we can say that, at a population level, LGBTQ individuals carry a higher cancer risk.”
Gwendolyn P. Quinn, PhD, MS, and Matthew B. Schabath, PhD, MS —senior members at Moffitt Cancer Center and senior professors at Morsani College of Medicine at University of South Florida who have focused their research on cancer incidence in the LGBTQ community — agreed specific, alterable risk factors are common.