LGBTQ+ population faces greater cancer risks. Also faces barriers to care, studies show.
Correction: This story was updated to reflect that hepatitis B vaccinations were higher among LGBTQ+ people than heterosexual adults.
LGBTQ+ people are more likely to face cancer risks and to experience barriers when trying to detect and treat the disease, new research shows.
LGBTQ+ people smoke cigarettes, consume alcohol and have obesity at a higher rate than heterosexual and cisgender people, prompting concern from researchers at the American Cancer Society that they also face higher cancer burdens. New survey data presented Monday by Dana-Farber Cancer Institute also indicates that LGBTQ+ people experience discrimination in doctors’ offices that prevents them from getting adequate screening and care. The Dana-Farber survey shows that many health providers aren't attuned to the bias patients face.
Coupled together, the new studies flag a problem in caring for a major sector of the population: Health care providers are not adequately identifying and treating cancer in LGBTQ+ patients. The new findings come amid a push to expand data so it better identifies people by their gender identity or sexual orientation.
“There may be folks that are avoiding health care because they don't feel welcome,” Dr. William Dahut, chief scientific officer at the American Cancer Society, told Paste BN. “Then, when they do present for care, their cancer will be at a place where it's more likely to lead to morbidity, or potentially even mortality.”
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Using federal health data from 2020 to 2022, American Cancer Society researchers found bisexual women who were 40 and older had much higher smoking rates compared with heterosexual women, according to a study published last week in the society’s journal, Cancer. Lesbian, gay, bisexual and transgender young people also smoked cigarettes at higher rates than their heterosexual or cisgender peers.
The study found that lesbian and bisexual women had higher rates of excess body weight and tracked higher obesity rates in bisexual women. Additionally, the research found bisexual women and transgender people were less physically active. Bisexual women also had higher alcohol intake, meaning they reported having more than seven drinks a week.
One explanation for the increased risk factors was "minority stress," from shouldering discrimination that leads to an increased mental health or substance use problems, or behaviors that increase cancer risk.
Screening and vaccinations – including for hepatitis B and HPV – were equally sought or sought more frequently among LGBTQ+ patients than heterosexual or cisgender people. But cervical or colorectal cancer screening was lower among transgender men, the study found. Also, the prevalence of cancer-causing infections, such as HIV and HPV, was higher among gay and bisexual men than in other demographics despite the decline in these infections in recent decades.
The American Cancer Study report acknowledged there is a scarcity of data about LGBTQ+ people of color, who may face increased risk because of sexual orientation or gender identity.
The new research also identified barriers with health providers. Nine states, most of them in the South and the Midwest, permit health providers or insurers to deny care or services to LGBTQ+ people based on their beliefs, according to the Movement Advancement Project, a think tank that tracks religious exemption laws.
Even when doctors felt they were treating everyone equally for cancer, patients still reported that bias had seeped into their health care, according to survey findings presented Monday by Dana-Farber Cancer Institute investigators at the annual American Society of Clinical Oncology conference. Dana-Farber collaborated with the Moffitt Cancer Center and the company Prime Education to survey 817 LGBTQ+ cancer patients and 115 oncology providers.
About 80% of patients said they hadn’t received appropriate preventative cancer screening, according to a study abstract. One of the most pernicious barriers was providers not mentioning taking a screening for cancer. The survey found that 28% of participants had no health provider. Less than a quarter of respondents said they felt at least moderately comfortable disclosing their gender identity or sexual orientation to a care provider. Just over a third of patients said their partners or caregivers felt welcome at appointments, and only 4% felt respected by their care team.
“It harms people’s health to be silent, to be invisible, to not be their full selves when they’re facing something as life-changing as cancer,” said Dr. Shail Maingi, the study's lead author and an oncologist in Dana-Farber’s cancer care equity program.
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In another Dana-Farber study, 84% of doctors said they felt comfortable treating LBGTQ+ cancer patients, and close to two-thirds of providers thought the patients felt safe. The stark contrast appeared to show a disconnect between these patients and their providers.
Researchers agreed that the dearth of data makes it difficult to adequately identify issues in improving cancer outcomes for LGBTQ+ people. The recent findings, they hope, will inspire health providers to push for more data so they can better identify health issues for patients.
“Until we begin to have data that we can trust as far as incidence and outcomes, it’s going to be hard to intervene in a meaningful way,” Dahut, of the American Cancer Society, said.