© The LGBT Cancer Project, 2007
Last Modified: April 23, 2008
There are approximately 1 million LGBT cancer survivors in the country today. This is based on the common estimate that approximately 10% of the population is gay, lesbian, bisexual and/or transgender.
Nearly every doctor has LGBT people as patients. According to the population census in 2000, same-sex couples are present in 99% of the counties in this country. This statistic does not factor in single LGBT people, those not able to come out publicly, or transgender men and women who may identify themselves as heterosexuals. It is impossible to determine who is LGBT by looking at a person's appearance, age, or marital status.
It is possible that LGBT are overrepresented among cancer survivors, and actually account for more than 10% of the total. The US government listed LGBT people as one of six population groups experiencing health disparities in this country, meaning that the burden of disease is not evenly distributed, but rather falls more heavily on these 6 groups. In fact, there is a growing body of evidence suggesting that LGBT people have a substantially greater risk of developing cancer than the general population.
These increased risks are not a result of difference in physiology or biochemistry, but a product of behaviors such as smoking and drinking, many of which can be traced to stress from living with discrimination and homophobia. Unfortunately, the increased risks are coupled with decreased cancer screening rates for LGBT people, resulting in cancers being picked up at a later stage, when they are more difficult to treat and the prognosis is worse.
Until health care providers become more knowledgeable and respectful and facilities become more safe for LGBT people, even free screening services will continue to be underutilized by this population.
LGBT people experience greater difficulties in obtaining quality healthcare. As a start, fewer lesbians and gay men have adequate health insurance, and uninsured rates are even higher among transgender people. Very few LGBT people are able to obtain health insurance under their partners’ health plans.
Once inside a doctor's office, LGBT patients are often confronted with intake forms that do not reflect the reality of their lives and providers who lack knowledge about LGBT health risks and issues. Same-sex partners need to be included in health care decisions but are not always invited or permitted in the room. Finally, most oncologists and social workers remain unaware of the psychosocial impact of cancer on LGBT families and sexuality.
Provider bias against homosexuality is well documented and over half of all medical schools provide no training at all on LGBT health issues. Those that do offer some instruction on this population provide an average of only two and a half hours of education during the four-year program.
Definitive research on the incidence of cancer in lesbians has yet to be conducted and published. However, there is a body of evidence suggesting that lesbians have a dense cluster of risk factors, significantly raising their risk of developing breast cancer as well as several other types of cancer. Some conflicting evidence also exists, highlighting the need for state-of-the- art research. Again, increased risks are coupled with lower screening rates for this population, resulting in cancers being detected when they are more difficult to treat.
For lesbians, the four cancer risk factors most often cited are:
Cigarette smoking among gay men is nearly double that of the general population. Smoking is responsible for 80% of all lung cancers, but it also increases the risk for many other cancers, including colon cancer, esophageal cancer, and anal cancer.
The same high-risk strains of HPV (human papilloma virus) that cause most cervical cancers in women are also responsible for causing anal cancer. The virus, spread through receptive anal intercourse, is estimated to be present in 65% of gay men without HIV and 95% of those who are HIV positive. A simple and inexpensive anal Pap test detects the virus but, unfortunately, few physicians are performing anal screening exams and offering anal pap smears to gay men, resulting in anal cancer rates as high as those of cervical cancer BEFORE the routine use of Pap smears in women came into vogue.
Prostate cancer is one of the most common cancers in men. Gay men with prostate cancer have some additional social and sexual challenges that are rarely addressed adequately by their oncologists and social workers. For example, prostate cancer treatment can have some distinct effects on gay sexual behavior and relationships.
HIV-positive people have a 30-40% chance of developing cancer in their lifetime. They are at greater risk of developing "AIDS-defining" cancers, e.g., Kaposi's Sarcoma and Non-Hodgkin's Lymphoma, and invasive cervical cancer. However, HIV also dramatically increases the risk for several other types of cancers:
Regardless of the type of cancer, the course of the disease tends to be different for HIV-positive people. In this population, patients are younger when diagnosed, their cancer tends to be found at a more advanced stage, and treatment is often complicated because of potential drug interactions.
Transgender people face the greatest barriers to quality health care, coupled with a dearth of research on their cancer risks and experiences. They face frequent discrimination by health care providers, many of whom also lack information about transgender bodies and health care needs.
Uninsured rates are highest among transgender people. In NYC, for example, The Department of Health reported in 1999 that 21% of transgender respondents reported having no health insurance of any kind. Even those with health insurance can face difficulties in obtaining appropriate cancer screenings. A transgender woman, listed on her insurance as female, but still having an intact prostate gland, would not be covered for prostate cancer screening. The same is true for a transgender man with an intact cervix.
Far too little is known about the cancer risks of transgender hormone use. Research is essential. However, the results may be limited as many transgender people obtain their hormones without a prescription and use varying and sometimes excessive dosages.
Transgender people have extremely high rates of smoking, drinking and HIV, all increasing their risks for developing an array of cancers, including lung cancer, anal cancer and liver cancer.
The cancer risks and survivorship issues of bisexual people are often invisible and, therefore, unaddressed. A medical intake form that asks for (legal) marital status may mislead the provider into mistaking the married lesbian for a heterosexual woman. Similarly, if the provider does not ask direct questions about sexual behaviors and risks, s/he might not realize that a male patient is bisexual and should be screened for HPV with an anal Pap smear and rectal exam. Also, it is important to know if a person is bisexual whenever it is necessary to engage his/her psychosocial support system.
For more information, visit The National LGBT Cancer Network.
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