Inside the Cancer Reasearch Lab at Stony Brook University Hospital...

Inside the Cancer Reasearch Lab at Stony Brook University Hospital in Stony Brook on Feb. 13, 2020. A new study looked at the possible elevated cancer risk to those in the LGBTQ+ community. Credit: Randee Daddona

Members of the LGBTQ+ population face unique ​stressors, discrimination and increased barriers to health care that can lead to an elevated cancer risk, according to a first-of-its-kind study released this week by the American Cancer Society.

The report, published in the journal Cancer during the start of Pride month, also points to lifestyle factors in that community that can raise cancer risk.

These include higher rates of cigarette smoking and excessive alcohol intake among lesbian, gay and bisexual adults compared to heterosexuals. Excess body weight, associated with an increased risk of developing at least a dozen types of cancer, is more common among lesbian and bisexual women, along with transgender individuals, researchers found.

LGBTQ+ members also typically receive fewer screenings for common forms of cancer, particularly in states with restrictive laws that allow medical providers and insurers to deny care based on personal and religious beliefs, the report concludes.

   WHAT TO KNOW

  • Members of the LGBTQ+ population face unique ​barriers and stressors that can lead to an elevated cancer risk, according to a new study by the American Cancer Society.
  • The report also points to lifestyle factors in that community that can raise cancer risk, such as alcohol and tobacco use.
  • The community also typically receives fewer cancer screenings, which can interfere with getting a timely cancer diagnosis, the report says.

Dr. Jason Domogauer, who was not involved in the study but is the director of the LGBTQ+ Cancer Care and Research Program at NYU Langone in Manhattan, which provides cancer screenings to the LGBTQ+ population, said the report showcases an under-the-radar problem that defies a simple solution.

“Oftentimes, the LGBTQ+ population are known as the invisible minority because, for better or worse, some of them are able to choose when to disclose [their orientation],” Domogauer said of visits with medical providers. “So, 'Am I walking into a doctor's office that is going to be safe for me?' But at the same time, by not disclosing they may not be able to fully have these conversations with providers.”

Dr. Jules Cohen, a medical oncologist at the Stony Brook Cancer Center, said fewer screenings, combined with a lack of trust of the medical system, also can interfere with an individual's ability to receive a timely cancer diagnosis and to take necessary prevention steps.

“These are important issues affecting quite a large number of people,” Cohen said. “And these issues have not been outlined in this kind of detail in the past.”

Researchers examined a prevalence of risk factors across the United States based on data in the National Health Interview Survey and the Behavioral ​Risk Factor Surveillance System, which are both collected by the Centers for Disease Control and Prevention. 

The study shows that members of the LGBTQ+ population may be at a greater cancer risk, in part based on behavioral tendencies such as drinking, smoking and excessive eating, that may serve as a coping mechanism to manage stressors in their lives.

For example, members of the LGBTQ+ community are more likely than heterosexual individuals to smoke cigarettes (16% compared with 12%), with rates more than doubled among bisexual women. Transgender women also were significantly more likely to smoke than non-transgender men or women, researchers found.

Lesbian, gay and bisexual individuals also are more likely than heterosexual people to drink alcohol excessively, especially among women, increasing their risks of several types of cancer, the report finds. For example, 14% of bisexual women consume more than seven drinks per week, compared with 8% of lesbian women and 6% of heterosexual women, the study said.

And while gay and bisexual men have less excess body weight than straight men, lesbian and bisexual women have higher rates of obesity than their heterosexual counterparts, the authors concluded.

“Minority stress, which is typically caused by discrimination, fear of violence and those sorts of things, causes an increase in general stress and anxiety,” said Tyler Kratzer, a cancer surveillance researcher at the American Cancer Society and lead author of the study. “And that can cause an increase in coping mechanisms … such as cigarette smoking and alcohol consumption that are risk factors for cancer.”

While some limited data shows that breast and cervical cancer rates are higher among lesbian and bisexual women, compared with heterosexual women, in part because they obtain fewer health screenings, Kratzer concedes there is limited data showing LGBTQ+ members as a whole are more frequently diagnosed, or succumb to instances of cancer, often because that information is not collected in health care settings.

The report also highlights a gap in presumptions of care, in which members of the LGBTQ+ community fear, whether accurately or not, a provider will refuse treatment due to their gender identity or sexual ​orientation. For example, nine states have “conscience ​clauses” that allow providers, staff and insurers to deny care and services to LGBTQ+ individuals based on personal and religious beliefs. 

For members of the transgender community, the report found, that fear is even more exacerbated. 

For example, only 46% of transgender men are up-to-date on colorectal cancer screening compared with 60% for all other men. Meanwhile, 68% of transgender men with a cervix are current for cervical cancer screening compared with 87% for all other women, the report found.

And a 2022 study found only 27% of medical students are confident in treating the health care needs of transgender patients, while nearly 30% are not comfortable treating transgender patients.

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