Published on June 23, 2021
LGBTQIA+ Patients Are Less Likely to Be Screened for Cancer
“Love takes off masks that we fear we cannot live without and know we cannot live within,” — Novelist and playwright James Baldwin.
As a gay, African American writer, James Baldwin spoke about discrimination as it pertains to sexuality and racial and class divides in his work. He is widely celebrated along with others in the LGBTQIA+ community during PRIDE month. June marks the anniversary of the Stonewall riots in 1969 in Greenwich Village, NY, in which the LGBTQIA+ community took to the streets to protest the violence and oppression that left physical and psychological damages that reverberate even today. Today, PRIDE celebrates joy and inclusion for all people and their allies.
People in the LGBTQIA+ community still face discrimination in many places, including in the medical system, although strides have been made to make medical care more inclusive.
How Sexual Orientation and Gender Identity Impact Cancer Screening
Data is lacking in understanding how and when people in the LGBTQIA+ community access cancer care.
Studies show that this population experiences decreased health care utilization compared to the heterosexual population and that they continue to experience discrimination in health care, according to urology researcher Michael J. Herriges Jr, MBBS, of SUNY Upstate Medical Center. Dr. Herriges presented the findings of a study at the 2021 annual meeting of the American Society of Clinical Oncology (ASCO).
The study looked at the prevalence of cancer screening (mainly breast, cervical, and prostate cancer) among heterosexual individuals and members of the LGBTQIA+ population in the United States.
The survey-based analysis included men and women age 18 and older from the Health Information National Trends Survey (HINTS) database (part of the National Cancer Institute’s division of cancer control and population sciences) between 2017 to 2019.
Of the survey respondents, around 95 percent of men and 97 percent of women identified as heterosexual. Less than 4 percent of men and less than 2 percent of women identified as gay and just over 1 percent of men and 1.5 percent of women identified as bisexual.
The study found that gay and bisexual people were less likely to be screened for prostate cancer (30.53% and 27.58% vs. 41.27%), breast cancer (63.81% and 45.37% vs 80.74%), and cervical cancer (90.48% and 86.11% vs. 95.36%) than heterosexual people.
Screening is essential, Dr. Herriges said, because lesbian-gay-bisexual (LGB) women face higher lifetime rates of breast cancer.
Dr. Herriges cited reasons such as fewer pregnancies, live births, and breastfeeding (which can be protective against breast cancer) for the higher rates of breast cancer, compared with heterosexual women.
Regarding cervical cancer, which has been firmly established to be caused by a sexually transmitted infection, Dr. Herriges said that for decades health care professionals were not advising Pap smears for LBG women. Now it is widely seen as a prevention strategy, emphasizing that all women should be screened for human papillomavirus (HPV).
For prostate cancer, gay men are less likely to have an up-to-date prostate-specific antigen (PSA) test result than heterosexual men.
“Health care professionals should be encouraged to improve cancer screening amongst lesbian, gay, and bisexual people,” Dr. Herriges said.
Promoting Health Equity in Cancer Care
Don Dizon, MD, Professor of Medicine at Brown University and Director of the Pelvic Malignancies Program at Lifespan Cancer Institute, emphasizes the importance of collecting information about sexual orientation and gender identity to provide the best, most compassionate care possible. This is important for recommending cancer screening and treatment for various cancer types.
But the experience is not always easy or comfortable for the patient. “Every time someone comes to a new physician, they have to face the prospect of coming out again,” Dr. Dizon said.
With the help of GLAAD, the National Public Radio (NPR) recently published a guide to gender identity terms on their website. It provides a glossary of terms that may be helpful for both parties in a medical setting.
Dr. Dizon said that he always reminds himself to ask the people in the room what their relationship is to the patient. This prompts patients and their care partners to self-identify so that no assumptions are made. He wrote a blog post about his own situation, where he misread the room and the people in it during an ovarian cancer consult. It happens, even to doctors who are part of the LGBTQIA+ community, he explained.
“That’s not an easy thing to ask. People may not feel comfortable putting themselves out there and being that vulnerable,” Dr. Dizon said.
Finding the Right Care Provider
“Coming to terms with self-acceptance and self-love is a process,” Dr. Dizon said. This can be challenging for people who are lesbian, gay, bisexual, transitioning or have transitioned to another gender, who still need screening for cancers that affect people who were born a different gender.
The National LGBT Cancer Network and OutCare both offer lists of cancer providers who welcome people of all gender identities and sexual orientations. These directories can be useful ways to find healthcare providers for screening, diagnostics, and treatments. For example, some providers have distinguished themselves by training all staff on transgender issues and reaching out to their local LGBTIA+ community.
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See Our Sources:
- ASCO Annual Meeting. ASCO (2021). “The Association of Sexual Orientation with Cancer Screening and Diagnosis.” meetinglibrary.asco.org/record/201618/abstract
- Pride Month. NPR (2021). “A Guide to Gender Identity Terms.” https://www.npr.org/2021/06/02/996319297/gender-identity-pronouns-expression-guide-lgbtq
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