Rainbow Access Initiative: Cancer

TOPIC INDEX

Cancer

Click on a link to go to a specific topic in this section:

CANCER IN THE LGBT COMMUNITIES

Lesbians and Cancer

Gay Men and Cancer

Transgender Cancer Risks

HIV and Cancer

CANCER SCREENING

Lesbians and Cancer Screening

Gay Men and Cancer Screening

Transgender People and Cancer Screening

Lesbian, gay, bisexual and transgender (LGBT) people are disproportionately affected by cancer. Our increased risk is due to a number of factors. We aren't as likely to get screenings so cancers are detected at a later stage when treatment is more complicated and the prognosis is worse. Once we are diagnosed with cancer, we are likely to experience the added challenge of being 'out' to our provider. Added to this is the fact that there is little information about how cancer may affect our unique sexuality and relationships

Cancer research on our population is scarce; there are no national surveys or cancer registries that collect information about sexual identity or sexual orientation, so the actual LGBT cancer prevalence is concealed. The National LGBT Cancer Network estimates that there are currently one million LGBT cancer survivors in the country today.

CANCER IN THE LGBT COMMUNITIES

Lesbians and Cancer
Because the large national cancer registries and surveys have not collected data about sexual orientation, lesbians are embedded and invisible within the vast wealth of information. But there is a growing body of evidence suggesting that lesbians have the richest cluster of cancer risk factors of any group of women. Lesbians have a 2-3 times greater risk of developing breast cancer as well as several other types of cancer.

The increased risks are not due to any physiological or genetic differences between lesbians and heterosexual women. They are the result of the stress and stigma of living with homophobia and discrimination. This results in behaviors that carry an increased risk. Taken together, as a cluster, they more than double a lesbian's risk of developing cancer.

For lesbians, the four cancer risk factors are:

Cigarette smoking: Data suggests that lesbians smoke cigarettes at nearly double the rate of heterosexual women.

Alcohol Use: Research reports higher rates of heavy drinking among lesbians than heterosexual women

Obesity: Studies report that lesbians are more likely to be overweight or have a BMI over 25.

Pregnancy: Lesbians are less likely to have biological children before age 30, which would offer some protection against cancer.

Gay Men and Cancer
Gay men also have increased risks for several types of cancer. Tobacco use is nearly double that of the general population and this dramatically increases the risk for lung cancer, as well as colon cancer, esophageal cancer, anal cancer and others.

The same high-risk strains of HPV (human papillomavirus) 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 use of routine Pap smears in women.

Transgender Cancer Risks
Many transgender people use hormones as part of their transition. Hormones are implicated in the development of many types of cancer, but there has been very little research on their effects on the transgendered. The results of even the limited research that is available may be questionable, though, 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; these all increase the risks for developing an array of cancers, including lung cancer, anal cancer and liver cancer.

HIV and Cancer
HIV-positive LGBT people have a 30-40% chance of developing cancer in their lifetime. The risks for the "AIDS-defining" cancers, e.g., Kaposi's Sarcoma, Non-Hodgkin's Lymphoma and invasive cervical cancer have decreased since the advent of Highly Active Anti-Retroviral Therapy (HAART), a combination of several (typically three or four) anti-retroviral drugs in the mid-1990's; however, HIV still dramatically increases the risk for these other types of cancers:

Hodgkin's Disease (10x)

Anal Cancer (50x)

Lung Cancer (7x)

Testicular Germ Cell Tumors (6x)

Regardless of the type of cancer, the course of the disease tends to be different for HIV positive people. 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.

CANCER SCREENING
People with increased cancer risks need to be extra diligent about screening. Unfortunately, the opposite is true in the LGBT community, where increased risks are coupled with lower screenings rates. Insensitive, unsafe and unwelcoming experiences with the health care system keep many LGBT people, even with adequate insurance coverage, from seeking non-emergency medical care.

Lesbians and Cancer Screening
In a large Harris Interactive Poll conducted in January 2005, 75% of lesbians reported that they delayed obtaining health care. This was true across ages, races and education levels. The two most commonly cited reasons in the Harris Poll for delaying health care visits were the cost of services and inadequate health insurance coverage. Very few companies offer same-sex partner benefits, meaning that LGBT people are limited to the insurance that their employer offers, if any. Not surprisingly, then, a smaller proportion of lesbians are covered by health insurance than women overall.

The third and fourth most cited reasons the lesbians in the Harris Interactive Poll gave for delaying health care were previous negative experiences and feared discrimination. Three quarters of the lesbians who experienced discrimination believed it was because of their sexual orientation.

Statistics obtained by the NYC Department of Health confirm this.

Only 73% of lesbians over 40 years old have ever had a mammogram vs. 87 % of heterosexual women

Only 57% of lesbians over 40 have had mammogram within the last 2 yrs vs. 77% of all women

Only 62% of lesbians have had a pap smear within the last 3 yrs vs. 80% of all women

Only 44% of lesbians over 50 have ever had a colonoscopy vs. 52% of all women over 50

Gay Men and Cancer Screening
Research suggests that the majority of gay men have not disclosed their sexual orientation to their primary physician, and they are less likely to do so than lesbians. The most cited reasons for non-disclosure were concerns about a negative response from their provider and confidentiality. A significant number of gay men thought their sexual orientation was irrelevant, even when they were HIV positive. Without knowledge of their sexual orientation, providers may not be able to offer appropriate information about health risks, cancer screening guidelines and treatment.

Transgender People and Cancer Screening
Uninsured rates are highest among transgender people. A December 1999 survey by the NYC Dept of Health found 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.

Transgender people have additional barriers to receiving regular cancer screening, besides those of discrimination and cost. We may not see ourselves at risk for cancers related to body parts that do not match our gender. For example, a transwoman is likely to avoid prostate screening because she does not identify with that body part anymore. A transman who binds his breasts may be unlikely to have a mammogram, as it requires ownership and concern about the health of one's breasts. Unfortunately, there is no statistical information for our population.

[Most of the above information was provided by the National LGBT Cancer Network]

CLICK HERE FOR