Jun 10, 2019

Studies suggest the LGBTQIA+ community is at higher risk for certain types of cancer; critical need for screening and prevention

Recent data on certain cancers has revealed that the LGBTQIA+ community may be at a higher risk. Is today’s healthcare community equipped to provide and respond to the specific needs of this patient population?

Our previous blog highlighted conclusions from the March 2019 Schabath et al study that measured oncologist comfort and knowledge with, and confidence in, the healthcare needs of the lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual (LGBTQIA+) community.1 Of the oncologist participants, 53% and 37% reported feeling confident in treating the specific needs of LGB patients and transgender patients, respectively.1 Encouragingly, 70% believed more education is wanted and needed on this patient population in order to provide for and improve upon the specific healthcare needs of this group, which represents up to 12% of the US adult population.1

Adding unfortunate fuel to the fire, some studies suggest people within the LGBTQIA+ community are at a disproportionately high risk for certain types of cancer, although the data to support that claim are unreliable at best.2

For example, there have been no studies on the prevalence or incidence of breast cancer among lesbian women, though some studies suggest they have a higher incidence of certain risk factors (not bearing children before age 40, increased incidence of smoking, etc.).2 Because of these risk factors, the Institute of Medicine (IOM) suggests lesbian women are at a higher risk for breast cancer than heterosexual women, without clear data.2

Another supported example is that anal cancer is clearly elevated in the gay male community. In the United States, approximately 3 in every 200,000 men will be diagnosed with anal cancer per year. Within the subset of gay males, this number climbs to 10 per 200,000 in HIV-negative men and nearly 92 per 200,000 HIV-positive men.2 These staggering numbers suggest a critical need for both screening and prevention in the gay and bisexual population, which presents another set of disparities related to healthcare for these specific populations.

The Pap smear, a lifesaving screening tool, has been used in detection of early cervical cancer since 1949.3 Since its introduction, the rate of cervical cancer has been reduced by more than half 3 and the National Cancer Institute (NCI) recommends routine screening among women for cervical cancer beginning at age 21 with a Pap test every 3 years.4

A Pap smear to detect anal cancer was introduced in the 1990s, yet by 2016 the incidence of anal cancer had increased at an average rate of 2.2% per year for the past decade.5 Additionally, there is no formal guidance around use or routine screening of this test for anal cancer among non-HIV infected individuals despite the significant reduction in the incidence of cervical cancer, largely attributed to the widespread and routine use of cervical cancer screening.2,3

The Schabath survey, fielded among 149 oncologists, asked whether regularly screening gay and bisexual men for anal cancer through anal Pap testing can increase life expectancy.1 This question yielded a 17.5% “neutral” and 30.2% “do not know” response, and also showed only 43% felt a Pap smear for anal cancer increased patient life expectancy.1

This suggests a lack of understanding of screening for this type of cancer, and, in fact, awareness of this test is, unfortunately, “remarkably low.”6 These studies highlight the knowledge gap between true understanding of the cancer risk among the LGBTQIA+ population and how to mitigate that risk presents a crucial disparity.

We dug a little deeper to better understand what healthcare, cancer, and patient type disparities exist among the LGBTQIA+ population, and why. In searching for these statistics, we came across lines like these: “sexual minority status is not collected in national surveys and registries”2; practice intake forms did not inquire about “sexual orientation and gender identity (SOGI)”1; “the majority of providers and medical students do not believe they need to know [the] sexual orientation” of their patients1; and “more than one-third” of providers are neutral or do not know if LGBTQIA+ patients are “more difficult to treat,”1 etc.

So, lack of awareness about the specific healthcare needs of LGBTQIA+ patients, coupled with a lack of routine collection of SOGI information, propagates a misunderstanding of LGBTQIA+ representation in individual patient populations. All of this suggests implicit bias and perpetuates a continued marginalization of the LGBTQIA+ community in healthcare practice.

With limited information, it is difficult for healthcare professionals to identify and counsel patients effectively on their specific cancer risks, simultaneously making it difficult for patients within the LGBTQIA+ community to receive optimal care for their specific needs.

Some healthcare networks are encouraging increased provider education to address cancer disparities in the LGBTQIA+ community.7 Providers can be identified as LGBT-trained, indicating they are dedicated to understanding the unique healthcare challenges among their LGBT patients.7

This type of training and designation, along with adherence to the NCI and IOM recommendation for standardized collection of SOGI information, is vital for the provision of patient-centered medical care and imperative to the research still needed to ensure sensitivity to and a higher quality of personalized healthcare for the LGBTQIA+ community.

 

Becky Chanoux, Associate Medical Director

Cynthia Slaby, Account Director

 

References:

1.

Schabath MB, et al. J Clin Oncol. 2019;37(7):547-558. Accessed June 4, 2019.

2.

Quinn GP, et al. CA Cancer J Clin. 2015;65(5):384-400.

3.

Burd EM. Clin Microbio Rev. 2003;16(1):1-17.

4.

National Cancer Institute. HPV and Pap Testing. https://www.cancer.gov/types/cervical/pap-hpv-testing-fact-sheet#q3. Accessed May 22, 2019.

5.

Leeds IL, Fang SH. World J Gastrointest Surg. 2016;8(1):41-51.

6.

Marcus E. Anal cancer: are you at risk? HIV Treatment Journal of TPAN. https://www.positivelyaware.com/articles/anal-cancer-are-you-risk. Accessed June 5, 2019.

7.

Penn Medicine. LGBT Health Program. https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/lgbt-health. Accessed May 22, 2019.