LGBTQ+ populations may have elevated risk of cancer, compounded by barriers to care: ACS report

Ahead of the kickoff of June’s annual Pride Month, the American Cancer Society has published a report examining cancer risk in the LGBTQ+ community—and concluding with a call to action to lower the likely heightened risks among the population.

The study looked at risk factors among people of varying sexual orientations and gender identities in the U.S., as collected in the Centers for Disease Control and Prevention’s National Health Interview Survey and Behavioral Risk Factor Surveillance System.

It found an elevated prevalence among the LGBTQ+ community of certain behaviors that are tied to increased cancer risk, including smoking, excess body weight and heavy alcohol use. Meanwhile, some groups within the community also have a higher-than-average prevalence of certain cancer-causing infections, such as HIV, HPV and hepatitis C; an HIV infection, for example, can heighten a person’s risk for at least 10 types of cancer.

Those risks are further compounded by the barriers that many people in the community face when trying to access healthcare. One major disparity cited by many LGBTQ+ patients is the fear that they’ll be denied care based on their gender identity or sexual orientation, which is termed the “presumption-of-care gap” and, as the ACS noted, is a particularly valid fear for anyone who lives in the nine U.S. states where clinicians and payers can indeed opt to deny care based on their own personal or religious beliefs under so-called “conscience clauses.”

There’s also the fact that many clinicians are either ignorant of or actively discriminatory toward LGBTQ+ patients and their health risks; the ACS report cited one study that found that only a quarter of medical students felt confident about the healthcare needs specific to transgender patients, while nearly a third said they weren’t comfortable treating trans patients.

“One of the biggest takeaways from our report is that LGBTQ+ people are probably at higher risk for cancer, yet experience multiple barriers to high-quality healthcare access like discrimination and shortfalls in provider knowledge of their unique medical needs,” Rebecca Siegel, the ACS’ senior scientific director of cancer surveillance and senior author of the study, said in a statement. “Everyone deserves an equal opportunity to prevent and detect cancer early, which is why it’s so important to remove these roadblocks for this population.”

The report was published Friday in the ACS’ journal Cancer, alongside a companion version of the article (PDF) for non-journal readers.

In it, the authors concluded with a call for ramped-up initiatives to reduce risk factor prevalence and eliminate barriers to care for the LGBTQ+ community. Included in the latter is the need for more population-specific data around cancer disparities, incidence and mortality, since information about sexual orientation and gender identity often aren’t collected in healthcare settings.

Taking those actions will ideally help to improve both education on and care for LGBTQ+ patients at risk of cancer. As it stands, per the report, many in the community are not receiving the preventive care they need: It cited data showing that less than half of trans men are up-to-date on colorectal cancer screening, compared to 60% of cisgender men, and fewer than 70% of trans men with a cervix are up-to-date on cervical cancer screening, compared to nearly 90% of cis women.

“All people should have a fair and just opportunity to live a longer, healthier life free from cancer,” said Lisa Lacasse, president of the ACS Cancer Action Network. “As part of our mission to advocate for public policies that reduce the cancer burden for everyone, ACS CAN urges policymakers and lawmakers to prioritize policies that address the serious challenges and barriers to comprehensive access to health care that LGBTQ+ people experience. Importantly, passing laws that facilitate and increase the appropriate collection of sexual orientation and gender identity data is crucial to better understanding cancer disparities and to ultimately improving health outcomes.”