Health Disparities and the LGBTQ population

Is the LGBTQ community carrying a disproportionate burden of cancer?  The answer may be yes.

It is not necessarily surprising to find that health disparities are prevalent in the lesbian community.  However, disparities are certainly not limited to the lesbian community, but to all of the sub-populations who identify with the LGBTQ [Lesbian, Gay, Bisexual, Transgender, and Questioning] community and beyond.  The community is comprised of a diverse group of people.  They are not all young, they are not all white, not all have access to financial resources.  Also, many live with multiple forms of oppression, not just the potential stigma of their sexual identity. Each of these components the can compound difficulty in obtaining adequate health care as well as adequately assessing potential health risks. 

What is needed is for is education within the LGBT community about increased risks, the importance of cancer screening, training of health care providers to recognize the needs of the LGBT community and to offer more culturally competent care to this population of patients.  Advocacy geared toward national and local cancer organizations, research organizations and encouragement of media to pay attention to the special needs of the LGBTQ and remember that they are cancer survivors, too, who have a diverse set of needs.

There is such limited data on LGBTQ and cancer.  The National Cancer Registry currently does not collect information about sexual orientation, or gender identity.  So the LGBTQ remain “hidden” among cancer survivors. This leaves us to speculate and hold the possible number of current cancer survivors at about 1 million. Due to information collected by the National Registry, for instance, we now know that white women are more likely to be diagnosed with breast cancer, but black women are more likely to die of it.  This type of data collected from the LGBTQ would be incredibly helpful in gaining funding for initiatives which reduce the barriers to care.

There are some increased risks, but because there is no data collection, we cannot say if, or how it translates into a greater incidence of cancer.  Risks associated with LGBTQ cancers can be attributed to living as a group of people who are also at risk for oppression and discrimination.  For instance, lesbians do not have different bodies than their heterosexual sisters, but are more likely to smoke cigarettes [tobacco use is twice as high in the LGBTQ community as in the general population], more likely than the general population to be overweight, again increasing the risk of cancer,  use of alcohol is higher which increases the risk of certain types of cancer.  Lesbian women are less likely to have a biological child before they are 30 years old which provides protective factors in some women’s cancers.  Yet another cause for concern is a greater incidence of the human papilloma virus [HPV] the cause of almost all forms of cervical cancer and has been recently linked to other cancers of the head and neck, the mouth, the throat, tonsils, and even certain lung cancers. What we all must be fighting for is to have young people [boys as well as girls] vaccinated with the HPV vaccine. Currently, insurance companies will not pay for vaccination for boys, only for girls.  We need to vaccinate all youth prior to first sexual contact Why?  In addition to protecting heterosexual men against HPV we need to protect men who have sex with men some of whom do not identify as gay [i.e  “the difference between what you do and who you feel like you are, or  your identity .”  Men may have sex with other men without taking on the gay identity.]  However, HPV also causes anal cancer in men who have anal sex.  The rates of anal cancer among men who have sex with men have exploded and are currently as high as the rates of cervical cancer in women before they started having pap smears. 

We have to actively educate and encourage everybody to have cervical pap smears on a regular basis Oppressed groups are less likely to go to the doctor because of real, or perceived discrimination there.  Heterosexual women are more likely to see a gynecologist with some regularity partly because they desire birth control, but lesbians, for example, who are not seeking, or in need of birth control, have a tendency to see a gynecologist less regularly.  Because the National Registry does not collect the data, we can only speculate, but there is concern that the rate of cervical cancer is higher in lesbians. HPV is less likely to be caught early in a pap smear before it becomes cancer and exists as pre-cancerous cells which can be excised, or treated in other ways.

The LGBTQ community and many other oppressed and discriminated communities have increased cancer risks coupled with lower screening rates. With higher risks you would think we would need to see the doctor more screening, however, people in this population are going to the doctor with less regularity. One reason is financial… LGBTQ have very low rates of being covered by insurance. Trans-gender people have some of the lowest rates of being covered by health insurance rates in the country. So, we can encourage people to go to the doctor, but we have to make sure that the cost isn’t prohibitive, and to make sure that they are going to be treated with respect and dignity.

Many LGBTQ do not reveal their sexual identity to their physicians for fear of discrimination, judgment.  We must make it safer for people have honest interactions with their health care providers. Otherwise the result is sub-optimal care.  For men who are gay or are on the ‘down-low’ my not receive appropriate screening for things such as anal cancer.  And LGBTQ are not crazy to view revealing their sexual identity as a problem.  Recent research suggests that 1 in 5 trans-gender people has been turned away by a health care provider.  Even doctors have prejudices, some even when they themselves identify as gay.   Many people won’t see a physician if they know that they are gay, or lesbian if they don’t feel as though they can relate to their needs. 

The goal: Everyone would have affordable health insurance, feel safe going to a doctor and that we wouldn’t see increased risks and lower screening rates in LGBTQ , or any other oppressed group, better data collection so funding is available to support research, education, and programming.

We need to all try to live healthier lives, give up smoking, eat better, exercise, sleep well.  The more ways in which you are oppressed the harder it is to do that.  So, we fight for the end of all oppression in ourselves, in our communities, and legislatively. 

We also need to provide adequate support for care-givers… for a woman who’s partner is another woman with breast cancer, a support group filled with men may be challenging.

The needs of the LGBTQ community must be recognized and addressed in the global effort to eliminate cancer.

Support the people in your life.  Encourage screening.  Go with loved ones and friends to appointments.  If YOU love someone help them to take better care of their bodies. 

Use this to move you to action!

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For More information…

National LGBT Cancer Network:  http://www.cancer-network.org/

The National LGBT Cancer Project – Out With Cancer:  lgbtcancer.com/

http://lgbtcancer.com/support-groups/

Iowa Cancer Consortium:  http://www.canceriowa.org/News—Publications/LGBT-Cancer-Resource-Guide.aspx

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