CLEVELAND — Being part of a Pride march is one thing, but getting access to medical care as an LGBTQ+ individual can be another. That's just one issue highlighted in a new American Cancer Society report.
"I think it's fantastic work and I think it's one small step towards the ongoing progress that we need to make. To have a national organization like the American Cancer Society, draw attention to it, I think is an early step. I the next step that comes with this is how can we further address it and how can we structure our care delivery to address these gaps," said Sarah Lynam, M.D. a gynocologic oncologist at University Hospitals Seidman Cancer Center.
Dr. Lynam often treats patients who've experienced obstacles in obtaining care.
"And now we're seeing it in hard facts as far as this is affecting the prevalence of cancer, within the LGBTQ community, this is affecting long term health outcomes, access to screening, and really tells us that we're paying attention to it, but we're not fixing the problem," she said.
The study looked at cancer prevalence and modifiable risk factors in the LGBTQ+ community.
LGBTQ+ individuals in the United States have elevated prevalence of smoking, excess body weight, and other factors that increase cancer risk.
For example, bisexual women are twice as likely as heterosexual women to smoke cigarettes (23% versus 10%) and drink heavily (14% versus 6%).
“Minority stress” is a likely contributor to behaviors like smoking that increase cancer risk according to other studies. Although these findings suggest cancer disparities, cancer incidence and mortality for this population are not available because sexual orientation and gender identity are not routinely collected in healthcare settings, despite the community’s willingness to report this information.
Perhaps the greatest health disparity faced by LGBTQ+ communities is the presumption-of-care gap, which is the fear that a provider will refuse care due to gender identity or sexual orientation.
The concern is especially valid for the 20% of this population who reside in the nine states where it is legal to refuse care to LGBTQ+ individuals due to “conscience clauses” that allow healthcare providers, staff and insurers to deny care and services based on personal and religious beliefs. Ohio is one of those states.
Dr. Lynam hopes the report is a wakeup call to health systems to be more inclusive.
"If there's somebody who's in the LGBTQ community right now who's seeing this and wondering how this directly impacts you, it's that you are at increased risk. Know that you are valued and that every person has the right to health care access," Dr. Lynam said.
Other highlights from the report include:
Excess body weight appears to be elevated among bisexual women according to one national survey, although the gold-standard source for this metric that includes an in-person physical exam – the National Health and Nutrition Examination Survey – does not collect data on sexual orientation or gender identity.
The prevalence of cancer-causing infections, such as human immunodeficiency virus (HIV), human papillomavirus (HPV), and hepatitis C virus (HCV) are considerably higher in some LGBTQ+ population groups. According to the CDC, for example, 70% of HIV infections are attributed to male-to-male sexual contact (versus 22% to heterosexual contact and 7% to injection drug use). HIV-infected individuals are at a higher risk for at least 10 cancers.
Screening for some cancers is low among transgender people; for example, 46% of transgender men are up-to-date on colorectal cancer screening compared to 60% of cisgender men and 68% of transgender men with a cervix are current for cervical cancer screening compared to 87% of cisgender women.
Only 25% of medical students are confident in the healthcare needs of transgender patients and 30% are not comfortable treating transgender patients, according to one study.