Punch #1
Lesbians, gay, bisexual, and transgender people have dramatically increased cancer risks. (There is ample research to say this with certainty.)
Punch #2
Lesbian, gay, bisexual, and transgender people have significantly lower cancer screening rates. (Research here is limited and inconsistent but overwhelmingly confirms this statement.)
A Knockout?
Increased cancer risks coupled with decreased screening rates probably result in both a greater incidence of cancer and cancers found at later stages when the prognosis is worse. (Data barely exists about cancer prevalence in the LGBT community, as no national cancer registries collect information about gender identity or sexual orientation, leaving us hidden within the records.)
The Slow-Motion Replay
Looking carefully, we see that there is little to no difference in the biology or physiology of LGBT bodies compared with the general population. The increased cancer risks result from behaviors, many of which can be traced back to the stress and stigma of living as sexual and gender minorities. On close inspection, we also see that the decreased screening rates are due to multiple barriers LGBT face in accessing safe, affordable, welcoming health care.
It is impossible to overstate the impact of minority stress. We use and abuse alcohol at higher rates. Lesbians are also more likely to be overweight, eat a high-fat diet, and not have a biological child before age 30, all increasing their cancer risks. As a group, we smoke at nearly twice the national rate. Gay men not only smoke and drink more than their heterosexual brothers but are more likely to be infected with HPV and/or HIV, both increasing their risk for multiple types of cancer. There is little supplemental data on transgender cancer risks, although the hormones used for transitioning have been implicated in cancers found in cisgender people.
Increased risks suggest that we should be hypervigilant about cancer screenings, but instead, we find that the opposite is true. Previous discrimination, low rates of health insurance coverage, and provider ignorance/insensitivity all serve to keep LGBT people out of the doctor's office as long as possible. In fact, one out of five transgender patients has actually been turned away by a doctor. When LGBT people don't feel safe coming out to their provider, and many don't, doctors can't assess the patients' cancer risks or order appropriate tests. For example, in a recent study in NYC, 39 percent of MSM (men who have sex with men) never told their provider about their sexual orientation. I can't imagine any of them were offered an anal pap smear, a simple, potentially life-saving test for anal cancer. Studies have shown that LGBT people also have lower rates for mammograms, cervical pap smears, and colonoscopies. For LGBT people of color, the numbers are even lower.
Fighting Back
The National LGBT Cancer Network is interfering with this deadly combination of punches to our community in a variety of ways. In the last year, using a generous grant from the Palette Fund, we have compiled a directory of over 400 LGBT-friendly, free or low-cost cancer screening facilities across the country. They have just been uploaded to our website. Our database covers colonoscopies, prostate cancer screening, anal pap smears, cervical paps, and mammograms. Some offer other culturally competent health-care services, as well.
We have selected each facility for inclusion based on its commitment to offering safe, affordable, welcoming care to all LGBT people. Each has demonstrated proven cultural competence in respecting the bodies, histories, and families of LGBT patients. Those highlighted with "stars" have shown exceptional commitment to transgender health. Each listing includes the name, phone, and email of a particular individual who has agreed to shepherd LGBT people through the screening process. This means, for example, that a transgender man who wants a mammogram will not be required to wear a pink robe and sit in the waiting room with women. He can request the first appointment of the day or a separate place to wait. We have found facilities where all members of our community can be seen, even those without health insurance and without documentation.
Our goal is for every LGBT person in the country to be within driving range of a safe, affordable, and welcoming cancer screening facility. Nearly all 50 states are covered so far. In remote or underserved geographic areas, we are offering our cultural competence training, Reexamining LGBT Healthcare, to facilities that want to be included but do not yet have the knowledge or training to warrant inclusion in our database.
So we must beat the first punch and be ready to fight back there, as well. We need to take better care of our health and lower our risks of cancer and other debilitating diseases. The National LGBT Cancer Network won't stop until we have shut cancer down completely. For today, we have made it easier to find a place to be screened in a safe and respectful environment. Take care of that body.