Health Care in Transition

The nation’s cancer care system is becoming more aware of, and sensitive to, the needs of the LGBTQ community.
A study published in the Journal of Community Health in 2017 further highlights the risk factors present in the LGBTQ community. The study stemmed from data from the 2014- 2015 Behavioral Risk Factor Surveillance System (BRFSS), a national telephone survey conducted annually in conjunction with the Centers for Disease Control and Prevention. Based on answers to questions about sexual orientation gathered from 27 states, both gay and bisexual men reported higher levels of mental distress and depression than heterosexual men, as did lesbian and bisexual women in comparison to heterosexual women. Furthermore, the study confirmed Margolies’ thoughts on behavioral issues, indicating that sexual minority populations tend to have higher rates not only of smoking and drinking, but also of obesity — all risk factors for developing certain kinds of cancer.

Other studies indicate that rates of breast, lung and colorectal cancers are higher for lesbian and bisexual women than for heterosexual women. Gay men, including those who are HIV-positive, are also at higher risk for some kinds of cancer, including anal cancer, which is relatively rare in the general population.

“Since the advent of antiretroviral medications, we don’t see too many cases of classic HIV-related cancers, like Kaposi sarcoma, but the increased risk for anal cancer may be due to the human papillomavirus (HPV) and a compromised immune system,” says Sean Cahill, director of policy research at the Fenway Institute in Boston, a center for research, training, education and policy development focused on global health issues. “For this reason, we encourage anal screening, especially for older men.”

Health screening is an important issue for all members of this community. Lesbians, bisexual women and transgender men have lower screening rates for both breast and cervical cancer compared to heterosexual women. For example, research indicates these groups are four to 10 times less likely to get a Pap test than heterosexual women, according to Cahill.

What is behind this discrepancy? “The underlying reason for these lower screening rates may be the result of the difficulty lesbians and bisexual women have in finding providers they feel comfortable with, combined with lower rates of insurance coverage,” explains Cahill. “Transgender men have an even harder time. They may be uncomfortable disclosing their status, so their providers may not even know what screenings to suggest.”

Margolies agrees, adding that, according to a country-wide survey conducted by the National LGBT Cancer Network, many patients are so worried about alienating their health care providers when a disease is life threatening that “they jumped back into the closet after receiving a cancer diagnosis. They were worried that a homophobic nurse would make them wait longer for pain medication. In many instances, LGBTQ patients simply don’t feel safe revealing who they are.”


Although correcting the health disparities that members of the LGBTQ community experience has been a slow process, there are signs of growing awareness of the issues, and some steps have been taken to address them. The passage of the Affordable Care Act gave more people access to insurance and health care, although now there is uncertainty about the status of this law. A groundbreaking 2011 report by The Institute of Medicine, “The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding,” laid the groundwork for greater equity in serving the LGBTQ community. Since then, a few large medical institutions have developed programs to improve care for this population.

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