For Gay and Bi Men, Cancer Treatment Disparities Are Real

Highlights

• Research suggests that gay and bisexual men experience disparities in cancer diagnosis and treatment outcomes.

• Gay and bisexual men are at an increased risk for cancers caused by the human papillomavirus (HPV), such as anal cancer.

• Cancer disparities stem from social stigma and discrimination, barriers to care, and unique cancer risks.

• Addressing cancer disparities requires public education and awareness, changes to policy and systems of care, and ongoing social support.

• Research shows that HPV vaccination can reduce risk for HPV-associated cancers. 

---

The most common types of cancer among American men include skin, prostate, lung, and colorectal cancer. However, gay and bisexual men are at a higher risk for certain types of cancer. Learning about these types of cancer can help you to take action to prevent or detect them early on.

This article highlights the issue of cancer disparities among gay and bisexual men, emphasizing the importance of addressing these disparities for improved health outcomes.

Cancer in Gay and Bisexual Men

Gay and bisexual men face disparities in cancer diagnosis and treatment when compared to their heterosexual counterparts. This means that they are more likely to be diagnosed with certain types of cancer and to experience poorer health outcomes than heterosexual men. 

Despite the fact that sexual minority groups have been largely overlooked in most population health surveys, available research suggests significant cancer disparities among gay and bisexual men. 

For example, data from the National Health Interview Survey showed that gay men had approximately 50 percent increased odds of reporting a cancer diagnosis than heterosexual men surveyed. 

Additional large-scale studies demonstrate that gay and bisexual men have an increased risk for cancer linked to the human immunodeficiency virus (HIV) and the human papillomavirus (HPV). 

Understanding Cancer Disparities

Anyone can develop cancer, regardless of their gender or sexual orientation. However, leading health authorities recognize that underserved and marginalized groups face disparities for a number of health disparities, including cancer.

The National Cancer Institute describes cancer disparities as differences in cancer measures for a specific population. 

Example measures include:

• Incidence: The number of new cancer cases.
• Prevalence: The number of all existing cancer cases.
• Mortality: Death from cancer.
• Survival: How long people with cancer survive following diagnosis.
• Morbidity: Any cancer-related health complications.
• Other measures: Additional measures may include screening rates, financial burden, stage at diagnosis, or other quality of life measures. 

Despite advances in research and health care, LGBTQ+ people experience poorer mental and physical health outcomes than their heterosexual peers. Researchers recognize that LGBTQ+ populations often experience delayed cancer diagnosis, delayed or insufficient care, and poor patient-reported outcomes.

Additional research is needed to establish the extent of cancer disparities in gay and bisexual men. For example, the National Institutes of Health (NIH) published a report over NIH-funded studies related to sexual and gender minority groups. Out of 384 studies, only 28 were dedicated to cancer. 

Contributing Factors to Cancer Disparities

Despite recent strides in LGBTQ+ rights and awareness, cancer disparities among gay and bisexual men are often overlooked in healthcare. There are several social and system-level factors that contribute to these disparities. Understanding these factors is critical for advancing the health and well-being of gay and bisexual men.

Stigma and Discrimination

Stigma and discrimination continue to negatively impact the lives of LGBTQ+ individuals. This occurs on a personal level and within broader societal and national contexts. 

The Center for Disease Control and Prevention (CDC) cites stigma and discrimination as a major influence on the health and well-being of gay and bisexual men. For example, homophobia can affect whether these men seek healthcare services or disclose their sexual orientation to their providers, which can affect the quality of care they receive.

Barriers to Care

Many Americans face staggering barriers to quality care. In addition to homophobia, stigma, and discrimination, gay and bisexual men may also face the following barriers to accessing care:

• Cultural competency barriers. Providers may lack awareness, understanding, and training on the specific needs of gay and bisexual men. This means they may not offer the necessary prevention education, screening, or treatment options to the patient.
• Financial barriers. Financial barriers include things having low income, having no or inadequate insurance, not having access to transportation, or not being able to take time off work for medical appointments. The costs of medical appointments, screenings, diagnostic tests, and treatment can hinder someone from seeking or following up on care.
• Limited awareness. Limited public education regarding cancer risks and considerations for gay and bisexual men may contribute to lower engagement in prevention and screening.

Mental Health Disparities

Sexual minority populations often experience minority stress. This refers to chronic stressors related to stigma, discrimination, harassment, or marginalization. Minority stress contributes to poor mental health, behavioral health, and physical health outcomes.

LGBTQ+ people also have a higher risk for mental health conditions, such as anxiety, depression, and substance use disorder, than their cisgender, heterosexual counterparts. Having a mental health condition, such as anxiety or depression, can influence whether or not someone seeks care, engages in healthy behaviors, or follows up with treatment. 

Unique Risks

Gay and bisexual men may face additional health risks related to their sexual behaviors. For example, men who have sex with men (MSM) have an increased risk for certain sexually transmitted infections (STIs) that are linked to some cancers.

Gay and bisexual men are at a higher risk for HPV than men who have sex with women. Until recently, HPV awareness and prevention were primarily aimed at women because it can cause cervical cancer. However, HPV is also strongly linked to oral, penile, and anal cancers.

Gay and bisexual men living with compromised immune systems or other comorbidities may be at an even greater risk for developing HPV-related cancer. For example, research shows that MSM living with HIV/AIDS have a significantly higher risk of developing HPV-associated cancers than the general population.

Limited Data

Gay and bisexual men are historically underrepresented within cancer research. The lack of large-scale studies on cancer disparities among gay and bisexual men has made it challenging to identify and address the unique needs of this population.

Types of Cancer Disparities Among Gay and Bisexual Men

All men are at risk for prostate, testicular, and colon cancer. However, certain types of cancer tend to occur at higher rates among gay and bisexual men.

Anal Cancer

Anal cancer is relatively rare among the general population. However, research suggests that MSM, especially those who have HIV, have a significantly higher risk of being diagnosed with anal cancer than the general population. 

Gay and bisexual men who engage in anal sex have higher rates of HPV infection. This is one factor that contributes to the increased risk for MSM to develop HPV-associated anal cancer. 

In addition to HPV, tobacco use also increases a person’s risk for anal cancer. Gay and bisexual men smoke cigarettes at higher rates than their heterosexual counterparts. 

Colorectal Cancer

Some research suggests that gay men have higher rates of colorectal cancer than the general population. Additional research suggests that gay and bisexual men may be less likely to engage in recommended screening for colorectal and prostate cancer. However, some results are mixed, and additional research is needed to understand the link between sexual orientation and colorectal cancer risk. 

Prostate Cancer

Prostate cancer is the second most commonly diagnosed cancer in men, regardless of sexual orientation. Researchers continue to explore the relationship between sexual orientation and prostate cancer risk.

Research suggests that gay and bisexual men diagnosed with prostate cancer tend to have poorer outcomes related to sexual function and quality of life. For example, some studies suggest that gay and bisexual men have poorer urinary, bowel, and quality of life outcomes following treatment for prostate cancer. 

Skin Cancer

Skin cancer is the most commonly diagnosed cancer in the United States. Research suggests that certain sexual and gender minority groups have an increased lifetime risk of skin cancer. Specifically, gay and bisexual men report higher rates of both skin cancer and indoor tanning bed use.

Testicular Cancer

Some studies have shown a higher incidence of testicular cancer among men with HIV/AIDS. Research on testicular cancer risk for MSM is currently limited. Additional research is needed to explore this connection.

Additional Cancer Disparities Among Gay and Bisexual Men

In addition to having an increased risk for developing certain types of cancer, gay and bisexual men also face disparities in cancer screening, diagnosis, and treatment outcomes.

Screening and Diagnosis

Research suggests that gay and bisexual men have lower rates of screening for certain types of cancer, despite having an increased lifetime risk for cancer diagnosis. For example, they tend to have lower screening rates for prostate and colorectal cancer. 

Gay and bisexual men are more likely to be diagnosed with cancer at later stages than heterosexual men. Late diagnosis can compromise treatment outcomes.

Gay and bisexual men belonging to ethnic or racial minority groups are less likely to receive cancer screening than their white counterparts. For example, African American MSM show lower rates of prostate-specific antigen (PSA) testing than their heterosexual counterparts.

Treatment Outcomes

Some research suggests that gay and bisexual men may experience worse cancer treatment outcomes than heterosexual men. Treatment experiences and treatment outcomes encompass a variety of health and quality of life indicators. 

A systematic review of health outcomes among sexual and gender minority groups found significant disparities in cancer treatment outcomes for MSM. Compared to heterosexual men, MSM reported:

• Greater fear of cancer recurrence 
• Poorer mental health outcomes
• Increased relationship difficulties

A recent study examined the health outcomes of gay and bisexual men treated for prostate cancer. Researchers found that gay and bisexual men reported significantly worse outcomes related to urinary, bowel, hormonal, and sexual function than their heterosexual peers.

Sexual Dysfunction

Gay and bisexual men tend to report poorer sexual function following cancer treatment than their heterosexual peers. This tends to be more common in cancer treatment for cancers related to the penis or testicles. Many gay and bisexual men also report anxiety and frustration related to homophobia and the heteronormativity of cancer rehabilitation services.

Cancer treatment side effects vary depending on cancer type, treatment method, and other individual risk factors. After treatment for prostate cancer, gay and bisexual men commonly report:

• Ejaculation problems
• Erectile dysfunction (ED)
• Pain during anal sex
• Pain during climax
• Loss of libido
• Lower frequency of sex

Promoting Health Equity for Gay and Bisexual Men

Reducing cancer disparities among gay and bisexual men will require a multi-faceted approach. This means that there’s still more work to be done at the patient, provider, community, and social levels.

Provider Education

We can’t improve healthcare experiences and outcomes for gay and bisexual men without adequate provider education. Research shows that LGBTQ+ people still experience and fear discrimination from their healthcare providers. Providers trained to work with LGBTQ+ patients are better positioned to provide quality care to gay and bisexual men.

Public Education and Awareness

Despite their increased risk for HPV-associated cancers, researchers have found that most MSM are unaware that HPV can cause anal cancer. Gay and bisexual men are less likely to be screened for cancer if they are unaware of their risk. They may also be hesitant to request screening due to fear of discrimination. 

Similar to STI screening, there’s no reason for cancer screening to be stigmatized. Increased public education and targeted awareness campaigns may help to promote healthy behaviors and to reduce stigma. 

Addressing Stigma and Discrimination

Discrimination and stigma rooted in homophobia continue to negatively impact the health of gay and bisexual men. Stigma and fear of discrimination can also dissuade men from seeking healthcare, disclosing their sexual orientation to providers, or following up with providers for screening and treatment. Addressing stigma and discrimination across social levels is critical to reducing cancer disparities among gay and bisexual men.

Health Systems and Policy

There are many barriers within our current healthcare systems and healthcare policies that contribute to cancer disparities in gay and bisexual men. Reducing these disparities requires improving access to healthcare, prohibiting discrimination within healthcare services, improving provider cultural competency, and promoting systems that are inclusive of LGBTQ+ providers and patients.

Community Support

Qualitative research suggests that many cancer patients and survivors benefit from participating in community and peer support groups during cancer treatment. Gay and bisexual men may benefit from additional support from LGBTQ+ peers and community members throughout treatment. LGBTQ+ advocacy organizations and LGBTQ allies can also help to promote screening, follow up, and treatment to reduce cancer disparities among LGBTQ+ populations.

Successful Initiatives and Future Directions

Research related to reducing cancer disparities among gay and bisexual men is still developing. However, there are several strategies that show promise in this area. Continued advocacy and collaboration is needed as researchers find new ways to address cancer disparities among LGBTQ+ populations.

Screening

Research shows that cancer screening rates are often much lower for LGBTQ+ people than for their heterosexual counterparts. By encouraging routine cancer screenings for HPV-associated cancers, providers can help to ensure early detection among gay and bisexual men. Providers should also follow cancer screening guidelines for all men and discuss screening, such as the PSA screening for men who are at higher risk.

HPV Vaccination

The HPV vaccine is the only vaccine that can prevent HPV-related cancer. The HPV vaccine is recommended for gay, bisexual, and other MSM up to age 26. HPV vaccination campaigns and targeted education for gay and bisexual men can help to increase vaccine and screening uptake.

Conclusion

Significant cancer disparities persist among gay, bisexual, and other MSM. These men face tremendous barriers in accessing quality care, which is fueled by stigma, discrimination, and homophobia. They also face unique cancer risks related to anal sex, such as an increased risk for HPV-associated cancers, and are at greater risk than heterosexual men for other types of cancer.                         

Addressing cancer disparities requires an all-hands-on-deck approach. This means we need healthcare providers, healthcare systems, policymakers, LGBTQ+ organizations, researchers, and LGBTQ+ allies to continue to collaborate to reduce disparities among gay and bisexual men. Potential strategies include public education and awareness campaigns, changes to policy and health systems, and bolstered social support.

Better Health for All with eDrugstore

A cancer diagnosis and treatment journey can derail emotional and sexual intimacy. You don’t have to face the journey alone. At eDrugstore, we provide a wealth of resources to help you keep your emotional and physical health on track. 

Take advantage of our free consultations with U.S.-licensed doctors who can write you a prescription to address your sexual health or erectile dysfunction concerns. We offer leading FDA-approved erectile dysfunction medications, including Viagra. To top it off, shipping is always on us.