DO LGBT YOUTH HAVE CANCER DISPARITIES?

Do LGBT youth have higher prevalence of cancer than other youth? To be honest, we don’t know. The lack of sexual orientation and gender identity (SOGI) on institutional intake forms across the medical professions has resulted in difficulty ascertaining LGBT health disparities, requiring researchers to establish studies to answer these sorts of questions. SOGI is also not recorded in cancer registries. What we do know is that LGBT adults do have higher cancer rates, and higher prevalence of cancer risk factors, many of which may be traced back to experiences and behaviors that began in adolescents. Recently, the head of the U.S. food and drug administration stated that smoking is a pediatric disease, because the majority of adult smokers started in adolescents and adolescents who reach adulthood without ever having smoked a cigarette have much lower rates of starting cigarette use later in life. I would argue that many LGBT health disparities, including cancer, may be traced to minority stress and behaviors linked to this form of stress as coping mechanisms. In fact one study, Dr. Rosario (who worked on the study) commented “Sexual minorities are at risk for cancer later in life, I suggest, from a host of behaviors that begin relatively early in life,” said Professor Rosario. “No sex or ethnic racial group is at greater risk or protected for these behaviors. Overall, the study underscores the need for early interventions.” (1)

Minority stress is a public health theory which explains that stress resulting from discrimination and stigmatization of minority groups affects the individuals health in a number of ways throughout the lifespan. Many studies of minority stress show that LGBT people experience this, which may be further compounded by racial minority status, disability, class or many other stigmatized identities an individual may hold while also being LGBT. Earlier this year a study found that LGB people who live in communities with high levels of anti-LGB prejudice had a 12 year reduction in life expectancy when compared to heterosexual peers in the same community who do not experience discrimination (2). In 2013 other studies found that LGB people who live in states without LGBT protective policies were 5X more likely than those in other states to have 2 or more mental disorders (3) and LGB people who experienced “prejudice-related major life events” were 3x more likely to suffer a serious physical health problem over the next year than people who had not experienced such events regardless of other factors such as age, gender, employment and health history (4).

So how does this play out for LGBT youth specifically? One study found that, when asked about concerns, heterosexual high school students stated grades and classes as number 1 on their list, with college and careers, and financial pressures related to college or jobs coming second and third, while LGBT students reported more immediate, tangible issues such as non-accepting families, school bullying and fear of being out as their top 3 concerns (in that order) (5). We also know how stigma and discrimination leads to negative mental health outcomes. So, it is no surprise that mental health issues such as stress, depression and anxiety lead to higher levels of smoking, alcohol consumption, substance abuse and riskier sexual behavior. One study found that LGBT students had higher prevalence in 10 risk categories (these were: behaviors that contribute to unintentional injuries, behaviors that contribute to violence, behaviors related to attempted suicide, tobacco use, alcohol use, other drug use, sexual behaviors, and weight management) (6). The same study Dr. Rosario commented on earlier found that of “the 12 cancer-risk behaviors included tobacco use, drinking alcohol, early sex, multiple sexual partners, higher body mass index (BMI) and lack of exercise. The report found that for all 12, sexual minorities were more likely than heterosexuals to engage in the risky behavior (1). Other studies have linked psychological distress and LGBT victimization to high smoking prevalences (6).

So, while there is limited data on cancer among LGBT youth, it is clear that lifetime stressors related to LGBT status, instilled in adolescence, coupled with unhealthy coping mechanisms, are responsible for increased cancer incidence among LGBT adults. It is my opinion that the roots of these cancers may be traced to experiences of homophobia as a LGBT pediatric health disparity.

References:

1. Rosario, M., Corliss, H. L., Everett, B. G., Reisner, S. L., Austin, S. B., Buchting, F. O., & Birkett, M. (2014). Sexual orientation disparities in cancer-related risk behaviors of tobacco, alcohol, sexual behaviors, and diet and physical activity: pooled Youth Risk Behavior Surveys. American journal of public health, 104(2), 245-254.
2. Garcia, M. (2014). Study: Antigay communities lead to early LGB  death. Advocate.com. Retrieved fromhttp://www.advocate.com/health/2014/02/16/study-antigay-communities-lead-early-lgb-death
3. Haas AP, Eliason M, Mays VM, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. Journal of homosexuality. 2011;58(1):10-51.
4. Durso, L. E., & Meyer, I. H. (2013). Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sexuality Research and Social Policy, 10(1), 35-42.
5. GROWING UP LGBT IN AMERICA (HRC). (2012) http://www.hrc.org/youth
6. 6.Kann, L., O’Malley Olsen, E., McManus, T., Kinchen, S., Chyen, D., Harris, W. A., & Wechsler, H. (2011). Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors among Students in Grades 9-12–Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. Morbidity and Mortality Weekly Report. Early Release. Volume 60. Centers for Disease Control and Prevention.