LGBT Americans More Susceptible to Certain Forms of Cancer

Gays and lesbians appear to be at higher risk for certain forms of cancer, the American Cancer Society says. At the same time, a survey of LGBT Americans indicates that there is little awareness of the risk within the community.

According to the Department of Health and Human Services, Center for Disease Control and Prevention, men who have sex with men (MSMs) are 17 times more likely than straights to develop anal cancer. The theory is that human papillomavirus (HPV)--which is thought to cause cervical cancer in women--can cause anal cancer in men.

Moreover, the American Cancer Society said in a March 23 news release, because gays and lesbians smoke twice as much as heterosexuals, they might be more at risk for lung cancer. Breast cancer among lesbians is also a concern: the news release warned that "lesbians have a dense cluster of risk factors significantly raising their risk" of the disease.

"Unfortunately, cancer research in the LGBT population is rarely conducted or published," the release said, adding, "Perhaps due to the lack of focus on cancer in the LGBT community, awareness of the risks of cancer within this population is surprisingly low."

Research carried out this month by LGBT-focused market research company Community Marketing, Inc. showed that just over 10% of respondents knew about the increased incidence of certain forms of cancer among GLBTs. At the same time, over three-quarters of those surveyed said that they knew someone in the LGBT community with cancer.

Cancer rates in the general population are 1 in 2 for men and 1 in 3 for women, meaning that half of all men and one-third of all women will have some form of cancer at some point in their lives.

The survey showed an unmet need for cancer screening and treatment services targeting the LGBT community. "The American Cancer Society (ACS) has recognized the high incidence of cancer in the LGBT community, and the need for greater services," the release said. "In 2010, ACS has begun conducting 'Cancer Chats' at the LGBT Community Center in New York City and in other locations, focused on raising awareness of cancer in the LGBT community and helping with concrete information such as nutrition therapy."

"Within the LGBT community, much of the health focus understandably has been on HIV/AIDS," Beth Israel Medical Center urologist Dr. Matthew Lemer said. "I care for many LGBT patients in my practice, and I see a high incidence of cancer among them. In the early 1980s some people erroneously called HIV/AIDS the 'gay cancer,' " Lemar added. "But LGBT patients do have legitimate cancers, which need to be recognized and treated with sensitivity to the salient needs of the community."

A Nov. 27, 2009 Bay Area Reporter article covered the higher rate of anal cancer in MSMs, noting that while the rate of anal cancer in the general population is 1 in 100,000, the rate rises to 35 out of 100,000 for IV-negative MSMs. For people living with HIV, the numbers increase drastically: estimates vary between 75 and 115 out of 100,000.

"The incidence of human papillomavirus-associated anal cancer is unacceptably high among HIV-positive men who have sex with men, and possibly in HIV-positive women," according to the University of California, San Francisco's Dr. Joel M. Palefsky. "Unlike most other malignancies occurring in the HIV-positive population, anal cancer is potentially preventable, using methods similar to those used to prevent cervical cancer in women," Palefsky added. Palesfsky is the co-leader of the Helen Diller Family Comprehensive Cancer Center's cancer and immunity program.

"That is a huge number" said the UCSF's Dr. J. Michael Berry. "It is not just a San Francisco phenomenon, it is happening all over the world," Berry added. Berry is an associate clinical professor of medicine in the Department of Hematology Oncology at the university, and also the associate director for HPV-related clinical studies. Noted Berry, "When we look at HIV-positive men, almost all of them will have HPV virus if we look for it." That in itself does not guarantee that cancer will result; only "a small percentage will go on to develop cancer," he said. But the data indicate that immune-compromised individuals, such as people living with HIV, are more susceptible to HPV leading to cancer.

There are other links between HPV and HIV according to Dr. Peter Chin-Hong, a UCSF researcher who said in a paper that individuals with HPV--and especially with more than one type of HPV--were at greater risk of contracting HIV, a Nov. 3, 2009 Bay Area Reporter article noted. The reason? Some sexually transmitted diseases (STDs) can affect the integrity of the body's tissues, making it easier for HIV to infect a person.

"That has long been known for sexually transmitted diseases such as syphilis and gonorrhea, but nobody has looked at HPV, perhaps because it is so common," Chin-Hong told an interviewer, adding, "Almost 100 percent of people get exposed to HPV in their lifetime. If you are not HIV-positive there, is about a 20 percent chance of detecting HPV at any one time, and a 10 to 20 percent chance it will go on to have persistent infection," Chin-Hong added.

The Food and Drug Administration has recommended that girls be vaccinated against HPV to prevent cervical cancer, but a Centers for Disease Control and Prevention advisory committee has recommended against vaccinating boys to prevent anal cancer, the article said. A similar recommendation in the British medical journal BMJ said that vaccinating all men against HPV would not be "cost effective," although vaccinations for gay men might still be prudent. However, the vaccinations work best when administered to individuals before adolescence.

The best advice for MSMs: to get checked for anal warts or anal cancer by a doctor on a regular basis and, if they have (or have in the past had) anal warts already, to get pap smears to check for cancer.