Cancer in Gay, Bisexual Men Needs More Study, Lancet Review Says.

Sexual orientation is still largely overlooked in studies of cancer, with little research on cancer disparities associated with gay and bisexual men, according to a review of literature published in The Lancet Oncology journal and headed by a BU School of Public Health researcher.

Ulrike BoehmerUlrike Boehmer, associate professor of community health sciences at BUSPH, and colleagues reviewed 47 cancer studies pertaining to gay or bisexual men, as well as other men who have sex with men (known as MSM). They found that with few exceptions, information on sexual orientation disparities in cancer incidence and mortality was not available for gay and bisexual men, but instead was inferred from populations with HIV/AIDS.

“Evidence of cancer disparities between sexual orientations is skewed towards information related to immunosuppression and infectious causes,” the authors said. “Thus, information is available on AIDS-related cancers, such as Kaposi’s sarcoma and lymphoma, and cancers with infectious causes (e.g., HPV), which are prevalent in populations infected with HIV, but is lacking for other cancer types. Most non-infectious cancers have yet to be studied in the context of sexual orientation.” They noted that only about 18 percent of cancers are caused by infection.

The authors called for a broader understanding of sexual orientation that defines sexual minorities as “socially and culturally distinct groups,” and for targeted research that identifies cancer disparities caused by sexual orientation, in line with work that has examined racial, ethnic or economic disparities. Missing from the research, they said, was information on MSM’s treatment decision-making, interactions with the health care system, and support available to cancer survivors.

“To bring knowledge about sexual minority men and cancer on par with other disparity groups, a framework of social justice, using social and behavioral research to systematically document inequities of sexual minority men and expose the causes for any inequities, will inform future efforts,” Boehmer said. “The crucial question, to be asked and answered, must be: how many lives can be improved and saved by giving sexual minority men the social and cultural conditions heterosexuals enjoy?”

The review was commissioned by Lancet Oncology because of an increasing awareness about LGBT (lesbian, gay, bisexual and transgender) issues, Boehmer said.

In the U.S., men have a 44 percent probability of being diagnosed with an invasive cancer over their lifetime, and cancer is the leading cause of death in men. U.S. estimates suggested that 822,300 men would be diagnosed with new invasive cancer, and 300,400 would die from cancer in 2011. Because of improvements in detection and treatment of many cancers, survival has improved, the authors noted.

Federal and other agencies spend billions of dollars on surveillance, cancer prevention efforts, and cancer research, acknowledging and working to eliminate cancer disparities related to gender, age, racial and ethnic origin, income, geographic location, and sexual orientation. But because of the absence of sexual orientation data in cancer registries, estimates that link cancer deaths to men’s sexual orientation are not available, which “hinders the elimination of cancer disparities associated with sexual orientation substantially,” the authors said.

Submitted by: Lisa Chedekel

chedekel@bu.edu

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