Associations Between Sexual Orientation and Overall and Site-Specific Diagnosis of Cancer: Evidence From Two National Patient Surveys in England

Abstract

PurposeTo address gaps in evidence on the risk of cancer in people from sexual minorities.Patients and MethodsWe used data from 796,594 population-based English General Practice Patient Survey responders to explore the prevalence of self-reported diagnoses of cancer in the last 5 years among sexual minorities compared with heterosexual women and men. We analyzed data from 249,010 hospital-based English Cancer Patient Experience Survey responders with sexual orientation as a binary outcome, and International Classification of Diseases, Tenth, Revision, diagnosis as covariate—38 different common and rarer cancers, with breast and prostate cancer as baseline categories for women and men, respectively—to examine whether people from sexual minorities are over- or under-represented among different cancer sites. For both analyses, we used logistic regression, stratified by sex and adjusted for age.ResultsA diagnosis of cancer in the past 5 years was more commonly reported by male General Practice Patient Survey responders who endorsed gay or bisexual orientation compared with heterosexual men (odds ratio [OR], 1.31; 95% CI, 1.15 to 1.49; P < .001) without evidence of a difference between lesbian or bisexual compared with heterosexual women (OR, 1.14; 95% CI, 0.94 to 1.37; P = .19). For most common and rarer cancer sites (30 of 33 in women, 28 of 32 in men), the odds of specific cancer site diagnosis among Cancer Patient Experience Survey respondents seemed to be independent of sexual orientation; however, there were notable differences in infection-related (HIV and human papillomavirus [HPV]) cancers. Gay or bisexual men were over-represented among men with Kaposi’s sarcoma (OR, 48.2; 95% CI, 22.0 to 105.6), anal (OR, 15.5; 95% CI, 11.0 to 21.9), and penile cancer (OR, 1.8; 95% CI, 0.9 to 3.7). Lesbian or bisexual women were over-represented among women with oropharyngeal cancer (OR, 3.2; 95% CI, 1.7 to 6.0).ConclusionLarge-scale evidence indicates that the distribution of cancer sites does not vary substantially by sexual orientation, with the exception of some HPV- and HIV-associated cancers. These findings highlight the importance of HPV vaccination in heterosexual and sexual minority populations.

Health and Well-being Among Sexual Minority People

“…A UK study of cancer showed higher rates of cancer diagnosis in the last 5 years in gay and bisexual male general practitioner (GP) patients compared to heterosexual men, but no difference in cancer diagnosis rates overall in lesbian and bisexual women compared to heterosexual women (Saunders et al 2017). The higher rates of cancer in gay and bisexual men were likely due to higher HIV/AIDS infection rates.…”

“…Gay or bisexual men were overrepresented among men with Kaposi's sarcoma and anal and penile cancer. (Saunders et al 2017). Lesbian or bisexual women were overrepresented among women with oropharyngeal cancer (Saunders et al 2017).…”

“…(Saunders et al 2017). Lesbian or bisexual women were overrepresented among women with oropharyngeal cancer (Saunders et al 2017). From a systematic review, it was found that bisexual women may have a higher rate of cervical cancer, and lesbians a lower rate of uterine cancer compared to heterosexual women (Robinson et al 2016), but UK evidence is inconclusive around reproductive system malignancy as Saunders et al 2017 did not find similar rates to those in Robinson et al (2016).…”

Disparities in lymphoma on the basis of race, gender, HIV status, and sexual orientation

“…Data regarding the management of lymphoma in HIV negative sexual minority patients is significantly lacking and is often limited to case reports. As a result of increased association of HIV and lifestyle factors such as smoking and alcohol use noted in various studies, most of what is known or extrapolated to the LGBTI community and malignancy is based older studies of HIV-associated malignancies (36,37). Frisch et al evaluated the association of sexual orientation and malignancy and determined an increased incidence of NHL, as well as anal cancer and Kaposi sarcoma among homosexual men (38).…”

Human papillomavirus genome variants and head and neck cancers: a perspective

“…This sex-ratio is mainly explained by the higher HPV transmission for vaginal-oral rather than penile-oral sexual intercourse. Saunders et al recently showed that risk of OPC was higher in women having sex with women compared with heterosexual women, although this association was not found in men having sex with men, in agreement with a higher risk of HPV transmission by vaginal- vs. penile-oral sex [ 60 ]. The lower risk of HPV-induced OPC observed in women could also be partly explained by the higher immunity acquired by women due to more frequent exposure to HPV in the genital mucosa and by a still little understood role of the combined exposure to HPV and tobacco that is generally stronger in men than women [ 59 ].…”