The National LGBT Cancer Action Plan: A White Paper of the 2014 National Summit on Cancer in the LGBT Communities

Abstract

Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality data among LGBT persons are lacking. This absence of cancer incidence data impedes research and policy development, LGBT communities' awareness and activation, and interventions to address cancer disparities. In this context, in 2014, a 2-day National Summit on Cancer in the LGBT Communities was convened by a planning committee for the purpose of accelerating progress in identifying and addressing the LGBT communities' concerns and needs in the spheres of cancer research, clinical cancer care, healthcare policy, and advocacy for cancer survivorship and LGBT health equity. Summit participants were 56 invited persons from the United States, United Kingdom, and Canada, representatives of diverse identities, experiences, and knowledge about LGBT communities and cancer. Participants shared lessons learned and identified gaps and remedies regarding LGBT cancer concerns across the cancer care continuum from prevention to survivorship. This white paper presents background on each of the Summit themes and 16 recommendations covering the following: sexual orientation and gender identity data collection in national and state health surveys and research on LGBT communities and cancer, the clinical care of LGBT persons, and the education and training of healthcare providers.

Current Best Practices for Sexual and Gender Minorities in Hospice and Palliative Care Settings

“…1,2 These inequities in turn influence perceptions, attitudes, and values of SGM individuals in accessing health care. 3 Several studies document high levels of mistrust of the health care system particularly among transgender, HIV-positive, and aging SGM populations. 4 According to the landmark Institute of Medicine report, 5 lack of education and research on the needs of SGMs, lack of cultural competency training for providers, and the absence of legal protections are key factors that contribute to the health care disparities experienced by SGMs.…”

Improved Rates of Cervical Cancer Screening Among Transmasculine Patients Through Self-Collected Swabs for High-Risk Human Papillomavirus DNA Testing

“…Given the importance of provider recommendation for motivating cisgender people to undergo cancer screening, the role of the relationship between provider and patients should be further investigated in TGNB samples. 26,[52][53][54] Conclusion Self-collected swab testing to screen for hr-HPV can increase rates of uptake and adherence to screening recommendations among an under-screened and underserved patient population. Self-collected swab testing could prove a key element to shrink screening disparities and progress toward more optimal care for TGNB individuals.…”

Awkward Choreographies from Cancer's Margins: Incommensurabilities of Biographical and Biomedical Knowledge in Sexual and/or Gender Minority Cancer Patients’ Treatment

“…Recent public health and policy research in the Global North affirms an urgent consensus that "vulnerable" populations are not well served by the current generation, translation, and mobilization of cancer knowledge, especially in light of related, longstanding health disparities (Burkhalter et al 2016;Polite et al 2017). North American population-based surveys among sexual and/or gender minority populations provide evidence of persistent breast and gynecologic cancer-related health disparities and knowledge divides (Cathcart-Rake 2018; Gibson et al 2017;Peitzmeier et al 2014;Sinding, Grassau and Barnoff 2006).…”

“…Cancer health research that has included to-date a focus on minority sexuality has tended overwhelmingly to include only "lesbians" as if constitutive of, or equivalent to, a homogenous, coherent and ahistorical whole while persistently overlooking the significance of dynamic gender differences amongst QLB breast and gynecologic cancer patients and trans patients (Burkhalter et al 2016;Fentiman 2017). The purposive and systematic attention to gender, as intersectionally linked with sexuality relative to experiences of accessing and mobilizing cancer health and treatment knowledge, constitutes one of the significant advances the Cancer's Margins project makes with respect to research on breast and gynecologic cancer classified under the rubric of "women's cancer" health and care (Crenshaw 1991;McCall 2005).…”