Empowering LGBTQIA+ Health: Cancer Knowledge Is Power. Learn The Risks

Endometrial cancer is most often seen during the post-menopause stage of life.

Possible signs and symptoms include:

• Bleeding between periods or after menopause: more than 90% of people diagnosed with endometrial cancer report abnormal vaginal bleeding
• Painful urination
• Pain during penetrative sex
• Pelvic pain
• Lumps or mass in the pelvic area

Several factors increase the risk of developing endometrial cancer. They include:

• Being a Black woman (more likely to have more aggressive forms of cancer and the racial group most likely to die from it)
• Having polycystic ovary syndrome (PCOS)
• Being overweight/obese
• Having diabetes
• Family history of Lynch Syndrome (genetic mutation that increases the risk of colon cancer, breast cancer, or ovarian cancer)
• Personal history of breast or ovarian cancers
• Using estrogen-only hormone therapy if your uterus is still intact
• Starting menstrual cycles at an age younger than 12
• Entering menopause later than the typical age (51 years old in the U.S. but it may be earlier in women of color)
• History of taking tamoxifen
• Prior pelvic radiation
• A high-fat diet
• Being infertile or never having been pregnant

There are also factors that lower the risk of endometrial cancer, like:

• hormonal birth control
• the use of an IUD
• being physically active
• pregnancy

Endometrial risk for the LGBTQIA+ community

Members of the LGBTQIA+ community are at greater risk of several of the conditions which increase the risk of endometrial cancer. Those include being overweight/obese, having type 2 diabetes, and having breast and ovarian cancer.

Also, the factors contributing to a lower risk of endometrial cancer are less likely. An LGBTQIA+ person has a lower likelihood of using birth control, and lesbians are 50% less likely to become pregnant/have a baby. Both birth control and pregnancy can lower the risk of endometrial cancer.

Additional disparities exist among Black women and other women of color, including those who are LGBTQIA+ community members. For example:

Diagnosis and Care

• Being Black or Hispanic increases the risk of being diagnosed at a more advanced stage of cancer.
• Black women are less likely to undergo diagnostic procedures that align with medical guidelines.
• Black, Hispanic, and Native American/Alaska Native women are less likely to receive treatment that adheres to clinical guidelines.

Treatment

• Black and Hispanic women are less likely to receive lymph node dissection and sampling, definitive surgical treatment, chemotherapy, and surgery, especially minimally-invasive surgery (laparoscopic surgery).
• What’s more, these findings apply even though Black women are more likely to receive care from GYN oncologists, high-volume uterine cancer surgeons, and at National Cancer Institute Centers!

Another possible reason why gynecological cancer rates are higher in LGBTQIA+ populations? Across obstetrics and gynecology residency programs, standardized training is lacking for LGBTQIA+ populations.

We want to give you the tools you need to find inclusive partners. You can find a list of cancer providers at the end of this article and links to other lists provided in the LGBTQIA+ series of articles.

Anal cancer

While cancer of the anus is rare in the general population (2 of 100,000 people per year), the incidence is much higher for people assigned male at birth having sex with men (40-80 of 100,000 people).

It’s important to note that while it’s most associated with gay men, people assigned female at birth can also develop anal cancer.

It’s often caused by the same HPV strains that cause cervical cancer. It also develops slowly like cervical cancer.

Possible signs and symptoms include:

• Mucus or bleeding from the bottom
• Itching and pain around the anus
• Lumps in and around the anus
• Bowel incontinence
• Looser stools

A push is being made to make an anal pap test (a moistened cotton swab that is used to collect cells from the anal canal) more routine, especially for high-risk populations.

Colorectal cancer

Sometimes called colon cancer, colorectal cancer (CRC) is cancer of the colon or rectum (the passage that connects the colon to the anus). Because colon cancer most often begins with abnormal growths called polyps, early screening is helpful to remove the polyps before they become cancerous.

Disturbingly, the incidence of colon cancer in those who are younger than 50 has been on the rise and now accounts for 10% of new diagnoses of colon cancer and 25% of new rectal cancers. This trend has been noted more significantly in males than in females.

Due to risk factors like obesity and smoking, the LGBTQIA+ community is disproportionately impacted by CRC.

Though symptoms often don’t appear in early stages, they can include:

• Rectal bleeding or bloody stool
• Abdominal pain or discomfort
• A feeling of incomplete bowel movements
• Fatigue
• Unintentional weight loss
• Change in bowel habits (frequency, size, shape)
• Diarrhea and/or constipation

Screening makes a difference! The 5-year survival rate for those diagnosed in Stage I is 91%.

Current guidelines recommend starting screening at age 45 unless you have a risk factor that increases the chances of developing CRC.

Although colonoscopy remains the “gold standard” for CRC screening, other options exist, including stool testing for blood and/or DNA changes.

Seek guidance from a healthcare professional to determine the age and best screening test for your particular situation and take advantage of the opportunity to save your life.

Prostate cancer

While women+ do not have a prostate, this cancer is of concern to transgender women. Prostate cancer is the most common type of cancer in males+.

Being African American and/or having a family history of prostate cancer increases your risk of developing it.

For transgender women, your risk may actually be lower if you’re on a hormone regimen.

Thus far, it appears that bisexual males are not at an increased risk of prostate cancer unless they’ve had 20 or more sexual partners.

Overall, though, research is lacking in the LGTBQIA+ community compared to the cisgender, heterosexual population. Studies are even more limited for specific cancers.

It’s of concern because most people with prostate cancer do not have symptoms, and there is some controversy regarding screening because even though men and trans women may develop prostate cancer, it may not be the ultimate cause of a person’s death.

Let’s talk about symptoms that can indicate prostate cancer. But understand that sometimes there are no symptoms.

• Problems with urination – difficulty starting, weak flow, pain or burning, frequent urination, especially at night, problems with emptying the bladder
• Blood in the urine
• Blood in semen, painful ejaculation
• Persistent pain in the back, hips, or pelvis

For those at high risk, screening can help you catch things early. If prostate cancer is caught in Stage 1, the 5-year survival rate is almost 100%.

The major ways to check for potential cancer are:

1. A PSA (prostate-specific antigen) blood test.
2. A rectal exam, during which your healthcare practitioner may feel nodules or a hard consistency.

Lung cancer

More LGBTQIA+ people use tobacco than their heterosexual counterparts, thereby increasing their risk for lung cancer. That said, it can also occur in those who haven’t smoked.

Beginning in the lungs, lung cancer is the world’s leading cause of cancer death—and the number one cause of preventable disease and death.

In most cases, lung cancer does not cause symptoms in the early stages. But when it does, some signs and symptoms are:

• An unrelenting cough
• Chest pain
• Coughing up blood

In later stages, there may be signs the cancer has spread like headaches, bone pain, a hoarse and/or scratchy voice, and unintentional weight loss.

Smoking is the most common cause of lung cancer. Speak with your healthcare practitioner to find out if you should go for lung cancer screening with a low-dose CT scan. See “Saved By the Scan,” a resource by the American Lung Association to help high-risk individuals get screened.