Skin Cancer Prevalence and Sexual Minority Disparities
Skin cancer is the most common cancer in the United States, with approximately 5 million Americans treated annually for $8.1 billion. Recently, studies have been carried out from 2014 to 2024 that have revealed the underlying discrimination regarding the lifetime prevalence of skin cancer across sexual minority groups. While skin cancer is perceived as a condition that dominantly affects fair-skinned people due to their lack of protective pigment called “melanin,” the reality is more complex as the intersections of race, ethnicity, and sexual orientation need to be taken into consideration.
Study Methodology: BRFSS Data Analysis
For this particular study, data from a national US telephone survey known as the “Behavior Risk Factor Surveillance System (BRFSS)” was analyzed. In 2014, BRFSS had publicized its “sexual orientation and gender identity (SOGI)” module that gathered sociodemographic and health-related data from non-institutionalized US adults. The analysis included respondents who were stratified as self-reported gays, lesbians, bisexuals, and heterosexuals. The survey was also directly standardized by age to enhance the accuracy of the inspection and proper representation of the masses.
Skin Cancer Prevalence by Sexual Orientation
Amongst all the 845,264 individuals that were included, it was found that the prevalence of skin cancer diagnosis for lesbians was 5.9%, 4.7% among bisexual women. The disparity was more pronounced when it came to men as it was 8.1% for gay men, 8.4% among bisexual men, and lastly 6.7% for heterosexual men.
Behavioral Factors and UV Exposure Among Gay and Bisexual Men
Thus, this study has conclusively shown that the increased prevalence of lifetime diagnosis of skin cancer has exponentially persisted for gay and bisexual men, which reflects high UV exposures within the populations, primarily due to behavioral differences such as increased engagement in indoor tanning due to appearance concerns and societal pressure.
Tanning Salons and Male-Male Partnered Households
Dr. Eleni Linos, a professor of dermatology and epidemiology at Stanford University, analyzed data from over 4,000 census tracts across ten major U.S. cities to highlight the concerning increase in the concentration of tanning salons near male-male partnered households. According to the research, 10% of households composed of male couples are twice as likely to have tanning salons compared to neighborhoods with fewer such households.
UV Radiation: A Significant Carcinogen
Recently, UV radiation has been upgraded to the highest cancer risk category, the most common carcinogen, joining arsenic and mustard gas. There are primarily two types of UV radiation: UVA, which penetrates the skin deeply, and UVB, which affects the epidermal layer of skin. Both UV rays damage the DNA in skin cells, leading to the formation of cyclobutane pyrimidine dimers (CPDs), which are DNA lesions that can result in mutations in oncogenes and tumor suppressor genes that initiate the process of carcinogenesis. The immune system may also be suppressed due to UV exposure, leading to the increased survival rate of mutated cells. Tanning beds provide a concentrated dose of UVA, which has been shown to increase the risk of melanoma by 75% for those who begin tanning before the age of 35. On this basis, the World Health Organization has classified tanning beds as a group 1 carcinogen.
Barriers to Preventive Healthcare Services for Sexual Minorities
Additionally, there is limited access to preventive healthcare services among sexual minorities, even more so if they also belong to an ethnic/racial minority as they are faced with compounded discrimination and stigma, which dampens their opportunity for cancer screening. According to studies regarding Cancer Epidemiology, sexual minorities, particularly gays and bisexual men, are less likely to receive regular full-body skin examinations and dermascopy, which increase the risk of common skin cancers such as melanoma and squamous cell carcinoma.
Public Health Intervention: Promoting Sunless Tanning
Despite these troubling findings, efforts have been made to encourage sunless tanning. For example, on the public beaches of Massachusetts, an intervention was held that included motivational messages to advocate the use of sunless tanning as an alternative to UV tanning, instructions for the proper use of sunless tanning products, a free trial of sunless tanning products, skin cancer education, and UV imaging to heighten participants' awareness of the sun damage on their skin and to serve as encouragement for sunless tanning. This project was also reward-oriented as participants received a $10 gift card for completing questionnaires at 2 months and $20 at 1 year. In addition, participants were entered into a lottery to win a $500 gift card for completing each follow-up. By 2 months, there was a 33% decrease in sunbathing and a 73% decrease in sunburns.
Addressing Inequities in Healthcare Services for Sexual Minorities
Similarly, to address inequities in healthcare services, healthcare providers need to undergo cultural competency training focused on LGBTQ+ issues, fostering a more inclusive environment. This training will help providers understand the unique healthcare needs of sexual minority groups, ultimately improving patient interactions and outcomes. Additionally, implementing culturally sensitive health campaigns specifically targeting these communities is vital. These campaigns should raise awareness about health risks, preventive measures, and the importance of regular screenings. Furthermore, establishing financially supported cancer screening programs in collaboration with LGBTQ+ organizations and community leaders will ensure that these services meet the specific needs of the community. By integrating these strategies, we can significantly reduce the probability of skin cancer prevalence in minorities.
Conclusion: Addressing Skin Cancer Disparities in Sexual Minorities
In conclusion, recent studies have shown that skin cancer does indeed discriminate, with male sexual orientation playing a significant role in lifetime prevalence rates. As the conversation surrounding health equity continues to evolve, both the medical community and public health officials must recognize and address the unique challenges faced by sexual minorities, particularly those from marginalized racial and ethnic backgrounds. By doing so, we can work towards inclusive healthcare practices that ensure all individuals receive the necessary attention and care to attenuate the risk of skin cancer.
Written By: Tisa Tamala
Edited By: Tarleen Chhatwal
https://jamanetwork.com/journals/jamadermatology/fullarticle/2760337 https://jamanetwork.com/journals/jamadermatology/fullarticle/2673329?resultClick=1
https://www.researchgate.net/publication/339217408_Association_Between_Sexual_Orient ation_and_Lifetime_Prevalence_of_Skin_Cancer_in_the_United_States
https://www.science20.com/news_staff/gay_bisexual_men_get_more_skin_cancer-245228 https://jamanetwork.com/journals/jamadermatology/article-abstract/2673329
Comments