The LGBTQIA+ community faces numerous challenges in healthcare settings, especially when it comes to building relationships and trust with doctors.
Coming out is a lifelong process for many LGBTQIA+ people. Unfortunately, it is not uncommon to experience homophobia and transphobia from others, whether they disclose it openly or not. This kind of discrimination creates further disparity regarding specific health issues like cancer.
Cancer does not affect everyone equally. Cancer disparities are differences between different groups of people in terms of cancer incidence and cancer outcomes. Disparities are magnified for racially and ethnically marginalised people, the poor, those who identify as LGBTQIA+, young people, and older adults.
A cancer diagnosis can be even scarier when you are part of a minority or underrepresented group such as the LGBTQIA+ community. LGBTQIA+ populations are disproportionately affected by at least seven types of cancer, including anal cancer, breast cancer, cervical cancer, colorectal cancer, lung cancer, prostate cancer, and uterine cancer.
Historically, racial, ethnic, and LGBTQIA+ populations have experienced discrimination and exclusion that has prevented them from achieving social and economic well-being. In addition, because of poverty, lack of education, and unstable employment opportunities, health security-specific issues, like uninsured patients and distrust of doctors, are made worse.
Discrimination specifically within the medical field could have an impact on how LGBTQIA+ people approach the profession.
Some studies show higher smoking and alcohol consumption rates among lesbian, gay, and bisexual youths than among heterosexual youths.
Barriers to Cancer Screening Activity
Transgender people, bisexual people, and gender-nonconforming people have a lower likelihood of presenting for screening for breast, cervical, and colon cancers.1
LGBTQIA+ populations and providers lacked knowledge about LGBTQ-specific cancer screening guidelines.2 For example, any person engaged in sexual contact with someone of the same sex might not be aware of HPV’s ability to be transmitted through anal sex or female-to-female contact and squamous cell carcinoma.3 In addition, women who disclosed their sexual orientation to providers were less likely to know about HPV spreading through female-to-female contact.
Lesbians are less likely than heterosexual women to be screened for cervical cancer with Pap tests or HPV tests. Also, they are less likely to initiate and complete the HPV vaccine series that would reduce their risk of developing cervical cancer.4
LGBTQIA+ members may wonder whether they should have a mammogram with breast implants. They absolutely can get mammograms with breast implants. During the mammogram, the technician will make sure as much breast tissue as possible is visible. Special techniques are used to move the implant out of the way and pull the breast tissue forward to be seen in an image (implant displacement techniques). Several additional views may be needed to examine the entire breast.
The breasts are carefully compressed to avoid rupturing the implants. As a result, people with breast implants are diagnosed with breast cancer at a similar stage and with a similar prognosis to those without breast implants.
A mammogram can still be done even with very little chest tissue. Likewise, an ultrasound or an MRI can be done where the chest is too flat.
A screening mammogram is recommended every two years for people aged 50 to 69 who have taken hormones (such as estrogen) for more than five years.5 People under 50 should become aware of how their breasts look and feel and note any changes.
EQUITY
Health equity can only be achieved when each person has the opportunity to reach their full health potential, and no one is prevented from attaining it because of social disadvantages.
Barriers from discrimination past, present, and future.
Discrimination has a traumatic impact on the body that may also have implications for health care. The prevalence of violence against transgender people, especially in South Africa, is compounded by the high rate of sexual and physical abuse transgender people face while undergoing medical care, which increases healthcare costs in both the short- and long term.
The LGBTQIA+ community faces significant barriers to receiving health care because of discrimination in the system. As a result, increased risks are coupled with lower screening rates for this population, resulting in cancers being detected late when they are more difficult to treat.
What can we do to be an ally?6
Both patients and professionals should know how their sexual orientation and gender identity are as this may affect the cancer experience. We need to understand that homophobia is the unwillingness to accept or like people based on their sexual orientation.
Remember that love is love!
References:
https://treatingcancer.co.za/download/sahcs-gahc-guidelines/?wpdmdl=1054&masterkey=61e16f805d2bf
Dr. Prinitha Pillay is a Specialist Radiation Oncologist in Gauteng. She is practicing in Johannesburg, offering radiation cancer treatments, comprehensive palliative care and psycho-social support. She offers a variety of treatments including Breast Cancer Treatment, Gynaecological , Gastrointestinal, Lung Cancer Treatment, Paediatric, Head and Neck, Prostate Cancer Treatment, Brain Cancer Treatment, Dermatological and Musculoskeletal Cancer Treatment.