Study Identifies Differences in the Prevalence of Skin Cancer Across Sexual Orientations, Gender

February 23, 2020

In this study, the skin cancer rates were higher among gay and bisexual men, compared with heterosexual men, but lower among bisexual women than heterosexual women.

In the largest study of skin cancer rates among sexual minorities to date, published in JAMA Dermatology, researchers detailed differences in the prevalence of skin cancer across various sexual orientations and gender identities.1

Rates were higher among gay and bisexual men, compared with heterosexual men, but lower among bisexual women than heterosexual women. Given these findings, researchers indicated that future advocacy efforts should continue to focus on implementing the Behavior Risk Factor Surveillance System (BRFSS) sexual orientation and gender identity (SOGI) module to improve understanding of the health and well-being of sexual minority populations. 

“It’s absolutely critical that we ask about sexual orientation and gender identity in national health surveys; if we never ask the question, we’d never know that these differences exist,” corresponding author Arash Mostaghimi, MD, MPA, MPH, director of the Dermatology Inpatient Service at the Brigham, said in a press release.2 “This information helps inform the nation about how to allocate health resources and how to train providers and leaders. When we look at disparities, it may be uncomfortable, but we need to continue to ask these questions to see if we’re getting better or worse at addressing them. Historically, this kind of health variation was hidden, but we now recognize that it’s clinically meaningful.”

Using annual questionnaires which surveyed a total of 845,264 adults outside of the institutional population in the US from 2014 to 2018 by the BRFSS, researchers identified 351,468 heterosexual men, 7,516 gay men, 5,088 bisexual men, 466,355 heterosexual women, 5,392 lesbian women, and 9,445 bisexual women. The adjusted odds ratios (AORs) of skin cancer prevalence were found to be significantly higher among both gay (AOR, 1.26; 95% CI, 1.05-1.51; = 0.01) and bisexual men (AOR, 1.48; 95% CI, 1.02-2.16; = 0.04) compared to heterosexual men. Additionally, among bisexual women the AORs of skin cancer were significantly lower (AOR, 0.78; 95% CI, 0.61-0.99; = 0.04), however, they were not among gay or lesbian women (AOR, 0.97; 95% CI, 0.73-1.27; = 0.81) compared with the AORs of skin cancer among heterosexual women. 

Researchers also used the same data to identify 368,197 cisgender men, 492,345 cisgender women, 1,214 transgender men, 1,675 transgender women, and 766 gender non-conforming (GNC) individuals.3 The age-adjusted lifetime prevalence of skin cancer was 6.6% (95% CI, 6.5%-6.8%) among cisgender men, 6.4% (95% CI, 6.2%-6.5%) among cisgender women, 6.0% (95% CI, 4.1%- 8.8%) among transgender men, 5.8% (95% CI, 3.5%-9.5%) among transgender women, and 7.1% (95% CI: 4.1%-11.9%) among GNC individuals. Compared to cisgender men, the adjusted odds ratios of skin cancer history were significantly lower among cisgender women (0.85 [95% CI, 0.82- 0.88]), higher among GNC individuals (2.11 [95% CI, 1.01- 4.39]), but not significantly different among transgender men or transgender women.

Notably, the data analyzed was based on self-reported skin cancer diagnoses, which were not confirmed by a physician. The SOGI module was also only implemented in 37 states, therefore it may not be generalizable across all states. Moreover, the BRFSS survey did not collect information about risk factors for skin cancer, such as UV exposure, Fitzpatrick skin type, HIV status, etc. Previous studies have reported higher usage of indoor tanning beds among sexual minority men though.

In an editorial written by Howa Yeung, MD, MSc, Hayley Braun, MPH, and Michael Goodman, MD, MPH, from Emory University, suggested that now that differences have been identified, the next stop is to try and understand why these differences occur and how they can be assuaged.4

“Despite stated US national priorities, skin diseases have remained largely hidden from existing research on [sexual and gender minority; SGM] health,” the authors of the editorial wrote. “It is time for dermatologists to lend their expertise to help prioritize the dermatology-related health of SGM persons.”

However, the CDC allegedly considered discontinuing the implementation of the SOGI module in future BRFSS surveys starting in 2019, which would get rid of an important data source intended to understand the health of SGM populations.

“This is the first time we’ve been able to look nationally at data about skin cancer rates among sexual minorities. Eliminating SOGI would prevent us from better studying this vulnerable population over time to see how rates may change from year to year,” Mostaghimi said. “As a next step, we want to connect with sexual minority communities to help identify the cause of these differences in skin cancer rates. This is work that will need to be done thoughtfully but may help not just sexual minorities but everyone.”

References:

1. Singer S, Tkachenko E, Harman RI, Mostaghimi A. Association Between Sexual Orientation and Lifetime Prevalence of Skin Cancer in the United States. JAMA Dermatology. doi:10.1001/jamadermatol.2019.4196.

2. Gay and bisexual men have higher rate of skin cancer [news release]. Boston, MA. Published February 12, 2020. newswise.com/articles/gay-and-bisexual-men-have-higher-rate-of-skin-cancer?sc=mwhr&xy=10021790. Accessed February 17, 2020. 

3. Singer S, Tkachenko E, Harman RI, Mostaghimi A. Gender Identity and Lifetime Prevalence of Skin Cancer in the United States. JAMA Dermatology. doi:10.1001/jamadermatol.2019.4197.

4. Yeung H, Braun H, Goodman M. Sexual and Gender Minority Populations and Skin Cancer – New Data and Renewed Priorities. JAMA Dermatology. doi:10.1001/jamadermatol.2019.4174.