Recognizing and Reducing Barriers to Cancer Care for LGBTQ+ People

Written by: Beth Dougherty

More than seven percent of adults in the US identify as LGBTQ+, according to a 2022 Gallup poll. That’s a record high and a doubling of the percentage measured a decade earlier.  

People in the LGBTQ+ community can face many societal barriers, including to healthcare. According to multiple surveys, about one in three LGBTQ+ people have had negative experiences with healthcare. Access to gender-affirming care is increasingly at risk in the United States and beyond, and LGBTQ+ people also live with health disparities, including higher rates of cancer and diagnosis of the cancer at more advanced stages. 

This data has been a wake-up call for many healthcare institutions, including Dana-Farber. Reducing the barriers to cancer care for LGBTQ+ people will require the efforts not just of institutions but also of providers, staff members at all levels, and patients. 

“We as healthcare providers need to provide culturally competent care for this population,” says Ole-Petter Hamnvik, MBBCh, BAO, MMSc, an endocrinologist in Dana-Farber’s Adult Survivorship Clinic. “LGBTQ+ people are at the same or higher risk as non-LGBTQ+ people for many cancers, so seeking care is also very important.”  

What do I need to know about cancer screening if I am LGBTQ+? 

Gender-affirming care that involves medical interventions such as hormone therapy or surgery does not increase risk of cancer beyond that of non-LGBTQ+ people. The medical community supports gender-affirming care, which in addition to medical interventions can also include legal, social, and mental health services, because evidence shows it improves mental health outcomes among LGTBQ+ people.  

When it comes to screening for cancer, however, LGBTQ+ people have lower rates of cancer screening despite higher rates of some cancer risk factors. Delayed or skipped screening can increase the risk that cancer will be missed or discovered at a later stage. 

“It’s not that LGBTQ+ people are less interested in their health,” says Hamnvik. “But screening for certain forms of cancer can be emotionally painful, especially if the person doesn’t identify with the anatomy being examined. This underscores the need for physicians to be knowledgeable and inclusive.” 

Another factor that could contribute to lower rates of screening might be misconceptions about LGBTQ+ cancer risks. Several screening recommendations differ based on sexual practices, gender-affirmation steps, and anatomy, so it’s important to know the facts: 

  • Anyone with a cervix could develop cervical cancer, including lesbian women and transgender men, and should be screened for cervical cancer between the ages of 25 and 65 (according to American Cancer Society (ACS) guidelines). 
  • People who initiate estrogen as part of gender-affirming care might develop breast tissue. Individuals who are older than 40-45 years (also according to ACS guidelines) should be screened for breast cancer if they have taken estrogen for more than 5 years. 
  • People who have undergone breast reduction surgery might still develop breast cancer, so any mass or symptom should be evaluated.  
  • Transgender women, nonbinary people, and other non-cis men may have a prostate. Determining how and when to screen for prostate cancer can vary depending on gender-affirming therapy. 
  • Individuals living with HIV should consider screening for anal cancer, though there aren’t any agreed-upon guidelines. 

Do not ignore signs and symptoms of cancer, such as breast lumps, vaginal discharge, bleeding, or bloating because you think a certain type of cancer won’t affect you.  

“Get screened,” says Hamnvik. “Don’t stay away from us, especially when it comes to cancer.” 

How do I find culturally competent care? 

One barrier LGBTQ+ patients face when seeking care is finding a nearby provider that is culturally competent and knowledgeable about LGBTQ+ health concerns. To increase the chances of a positive healthcare experience, LGBTQ+ patients and their families can seek out care providers that will be knowledgeable and supportive of LGBTQ+ health concerns.  

Search tools include: 

Dana-Farber also provides resources and support services for LGBTQ+ patients

Even with such commitments and policies, there’s still a chance you might encounter a problem, says Hamnvik. But institutions like Dana-Farber that are committed to LGBTQ+ support are also focused on continued improvement and training.  

“If you have the strength to do so, let the institution know what happened,” says Hamnvik. “We are listening. Your voice can inspire positive change.” 

If you are a Dana-Farber patient and have a concern, please reach out to the Patient/Family Relations Program

The medical community supports gender-affirming care, which in addition to medical interventions can also include legal, social, and mental health services, because evidence shows it improves mental health outcomes among LGTBQ+ people.

What information do I need to share with my doctor? 

People might feel that their gender, sexuality, and anatomy are private, particularly when they are being seen for a health issue that is not related to sexuality or gender. A miscommunication or lack of communication might not affect care for something like a sprained ankle, but when it comes to cancer, gender, sexuality, and anatomy do matter. 

Here are a few things patients can do: 

  • Choose clinicians that you trust to have cultural competency by using provider directories and finding LGBTQ+-interested providers in hospital directories. 
  • Be open and out with your trusted clinician and enter complete information (if possible) in your medical record. 
  • Request specific accommodations if needed. 
  • Expect to be treated with dignity and respect, make corrections to small slights in the moment, and report larger mistakes or discrimination to the institution as soon as you can. 

Hamnvik stresses that it remains a two-way street: “It’s important for the doctors to be educated and trained to navigate these conversations,” says Hamnvik. “But patients can also help by having clear boundaries while also being open to hearing how shared information will improve their care.” 


About the Medical Reviewer

Ole-Petter R. Hamnvik, MBBCh, BAO, MMScOle-Petter R. Hamnvik, MB BCh BAO, MMSc is an assistant professor of medicine at Harvard Medical School and a practicing endocrinologist at Brigham and Women’s Hospital and at Dana-Farber Cancer Institute with a specific interest in endocrine disorders in cancer patients. He is also a clinician-educator, having completed the Rabkin Fellowship in Medical Education and the Harvard Macy Program for Educators in Health Professions. He now serves as the fellowship program director for the Training Program in Endocrinology, Diabetes and Hypertension at BWH. He is the education editor for NEJM Group where he provides editorial oversight of their educational portfolio, including Resident360 and Knowledge+, and provides guidance on the development of new educational initiatives.