Self-reported lifetime prevalence of skin cancer was higher among gay and bisexual men, as well as among gender nonconforming people, researchers reported.
Gay and bisexual men had a 26% (adjusted odds ratio 1.26, 95% CI 1.05-1.51) and 48% (aOR 1.48, 95% CI 1.02-2.16) higher odds of skin cancer, respectively, versus heterosexual men, according to Sean Singer, of Brigham and Women’s Hospital in Boston, and colleagues in a brief report in JAMA Dermatology.
On the other hand, bisexual women had a 22% lower rate of skin cancer compared with heterosexual women (aOR 0.78, 95% CI 0.61-0.99). However, lesbian women saw no significant difference in the prevalence of skin cancer versus heterosexual women (aOR 0.97, 95% CI 0.73-1.27).
These patterns also extended beyond sexual orientation: Gender nonconforming individuals saw a significantly higher lifetime prevalence of skin cancer versus cisgender men (aOR 2.11, 95% CI 1.01-4.39), according to the same authors in a related JAMA Dermatology research letter.
However, neither transgender men nor women saw a significantly higher rate of skin cancer compared with cisgender men (aOR 1.12, 95% CI 0.66-1.92; aOR 1.19, 95% CI 0.73-1.93).
The study authors as well as an accompanying editorial said that indoor tanning is a likely explanation for the findings, citing other studies showing, for example, high concentrations of tanning salons in neighborhoods populated by gay men. The studies by Singer and colleagues had no data directly supporting the conjecture.
“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,” said study co-author Arash Mostaghimi, MD, MPA, MPH, also of Brigham and Women’s Hospital, in a statement.
Mostaghimi said such information is vital to public health, particularly in regards to allocation of health resources and training providers.
“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,” he stated.
Both cross-sectional studies drew upon data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys, spanning from 2014 to 2018. This included data on nearly 850,000 U.S. adults from 37 different states, which included roughly 350,000 heterosexual men, 7,500 gay men, 5,000 bisexual men, 470,000 heterosexual women, 5,400 lesbian women, and 9,500 bisexual women. History of skin cancer was self-reported.
In the accompanying editorial, Howa Yeung, MD, of Emory University School of Medicine in Atlanta, and colleagues praised the new findings on gender nonconforming individuals.
However, Yeung’s group pointed out that one shortcoming of these analyses was the lack of data on skin cancer subtypes and locations of skin cancers. Such data could help “generate hypotheses on the relative contributions of risk factors such as human papillomavirus infections or UV radiation exposure,” they said, adding that “High prevalence of human papillomavirus infections in gay and bisexual men may contribute to anal, oral, or genital squamous cell carcinomas.”
Another methodological limitation to the findings on gender minorities was that cisgender men were used as the only reference category for which transgender and gender nonconforming individuals were compared with, Yeung’s group said. They noted that future studies should also include cisgender women as a comparator group in order to “create a fuller understanding of biological, behavioral, and sociocultural factors that influence skin cancer epidemiology.”
Yeung and colleagues highlighted that the CDC has “allegedly threatened to remove the optional [sexual orientation and gender identity (SOGI)] data collection module from the BRFSS starting in 2019.”
“Although the CDC has since denied this plan, persistent skin cancer differences in [sexual and gender minority] subpopulations highlight the important roles that dermatologists, along with the rest of organized medicine, have in advocating for the continued collection of SOGI and dermatology-related disease data in federal health surveys,” they said.
Mostaghimi explaining that this “is the first time we’ve been able to look nationally at data about skin cancer rates among sexual minorities” and that eliminating sexual orientation and gender identity data collection would prevent researchers from studying this “vulnerable” population in regards to fluctuating skin cancer rates throughout time.
“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,” he stated.
Singer disclosed no relevant relationships with industry. Mostaghimi disclosed serving as associate editor of JAMA Dermatology. Co-authors disclosed support from the American Skin Association and relevant relationships with Pfizer, 3Derm, Lucid, Hims, Incyte, Eli Lilly, Aclaris Therapeutics, and Concert Pharmaceuticals.
Yeung and co-authors disclosed relevant relationships with Syneos Health, the National Center for Advancing Translational Sciences of the NIH, the Patient-Centered Outcomes Research Institute, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.