Oral and Anal Cancer

Coming Out to Your Doctor May Be First Important Step in Reducing

Barriers to Diagnosis, Treatment of Oral, Anal Cancer Among LGBT Individuals

All people can increase the possibility of better health outcomes – particularly those at special risk for anal or oral cancer – by taking that first step of choosing a health care provider who is open to all of your health concerns, including sexual health.

Having a doctor who understands your specific health care needs and who asks the right questions about all of your health behaviors, including sexual health, can go a long way toward making an early diagnosis or developing an effective treatment plan for cancer.  Even though the most common types of cancer among men in the United States are prostate, lung, colon, and skin cancers, according to the American Cancer Society, gay, bisexual and transgender individuals also are at certain risk for anal and oral cancer because of sex with other men, even though both can impact men who don’t engage in same-sex relations. Early detection and diagnosis are important in all forms of cancer before the cancer spreads, making it easier to treat. But barriers to care impacting GBT individuals often stand in the way of early diagnosis or early treatment. Let’s look at some specific barriers to cancer diagnosis and treatment among GBT individuals, and how male- to-male sex can impact the incidence of anal and oral cancers.

At the core of anal and oral cancer is the human papilloma virus, or HPV, the most common sexually transmitted virus and infection in the United States, according to the Centers for Disease Control. In fact, every day in the United States, about 12,000 people 15-24 are infected with HPV. The majority of them, however, will clear the virus naturally and never know that they were exposed or had it, the Oral Cancer Foundation says. According to the CDC, HPV is a group of more than 150 related viruses, and each HPV in the group is given a number – its HPV type. HPV gets its name from the warts – or papillomas – some HPV types cause. Some HPV types lead to cancer – including anal and oral cancer, and cervical cancer in women. More than 40 HPV types can infect the genital areas of males and females, and vaccines can prevent infection with the most common types, the CDC says.

HPV is transmitted through having anal or oral sex or other intimate skin-to-skin contact with someone who has the virus. It is most commonly spread during vaginal or anal sex, according to the CDC. Anyone who is sexually active can get HPV, and most all sexually active men and women get it at some point in their lives, the CDC says. HPV can be transmitted even when an infected person has no signs or symptoms, and symptoms can develop years after sexual contact with someone. That makes it harder to know when a person first became infected.

HPV risk is increased by having anal sex and having many sexual partners. Another risk factor is a weak immune system because of HIV infection or other factors, which also is often a significant concern for LGBT individuals. Some HPV types transmitted via oral sex can lead to oral cancer. In fact, HPV is the leading cause of oropharyngeal cancers (the back of the mouth and part of the throat). White, non-smoking males 35-55 are most at risk at a 4-1 ratio over females, according to the Oral Cancer Foundation. Statistically, research shows that straight men are slightly more likely to develop oral cancer than gay men, primarily because of HPV in vaginal fluids transmitted through cunnilingus. The reverse is true for anal cancer, with men who have sex with men having a higher incidence of anal HPV.  Please note that women who have sex with women are also exposed to anal HPV.

For LGBT individuals, getting to an early diagnosis and even on an early treatment plan can be complicated by a number of factors:

  • Fear about discrimination, which often results in LGBT patients not telling their doctors about their sexual orientation. In these situations, not coming out to your doctor about sexual orientation gives the health provider an incomplete picture of your total health, including your sexual health. Because of that, the doctor may not ask the right questions about sexual activity which may prevent the provider from making an early diagnosis or developing an early plan of attack for treating cancer.
  • Negative experiences with health care professionals, which leads some LGBT individuals to delay or avoid medical care. Because we may have had a health care provider react in a negative way about information that we’ve shared, we may be less apt to take advantage of routine care, including early detection tests. Again, because the health care provider is working with less information and an incomplete picture, an accurate cancer diagnosis may be delayed, making treatment more difficult.
  • Health care costs may prevent you from doing the right thing in visiting your doctor. In fact, some health insurance policies do not cover unmarried partners, adding another barrier for LGBT people. For some in our community, income issues or ethnicity, education, geographic isolation, immigration status, knowledge and cultural beliefs all may be barriers that impact early diagnosis of anal or oral cancer, or overall quality of care.

Eliminating issues of social stigma and shame are important as we celebrate self-affirmation within the LGBT community. Because of that, now would be an excellent time to eliminate any potential barriers in the exchange of information between you and your health provider, and following are some specific recommendations to help you do that – as well as prevent the onset of oral or anal cancer:

  • Find specialized doctors who are LGBT friendly and who understand your specific health care needs. A GBT friendly health care provider allows for comfortable patient-doctor interactions, facilitating a free exchange of information about all elements of a patient’s health history, including sexual activity. Some LGBT community groups and media are likely to list health care providers friendly to the needs of community. Asking your friends and others in the community also is a resource for finding LGBT friendly health care providers.
  • Have open conversations about medical history – including relevant details about your sexual activity – with LGBT-friendly providers. Shielding relevant details about your sexual history or details that feel embarrassing can serve as a barrier to helping your physician help you early diagnose or determine an early treatment plan for anal or oral cancer, or other health issues. Sixty percent of black gay men, for example, reported that they had not disclosed their sexual orientation to their doctor, according to Project Healthy Living, a group of African-American gay and bisexual men in Washington, D.C. Project Healthy Living encourages open and honest communication with health care providers, as LGBT individuals often have unique medical concerns, including issues such as depression, anxiety, substance abuse or HIV/AIDS.
  • Reduce the number of sex partners, use condoms and stop smoking to lower risk of the transmission of HPV. Unfortunately, some research shows that gay men use tobacco at a higher rate than their heterosexual counterparts, according to a Healthy People 2020 health fact sheet. Additionally, condoms do not always protect against HPV, because HPV can be passed by skin-to-skin contact with any area of the body, including areas that are not covered by a condom. Even so, health care providers recommend use of condoms to protect against HIV and other diseases passed through body fluids.
  • Report any rectal symptoms to a health care professional A rectal exam will identify some cases of anal cancer early. Some experts recommend screening with an anal Pap test – similar to the test done for women – if you are at high risk for anal cancer. LGBT individuals should consult with their health care provider to determine whether to participate such screening. The good news is, treatments for HPV do exist, even though the recurrence of papilloma warts are common, and the rate of infection between partners can be high.

Some other recommendations from the American Cancer Society in reducing cancer generally include:

  • Eliminate tobacco.
  • Pay attention to staying at a healthy weight.
  • Get on a regular exercise program to get moving and manage weight.
  • Follow a healthy nutrition program with plenty of fruits and vegetables.
  • Reduce your alcohol consumption to no more than two drinks a day.
  • Beware of the effects of the sun on your skin and protect it through sunscreen and decreased exposure.
  • Begin to better know yourself, your family history, and your risks – and be courageous in sharing that information with GBT-friendly health providers.
  • Be proactive and get your regular check-ups and cancer screening tests.