On March 19, the RI American Cancer Society Cancer Action Network, commonly abbreviated as ACS CAN, held a virtual event titled “Beyond the Rainbow: Addressing Cancer Disparities in LGBTQIA+ Communities”. The event, which was held over Zoom, discussed the significant effect of cancer on LGBTQ+ people and achievable policy solutions.
Moderated by Bob Gordon, a lifelong ACS CAN volunteer from California, the discourse attracted over 100 guests. Its aim was to emphasize “the vital role of vibrant and diverse voices in raising awareness about the challenges facing LGBTQ+ communities” as a part of the 22nd National LGBTQ+ Health Awareness Week, according to Gordon.
One-third of LGBTQ+ individuals report that their health care provider did not mention cancer screening to them, according to Gordon. “Many of us face obstacles to treatment, such as fear of discrimination from providers.”
The participants for the event included Gladys Arias, the deputy for Health Equity Policy Analysis and Congressional Support at ACS CAN, and Professor of Medicine and Surgery Don Dizon, the chairman of Women’s Cancers at Lifespan Cancer Institute, Austin Morreale, a two-time cancer survivor and community engagement consultant with three New Jersey nonprofits.
Dizon stressed during the discussion how crucial it is to foster confidence between healthcare providers and LGBTQ+ patients, particularly since many sexual and gender minority people have had bad experiences with the system.
“In the doctor-patient relationship, there’s a lot of discomfort about talking to people about their sexual orientation or gender identity,” Dizon said.
Assumptions about sexual and gender minority frequently prevent them from receiving proper treatment or early cancer detection, raising the risk of death, such as the notion that gay people are not at risk for HPV.
The problem is pervasive, Dizon said, citing a study that found that nearly half of all physician respondents exhibited some obvious discrimination against sexual and gender minorities, while over 80% exhibited inherent biases.
As a cancer survivor, Morreale acknowledged that these biases had directly impacted him, delaying his fight with ovarian cancer by preventing early screening for him.
“I was given a script for a pelvic ultrasound by the health center I’d been going to. But, when I went in to get the ultrasound, I thought it was advisable to mention … that I was gay,” Morreale said.
“At that moment, the technician said, ‘If you’ve only had homosexual sex, then I cannot do this.’ If she had administered the ultrasound, I fully believe the cancer would have been caught much, much earlier,” Morreale said.
Morreale eventually recovered, but his cancer wasn’t discovered until it reached Stage IIIC, where it had already spread to his pelvic lymph nodes.
The importance of training and knowledge in addressing these health disparities was also highlighted by Morreale, Dizon, and Arias.
One area where further research may be conducted to increase healthcare provision is the impact of gender-affirming hormone therapy on uterine, breast, and various hormone-driven cancer outcomes, according to Dizon. Despite the current, scant evidence, some doctors and patients still worry that testosterone therapy increases the risk of cancer recurrence.
“(When) making a decision in the face of uncertainty, one of the things that happens a lot is this sense of blame, the idea that ‘if you do this and your cancer comes back, it was your fault,'” Dizon said. That is “psychologically and literally damaging and nearly antithetical to why we treat cancer in the first place” and “at the very least, it’s unethical.”
Additionally, the discourse highlighted the frequently insufficient use of passing laws, such as those that require the collection of gender and sexual identity demographics.
“Implementation is a whole other beast … after you’ve drafted a policy or a bill,” Arias said.
Implementing laws continues to take months or even years after they are passed into law. Arias argued that the key to increasing the importance of some issues is to work with different round tables, coalitions, and advocacy groups in terms of developing a sense of strength in numbers.
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Arias even emphasized the value of retelling stories similar to Morreale’s. “Sometimes policy is too complicated to comprehend, and there can be a lot of jargon, and the best message of how it impacts people and makes their lives better is lost,” she said.
Arias also referred to the advocacy efforts of ACS CAN, which range from cancer prevention efforts to anti-discrimination bills. For instance, ACS CAN fights against morality provisions, which protect healthcare providers who refuse to provide service on moral and religious grounds. These clauses, along with trouble obtaining healthcare and other structural barriers, limit care access.
The panelists’ goals were to gain a better understanding of the opportunities and barriers in the LGBTQ+ healthcare market.
“We in healthcare must do our part to ensure that care is equitable given the current national political climate. No one benefits in segregated systems,” Dizon told the Herald.
