Yeung H, Braun H, Goodman M. Sexual and Gender Minority Populations and Skin Cancer—New Data and Renewed Priorities. JAMA Dermatol. Published online February 12, 2020. doi:10.1001/jamadermatol.2019.4174
Sexual and gender minority (SGM) persons include, but are not limited to, individuals who identify as lesbian, gay, bisexual, or transgender, as well as individuals whose sexual orientation, gender identity or expression, or reproductive development are characterized by nonbinary constructs of sexual orientation, gender, and/or sex. The National Cancer Institute (NCI) has called for specific research to “assess cancer risk to inform improved decision-making, risk reduction interventions, and screening options for early cancer detection in SGM populations.” Notably, population-based data on skin cancer epidemiology in SGM persons remain inadequate. Without robust epidemiologic data, it has been challenging for dermatologists to recognize and articulate their specific roles within broader national conversations on improving SGM health. Emerging skin cancer data, particularly among gay and bisexual men, indicate unmet needs for skin cancer prevention in specific SGM subpopulations.
In this issue of JAMA Dermatology, Singer and colleagues expand the literature on skin cancer burden in SGM populations by using US population-based survey data. In 2 similarly designed, cross-sectional studies using the Behavioral Risk Factor Surveillance System (BRFSS) surveys, self-reported lifetime history of any skin cancer was assessed across sexual orientation and gender identity (SOGI) groups in pooled data from 37 states between 2014 and 2018. Consistent with previously reported differences in skin cancer history and risk factors related to sexual orientation, gay and bisexual men reported 26% to 48% higher odds of being diagnosed with skin cancer compared with matched heterosexual men, while bisexual women reported 22% lower odds of being diagnosed with skin cancer compared with matched heterosexual women. New to the literature, gender-nonconforming persons reported double the adjusted odds of being diagnosed with skin cancer as compared with cisgender men, while no difference was seen in transgender men and transgender women as compared with cisgender men. Although the differences in prevalence estimates are small in absolute magnitude, these data provide additional concrete examples of disproportionate skin cancer burden within SGM subpopulations.
Epidemiologic studies of skin cancer in SGM populations are difficult to perform, and the data examined the by Singer and colleagues should not be taken for granted. Key demographic variables relevant to SGM persons have historically not been collected. The Centers for Disease Control and Prevention (CDC) has allegedly threatened to remove the optional SOGI data collection module from the BRFSS starting in 2019, which would eliminate an important data source aimed to understand the health status of SGM populations. Although the CDC has since denied this plan, persistent skin cancer differences in SGM 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. Read the full article via Jama