Associations Between Sexual Orientation and Overall and Site-Specific Diagnosis of Cancer: Evidence From Two National Patient Surveys in England.

Abstract

Purpose

To address evidence gaps on the risk of cancer in people from sexual minorities.

Patients and methods

We used data from 796,594 population-based English General Practice Patient Survey (GPPS) responders to explore the prevalence of self-reported diagnosis of cancer in the last 5 years among sexual minorities compared with heterosexual women and men. We analysed data from 249,010 hospital-based English Cancer Patient Experience Survey (CPES) responders with sexual orientation as a binary outcome, and ICD-10 diagnosis as covariate (38 different common and rarer cancers, with breast and prostate cancer the baseline categories for women and men, respectively) to examine whether people from sexual minorities are over- or under-represented among different cancer sites. For both analyses, we used logistic regression, stratified by sex and adjusted for age.

Results

A previous diagnosis of cancer in the past 5 years was more commonly reported by male GPPS responders who endorsed gay/bisexual orientation compared with heterosexual men, OR(95%CI) 1.31(1.15-1.49), p<0.001; without evidence of a difference between lesbian/bisexual compared with heterosexual women 1.14(0.94-1.37), p=0.19. For most common and rarer cancer sites (30/33 in women, 28/32 in men), the odds of specific cancer site diagnosis among CPES respondents appeared independent of sexual orientation. There were however notable differences in infection-related (HIV, HPV) cancers. Gay/bisexual men were over-represented among men with Kaposi’s Sarcoma 48.2(22.0-105.6), anal 15.5(11.0-21.9), and penile cancer 1.8(0.9-3.7). Lesbian/bisexual women were over-represented among women with oro-pharyngeal cancer 3.2(1.7-6.0).

Conclusions

Large scale evidence indicates that the distribution of cancer sites does not vary substantially by sexual orientation, except for some HPV and HIV associated cancers. The findings highlight the importance of HPV vaccination in heterosexual and sexual minority populations.