In the largest study to date of skin cancer rates among individuals who identify as gay, lesbian, or bisexual, investigators from Brigham and Women's Hospital reported important differences in skin cancer prevalence among sexual minorities. Rates of skin cancer were higher among gay and bisexual men compared to heterosexual men, but lower among bisexual women than heterosexual women. These findings may have implications for patient education and community outreach initiatives focused on reducing skin cancer risk, as well as for the design of future nationwide surveys. The results were published by Singer et al in JAMA Dermatology.

“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 corresponding study author Arash Mostaghimi, MD, MPA, MPH, Director of the Dermatology Inpatient Service at Brigham and Women’s. "This information helps inform the nation about how to allocate health resources and how to train providers and leaders. 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.”

Study Background

Dr. Mostaghimi and colleagues leveraged data from the Behavioral Risk Factor Surveillance System (BRFSS), using information collected from annual questionnaires from 2014 to 2018. The Centers for Disease Control and Prevention (CDC) uses the BRFSS to collect information about risk factors and behaviors among adults—about 450,000 people are interviewed by telephone using the BRFSS each year. Beginning in 2014, the BRFSS began using the sexual orientation and gender identity (SOGI) module to include questions about sexual orientation and gender identity. This module was administered in 37 states.

Researchers compared skin cancer rates among heterosexual men to rates in gay or bisexual men and compared rates among heterosexual women to lesbian or bisexual women. The study included 351,468 heterosexual men (mean age = 47.7 years); 7,516 gay men (mean age = 42.7 years); 5,088 bisexual men (mean age = 39.3 years); 466,355 heterosexual women (mean age = 49.7 years); 5,392 lesbian women (mean age = 41.9 years); and 9,445 bisexual women (mean age = 32.7 years).

Findings

Rates of skin cancer were 8.1% among gay men and 8.4% among bisexual men—statistically higher than the rate of 6.7% among heterosexual men. Skin cancer rates were 5.9% among lesbian women and 6.6% among heterosexual women, which was not a statistically significant difference—however, the rate of 4.7% among bisexual women was statistically significantly lower than heterosexual women.

The authors note that the data are based on self-reported skin cancer diagnoses, which have not been confirmed by a physician. The SOGI module was also only implemented in 37 states, so may not be generalizable to all states.

The BRFSS survey did not collect information about risk factors for skin cancer, such as ultraviolet exposure, Fitzpatrick skin type, human immunodeficiency virus status, and more. However, smaller studies have reported higher usage of indoor tanning beds among sexual minority men, a known risk factor for skin cancer.

The CDC recently considered stopping implementation of the SOGI module for future BRFSS surveys—a decision Dr. Mostaghimi feels would hinder efforts to support this population.

“This is the first time we've been able to look nationally at data about skin cancer rates among sexual minorities. Eliminating SOGI would prevent us from better studying this vulnerable population over time to see how rates may change from year to year,” he said. “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.”

Disclosures: For full disclosures of the study authors, visit jamanetwork.com.