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Differences in skin cancer rates by sexual orientation identified

A study comparing skin cancer rates among sexual minorities has found that homosexual and bisexual men have higher rates than heterosexual men, but bisexual women have lower rates than homosexual or heterosexual women.

Published online ahead of print in JAMA Dermatology (Feb. 12, 2020), the cross-sectional study analyzed data from the 2014-2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys of a noninstitutionalized population in the United States that included 845,264 adult participants who self-identified as being heterosexual, homosexual, or bisexual.

Rates of skin cancer were 8.1% among homosexual 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 homosexual 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 sexual orientation and gender identity (SOGI) module of the BRFSS surveys was also only implemented in 37 states, so may not be generalizable to all states.

Another limitation on the study is that the BRFSS survey did not collect information about risk factors for skin cancer, such as UV exposure, Fitzpatrick skin type, or HIV status. The authors note that smaller studies have reported higher usage of indoor tanning beds among sexual minority men, a known risk factor for skin cancer.

The research team also note that it was possible to break down skin cancer risk by sexual orientation only because of the inclusion of a SOGI module into a nation-wide system of surveys.

“It’s absolutely critical that we ask about sexual orientation and gender identity in national health surveys; if we never ask the question, we would never know that these differences exist,” said corresponding author Dr. Arash Mostaghimi, in a press release. Dr. Mostaghimi is director of the dermatology inpatient service at Brigham and Women's Hospital in Boston. “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 are getting better or worse at addressing them. Historically, this kind of health variation was hidden, but we now recognize that it’s clinically meaningful.”

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