Skin Cancer Prevalence Higher in Men Who Identify as Gay, Bisexual

The prevalence of self-reported lifetime skin cancer is higher in men who identify as gay or bisexual compared with men who identify as heterosexual, according to results of a cross-sectional analysis published in JAMA Dermatology.

Additional data demonstrated that women who identified as bisexual, but not lesbian, were less likely than women who identified as heterosexual to have reported a skin cancer diagnosis.

“This information helps inform the nation about how to allocate health resources and how to train providers and leaders,” Dr. Arash Mostaghimi, director of the dermatology inpatient service at Brigham and Women’s Hospital and the study’s senior author, said in a press release. “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."

Researchers analyzed data from the 2014-2018 Behavioral Risk Factor Surveillance System surveys of noninstitutionalized adults who self-identified as heterosexual, gay, lesbian or bisexual to assess the association between sexual orientation and lifetime skin cancer prevalence.

The study comprised 845,264 individuals — 351,468 heterosexual men, 7,516 gay men, 5,088 bisexual men, 466,355 heterosexual women, 5,392 lesbian women and 9,445 bisexual women.

Measuring self-reported lifetime history of skin cancer was the primary goal of the study.

Lifetime prevalence of skin cancer was 8.1% among men who identified as gay, 8.4% in bisexual men and 6.7% in heterosexual men, after adjusting for age.

Lifetime prevalence of skin cancer differed slightly in the population of women. Age-adjusted prevalence of skin cancer diagnosis was 5.9% in women who identified as lesbian, 4.7% among bisexual women and 6.6% among heterosexual women.

“This is the first time we've been able to look nationally at data about skin cancer rates among sexual minorities,” Mostaghimi 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.”

The researchers mentioned that there is likely a tie between the increased risk of skin cancer and an increased exposure to indoor tanning in gay and bisexual male populations. “The primary motivators for indoor tanning among sexual-minority men have been shown to be concerns about appearance and community pressures, and a recent study showed that indoor tanning salons are more likely to be located near neighborhoods with higher concentrations of male-male partnered households,” the researchers wrote.

In this study, the researchers did not ask participants to report on whether they engaged in indoor tanning. However, they suggested that “health care professionals should counsel sexual-minority male patients against using indoor tanning beds or to consider sunless tanning, which has proven effective in reducing indoor tanning bed use among women.”

They concluded that “Patient education and community outreach initiatives focused on reducing skin cancer risk behaviors among gay and bisexual men may help reduce the lifetime development of skin cancer in this population.”

They acknowledged that the study had some limitations, including that the data are based on self-reported and unvalidated skin cancer diagnoses which may be inaccurate. Another limitation, according to the researchers, was that the survey did not collect information regarding factors that could potentially skew results, including UV exposure, HIV status, measures people take to protect themselves from sunlight and a participant’s score on the Fitzpatrick skin type scale, which indicates how likely someone’s skin is to be damaged by sun exposure.

Based on these findings, Dr. Howa Yeung and colleagues, who were not involved with the study, suggested that the next phase of this research should circle around identifying why these differences exist.

“Now that differences have been identified, the next step is to understand why these differences exist and how they can be mitigated,” they wrote in an editorial that accompanied the study findings.

This could include diminishing the frequency of indoor tanning, Yeung and colleagues noted. “A recent qualitative study identified salient factors (that drive interest in) indoor tanning among gay and bisexual men to inform targeted skin cancer prevention approaches, such as appearance-focused interventions, community-oriented messaging, and policy efforts to reduce tanning access,” they wrote. “Many important research and clinical questions remain.”