Do Sexual Orientation and Gender Identity Influence Skin Cancer Risk?

By Kaitlyn D’Onofrio - Last Updated: February 14, 2020

Researchers recently explored the association between sexual orientation and gender identity and lifetime skin cancer prevalence. They found that gay and bisexual men, compared to heterosexual men, were more likely to report skin cancer over the course of their lives.

The use of tanning beds is a previously established risk factor for cancer—a factor the study authors noted in their paper.

“Bisexual men have reported more frequent use of indoor tanning beds compared with use among heterosexual men; however, no study has investigated skin cancer prevalence among gay, lesbian, and bisexual individuals as separate groups,” they wrote, reporting in JAMA Dermatology. “In this study, we evaluated whether lifetime prevalence of skin cancer differs among gay, lesbian, and bisexual individuals compared with heterosexual individuals.”

The study was cross-sectional in design and included data from the 2014-2018 Behavioral Risk Factor Surveillance System (BRFSS) surveys. BRFSS surveys, conducted by phone, collect demographic and health data for U.S. adults; the survey added a sexual orientation and gender identity module in 2014. Skin cancer history was ascertained through the question, “Has a doctor, nurse, or other health professional ever told you had skin cancer?” If respondents said “don’t know” or “not sure” or did not provide answers regarding sex, sexual orientation, or lifetime skin caner diagnosis, they were not included in the final analysis.

Final analysis included 845,264 respondents: 351,468 heterosexual men (mean age, 47.7 years; 95% confidence interval [CI], 47.5-47.8 years), 7,516 gay men (mean age, 42.7 years; 95% CI, 41.9-43.5 years), 5,088 bisexual men (mean age, 39.3 years; 95% CI, 38.2-40.4 years), 466,355 heterosexual women (mean age, 49.7 years; 95% CI, 49.6-49.9 years), 5,392 lesbian women (mean age, 41.9 years; 95% CI, 40.7-43.2 years), and 9,445 bisexual women (mean age, 32.7 years; 95% CI, 32.2-33.2 years).

Age-adjusted lifetime prevalence of skin cancer diagnosis was highest among gay (8.1%; 95% CI, 6.8–9.5%) and bisexual (8.4%; 95% CI, 6.3–11.0%) men; in comparison, prevalence was lower among heterosexual men (6.7%; 95% CI, 6.5–6.9%). Gay and bisexual men had a significantly higher adjusted odds ratio (aOR) of skin cancer diagnosis compared to heterosexual men (1.26; 95% CI, 1.05–1.51; P=0.01 and 1.48; 95% CI, 1.02–2.16; P=0.04, respectively).

Differences were not as pronounced among the women. Age-adjusted lifetime prevalence of skin cancer diagnosis among lesbians was 5.9% (95% CI, 4.8–7.3%), among bisexual women was 4.7% (95% CI, 3.8–5.7%), and among heterosexual women was 6.6% (95% CI, 6.5–6.8%). Bisexual women had a lower aOR of skin cancer diagnosis compared to heterosexual women (0.78; 95% CI, 0.61–0.99; P=0.04), but lesbian women did not (aOR=0.97; 95% CI, 0.73–1.27; P=0.81).

“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 author Arash Mostaghimi, MD, MPA, MPH, director of the Dermatology Inpatient Service at the Brigham, in a press release. “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.”