27 For gay/bisexual men who are also racial/ethnic minorities, the combined effects of belonging to 2 socially marginalized groups are likely to be worse than those of belonging to either group alone, potentially leading to even greater disparities in recommended cancer testing. 26Ĭoncerns about stigmatization and the risks of disclosing personal health information may cause some gay/bisexual men to delay or completely forego the use of non-urgent, discretionary services such as cancer screening – particularly if they are still coming to terms with their sexual orientation. 25 Although race-specific data on cancer incidence are not available for the gay/bisexual male population, the sharp increase in HIV among minority gay/bisexual men in the same decade suggests that subgroups of this population have limited access to important preventive services. 10 – 12, 24 In an analysis of national Surveillance, Epidemiology and End Results data from 1992 to 2001, CRC incidence among males declined by averages of 1.3% per year for Whites and 0.8% for Asians/Pacific Islanders, with no such improvement for African Americans or Latinos. 20 – 23 Similarly, African Americans and Latinos are less likely to receive CRC screening than are Whites, despite marked differences in disease rates.
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A recurrent finding is the relatively low use of prostate cancer screening and treatment among African Americans, who are more likely to develop and die of prostate cancer than are other groups. Racial/ethnic differences in prostate and colorectal cancers and access to services have been documented extensively. Estimates of the association of sexual orientation with CRC and PSA testing may provide useful information to planners and providers of prevention outreach and clinical services for gay/bisexual men. 19 However, these screening practices could lead to harmful therapies that impair patient functioning and well-being without improving outcomes. 16 – 18 Despite the lack of a known association between HIV and prostate cancer, some clinicians working in the gay community maintain that HIV-positive men should receive PSA testing at ages younger than those recommended by clinical guidelines in order to avoid HIV-related complications of treatment for advanced cancers. 14 There is evidence that CRC is more common among HIV patients, 15 and that it develops at an earlier age and is more aggressive than it is among persons without HIV.
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This gap in the literature is a concern from both public health and clinical perspectives, given the relatively high prevalence of HIV in the gay/bisexual male population. Several studies suggest that lesbians are less likely than heterosexual women to receive cancer screening 13 however, no quantitative analyses have compared the use of cancer tests between gay/bisexual and heterosexual men.
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7 – 12 Relatively little information, however, is available on the association of cancer testing with sexual orientation. Previous work has shown that the use of prostate and colorectal cancer testing differs by patient race/ethnicity, income, education, and other characteristics. 5 Although stronger evidence exists for the efficacy of routine CRC testing, national data suggest that men in the general population are more likely to be tested for prostate cancer. Preventive Services Task Force has concluded that current evidence does not support PSA testing. For example, the American Cancer Society recommends annual PSA testing for men age 50 and over, 4 whereas the U.S. 2, 3 By contrast, there is less support from randomized controlled trials for the use of prostate-specific antigen (PSA) testing, and a low level of agreement between different clinical preventive guidelines.
1 Colorectal cancer (CRC) screening is widely recommended for adults age 50 and over, based on evidence that early detection can decrease cancer incidence and mortality through the identification of preclinical lesions. Prostate and colorectal cancers are the second and third most common causes of cancer deaths among men in the United States, exceeded only by lung cancer.