Men who have sex with men are more likely to develop anal and oral cancers. Here’s how to prevent and screen for them.
Data about cancer risk for gay and bisexual men is somewhat limited because medical records don’t include sexual orientation. Some evidence suggests that men who have sex with men (MSM) have a slightly higher likelihood of being diagnosed with cancer. What is clear, however, is that two types of cancer pose a much higher risk for gay and bisexual men, and the reasons largely have to do with types of sexual activity. A lack of routine health screenings and the unwillingness of some doctors to discuss sexuality can increase their patients' risk of cancer as well.
For gay or bisexual men and other MSM, the two biggest cancer risks are anal cancer and oral cancer. Because gay and bisexual men are also at higher risk for hepatitis B, according to the Centers for Disease Control and Prevention (CDC), they may also have greater odds of developing liver cancer, which is driven by hepatitis B infection.
Anal Cancer in Gay and Bisexual Men
Although anal cancer is rare in the general population, it’s one of the most common cancers in gay and bisexual men. Studies estimate that gay and bi men and MSM are 20 times more likely than heterosexual men to develop anal cancer. More than 90 percent of anal cancers are caused by HPV, specifically the HPV-16 strain, according to the CDC.
A study published in 2022 showed it’s possible to diagnose and treat abnormal cells in the anus before they develop into full-blown cancer. But doctors are not likely to automatically screen for anal cancer, or even give colorectal exams to detect prostate cancer, according to Alan Nyitray, PhD, an associate professor of psychiatry and behavioral medicine at the Medical College of Wisconsin in Milwaukee.
“A lot of providers are not comfortable doing an anal exam, possibly because there’s so much stigma associated with the anus,” says Dr. Nyitray. There is no national consensus on the need for anal cancer screening, but that may change if and when the U.S. Preventive Services Task Force issues a recommendation, which Nyitray believes will happen. Until then, it’s likely that you’ll have to ask for the screening.
Oral Cancer in Gay and Bisexual Men
Oropharyngeal cancer (which includes the back of the mouth and throat) is the eighth most common cancer among all men in the United States, according to Cancer.Net. The most common risk factors for oropharyngeal cancer include:
- A history of heavy smoking
- Heavy alcohol use
- Being infected with HPV, especially HPV-16
Gay and bi men are more likely than their straight counterparts to have all three risk factors, according to Vanderbilt University Medical Center.
Signs of oropharyngeal cancer include a lump in the neck or a sore throat, which can occur with many other diseases. Unlike for HPV infection in the anus, no test has been approved by the U.S. Food and Drug Administration (FDA) to diagnose HPV in the mouth or throat. For the vast majority of people, HPV goes away by itself within two years, and a very small number of people will progress to an HPV-related oropharyngeal cancer.
It is possible to treat oropharyngeal cancer, and easier to do so when it’s detected early. Early detection means your doctor and dentist are aware that you have a risk factor for oral HPV (that is, receptive oral sex) and whether you’ve noticed abnormal changes in your mouth and throat.
How Gay and Bisexual Men Can Reduce Cancer Risks
Kenneth Mayer, MD, the medical research director and cochair of the Fenway Institute in Boston, suggests four actions that reduce the risk of cancer for gay and bisexual men:
- Stop smoking (which is good advice for everyone)
- Drink less (also good advice for everyone)
- Get vaccinated for HPV and viral hepatitis
- Get tested for HIV (also good advice for everyone)
HPV Vaccination
HPV vaccines have been used for over 15 years and are now approved for boys and men between ages 9 and 45. The thinking behind the age cutoff is that by midlife, most men have had the bulk of their sexual partners and therefore have already been exposed to many strains of HPV. But Mayer says there is still value in getting vaccinated later in life.
“Even if you can reduce your risk of cancer by 5 percent, I think [getting vaccinated is] worth it,” he says. “There are no downsides to the vaccination as long as you can afford it out of pocket.”
Most insurers will not cover the cost of HPV vaccination if you’re over 45, making a full series of three shots a serious financial strain. And the verdict is still out on how effective HPV vaccines are in preventing oropharyngeal cancers.
Hepatitis B Vaccination
People chronically infected with hepatitis B have a greater lifetime risk of liver cancer. According to the CDC, gay and bi men and MSM have a greater risk of hepatitis B, which spreads through semen and blood during sexual activity. Hepatitis A is commonly passed through the stool to the mouth, and is another risk to the liver. The CDC recommends that all men who have sex with men get vaccinated for hepatitis A and B.
HIV Testing
HIV is a strong predictor of greater risk of anal cancer, partly because condomless sex is a driver of HIV as well as HPV and hepatitis B. A positive HIV test result should alert a doctor to order other screening tests. Because your primary care doctor might not automatically prescribe these tests, it may be up to you to ask for them. That requires getting comfortable talking about your sexual practices.
Finding LGBTQ+-Affirming Doctors
The disparities in cancer care for gay and bisexual men, and the broader LGBTQ+ population, could be exacerbated by the lack of LGBTQ+ cultural competence among healthcare practitioners, and even anti-LGBTQ+ bias and discrimination.
“Health providers can be judgmental about sex practices, and men who have sex with men may not want to put up with that,” Mayer says. “That means these patients may be less likely to get other regular screenings, like for colon cancer, as well.”
If your doctor is unwilling to discuss your sexual practices and the cancer risks that may come with them, you will need to seek a more welcoming healthcare environment. An LGBTQ+ clinic is one option, and they’re easier to find if you live in a large metropolitan area. If you’re not near a big city or if you’re having trouble finding the right match for a healthcare provider in your insurance network, GLMA offers an LGBTQ+ inclusive provider directory.
https://www.everydayhealth.com/cancer/gay-and-bisexual-men-are-at-higher-risk-for-these-cancers/
