Most Latinx people who are LGBTQI+ reported being reluctant to share their gender identity and/or sexual orientation with a health care provider, and a majority have never received cancer information tailored for their community, according to City of Hope-led survey results that will be presented at an American Association for Cancer Research (AACR) meeting held from Sept. 20-23.
LGBTQI+ individuals are at higher risk of developing cervical and oral cancers, and Latinx people have higher risk of developing viral-associated cancers, including in the liver and stomach. Yet substantial cancer health disparities exist for both LGBTQI+ individuals and for Latinx people, said Mayra Serrano, M.P.H., CHES, manager of the Center of Community Alliance for Research & Education at City of Hope, a world-renowned independent research and treatment center for cancer, diabetes and other life-threatening diseases.
"Together, this group is a double minority whose increased risk for certain cancers, unfortunately, are not currently being addressed," said Serrano, who led the ongoing survey project. "We hope that our survey results add to a conversation that needs to be had about how people - regardless of their gender, sexuality, race or ethnicity - should receive equal and appropriate health treatment and disease prevention education."
Working with the Latinx Task Force in the Greater Los Angeles area, Serrano and her colleagues aim to reduce health disparities. The goal is to understand cancer-related knowledge and behavior within the LGBTQI+ Latinx community. Serrano will present the ongoing data in San Francisco at the 12th AACR Conference on The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.
Examples of a lack of cultural competency occur when, say, a health care provider uses inappropriate gender pronouns in conversation or in written materials, or when the physician and support staff assume that the patient is cisgender (they agree with the sex assigned at birth) and heterosexual during discussions about sex and the need for birth control.
"Results will guide future outreach to and education efforts for the LGBTQI+ Latinx community and their health care providers," Serrano said. "We need to better meet the needs of underserved populations."
Some 176 people completed the survey as of June 2019. Most (74%) identified as Latinx, 82% identified as cisgender, 40% identified as gay, 28% identified as queer. Some shared their gender identity or sexual orientation with providers (44%), but those who identified as bisexual were less likely to share that information.
Most respondents (73%) said they were afraid to share their gender identity and/or sexual orientation with health care providers. People who identified as queer were more likely to be reticent about sharing their sexual orientation.
"The early data suggest that there is an urgent need to train health care providers how to make their practice more culturally competent, safe and welcoming for LGBTQI+ Latinx communities," Serrano said.
Key responses include:
- 91% of respondents said they have never received LGBTQI-tailored cancer information
- 60% of respondents ages 21 to 29 who were eligible for Pap testing had not been tested in the past three years, compared with 22% of all eligible individuals in the United States
- 50% of those eligible for a mammogram had not had one in the past two years, compared with 29% of all eligible individuals in the United States.
Serrano and the Latinx Task Force are collaborating with local LGBTQI+ organizations to expand the survey. They also are developing educational materials for the LGBTQI+ Latinx community and are working on cultural competency training guides for health care providers.
Serrano's interest in this topic is a result of and contributes to City of Hope's diversity and inclusion efforts. City of Hope hosts a group called Pride in the City, which promotes a safe and welcoming environment for LGBTQ patients, families and employees.
Thus, for the past three years, the Human Rights Campaign has given City of Hope a perfect score on its Healthcare Equality Index, a report card that evaluates a health care facility's "policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees."