Reply to cancer survivorship and sexual orientation

Abstract

We are grateful for the opportunity to respond to Dr. Frisch's letter regarding our article.1 Most cancer registries do not record nonmelanoma skin cancer (NMSC). The California Health Interview Survey from which we derived our data collected self-reports of both melanoma and NMSC, allowing us to consider all types of skin cancer in our analysis. We took Dr. Frisch's concern that the inclusion of NMSC might have biased our results seriously, and reanalyzed the data after excluding NMSC. The results we reported did not change substantially after the exclusion of NMSC. Adult cancer diagnoses significantly differed by sexual orientation (p < .0001), with gay men reporting the most (5.7%) diagnoses, and heterosexual men reporting a rate of 3.4% and bisexual men reporting a rate of 2.9%. After excluding NMSC from other cancers, sexual orientation differences were found to persist (p = .03); more gay men with cancer reported other cancers, 41.0%, whereas 29.0% of heterosexual men and 37.9% of bisexual men reported other cancers. After excluding NMSC and adjusting for covariates, gay men were found to have 2.17 (95% confidence interval, 1.63-2.90) times the odds of reporting a diagnosis of cancer compared with heterosexual men. We respectfully contend that our further analyses do not support Dr. Frisch's suggestion of bias. We are sympathetic to Dr. Frisch's second suggestion to unpack the “other” cancer category and examine acquired immunodeficiency syndrome (AIDS)-defining cancers separately. We must reiterate the limitation previously stated that these specific data are not available to us. Although we gratefully acknowledge the attention our study has generated, we also note the gender dynamics in response to our study. We wish an equal amount of attention had been paid to our finding with respect to women cancer survivors, in that lesbian and bisexual women cancer survivors have 2 to 2.3 times the odds of reporting fair or poor health compared with heterosexual women cancer survivors. The study by Frisch et al2 is limited to lesbians, gays, and bisexuals (LGBs) in partnerships, and thus is not representative of all LGBs. To the best of our knowledge, data regarding cancer in LGB populations are scarce. We suggest that despite each study's limitations, the work of Frisch et al and our own make complementary and equally valuable contributions toward understanding cancer in LGB populations. We reiterate our call for future studies that examine the cancer incidence and mortality in the LGB population to understand why more gay men are cancer survivors, and why lesbians and bisexuals have similar rates of cancer survivorship compared with heterosexuals. Dr. Boehmer has received funding from American Cancer Society Grant RSGT-06-135-01-CPPB to focus on sexual orientation disparities in the adjustment of breast cancer survivors. The analyses presented herein were conducted in this context.