LGBTQ patients have unique risk factors for cancer and oncologists admit they don’t know enough about them, a new national survey reveals.

The LGBTQ population’s health care needs are often different from those of cis-hetero patients, including when it comes to cancer detection and treatment. Sexual and gender minority individuals are at higher risk for certain cancers, and barriers to health care for this group are well-documented — but even when these patients make it to the doctor’s office, physicians may be unprepared to meet their needs.

A new national survey of oncologists found that most providers feel they don’t know enough about the specific health needs of lesbian, gay, bisexual and transgender patients.

Asked about six aspects of cancer care and prevention among LGBTQ patients — including the effects of screening interventions, lifestyle risk factors and access to health insurance — many of the 149 oncologists who responded to the survey reported not knowing the facts or not being confident in their knowledge. All of the doctors work at National Cancer Institute-designated cancer centers.

“I continue to be surprised at how low the knowledge is,” Dr. Gwendolyn Quinn, one of the study’s authors and a professor of population health at NYU Langone Health, told HuffPost.

The new survey was an expansion of a pilot study Quinn and her collaborators conducted in Florida and published in 2017, in which less than half of oncologists who participated correctly answered knowledge questions related to LGBTQ patients.

“I continue to be surprised at how low the knowledge is.”Dr. Gwendolyn Quinn, one of the study’s authors

The new survey asked a nationally representative group of oncologists to review a similar set of questions about LGBTQ cancer care and say whether they thought the statements were true (“Agree,” “Strongly agree”), believed they were false (“Disagree,” “Strongly disagree”) or admit that they weren’t sure (“Neutral/do not know”).

A high percentage of providers responded “Neutral/do not know” to most questions ― including whether regular anal cancer screening for gay and bisexual men could increase life expectancy (47.7 percent), if there was a higher prevalence of smoking among LGBTQ individuals (67.1 percent), and whether transgender patients are less likely to have health insurance (57.7 percent).

Quinn said for this study, participants were asked about confidence in their knowledge of LGBTQ patients’ health needs at the beginning of the survey and then again after the knowledge questions. At the start of the survey, 53 percent of oncologists felt confident regarding lesbian, gay and bisexual patients’ health needs and 37 percent felt confident regarding transgender patients’ health needs. After responding to the questions, the physicians’ confidence dropped to 39 percent and 19.5 percent, respectively.

As predicted, “the survey became an intervention of sorts to help physicians realize what they didn’t know,” said Quinn.

“I think it’s very sad if medical providers don’t even understand some of these basic points,” Dr. NFN Scout, deputy director of the National LGBT Cancer Network and an expert in transgender health, told HuffPost. “But of course, it’s not taught in schools. On average, medical schools provide less than an hour of information on the LGBTQ population. So how can we expect this to change until the systems that are a part of the medical world start to change?”

Meeting The Needs Of LGBTQ Patients

Differences in the risks and needs of LGBTQ cancer patients largely stem from social and economic challenges and lifestyle factors. Data show queer adults in the U.S. are less likely to have jobs and health insurance. But even with health insurance, lesbian, gay and bisexual adults are more likely to delay medical care compared to their heterosexual counterparts — a fact that is particularly worrisome given the crucial importance of early cancer detection for treatment and survival.

“We’ve seen this again and again, that exposure to discrimination or even fear of discrimination from health care providers and health care systems can actually lead to health care avoidance,” said Dr. Megan Sutter, another author on the study and an OBGYN at NYU’s School of medicine. “In the case of cancer treatment, if you’re not screening appropriately, getting preventive care and are also delaying potential curative treatment, it can have detrimental effects.”

Barriers to health care are even greater for transgender Americans, who have even higher rates of poverty, unemployment, homelessness and poor health linked to pervasive discrimination and a general lack of legal protections.

“Out of the LGBTQ population, the trans population often experiences the most extreme health discrimination, the most extreme barriers to care, the most extreme level of societal exclusion,” Scout, who identifies as transgender, said. “We are often poor; we are often suicidal. We are often struggling to get work and certainly struggling to get health care.”

There are also behavioral and lifestyle factors that increase LGBTQ individuals’ risk for certain cancers, according to Quinn.  

“For example, women who don’t ever have a child have increased risk for gynecologic cancer and women who identify as lesbian are less likely to have a child, though certainly many of them do,” said Quinn, who’s done separate research into how some cancers disproportionately impact LGBTQ individuals. “Also, people who engage in receptive anal intercourse have increased risk for HPV-related anal cancer.”

“If someone who is heterosexual and cisgender has those same behaviors, they have those same risks,” she added.

Cigarette smoking among LGBTQ individuals in the U.S. is higher than among heterosexual Americans ― leaving the population at higher risk for many forms of cancer, including lung cancer, cervical cancer and colon cancer.  Higher smoking rates in the community are likely due to stigma-related stress, targeted marketing by the tobacco industry and lack of access to tobacco treatment, according to the American Lung Association.

Changing The System

Scout said one big step toward understanding the LGBTQ community’s cancer risks and meeting their needs is for doctors to collect data on the sexual orientation and gender identity of their patients, something he noted is recommended by the American Society of Clinical Oncology (ASCO).

 “Unfortunately, providers rarely collect sexual and gender minority data in health records, so that means that we don’t have cancer-related data for our population,” he explained.

Even though most physicians who responded to the survey said they felt it was important to know the sexual orientation and gender identity of their patients, 63 percent said their institution’s intake forms did not inquire about a patient’s sexual orientation, 54 percent said they did not inquire about a patient’s sex at birth, and 55 percent did not inquire about current gender identity.

Quinn said many providers insisted they would treat all their patients the same regardless of how they identified. This is a nice sentiment in theory, she said, but in practice, doctors should be prepared to tailor prevention discussions and treatment options to LGBTQ individuals’ specific needs.

Referring to a section of the survey from which results have not been published, Quinn said, “Many physicians would respond ‘I treat all my patients the same, I give them all good care, so I don’t need to know this.’ So we have a duty to help physicians understand why they need to know the sexual orientation and gender identity of their patient. And what they can do about it once they have that information.”

“I would only hope that evidence like this can help move people to take steps to remedy the situation,” Scout said, in reference to the survey’s findings. “I don’t think anyone is proud of offering substandard care to one element of the population.”

Researchers did find one bright spot: Roughly 70 percent of respondents said they were interested in receiving education regarding lesbian, gay, bisexual, transgender and queer patients’ unique health needs.

But the solution requires more than the efforts of individual providers to improve their own practices, Scout argued, underscoring the need for reform in the medical community at large.

A rainbow sticker in your office doesn’t say ‘we do it perfectly’ or ‘we suddenly become experts’ but it says ‘we are willing to learn.’”NFN Scout, deputy director of the National LGBT Cancer Network

“We need systems changed to solve this problem; we need all the medical schools to change their curriculum routinely. We need professional societies like ASCO to provide more detailed information to their member doctors on the subject,” he said, adding that organizations should also provide accreditation that includes competency in LGBTQ needs and fund research that helps support prevention campaigns. “There are a lot of different system changes that need to happen in order to fix this.” 

Quinn agreed. “We think physicians are a great place to start but we know that in order for patients to get the best possible care that institutions need to be trained — from the nurses to schedulers to the valet — about culturally relevant interactions.”

In the meantime, small changes can make important differences. Scout said providers can make their offices more welcoming to LGBTQ individuals by doing things like making intake forms and health promotion materials more inclusive.

“We have a long history of problems with the medical system, which means we come in wary,” he said. “If you’re trying to be a welcoming provider, it’s really up to you to provide some sign of welcome; and that can be as literal and as small as a rainbow sticker in your waiting room. Those are the types of things that help us relax.”

“If you’re an oncologist and aren’t willing to make even that small of an investment, then, unfortunately, you’re standing on the shoulders of people who have been bigoted and discriminatory in the past,” he added. “A rainbow sticker in your office doesn’t say ‘we do it perfectly’ or ‘we suddenly become experts’ but it says ‘we are willing to learn.’”

D.C.C. restaurant will pay $7,000 as part of a settlement after an employee tried to stop a transgender woman from using a women’s restroom last summer, D.C.’s attorney general said this week.

Charlotte Clymer, a transgender woman and activist with the Human Rights Campaign, which advocates for LGBTQ equality, was asked to show identification June 22 when she tried to use a women’s restroom at Cuba Libre, a downtown Cuban restaurant and rum bar.

Charlotte Clymer (Courtesy of Charlotte Clymer)

Clymer said the employee followed her into the restroom, then a manager also asked for identification when she emerged from the restroom. After a confrontation with the manager — at which point she pulled up the D.C. Human Rights Acton her phone — she said she was told to leave, and then called police.

The D.C. Human Rights Act prohibits discrimination based on gender identity or expression in housing, employment, public accommodations and educational institutions.

D,C. Attorney General Karl A. Racine (D) said in a statement Wednesday that Cuba Libre would pay a $7,000 penalty to the District for violating the act. The restaurant must also train staff on D.C. laws regarding gender identity and post signs that “all individuals are allowed to use the restroom that corresponds to their gender identity or expression,” the statement said.

Racine said he will introduce legislation to “clarify” the right of his office to pursue cases involving Human Rights Act violations.

“The District’s laws reflect one of our residents’ most deeply-held values: that all people should be treated equally,” Racine said in a statement. “With this settlement, Cuba Libre is required to maintain policies that will ensure this type of discrimination does not happen again.”

Barry Gutin, a Cuba Libre co-owner, said in a statement that the restaurant performed the training and signage requirements, and also plans to offer training open to all D.C.-area restaurant employees to “help understand the challenges of the LGBTQ community.”

“Our focus now is to help ensure safety for D.C.’s transgender community at all area restaurants,” the statement said.

The restaurant apologized after the June incident. Racine, who said the employees involved were fired, thanked Cuba Libre’s management and staff for “cooperating fully in our investigation and seeking to rectify their wrongdoing.”

Clymer called the settlement “a great outcome.”

“All parties worked together to make sure a terrible night was turned into a great teaching moment, which was built on the history of advocacy by trans folks in D.C., particularly trans women of color,” she wrote in an email. “I saw a resolution to this because of the foundation they laid.”


Rep. Tulsi Gabbard (D-HI) announced last week that she’s running for president, and in the days since, the conversation has quickly focused on her past record opposing LGBTQ equality.

The earliest days of Gabbard’s political career were spent at her father’s organization The Alliance for Traditional Marriage, which campaigned for a state constitutional amendment banning same-sex marriage in Hawaii. Mike Gabbard also led a coalition called Stop Promoting Homosexuality, and hosted an anti-gay radio show called Let’s Talk Straight Hawaii. He openly promoted ex-gay ministries, encouraging those “who are addicted to homosexual behavior” to seek help through conversion therapy.

In 2000, Gabbard’s mother Carol Gabbard was running for Hawaii Board of Education, and 19-year-old Tulsi defended her against attacks from LGBTQ activists. “This war of deception and hatred against my mom is being waged by homosexual activists because they know, that if elected, she will not allow them to force their values down the throats of the children in our schools,” she said at the time.

A few years later, Gabbard — the youngest lawmaker ever elected to the Hawaii state legislature — testified against a civil unions bill. “To try to act as if there is a difference between ‘civil unions’ and same-sex marriage is dishonest, cowardly and extremely disrespectful to the people of Hawaii,” she insisted, warning how LGBTQ activists were trying to impose their agenda. “As Democrats we should be representing the views of the people, not a small number of homosexual extremists.”

When she ran for Congress in 2012, Gabbard apologized for her past “hurtful” comments to the LGBTQ community. Since then, she has actually had a fairly strong record of supporting LGBTQ equality, including co-sponsoring The Equality Act. The Human Rights Campaign gave her a score of 100 for her votes during the 115th Congress, with scores of 88 and 92 for the previous two sessions, respectively.

Still, progressives might have reason to be concerned about her more recent social positions. In an op-ed just last week, Gabbard excoriated fellow lawmakers who “incite bigotry based on religion.” Sens. Mazie Hirono (D-HI) and Kamala Harris (D-CA) had criticized Brian Buescher, one President Donald Trump’s judicial nominees, for his membership in the Knights of Columbus, a Catholic organization that has campaigned heavily against LGBTQ equality and a woman’s right to have an abortion. Gabbard accused them of engaging in anti-Catholic religious bigotry for questioning his affiliation with the controversial group.

Opponents of LGBTQ equality have long claimed that its advances infringe upon their “religious freedom.” Indeed, several cases seeking Supreme Court review involve businesses refusing service or employment to LGBTQ people based on their religious beliefs. Despite this claim, studies have shown that those who defend such discrimination do so regardless of whether it’s motivated by religious beliefs or not. Gabbard seems to subscribe to the same disingenuous interpretation of “religious freedom” to defend a powerful and politically influential organization like the Knights of Columbus.

In response to fresh scrutiny of her past statements, Gabbard issued a new statement to CNN indicating that she “regret[s] the positions” she took in the past. “I’m grateful for those in the LGBTQ+ community who have shared their aloha with me throughout my personal journey.” After boasting her support for various pro-LGBTQ bills during her time in Congress, she added, “Much work remains to ensure equality and civil rights protections for LGBTQ+ Americans and if elected President, I will continue to fight for equal rights for all.”

Two North Carolina women have been released on bail after attacking a transgender woman in the bathroom of a Raleigh bar last year. 

Jessica Fowler, 31, and Amber Harrell, 38, were arrested and charged with second-degree kidnapping and sexual battery over an incident that took place at Milk Bar on Dec. 9, the Associated Press reports. 

The 29-year-old victim was inside the bar's bathroom when Fowler and Harrell entered and began verbally assaulting her. The pair allegedly exposed themselves and groped the victim against her will, at one point asking her if she had a penis. 

The woman told police that the pair followed her out of the bathroom and continued to attack her, despite a bartender's multiple attempts to intervene. 

The victim called 911 the day after the incident to file a report, though the assailants were not arrested until this week, WRAL reports.

Fowler and Harrell have both been released from prison on $30,000 and $50,000 bonds, respectively, according to the Greensboro News & Record

Public bathrooms have been a hot-button issue in North Carolina since the state passed a bill in 2016 stating transgender people must use restrooms matching the gender on their birth certificates, a move that many viewed as discriminatory. The controversial law was repealed in 2017 and replaced with a contentious new bill that prevented local governments from passing laws to protect the rights of LGBTQ people.

LANSING, Mich. (WLNS)-- - Gov. Gretchen Whitmer signed an executive directive today that protects against discrimination of people in the LGBTQ community.

This directive protects LGBTQ community members to get equal opportunities when looking at state employment opportunities, state contracting or service and receiving state grants/loans.

It was signed at Affirmation in Ferndale, which is one of the largest LGBTQ community services in the state.

Gov. Whitmer says hopes this new directive creates a blue print for the rest of the country to follow.

"With a stroke of a pen, I have just put Michigan in a leadership role," said Gov. Whitmer.

Gov. Whitmer and her team stated that this was at the top of their list and is the ninth directive signed in just six days in office. 

The community showed up to witness the signing and congratulate Gov. Whitmer for signing this so early on. Lt. Gov. Garlin Gilchrist says the turnout shows just how badly this needed to be put into order.

"It means that people have been hurting, it means that there's been so much pain, so much damage that's been done by discriminatory laws and discriminatory policies. That's ending with our administration," said Lt. Gov. Gilchrist.

Jeynce Poindexter works with Equality Michigan as a transgender specialist and victim advocate. She works with families who have lost a loved one due to transgender discrimination. She says this new directive will help community members fear being killed and not given equal opportunities.

"We're going to make sure that we're going to do something to make sure that your life and it's stability, is stable. I appreciate that with my life," said Poindexter.

To Poindexter, this signing means Gov. Whitmer kept a personal promise to her that she would get to work on it.

"This is not just showing up in the space, this is here supporting people who made me a promise, and then stuck to it," said Poindexter.

The directive also requires state departments to have a "equity and inclusion officer" to educate workers about sexual orientation and gender identity, as well as handle complaints.


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