ACS - healthevidencedigest

📌 What this post covers In 2024, the American Cancer Society published its first dedicated report on cancer in LGBTQ+ people, and the findings were stark: LGBTQ+ individuals are more likely to develop certain cancers, face more barriers to screening and diagnosis, and report worse experiences of care than their heterosexual and cisgender counterparts. A central driver of these disparities is a problem that sounds administrative but has real clinical consequences: most health systems still do not routinely collect sexual orientation and gender identity (SOGI) data. Without that data, oncology teams cannot identify these patients, tailor their care, or study outcomes in any systematic way. This post covers what the evidence shows about LGBTQ+ cancer disparities, why the data collection gap is central to the problem, and what the research community is doing to address it, including a new national research center funded by the American Cancer Society specifically to improve outcomes in this population.

Approximately 7.6% of U.S. adults identify as LGBT or something other than heterosexual, according to the most recent Gallup data. Applied to the ACS’s 2024 estimate of more than 2 million new cancer diagnoses annually, that translates to approximately 152,000 sexual and gender minority (SGM) people receiving a cancer diagnosis each year in the United States. That is a large population. It is also a population for which the evidence base is thin, clinical guidelines are largely unadapted, and routine care is frequently inadequate.

This is not a new observation. The National Institutes of Health formally designated sexual and gender minorities as a population experiencing health disparities for research purposes in 2016. The Institute of Medicine called for increased research investment in SGM health in 2011. A decade and a half later, the research infrastructure to support that work is only now beginning to reach the scale the problem requires.

What the Evidence Shows: LGBTQ+ Cancer Disparities Are Real and Understudied

The 2024 ACS Cancer Facts and Figures Special Section on Cancer in LGBTQ+ People is the most comprehensive synthesis of this evidence to date. Its findings point to disparities across three dimensions: higher cancer risk, lower screening uptake, and worse experiences of care.

Higher cancer risk driven by modifiable factors

LGBTQ+ individuals have higher rates of several modifiable cancer risk factors compared to heterosexual and cisgender populations. The disparities are not uniform across all subgroups, but the patterns are consistent enough to be clinically meaningful.

Tobacco use: LGBTQ+ individuals have higher rates of smoking than the general population. Tobacco is the leading preventable cause of cancer, responsible for at least 30% of all cancer deaths. Higher tobacco prevalence in LGBTQ+ communities is a downstream consequence of stress, social marginalization, and targeted marketing by the tobacco industry to LGBTQ+ communities over decades.

Alcohol use: Lesbian, gay, and bisexual individuals are more likely to engage in heavy alcohol consumption than heterosexual peers, according to the ACS report. Alcohol use increases risk for liver, esophageal, colorectal, oral, stomach, and breast cancers.

Excess body weight: Lesbian and bisexual individuals assigned female at birth are more likely to have excess body weight than their heterosexual counterparts, with lower rates of leisure-time physical activity contributing to the disparity. Excess weight is a risk factor in at least 12 types of cancer.

HIV status: Gay and bisexual men have substantially higher rates of HIV infection, and people living with HIV have elevated risk for multiple cancers, including non-Hodgkin lymphoma, Kaposi sarcoma, and anal cancer, as well as certain non-AIDS-defining cancers.

The ACS authors were careful to frame these risk factors as products of social and structural conditions, not inherent properties of LGBTQ+ identity. The minority stress model, which documents how chronic exposure to discrimination, stigma, and social marginalization produces downstream health consequences, is the framework that best explains these patterns.

Lower screening rates and later-stage diagnoses

The disparities are not limited to risk exposure. They extend to cancer detection.

At the 2024 ASCO Annual Meeting, researchers presented findings from a study of 817 LGBTQ+ cancer patients: 80% had not received appropriate cancer screening for their age. The reasons were not primarily attitudinal. They reflected structural barriers: the provider did not mention screening, the patient did not have a provider for routine care, and lack of insurance. Avoidance of healthcare settings due to prior experiences of discrimination was also a significant contributing factor.

NCI’s Cancer Currents Blog summarized the evidence clearly: there is consistent evidence that SGM people are less likely to seek care for possible cancer symptoms, and as a result their cancers may be diagnosed at more advanced stages. Later-stage diagnosis is one of the most powerful predictors of worse outcomes in most cancer types.

Worse experiences during cancer care

A 2025 study from the Moffitt Cancer Center published in JNCI Monographs analyzed real-world SOGI data collected at an NCI-designated comprehensive cancer center and found that SGM individuals with a history of cancer report significantly greater distress, relationship difficulties, substance use, dissatisfaction with cancer care, and lower quality of life compared with heterosexual and cisgender counterparts.

A 2023 study in JAMA Oncology examining breast cancer in sex and gender minority groups found disparities in diagnosis, treatment, and outcomes compared to cisgender women. And a 2025 review in PMC covering breast cancer disparities in LGBTQ+ communities concluded that disparities exist from screening through survivorship and lead to measurably worse outcomes.

The Root Cause: You Cannot Fix What You Cannot Measure

If there is a single structural problem behind LGBTQ+ cancer disparities, it is the routine failure to ask patients who they are.

Sexual orientation and gender identity (SOGI) data refers to the collection of patients’ sexual orientation and gender identity in clinical intake and electronic health records. Most health systems in the United States do not do this consistently or at all. When oncology teams do not know a patient is gay, bisexual, transgender, or nonbinary, they cannot screen for subgroup-specific risks, connect the patient to appropriate support services, or enroll them in research studies that could generate knowledge about their population.

The consequences are not merely administrative. A transgender woman who presents with breast symptoms may receive different clinical attention than a cisgender woman. A gay man’s partner may not be included in care conversations in the same way as a heterosexual spouse. A nonbinary patient’s need for survivorship support that accounts for their identity may simply not be addressed.

A 2025 JNCI Monographs paper on SOGI data collection in oncology described the problem directly: a standardized approach to collecting accurate SOGI data is critical to best serving LGBTQ+ patients’ cancer care needs, fully understanding the scale of disparities, and generating the research needed to address them. The paper called for best practices for SOGI collection and dissemination across cancer centers.

Why SOGI data collection is harder than it sounds, and why it is still the right target Healthcare providers sometimes resist SOGI data collection out of concern that patients will find the questions intrusive or that the data will be used inappropriately. The research does not support this concern. Multiple studies have shown that most patients, including LGBTQ+ patients, are willing to disclose SOGI information when asked in a respectful, standardized clinical context, and that they consider it important for their care. The barriers are primarily on the provider and system side, not the patient side. Implementation requires: standardized, validated questions in intake workflows (the “Do Ask, Do Tell” framework from The Fenway Institute); training staff in respectful, inclusive communication; integrating SOGI fields into electronic health record systems; and using the data for clinical decision support rather than collecting it and ignoring it. None of these steps are technically complex. They require institutional commitment.

What the Research Community Is Doing About It

The evidence base for LGBTQ+ cancer disparities has grown substantially in the past five years, but the research infrastructure to support it has lagged behind. Several developments are beginning to address that gap.

The Q Cancer Research Center

In Spring 2026, the American Cancer Society funded a new Cancer Health Research Center (CHERC) at the University of Rochester: the Q Cancer Research Center. It is designed as a national center without walls, meaning its scope extends beyond a single institution.

The Q Cancer Research Center’s funded projects specifically address three of the gaps identified above: improving the standardized collection of SOGI data in clinical settings, developing survivorship programs tailored to LGBTQ+ patients’ specific needs and identities, and training a new generation of researchers with expertise in LGBTQ+ cancer health equity. The center’s structure as a national collaborative rather than a site-specific program is designed to generate findings and tools that can be implemented broadly.

NCI investment in SGM cancer research

The National Cancer Institute has developed a dedicated funding opportunity for research on cancer care and outcomes in SGM cancer survivors, and launched the SGM Cancer CARE program to train 150 early-career investigators over five years. The first national conference dedicated to SGM cancer research was held in October 2023, with nearly 200 attendees, marking a recognition within the research community that this field needs its own infrastructure.

Growing clinical recognition

The American Society for Clinical Oncology (ASCO) has recognized SGM communities as a population experiencing health disparities and has increasingly incorporated SGM health equity into its conference programming and clinical guidance development. The Fenway Institute maintains the “Do Ask, Do Tell” SOGI data collection framework and training resources for clinical teams. The National LGBT Cancer Network provides patient navigation and provider education specifically focused on LGBTQ+ cancer care.

What This Means for Patients and Clinicians

For LGBTQ+ patients navigating cancer screening and care

The disparities documented in the research are real but they are not inevitable. They are products of structural barriers, not immutable characteristics of LGBTQ+ identity. Several resources exist specifically to support LGBTQ+ patients in cancer prevention and care:

The National LGBT Cancer Network provides education, advocacy, and referrals to inclusive cancer care providers
GLMA: Health Professionals Advancing LGBTQ+ Equality maintains a provider directory of LGBTQ-affirming healthcare professionals
The Fenway Institute is a clinical and research center with deep expertise in LGBTQ+ health, including cancer
NCI’s cancer screening resources provide evidence-based information on recommended screening by cancer type; discussions with any provider should account for individual anatomy and history, not assumed demographics

If you have experienced discrimination or inadequate care in oncology settings because of your sexual orientation or gender identity, that experience is well-documented and not isolated. Seeking a second opinion from a provider with LGBTQ+ health expertise is a reasonable step.

For oncology clinicians and care teams

The single most actionable change most clinical settings can make is implementing standardized SOGI data collection at intake. The Fenway Institute’s “Do Ask, Do Tell” resources provide validated question formats and implementation guidance. Collecting this data is not sufficient on its own; care teams need to use it to inform clinical conversations, support navigation to LGBTQ+-specific resources, and report it in ways that can be aggregated for research.

Survivorship care plans should explicitly address LGBTQ+ patients’ specific needs, including the intersection of gender-affirming hormone therapy with cancer treatment decisions, the mental health burden associated with minority stress, and the importance of including chosen family and partners in care conversations.

For related women’s health and cancer coverage on Health Evidence Digest, see our posts on the first approved immunotherapy for ovarian cancer, cervical cancer screening guidelines for 2026, and AI-supported mammography and the MASAI trial findings.

Sources

ACS 2024 LGBTQ+ Cancer Special Section: American Cancer Society. Cancer Facts and Figures 2024 Special Section: Cancer in People Who Identify as Lesbian, Gay, Bisexual, Transgender, and/or Queer. cancer.org.

ACS LGBTQ+ Report press release (2024): American Cancer Society Releases Pioneering LGBTQ+ Cancer Report. pressroom.cancer.org. May 2024.

NCI Cancer Currents LGBTQ+ disparities: Cancer Health Disparities Among LGBTQ+ People. cancer.gov. May 2024.

Moffitt SOGI data study (JNCI Monographs 2025): Zamani SA, Pérez-Morales J, et al. Sexual orientation and gender identity data reveals real-world cancer disparities among sexual and gender minorities at an NCI-Designated Comprehensive Cancer Center. JNCI Monographs. 2025;69:76-87. doi:10.1093/jncimonographs/lgaf017. PMC12268166.

SOGI data collection best practices (JNCI Monographs 2025): Developing, implementing, and disseminating best practices for SOGI collection among cancer patients. JNCI Monographs. 2025;69:96. doi:10.1093/jncimono/lgaf016.

ASCO 2024 LGBTQ+ screening abstract: Maingi S, Schabath MB, Dewald I, et al. Disparities uncovered: LGBTQ+ patients report on their cancer care journey. ASCO 2024. Abstract 1516.

Breast cancer LGBTQ+ disparities (JAMA Oncology 2023): Eckhert E et al. Breast cancer diagnosis, treatment, and outcomes of patients from sex and gender minority groups. JAMA Oncol. 2023;9(4):473-480.

Breast cancer LGBTQ+ review (PMC 2025): Breast Cancer Disparities in the LGBTQ+ Community. PMC12320750.

Gallup LGBTQ+ identification data: LGBT Identification in U.S. Ticks Up to 7.6%. Gallup.

Minority stress model reference: Meyer IH. Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations. Psychol Bull. 2003.