Lesbian, Gay, Bisexual, and Transgender (LGBT) also known as sexual and gender minority (SGM) populations have been the focus of global attention. Most importantly, LGBT populations have been addressed in the context of human rights in multiple reports and other activities by the United Nations and other international organizations. There is great variation among countries in the recognition of LGBT individuals’ human rights. A global focus on LGBT populations’ health is still limited, with the notable exception of HIV research. This book on LGBT populations and cancer in the global context is, therefore, an important step in that it will broaden the focus on LGBT populations’ health.
Globally, cancer is the second leading cause of death. Cancer morbidity and mortality are increasing disproportionately among populations in lower-income countries. A review conducted by the World Health Organization (WHO) found that of the 82% of member states (158) countries, only 35% of the national cancer control plans addresses vulnerable population, including LGBT populations. These findings reflect an increasing awareness about equity when addressing cancer prevention and control, including LGBT populations.
This book addresses LGBT populations’ cancer burden across countries that range from high- to low-income countries to support efforts in diverse countries that are working towards reducing LGBT populations’ cancer burden. It documents place-specific challenges that impede progress towards reducing the LGBT cancer burden as well as critically assesses the variation in cancer control efforts that target LGBT populations and cancer to support progress at a global scale. This book includes six sections that cover the six WHO regions, with each chapter written by an author from the specific region s/he is covering. Each chapter makes use of a template that contextualizes the region, local data collection/availability, risk factors, cancer prevention, detection, diagnosis, treatment, and survivorship.
Author(s): Ulrike Boehmer, Gabriele Dennert
Publisher: Springer
Year: 2022
Language: English
Pages: 330
City: Cham
WHO Regions
Acknowledgments
Contents
Chapter 1: Foreword: Challenges and Opportunities for LGBT Populations and Cancer in Global Oncology
1.1 Introduction
1.2 Challenges
1.2.1 Societal Challenges
1.2.2 Community Challenges
1.2.3 Interpersonal Challenges
1.2.4 Individual Challenges
1.2.5 Research Challenges
1.3 Opportunities
1.3.1 Societal Opportunities
1.3.2 Community Opportunities
1.3.3 Interpersonal Opportunities
1.3.4 Individual Opportunities
1.3.5 Research Opportunities
1.4 Looking Forward
References
Chapter 2: Introduction
References
Part I: Africa
Chapter 3: A Double Dose of Stigma – Being Gay and Living with Cancer in Kenya
3.1 To Come Out or Not To Come Out?
3.2 It Is All in the Mind
3.3 When Reality Bites
3.4 A Different Way of Thinking
References
Untitled
Chapter 4: Sexual Orientation, Gender Identity and Cancer in South Africa
4.1 Introduction
4.2 Legal Framework and Social Context
4.3 The South African Healthcare System
4.4 Sexual Orientation, Gender Identity and Access to Healthcare
4.5 Cancer Prevalence and Risk Factors
4.6 Conclusion
References
Part II: Americas
Chapter 5: Making the Situation of TLGBI People Around Cancer visible: Observations From the Andean Region
5.1 Introduction
5.2 The Routes of the Investigation on TLGBI Health in the Region
5.3 Health of TLGBI People in the Andean Region
5.4 HIV and AIDS: Matrix of Hegemonic Intervention
5.5 Diagnosis of the Situation of Cancer in TLGBI People
5.6 Final Reflections
References
Chapter 6: Cancer Care Challenges for the LGBT Population in Brazil
6.1 Introduction
6.2 Brazilian Characteristics and the LGBT Context
6.3 Inequalities in Brazil
6.4 The Sistema Único de Saúde (Unified Health System – SUS) and the Care of Persons with Cancer
6.5 Challenges and Threats to the Rights of LGBT People in Brazil
6.6 Barriers and Invisibility of LBGT People Within Health Services
6.7 Policies and Challenges to LGBT Health in Brazil
6.8 Vulnerability and Its Relation to Cancer Care
6.9 Risk Factors and Cancer
6.10 Transgender People
6.11 Cancer Risk in People Living with HIV
6.12 Palliative Care Specificities for LGBT Populations
6.13 How Paulo Freire’s Pedagogy Could Help in the Training of Friendly Health Professionals?
6.14 Final considerations
References
Chapter 7: Cancer and the SGM Population in Canada and the USA
7.1 Introduction
7.2 Prevalence of SGM People in the USA and Canada
7.3 Legal Protections for SGM People
7.4 Socioeconomic Disadvantage
7.4.1 Intersectionality of Socioeconomic Disadvantage
7.5 Health Care Access in Canada and the USA
7.5.1 Cancer Risk Factors
7.6 Health Equity Promotion Model
7.6.1 Barriers to Health Care
7.6.2 Facilitators to Health Care
7.7 Prevention of Cancer Among the SGM Population
7.7.1 HPV Vaccination
7.7.2 Reducing Obesity and Increasing Physical Activity
7.7.3 Smoking Cessation
7.7.4 Alcohol Use Interventions
7.8 Summary
7.9 Cancer Screening
7.9.1 Barriers to Cancer Screening
7.9.2 Facilitators to Cancer Screening
7.10 Summary
7.11 Cancer Survivorship
7.11.1 Prevalence
7.11.2 Sequelae of Cancer Treatment and Physical Health
7.11.3 Psychosocial and Mental Health
7.12 Health Behaviors
7.12.1 Access to Care and Relationships with Health Care Providers
7.12.2 Social Support
7.12.3 Palliative and End-of-Life Care
7.13 Summary and Gaps in the Survivorship Literature for SGM
7.14 Conclusion
References
Part III: South-East Asia
Chapter 8: The South-East Asia Region: Societal Conditions for LGBT Health and Cancer Research
8.1 Introduction
8.2 Legal Situation and LGBT Community Culture
8.3 Cancer in the South-East Asia Region
8.4 LGBT Health Research Across the Cancer Prevention and Control Framework
8.5 Conclusion
References
Part IV: Europe
Chapter 9: The Eurocentralasian Lesbian* Community Perspective on Cancer and LBQ Women: Advocating for More Research and Activism Collaboration
9.1 Introduction
9.2 Lack of Data on Lesbian Health as a Barrier to Effective Advocacy Work
9.3 The Struggles of Lesbian and Other Non-heterosexual Women in Accessing Cancer Care and Healthcare
9.3.1 The Impact of Social Stigma and Discrimination on Lesbian and Other Non-heterosexual Women
9.3.2 The Impact of Gender Inequalities on Lesbian and Other Non-heterosexual Women
9.3.3 The Consequences of Exposure to Multiple Biases for Lesbian and Other Non-heterosexual Women
9.4 Building Resilience: Reactions from the Movement
9.4.1 Examples of Community-Based Support in the Face of Adversity
9.5 Recommendations from the Ground
9.6 Conclusion
References
Chapter 10: LGBT+ and Cancer in the WHO European Region: Current Situation in 12 Eastern European and Central Asian Countries
10.1 Background of the Healthcare System in 12 Eastern European and Central Asian Countries
10.2 Scale of the Problem: The Growing Cancer Burden and Inequalities in the European Region
10.3 Size of the LGBT+ Community in the 12 EECA Countries
10.4 Historical Overview of Legal and Healthcare Environment of LGBT+ Community in the 12 EECA Countries
10.5 “Leaving No One Behind”
10.6 Conclusion
References
Chapter 11: Sexual and Gender Minorities and Cancer in Germany: The Striking Absence of Understanding Their Cancer-related Needs
11.1 Introduction/Background
11.2 Terminology
11.3 Legal Situation of Sexual and Gender Minorities
11.4 Description of SGM Populations
11.5 Socioeconomic Situation of SGM Populations
11.6 General Health Situation of SGM People
11.7 German Health Care System
11.8 Access to Health Care and Cancer Care
11.9 SGM-Specific Access Barriers to Health and Cancer Care
11.10 Cancer in the General Population
11.11 Cancer in SGM People
11.12 Cancer Prevention
11.13 Early Detection of Cancer
11.14 Cancer Treatment, Survivorship, Rehabilitation, and Psycho-Oncology
11.15 End-of-Life Care and Palliative Care
11.16 Social Support, Networks, and Cancer
11.17 Research Situation and Research Gaps
11.18 Conclusions
References
Chapter 12: LGBT Populations and Cancer in the UK
12.1 Introduction
12.1.1 Terminology
12.1.2 Prevalence of Minority Sexual Orientation and Gender Identity
12.1.3 Health Service Structure in the UK
12.1.4 Cancer Screening in the UK
12.1.5 Monitoring of Sexual Orientation and Gender Identity
12.1.6 Gender Identity Care in the UK
12.1.7 Healthcare Provider Education on LGBT Healthcare Needs
12.2 Sexual Orientation
12.2.1 Risk Factors
12.2.1.1 Smoking
12.2.1.2 Alcohol
12.2.1.3 Diet
12.2.1.4 Obesity
12.2.1.5 Physical Inactivity/Activity/Exercise
12.2.1.6 Infections
12.2.2 Prevention
12.2.3 Detection
12.2.3.1 Breast Screening
12.2.3.2 Bowel Screening
12.2.3.3 Cervical Screening
12.2.4 Diagnosis
12.2.4.1 Breast Cancer
12.2.4.2 Cancer Risk Estimates
12.2.5 Treatment
12.2.5.1 Cancer Care Experience
12.2.5.2 Examples of More Appropriate Care
12.2.6 Survivorship and End-of-Life Care
12.3 Gender Identity
12.3.1 Risk Factors
12.3.1.1 Smoking
12.3.1.2 Alcohol
12.3.1.3 Diet, Obesity and Physical Activity
12.3.1.4 HIV
12.3.1.5 Cross-Sex Hormones
12.3.2 Prevention
12.3.3 Detection
12.3.4 Diagnosis and Incidence
12.3.5 Treatment
12.3.6 Survivorship
12.4 Conclusion
References
Part V: Eastern Mediterranean
Chapter 13: LGBT Populations and Cancer in the Eastern Mediterranean Region: Insights and Challenges with a Focus on Lebanon
13.1 Cancer Epidemiology in the Eastern Mediterranean Region
13.2 Religion
13.3 Family and Society
13.4 Legal Context
13.5 Activism
13.6 Healthcare
13.7 Cancer Screening and Diagnosis
13.8 Conclusion
References
Part VI: Western Pacific
Chapter 14: LGBT Populations and Cancer in Australia and New Zealand
14.1 A Note on Terminology
14.2 LGBT Populations in Australia and New Zealand
14.2.1 Health Care Systems in Australia and New Zealand
14.2.2 Counting LGBT People
14.2.3 Wellbeing of LGBT People and Engagement with Health Care
14.3 Cancer Risk Factors
14.3.1 Alcohol and Tobacco Use in LGBT People
14.3.2 Alcohol and Tobacco Use in Lesbian, Bisexual, and Queer Women
14.3.3 Alcohol and Tobacco Use in Gay and Bisexual Men
14.3.4 Alcohol and Tobacco Use in Trans and Gender Diverse People
14.3.5 Overweight, Obesity, and Physical Activity
14.3.6 Sexual Health
14.3.7 Human Papillomavirus (HPV)
14.3.8 Human Immune Deficiency Virus (HIV)
14.3.9 Hepatitis B
14.3.10 Gender-Affirming Hormone Therapy and Cancer Risk
14.4 Prevention
14.4.1 HPV Vaccination
14.5 Detection
14.5.1 Cancer Screening Programs in Australia and New Zealand
14.5.2 Cervical Screening
14.5.3 Breast Screening
14.5.4 Colorectal and Anal Cancer Screening
14.5.5 Barriers to Screening
14.6 Diagnosis
14.6.1 Incidence of Cancer in LGBT People
14.6.2 Barriers to Diagnosis and Care
14.7 Treatment
14.7.1 Gay and Bisexual Men with Prostate Cancer
14.7.2 Trans and Gender Diverse People
14.8 Survivorship
14.8.1 LGBT Survivorship Experiences
14.8.2 Gay and Bisexual Men After Prostate Cancer
14.8.3 Lesbian and Bisexual Women
14.8.4 Information and Resources
14.8.5 End-of-Life
14.9 Summary
References
Chapter 15: Challenges in Cancer Control Confronting the LGBT Population in China: Health Risks, Unique Barriers, and Unmet Needs
15.1 Introduction
15.2 Challenges in Cancer Control Among Chinese LGBT People
15.2.1 Health Risks
15.2.1.1 Substance Use
15.2.1.2 Sexual Risk Behaviors
15.2.2 Unique Barriers to Health Care Access
15.2.2.1 External Factors
15.2.2.2 Internal Factors
15.2.3 Unmet Needs
15.3 Implications for LGBT Health Care and Cancer Control in China
15.3.1 Culturally Competent Interventions
15.3.2 Clinical Care and Services That Incorporate LGBT Health Care Needs
15.3.3 LGBT-Specific Spaces and Service Providers
15.4 Conclusion
References
Chapter 16: Conclusion: What Have We Learned About Cancer and the Global LGBT Community?
References
Index
