Not all Americans benefit equally from recent improvements in life expectancy and overall health. Differences in the incidence, prevalence, and mortality of disease exist among specific population groups. While health disparities have been routinely characterized by race or ethnicity, the term also refers to gender, age, education, income, social class, disability, geographic location, and sexual orientation since these all have a direct or indirect impact on an individual’s health.¹

Members of the lesbian, gay, bisexual, and transgender (LGBT) community have specific health needs that are often associated with social and structural inequities. The U.S. Department of Health and Human Services (HHS) has worked to promote equal treatment, provide tailored resources, identify specific health needs, improve access to health coverage for LGBT Americans, and improve collection of sexual orientation and gender identity variables in population-based data systems.^2,3 As the nation’s health protection agency within HHS, the Centers for Disease Control and Prevention (CDC) strives to improve the health of LGBT communities by increasing awareness of health care access issues and supporting culturally appropriate and relevant programs and science. Since LBGT populations may be disproportionally affected by certain cancer types, CDC’s Division of Cancer Prevention and Control (DCPC) takes a public health approach to identify opportunities that promote health equity and to establish cancer prevention and control priorities for LGBT populations.⁴ This article provides an overview of DCPC’s current and potential future work in LGBT populations in surveillance and research, public health programs, and public health partnerships.

In 2011, The Institute of Medicine (IOM) identified research gaps and opportunities for LGBT populations, including the need for more LGBT-specific data.⁵ Public health surveillance and research activities are critical for planning, evaluating, and building the evidence base for public health programs. DCPC uses two major types of surveillance systems for cancer data: cancer registries and behavior-based surveys.

CDC promotes adoption of evidence-based cancer screening interventions for underserved populations who experience a disproportionate burden of cancer through two programs. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to breast and cervical cancer screening and diagnostic services to low-income, uninsured and underinsured women.¹⁶ The Colorectal Cancer Control Program (CRCCP) intends to increase colorectal cancer screening rates by implementing evidence-based, population-level strategies to promote colorectal cancer screening and providing screening services.¹⁷ Since neither program includes gender as an eligibility requirement, CDC is able to address the cancer screening needs of LGBT populations who may be uninsured or underinsured. For example, transgender men and women who have taken hormones and meet program eligibility requirements may receive breast cancer screening through the NBCCEDP. Also, transgender men who have not had a bilateral mastectomy or hysterectomy continue to be eligible for breast and cervical cancer screening.²

The National Comprehensive Cancer Control Program (NCCCP) supports a collaborative, data-driven process to reduce cancer risk, find cancers earlier, improve treatments, increase the number of people who survive cancer, and improve the quality of life for cancer survivors.¹⁸ One of the NCCCP priorities includes promoting health equity as it relates to cancer control. Of the 58 programs funded by CDC, there are 5 that include objectives related to LGBT populations. As the surveillance data for LGBT populations become readily available, more NCCCP programs may include objectives that specifically address this population.

Based on the tenants of comprehensive cancer control, DCPC has partnered with CDC’s Office on Smoking and Health to fund the Consortium of National Networks to Impact Populations Experiencing Tobacco-Related and Cancer Health Disparities (National Networks Consortium).¹⁹ It is intended to address tobacco use and cancer in underserved communities in a variety of ways, including enhancing the quality and performance of public health data and information systems and public health practices and services. The National Networks Consortium supports including sexual orientation in tobacco surveillance surveys.²⁰ One of the funded National Networks Consortium partners is LGBT HealthLink and focuses on addressing health disparities in LGBT populations through building capacity for community collaborations, providing education, helping to bridge communication and outreach gaps among LGBT communities and local health providers, and disseminating research findings to support program efforts.²¹

Identifying cancer disparities among LGBT populations and effectively monitoring efforts to reduce them has been limited by a lack of specificity, uniformity, and quality in data collection and reporting procedures.²² Consistent methods for collecting and reporting health data can help advance an understanding of the nature of cancer prevention and control efforts in the LGBT community, and ultimately lead to public health efforts to reduce those disparities and advance health equity.