Half of my professional time is spent encouraging LGBT people to take better care of our health. The other half of my time is spent facilitating support groups for LGBT cancer survivors. Yet, I never imagine that poor "lifestyle choices" brought about their cancer.
It's normal to want the cause for illness to be something within our control. The ideas of randomness and bum luck are nearly too much for us to bear. I experienced this first hand when my mother was diagnosed with emphysema, and people appeared to withhold their sympathy until they found out if she had smoked cigarettes. The relationship between our lives and our health is more complex than that.
LGBT people live with a cancer paradox: we have to do all we can to protect our health now because much of our adult cancer risk is caused by what we had to do to survive in our youth.
Increasing evidence suggests that, especially for LGBT people, the cancer risk wheels are set in motion in childhood. A powerful recent study found that sexual minority youth were more likely to engage in 12 cancer risk behaviors than their heterosexual peers. The dozen behaviors, all of which increase their chances of getting cancer as adults, include tobacco use, multiple sexual partners, alcohol use, higher body mass index and lack of exercise.
To a large extent, our youth are engaging in unhealthy behaviors as a consequence of being victimized for their sexual orientation and gender identity by their peers. They are turning to tobacco, alcohol and unsafe sex to cope with bullying. I wish they didn't, but it sure beats suicide. They did what they could to survive and they deserve my praise for having made it through alive.
The effects of childhood bullying last into adulthood. Another recent study found that those who had been bullied in childhood were more likely to have poor physical and psychological health as adults, including increased risk for depression, anxiety disorders, and suicidal thoughts. In addition to the health problems, the adult survivors of childhood bullying often lacked a social support system, had lower educational levels, higher levels of unemployment, and less general satisfaction with life.
This doesn't mean that cancer is inevitable and there is no point in trying to eat and live well now, but it does suggest that we need to focus more energy on removing the early causes of cancer and its stigma. We need to offer more support to our cancer survivors. And, maybe our health messages need to be rewritten if we want to reach those who are already living with increased stress.
Meanwhile, the connection between diet and cancer is turning out to be much weaker than we originally thought. Twenty years ago, we were convinced that fiber, red meat and vegetables were all having a strong impact on our health. Today, for better or for worse, we know that the relationship is more complicated. Some say we can forget the link between dairy products and pancreatic cancer. There is less convincing evidence that fruits and vegetables are protective against cancer. And, no, colon and thyroid cancer cannot be avoided by eating broccoli, cabbage and brussels sprouts.
The relationship between our diet and cancer risk may be complicated, but it is not insignificant. Vegetables do have an impact on estrogen-negative breast cancers. Drinking to excess is still unhealthy. Tobacco really does cause multiple health problems, including cancer. And, clearly, being fat is not healthy, even if eating fat is less harmful than we originally thought.
Where does that leave us? Don't throw up your hands or give up your gym membership. I have three suggestions.
1. Live like your life is worth saving. Do your best to eat well, regularly move your body and find support to help you quit smoking.
2. Stay up to date with your cancer screenings. When caught early, many cancers are highly treatable. Under Obamacare, cancer screenings are covered by insurance, without requiring a co-pay.
3. If someone you know gets cancer, offer to be part of the support system. Don't spend a minute silently wondering about the cause. The etiology of cancer is complicated and capricious and we only understand part of the story so far.
For more information about LGBT cancer support groups, visit www.cancer-network.org