A new study, published online ahead of print by the journal Cancer, has found that gay men are about twice as likely to report being diagnosed with cancer compared with straight men. The study’s lead author, Ulrike Boehmer, PhD, from the Boston University School of Health, told Reuters Health that gay men have much higher rates of cancer risk factors, including HIV, which could partly account for the difference.

Very few studies have examined how sexual orientation affects cancer diagnosis and survival, though numerous studies have documented that gay and bisexual men and women often have poorer health outcomes than heterosexual men and women. The reasons for this are complicated—for example, gay and bi men and women smoke and drink more—but they also frequently encounter a health care system that is at best ignorant of their care needs, and at worst is actually hostile.

To gain a better understanding of cancer survivorship in gay and bi men and women, Boehmer and her colleagues examined data from a large survey on cancer survivorship conducted by the State of California recently, which happened to ask about sexual orientation. The study included surveys completed by more than 120,000 adults residing in the state.

Boehmer’s team found that among the 51,000 men who were surveyed, 8 percent of gay or bisexual men reported having had cancer, while just 5 percent of straight men did so. Of the 71,000 women included in the study, there were no differences in self-reported cancer survival between lesbian or bisexual women and straight women. Lesbian and bi cancer survivors were, however, more likely to rate their current health as fair or poor than straight female cancer survivors, who were more likely to rate their health and good or excellent.

Liz Margolies, executive director of The National LGBT Cancer Network, warned Reuters about drawing too may conclusions from the study, given that it is based on surveys that can’t give a complete picture. She also commented, however, that the lack of hard data on cancer in sexual minorities is “one of the biggest problems we have.”

The study couldn’t control for a few important aspects: the rates of smoking and alcohol consumption and the effect of human papillomavirus (HPV) infection, which can lead to both cervical and anal cancer. Anal cancer is far more prevalent among gay men, and many times more common among HIV-positive gay men.

The bottom line for Margolis is that better care that is sensitive to the needs of gay and bisexual men and women is desperately needed.

“I don’t think that we’re going to get people to have early screening or see doctors except in emergencies…until they can be guaranteed a safe and welcoming experience” at the doctor’s office, she told Reuters.

She also went on to describe the care that men and women need. “Because more gay men report as cancer survivors, we need foremost programs for gay men that focus on primary cancer prevention and early cancer detection,” she explained to Reuters, and concluded: “Because more lesbian and bisexual women than heterosexual women with cancer report that they are in poor health, we need foremost programs and services that improve the well-being of lesbian and bisexual cancer survivors.”