Higher Cancer Risks for Gay and Bisexual Men: Prevention and Screening

Kenneth Mayer, MD, the medical research director and cochair of the Fenway Institute in Boston, suggests four actions that reduce the risk of cancer for gay and bisexual men:

• Stop smoking (which is good advice for everyone)
• Drink less (also good advice for everyone)
• Get vaccinated for HPV and viral hepatitis
• Get tested for HIV (also good advice for everyone)

HPV Vaccination

HPV vaccines have been used for over 15 years and are now approved for boys and men between ages 9 and 45. The thinking behind the age cutoff is that by midlife, most men have had the bulk of their sexual partners and therefore have already been exposed to many strains of HPV. But Mayer says there is still value in getting vaccinated later in life.

“Even if you can reduce your risk of cancer by 5 percent, I think [getting vaccinated is] worth it,” he says. “There are no downsides to the vaccination as long as you can afford it out of pocket.”

Most insurers will not cover the cost of HPV vaccination if you’re over 45, making a full series of three shots a serious financial strain. And the verdict is still out on how effective HPV vaccines are in preventing oropharyngeal cancers.

Hepatitis B Vaccination

People chronically infected with hepatitis B have a greater lifetime risk of liver cancer. According to the CDC, gay and bi men and MSM have a greater risk of hepatitis B, which spreads through semen and blood during sexual activity. Hepatitis A is commonly passed through the stool to the mouth, and is another risk to the liver. The CDC recommends that all men who have sex with men get vaccinated for hepatitis A and B.

HIV Testing

HIV is a strong predictor of greater risk of anal cancer, partly because condomless sex is a driver of HIV as well as HPV and hepatitis B. A positive HIV test result should alert a doctor to order other screening tests. Because your primary care doctor might not automatically prescribe these tests, it may be up to you to ask for them. That requires getting comfortable talking about your sexual practices.