People who identify as lesbian, gay, bisexual, or transgender (LGBT) may experience differences in outcomes or experiences across the cancer pathway compared to the general population. This chapter describes the cancer trajectory of people who identify as LGBT in Australia and New Zealand, drawing on available evidence regarding cancer risk factors, HPV vaccination, cancer screening, cancer incidence, treatment, and survivorship experiences, and importantly, substantial gaps in knowledge are highlighted. Though gains are being made in terms of social and legal equality for LGBT people in both Australia and New Zealand, there are ongoing areas of disparity that may leave LGBT people vulnerable an increased level of some cancer risk factors, as well as inferior cancer-related experiences and outcomes. Greater inclusivity of LGBT people in population-level data collection is urgently needed to address gaps in knowledge regarding cancer risk factors and participation in preventive health care, incidence, and outcomes, with research also required to understand and address disparities in experiences of LGBT people as they navigate each step of the cancer pathway, from screening to survivorship or end-of-life care.
- Gender and sexual minorities
- Transgender persons
This is a preview of subscription content, access via your institution.
Tax calculation will be finalised at checkout
Purchases are for personal use onlyLearn about institutional subscriptions
Price E. LGBT sexualities in social care research. London: School for Social Care Research, London School of Economics and Political Science; 2011.
MacCarthy S, Reisner SL, Nunn A, Perez-Brumer A, Operario D. The time is now: attention increases to transgender health in the United States but scientific knowledge gaps remain. LGBT Health. 2015;2(4):287–91.
Witten T, Eyler E. Transgender and aging: beings and becomings. In: Witten T, Eyler E, editors. Gay, lesbian, bisexual & transgender aging: challenges in research, practice & policy. Baltimore: John Hopkins University Press; 2012.
Cover, R. Emergent Identities: new sexualities, genders and relationships in a digital era. United Kingdom, Taylor & Francis, 2018.
Tordoff D, Andrasik M, Hajat A. Misclassification of sex assigned at birth in the behavioral risk factor surveillance system and transgender reproductive health: a quantitative bias analysis. Epidemiology. 2019;30(5):669–78.
Newman CE, Smith AKJ, Duck-Chong E, Vivienne S, Davies C, Robinson KH, et al. Waiting to be seen: social perspectives on trans health. Health Sociol Rev. 2021;30(1):1–8.
Bauer G, Hammond R, Travers R, Kaay M, Hohenadel K, Boyce M. “I don’t think this is theoretical; this is our lives”: how erasure impacts health care for transgender people. J Assoc Nurses AIDS Care. 2009;20(5):348–61.
(APRA), A.P.R.A. Quarterly private health insurance statistics September 2020. 2020.
Australian Institute of Health and Welfare. Health expenditure Australia 2015–16. Health and welfare expenditure series no. 58. Cat. no. HWE 68. Canberra: AIHW; 2017.
Ministry of Health. Private health insurance coverage 2011–15: New Zealand Health survey. Wellington: Ministry of Health; 2016.
OECD. Country note: how does health spending in New Zealand compare? 2015.
Australian Bureau of Statistics. General social survey: summary results, Australia. 2020 [28 November 2020]. Available from: https://www.abs.gov.au/statistics/people/people-and-communities/general-social-survey-summary-results-australia/latest-release.
Australian Bureau of Statistics. Same-sex couples in Australia. 2016. [30 November 2020]. Available from: http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0~2016~Main%20Features~Same-Sex%20Couples~85.
Ministry of Health. Sexual orientation: findings from the 2014/15 New Zealand health survey. Wellington: Ministry of Health; 2019.
Collin L, Reisner SL, Tangpricha V, Goodman M. Prevalence of transgender depends on the “case” definition: a systematic review. J Sex Med. 2016;13(4):613–26.
William Leonard MP, Mitchell A, Lyons A, Smith A, Patel S, Couch M, Barrett A. Private lives 2: the second national survey of the health and wellbeing of gay, lesbian, bisexual and transgender (GLBT) Australians. In: Monograph series number 86. Melbourne: The Australian Research Centre in Sex, Health & Society, La Trobe University; 2012.
Karp P. ABS said census questions on gender and sexual orientation risked public backlash. The Guardian. 2019.
Stats NZ. Sex, gender, and sexual orientation. 2019 [28 November 2020]. Available from: https://www.stats.govt.nz/reports/sex-gender-and-sexual-orientation.
Hughes M. Health and well being of lesbian, gay, bisexual, transgender and intersex people aged 50 years and over. Aust Health Rev. 2018;42(2):146–51.
Jones T, del pozo de Bolger A, Dune T, Lykins A, Hawkes G. Female-to-male (FtM) transgender people’s experiences in Australia: a national study. Switzerland: Springer International Publishing; 2015.
Power J, Brown R, Schofield M, Pitts M, McNair R, Perlesz A, et al. Social connectedness among lesbian, gay, bisexual, and transgender parents living in metropolitan and regional and rural areas of Australia and New Zealand. J Community Psychol. 2014;42(7):869–89.
McNair R, Andrews C, Parkinson S, Dempsey D. GALFA LGBTQ homeless research project: final report. Melbourne: The University of Melbourne & Swinburne University of Technology; 2017.
Riggs D, Ansara G, Treharne G. An evidence-based model for understanding the mental health experiences of transgender Australians. Aust Psychol. 2015;59(1):32–9.
Kerr L, Fisher CM, Jones T. TRANScending discrimination in health & cancer care: a study of trans & gender diverse Australians. Melbourne: Australian Research Centre in Sex, Health & Society, La Trobe University; 2019.
Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL. Sexual orientation and mental health in a birth cohort of young adults. Psychol Med. 2005;35(7):971–81.
Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mental health problems and suicidality in young people? Arch Gen Psychiatry. 1999;56(10):876–80.
Veale J, Byrne J, Tan KKH, Guy S, Yee A, Nopera TM-L, Bentham R. Counting ourselves: the health and wellbeing of trans and non-binary people in Aotearoa New Zealand. Hamilton: Transgender Health Research Lab, University of Waikato; 2019.
Burkhalter JE, Margolies L, Sigurdsson HO, Walland J, Radix A, Rice D, et al. The national LGBT cancer action plan: a white paper of the 2014 national summit on cancer in the LGBT communities. LGBT Health. 2016;3(1):19–31.
Gibson AW, Radix AE, Maingi S, Patel S. Cancer care in lesbian, gay, bisexual, transgender and queer populations. Future Oncol. 2017;13(15):1333–44.
Quinn GP, Sanchez JA, Sutton SK, Vadaparampil ST, Nguyen GT, Green BL, et al. Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations. CA Cancer J Clin. 2015;65(5):384–400.
Stein CJ, Colditz GA. Modifiable risk factors for cancer. Br J Cancer. 2004;90(2):299–303.
Australian Institute of Health and Welfare. Australia’s health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW; 2018.
Saphira M, Glover M. The effects of coming out on relationships and health. J Lesbian Stud. 2001;5(1–2):183–94.
Deacon RM, Mooney-Somers J. Smoking prevalence among lesbian, bisexual and queer women in Sydney remains high: analysis of trends and correlates. Drug Alcohol Rev. 2017;36(4):546–54.
Mooney-Somers J, Deacon RM, Scott P, Price K, Parkhill N. Women in contact with the Sydney LGBTQ communities: report of the SWASH lesbian, bisexual and queer women’s health survey 2014, 2016, 2018. Sydney: Sydney Health Ethics, University of Sydney; 2018.
Brown R, McNair R, Szalacha L, Livingston PM, Hughes T. Cancer risk factors, diagnosis and sexual identity in the Australian Longitudinal Study of Women’s Health. Womens Health Issues. 2015;25(5):509–16.
Kolstee J, Deacon RM, Haidar S, Gray J, Mooney-Somers J. Changes in social networks are associated with lesbian, bisexual and queer women quitting smoking: an analysis of Australian survey data. Drug Alcohol Rev. 2019;38(1):76–81.
Praeger R, Roxburgh A, Passey M, Mooney-Somers J. The prevalence and factors associated with smoking among lesbian and bisexual women: analysis of the Australian National Drug Strategy Household Survey. Int J Drug Policy. 2019;70:54–60.
McNair R, Pennay A, Hughes TL, Love S, Valpied J, Lubman DI. Health service use by same-sex attracted Australian women for alcohol and mental health issues: a cross-sectional study. BJGP Open. 2018;2(2):bjgpopen18X101565.
Pennay A, McNair R, Hughes TL, Leonard W, Brown R, Lubman DI. Improving alcohol and mental health treatment for lesbian, bisexual and queer women: identity matters. Aust N Z J Public Health. 2018;42(1):35–42.
Clackett S, Hammoud MA, Bourne A, Maher L, Haire B, Jin F, Lea T, Degenhardt L, Bath N, Mackie B, Batrouney C, Prestage G. Flux: following lives undergoing change 2014–2017 surveillance report. Sydney: The Kirby Institute, UNSW; 2018.
Australian Bureau of Statistics. National health survey: first results. 2018 [27 November 2020]. Available from: https://www.abs.gov.au/statistics/health/health-conditions-and-risks/national-health-survey-first-results/latest-release.
Prestage G, Hammoud M, Jin F, Degenhardt L, Bourne A, Maher L. Mental health, drug use and sexual risk behavior among gay and bisexual men. Int J Drug Policy. 2018;55:169–79.
Cheung AS, Ooi O, Leemaqz S, Cundill P, Silberstein N, Bretherton I, et al. Sociodemographic and clinical characteristics of transgender adults in Australia. Transgend Health. 2018;3(1):229–38.
Boza C, Nicholson Perry K. Gender-related victimisation, perceived social support, and predictors of depression among transgender Australians. Int J Transgend. 2014;15(1):35–52.
Ministry of Health. Annual update of key results 2016/17: New Zealand health survey. 2017 [November 27 2020]. Available from: https://www.health.govt.nz/publication/annual-update-key-results-2016-17-new-zealand-health-survey.
Ministry of Health. Obesity statistics. 2020 [20 November 2020]. Available from: https://www.health.govt.nz/nz-health-statistics/health-statistics-and-data-sets/obesity-statistics.
Denison E, Kitchen A. Out on the fields. The first international study of homophobia in sport. 2015. Available from www.outonthefields.com.
Symons C, Sbaraglia M, Hillier L, Mitchell A. Come out to play. The sports experiences of lesbian, gay, bisexual and transgender (LGBT) people in Victoria. Victoria: Institute of Sport, Exercise and Active Living and the School of Sport and Exercise Science at Victoria University; 2010.
Australian Human Rights Commission. Guidelines for the inclusion of transgender and gender diverse people in sport. Sydney; 2019
Lee E, Mao L, Broady T, Bavinton B, McKenzie T, Batrouney C, Malholtra S, Manwaring J, West M, Prestage G, Holt M. Gay community periodic survey: Melbourne 2018. Sydney: Centre for Social Research in Health, UNSW Sydney; 2018.
UNSW. Gay community periodic surveys. [14 November 2021]. Available from: https://www.unsw.edu.au/arts-design-architecture/our-research/research-centres-institutes/centre-social-research-health/our-projects/gay-community-periodic-surveys.
Callander D, Wiggins J, Rosenberg S, Cornelisse V, Duck-Chong E, Holt M, Pony M, Vlahakis E, MacGibbon J, Cook T. The 2018 Australian trans and gender diverse sexual health survey: report of findings. Sydney: Kirby Institute. https://doi.org/10.26190/5d7ed96ceaa70. https://tgdsexualhealth.com/.
Saxton PJ, Dickson NP, Hughes AJ, Ludlam AH. Infrequent condom use with casual partners among New Zealand gay and bisexual men. N Z Med J. 2015;128(1426):49–61.
Poynten IM, Jin F, Templeton DJ, Prestage GP, Donovan B, Pawlita M, et al. Prevalence, incidence, and risk factors for human papillomavirus 16 seropositivity in Australian homosexual men. Sex Transm Dis. 2012;39(9):726–32.
Poynten IM, Tabrizi SN, Jin F, Templeton DJ, Machalek DA, Cornall A, et al. Vaccine-preventable anal human papillomavirus in Australian gay and bisexual men. Papillomavirus Res. 2017;3:80–4.
Templeton DJ, Williamson C, Jin F, Hillman RJ, Roberts JM, Law C, et al. Prevalence and associations of larger burden of intra-anal high-grade squamous intraepithelial lesions at baseline in an Australian cohort of gay and bisexual men: the study of the prevention of anal cancer. Cancer Epidemiol. 2020;64:101661.
Kirby Institute. SPANC: study of the prevention of anal cancer [20 November 2020]. Available from: https://kirby.unsw.edu.au/project/spanc.
Poynten IM, Stein AN, Conway EL, Prestage G, Regan DG, Jin F, et al. Geographical clustering of anal cancer incidence in Australia. Sex Health. 2012;9(6):509–12.
Ong JJ, Chen M, Tabrizi SN, Cornall A, Garland SM, Jin F, et al. Anal HPV detection in men who have sex with men living with HIV who report no recent anal sexual behaviours: baseline analysis of the Anal Cancer Examination (ACE) study. Sex Transm Infect. 2016;92(5):368–70.
Petoumenos K, van Leuwen MT, Vajdic CM, Woolley I, Chuah J, Templeton DJ, et al. Cancer, immunodeficiency and antiretroviral treatment: results from the Australian HIV Observational Database (AHOD). HIV Med. 2013;14(2):77–84.
Austalian Government Department of Health. Eighth national HIV strategy 2018–2022. Canberra: Department of Health.
Saxton PJ, Dickson NP, Griffiths R, Hughes AJ, Rowden J. Actual and undiagnosed HIV prevalence in a community sample of men who have sex with men in Auckland, New Zealand. BMC Public Health. 2012;12:92.
Saxton PJ, Dickson NP, McAllister SM, Hughes AJ, Sharples K. HIV prevalence among men who have sex with men in New Zealand 1985–2009: 25 years of public health monitoring. Int J STD AIDS. 2012;23(4):274–9.
The Kirby Institute. Hepatitis B and C in Australia annual surveillance report supplement 2016. Sydney: The Kirby Institute, UNSW Australia; 2016.
Lockwood J, Gray J, Selvey C. Undiagnosed hepatitis B and C infection is rare in Sydney gay and bisexual men attending a community HIV testing site. Sex Health. 2017;14(3):296–7.
McFarlane T, Zajac JD, Cheung AS. Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals-a systematic review. Clin Endocrinol. 2018;89(6):700–11.
Lienhoop T, Smetko M, Green L. Breast cancer in transgender women: a case report. Clin Imaging. 2020;68:20–3.
Pattison ST, McLaren BR. Triple negative breast cancer in a male-to-female transsexual. Intern Med J. 2013;43(2):203–5.
Treskova I, Hes O, Bursa V. Long-term hormonal therapy resulting in breast cancer in female-to-male transsexual: case report. Medicine (Baltimore). 2018;97(52):e13653.
Stone JP, Hartley RL, Temple-Oberle C. Breast cancer in transgender patients: a systematic review. Part 2: female to male. Eur J Surg Oncol. 2018;44(10):1463–8.
Hyde Z, Doherty M, Tilley M, McCaul K, Rooney R, Jancey J. The first Australian national trans mental health study: summary of results. Perth: School of Public Health, Curtin University; 2014.
Peitzmeier S, Gardner I, Weinard J, Corbet A, Acevado K. Health impact of chest binding among transgender adults: a community-engaged, cross-sectional study. Cult Health Sex. 2017;19(1):64–75.
Wolf-Gould C, Wolf-Gould C. A transgender woman with testicular cancer: a new twist on an old problem. LGBT Health. 2016;3(1):90–5.
Chow EPF, Tabrizi SN, Fairley CK, Wigan R, Machalek DA, Garland SM, et al. Prevalence of human papillomavirus in young men who have sex with men after the implementation of gender-neutral HPV vaccination: a repeated cross-sectional study. Lancet Infect Dis. 2021;21(10):1448–57.
Australian Institute of Health and Welfare. Cervical screening in Australia 2018. Canberra: AIHW; 2018.
Saphira M, Glover M. New Zealand national lesbian health survey. J Gay Lesbian Med Assoc. 2000;4:49–56.
Curmi C, Peters K, Salamonson Y. Barriers to cervical cancer screening experienced by lesbian women: a qualitative study. J Clin Nurs. 2016;25(23–24):3643–51.
Curmi C, Peters K, Salamonson Y. Lesbians’ attitudes and practices of cervical cancer screening: a qualitative study. BMC Womens Health. 2014;14:153.
Tamargo CL, Quinn GP, Sanchez JA, Schabath MB. Cancer and the LGBTQ population: quantitative and qualitative results from an oncology providers’ survey on knowledge, attitudes, and practice behaviors. J Clin Med. 2017;6(10):93.
Beswick A, Corkum M, D’Souza D. Locally advanced cervical cancer in a transgender man (PRACTICE: CASES: VULNERABLE POPULATIONS: CPD). CMAJ. 2019;191(3):E76–8.
Brown B, Poteat T, Marg L, Galea JT. Human papillomavirus-related cancer surveillance, prevention, and screening among transgender men and women: neglected populations at high risk. LGBT Health. 2017;4(5):315.
Cancer Australia. Cancer incidence. 2019 [5 August 2020]. Available from: https://ncci.canceraustralia.gov.au/diagnosis/cancer-incidence/cancer-incidence.
Ministry of Health. Cancer: historical summary 1948–2017. 2020 [29 November 2020]. Available from: health.govt.nz/publication/cancer-historical-summary-1948-2017.
Australian Institute of Health and Welfare. Australasian Association of Cancer Registries. 2020 [cited 2020 27th of May]. Available from: https://www.aihw.gov.au/about-our-data/our-data-collections/aacr.
Poynten IM. Current policy and research on cancer in LGBT communities internationally. In: Boehmer U, Elk R, editors. Cancer and the LGBT community: unique perspectives from risk to survivorship. Cham: Springer International Publishing; 2015. p. 293–311.
Meads C, Moore D. Breast cancer in lesbians and bisexual women: systematic review of incidence, prevalence and risk studies. BMC Public Health. 2013;13:1127.
Quinn GP, Alpert AB, Sutter M, Schabath MB. What oncologists should know about treating sexual and gender minority patients with cancer. JCO Oncol Pract. 2020;16(6):309–16.
Margolies L, Brown CG. Current state of knowledge about cancer in lesbians, gay, bisexual, and transgender (LGBT) people. Semin Oncol Nurs. 2018;34(1):3–11.
Jin F, Vajdic CM, Law M, Amin J, van Leeuwen M, McGregor S, et al. Incidence and time trends of anal cancer among people living with HIV in Australia. AIDS. 2019;33(8):1361–8.
van Leeuwen MT, Vajdic CM, Middleton MG, McDonald AM, Law M, Kaldor JM, et al. Continuing declines in some but not all HIV-associated cancers in Australia after widespread use of antiretroviral therapy. AIDS. 2009;23(16):2183–90.
Australian Human Rights Commission. Resilient individuals: sexual orientation, gender identity & intersex rights. National Consultation Report. 2015.
Dhand A, Dhaliwal G. Examining patient conceptions: a case of metastatic breast cancer in an African American male to female transgender patient. J Gen Intern Med. 2009;25(2):158–61.
Gooren L, Morgentaler A. Prostate cancer incidence in orchidectomised mate-to-female transsexual persons treated with oestrogens. Andrologia. 2013;46(10):1156–60.
Clarke M, Lewin J, Lazarakis S, Thompson K. Overlooked minorities: the intersection of cancer in lesbian, gay, bisexual, transgender, and/or intersex adolescents and young adults. J Adolesc Young Adult Oncol. 2019;8(5):525–8.
Russo S, McCaffery K, Ellard J, Poynten M, Prestage G, Templeton DJ, et al. Experience and psychological impact of anal cancer screening in gay, bisexual and other men who have sex with men: a qualitative study. Psychooncology. 2018;27(1):125–31.
Feeney L, Poynten M, Jin FJ, Cooper C, Templeton DJ, Dwyer MRO, et al. Awareness and knowledge of anal cancer in a community-recruited sample of HIV-negative and HIV-positive gay and bisexual men. Sex Health. 2019;16(3):240–6.
Ussher JM, Perz J, Kellett A, Chambers S, Latini D, Davis ID, et al. Health-related quality of life, psychological distress, and sexual changes following prostate cancer: a comparison of gay and bisexual men with heterosexual men. J Sex Med. 2016;13(3):425–34.
Thomas C, Wootten A, Robinson P. The experiences of gay and bisexual men diagnosed with prostate cancer: results from an online focus group. Eur J Cancer Care (Engl). 2013;22(4):522–9.
Riggs D, Due C. Gender identity Australia: the healthcare experiences of people whose gender identity differs from that expected of their natally assigned sex. Adelaide: School of Social and Policy Studies, Flinders University; 2013.
Beyond Blue. In my shoes: experiences of discrimination, depression, and anxiety among gay, lesbian, bisexual, trans, and intersex people. Hawthorn: Beyond Blue; 2012.
Kerr L, Fisher CM, Jones T. “I’m not from another planet” – the alienating cancer care experiences of trans and gender diverse people. Cancer Nurs. 2021;44(6):E438–46.
Kerr L, Fisher CM, Jones T. Key informants discuss cancer care research for trans and gender diverse people. J Cancer Educ. 2021;36(4):741–6.
Lisy K, Ward A, Schofield P, Hulbert-Williams N, Bishop J, Jefford M. Patient-reported outcomes of sexual and gender minority cancer survivors in Australia. Psychooncology. 2019;28(2):442–4.
Wassersug RJ, Lyons A, Duncan D, Dowsett GW, Pitts M. Diagnostic and outcome differences between heterosexual and nonheterosexual men treated for prostate cancer. Urology. 2013;82(3):565–71.
Thomas C, Wootten AC, Robinson P, Law PCF, McKenzie DP. The impact of sexual orientation on body image, self-esteem, urinary and sexual functions in the experience of prostate cancer. Eur J Cancer Care (Engl). 2018;27(2):e12827.
Ussher JM, Perz J, Rose D, Dowsett GW, Chambers S, Williams S, et al. Threat of sexual disqualification: the consequences of erectile dysfunction and other sexual changes for gay and bisexual men with prostate cancer. Arch Sex Behav. 2017;46(7):2043–57.
Rose D, Ussher JM, Perz J. Let’s talk about gay sex: gay and bisexual men’s sexual communication with healthcare professionals after prostate cancer. Eur J Cancer Care (Engl). 2017;26(1). https://doi.org/10.1111/ecc.12469.
Ussher JM, Perz J, Gilbert E, Australian C, Sexuality Study T. Perceived causes and consequences of sexual changes after cancer for women and men: a mixed method study. BMC Cancer. 2015;15:268.
Drysdale K, Cama E, Botfield J, Bear B, Cerio R, Newman CE. Targeting cancer prevention and screening interventions to LGBTQ communities: a scoping review. Health Soc Care Community. 2021;29(5):1233–48.
Cartwright C, Hughes M, Lienert T. End-of-life care for gay, lesbian, bisexual and transgender people. Cult Health Sex. 2012;14(5):537–48.
Hughes M, Cartwright C. LGBT people’s knowledge of and preparedness to discuss end-of-life care planning options. Health Soc Care Community. 2014;22(5):545–52.
Australian Government Department of Health. Exploratory analysis of barriers to palliative care. issues report on people who identify as lesbian, gay, bisexual, transgender or intersex. 2019.
Better Health Channel. Palliative care for the LGBTI community. 2020 [30 November 2020]. Available from: https://www.betterhealth.vic.gov.au/health/servicesandsupport/Palliative-care-for-the-LGBTI-community.
Palliative Care Victoria. For healthcare professionals. LGBTI people. [30 November 2020]. Available from: https://www.pallcarevic.asn.au/healthcare-professionals/cultural-safety/lgbti-people/.
Editors and Affiliations
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Lisy, K., Peters, M.D.J., Kerr, L., Fisher, C. (2022). LGBT Populations and Cancer in Australia and New Zealand. In: Boehmer, U., Dennert, G. (eds) LGBT Populations and Cancer in the Global Context. Springer, Cham. https://doi.org/10.1007/978-3-031-06585-9_14
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-06584-2
Online ISBN: 978-3-031-06585-9