As gay males, we are at higher risk for certain cancers. We can reduce this risk by changing some fundamental behaviors. The greatest of which is smoking. Not only is this a significant cause of lung cancer, but for those living with HIV, it is known to reduce immune system functions.

HPV, the Human Papilloma Virus, is more challenging for us to avoid because, unfortunately, many of us are already exposed to this virus. Understanding our risks and how we can reduce them is part one of remaining cancer free. The second part is having a positive relationship with your medical provider so that you are screened for these cancers and able to receive quick treatment if the results are positive.

The following six cancers are of growing concern to healthcare providers regarding our community as our rates are either higher than straights or increasing at alarming rates. One of the primary reasons is that gay males are not as likely to be screened for some of these cancers, and fear of homophobia keeps many of us from discussing essential facts about our sexual lives with our doctors.

Gay male cancer rates are the next major health crisis we must address.


Each year anal cancer is diagnosed in about 2 out of every 100,000 people in the general population. Current estimates are that HIV-negative MSMs are 20 times more likely to be diagnosed with anal cancer. Their rate is about 40 cases per 100,000. HIV-positive MSMs are up to 40 times more likely to be diagnosed with the disease, resulting in a rate of 80 anal cancer cases per 100,000 people.


Infection with certain types of human papillomavirus (HPV) increases the risk of most anal cancers. HPV can be spread during sexual activity – including anal and oral sex – but sex doesn’t have to occur for the infection to spread. HPV can be passed from one person to another during skin-to-skin contact with an infected body area. There are both low-risk and high-risk types of HPV. However, low-risk types of HPV don’t develop into cancer, and the body can usually clear most of them by itself. But, high-risk types of HPV can stay in the body and may eventually develop into cancer.

While routine HPV vaccination is recommended to prevent certain cancers that can happen in men, it should be given at ages 9 to 12. However, HPV vaccination is also recommended for males 13 to 26 years of age who have not been vaccinated or received all their doses. HPV vaccination is also recommended through age 26 for men who have sex with men and for people with weakened immune systems (including people with HIV infection) if they have not previously been vaccinated. Vaccination at the recommended ages will help prevent more cancers than vaccination at older ages. If you’re between 27 and 45, talk to your doctor to determine if HPV vaccination might benefit you. 

It’s important to remember that condoms can’t protect entirely because they don’t cover every possible HPV-infected area of the body, such as the skin of the genital or anal area. HPV can still be passed from one person to another by skin-to-skin contact with an HPV-infected area of the body that is not covered by a condom. Still, condoms may provide some protection against HPV.

There is no widely recommended screening test for anal cancer in the U.S. However, some experts recommend screening with a digital rectal exam (DRE) and an anal Pap test for those at high risk for anal cancer. This test has not been studied enough to know how often it should be done or if it helps reduce the risk of anal cancer. But you may want to talk to a provider about whether this test might be proper for you.

Risk Factors

  • Have had many sex partners or unprotected sex (this increases your chance of HPV infection)
  • Smoke
  • Have a weakened immune system because of HIV


A growing number of gay physicians and health activists now believe that routine screening, using an anal pap smear, could reduce the incidence of anal cancer as dramatically as it has cervical cancer in women. They recommend that all MSMs, especially those who are HIV+, be tested every 1-3 years, depending on their immunological well-being and CD4 count. They suggest that HIV-negative individuals be tested every three years. Still, some clinicians are not convinced that routine screening of all MSMs is warranted. They cite the small number of positive cases, the shortage of facilities for follow-up procedures, and the fear, cost, and pain involved in pursuing small cell changes, called dysplasias. In addition, most health insurance policies do not cover anal pap smears.


These may include anal or rectal symptoms such as bleeding, itching, discomfort, pain, swelling, or discharge.


Colorectal cancer (CRC) is the third most common cancer in the U.S. Because sexual orientation data are not included in cancer registries, we do not know the CRC incidence and mortality in sexual minorities. We have inconsistent and limited evidence of greater CRC prevalence in sexual minorities. Among men, we have limited data on a subpopulation of sexual minority men living with HIV infection, indicating that HIV-infected populations presented with a greater prevalence of CRC compared to controls without HIV. 

Risk Factors

  • Inflammatory bowel disease
  • Colon or rectal polyps
  • Personal or family history of colon cancer
  • Type 2 diabetes
  • Smoking
  • Drinking a lot of alcohol
  • Being overweight
  • Not being active
  • Eating a diet with a lot of red and processed meat


Get screened, even if you have no symptoms. Screening tests can often help find polyps before they become cancer. Colorectal cancer can be prevented if pre-cancerous polyps are removed, and regular screening for other problems is done. If colorectal cancer is found during routine screening, it is often at an early stage when it might be easier to treat. 

For all people at average risk of colorectal cancer, the American Cancer Society recommends starting regular screening at age 45.

People who are in good health should continue regular colorectal cancer screening through the age of 75.

For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health, and prior screening history. People over 85 should no longer get colorectal cancer screening.

Screening can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test) or with an exam that looks at the colon and rectum (a visual exam)


Colorectal cancer often starts with a polyp – a small growth on the lining of the colon or rectum.

Lung cancer

Lung cancer is the second most common cancer and the leading cause of cancer death in the U.S. and worldwide. Anyone can get lung cancer, including people who have never smoked and don’t currently use tobacco products. Still, smoking is by far the leading cause of lung cancer and is also known to be linked to 12 other types of cancer. Research has shown the smoking prevalence rate among self-identified gay men was 33.2%, which was 55.9% higher than the rate among heterosexual men.

Risk Factors

  • Smoking
  • Exposure to radon, asbestos, or air pollution
  • If you have had lung cancer, you have a higher risk of developing another lung cancer
  • Family history of lung cancer
  • Previous radiation to the chest or lungs


The American Cancer Society recommends screening for certain people at higher risk for lung cancer. If you are 50 to 80 years old, smoke or used to smoke, and are in reasonably good health, you might benefit from screening for lung cancer with a yearly low-dose C.T. scan.


The most common signs of lung cancer are a cough that won’t disappear, chest pain, shortness of breath, weight loss, and fatigue.


Gay and bisexual men have no increased risk of prostate cancer compared to straight men. Neither oral nor anal sex increases the risk of prostate cancer. One’s sexual orientation does not cause prostate cancer.

However, studies have shown that gay and bisexual men are more negatively impacted by prostate cancer’s side effects than straight men. The impact on intimacy for gay and bisexual men is particularly profound. Talking with your partner about erectile dysfunction and utilizing various resources may help you navigate these difficulties.

Despite prostate cancer being the most common cancer in men who have sex with men (GBM), the main finding is that prostate cancer in GBM is very under-researched. With only 30 published articles in English (a rate of 1.9 articles per year), most of the literature is limited to case studies or anecdotal reports. There is evidence of a link between human immunodeficiency virus (HIV)-positive status and prostate cancer, with early studies showing HIV infection as a risk factor and more recent studies as it being protective.

Antiretroviral treatment appears protective. Globally, only four quantitative studies have been published. Based on this admittedly limited literature, GBM appear to be screened for prostate cancer less than other men and are diagnosed with prostate cancer at about the same rate but have a poorer sexual function and quality-of-life outcomes.

Risk Factors

  • Men of African ancestry
  • Those with a family history of prostate cancer
  • Men older than age 50


Beginning at about age 45 (age 40 if you are Black or have a strong family history of prostate or other cancers), all men should talk to their doctor about screening for prostate cancer. Routine screening starts with a PSA blood test and may include a rectal exam—both are simple and relatively painless.

The PSA test is the leading method of screening for prostate cancer. PSA screening can help catch the disease early when treatment may be more effective and potentially have fewer side effects. The PSA test may be done with a digital rectal exam (DRE), in which a physician inserts a gloved finger into the rectum to examine the prostate for irregularities.

PSA, or prostate-specific antigen, is a protein produced by the prostate and mainly found in semen, with tiny amounts released into the bloodstream. When there’s a problem with the prostate—such as the development and growth of prostate cancer—more PSA is released. Sometimes, a man’s prostate releases slightly high PSA for other reasons. Rising PSA eventually reaches a level where a blood test can easily detect it.

The American Cancer Society recommends that men make an informed decision with a healthcare provider about whether to be tested for prostate cancer. This is because research has not yet proven that the possible benefits of testing outweigh the harms of testing and treatment. Before being tested, men should receive this information to learn about the pros and cons of testing.


Unfortunately, there usually aren’t any early warning signs for prostate cancer. The growing tumor does not push against anything to cause pain, so the disease may be silent for many years. That’s why screening for prostate cancer is such an essential topic for all men and their families.

  • A need to urinate frequently, especially at night, some- times urgently
  • Difficulty starting or holding back urination
  • Weak, dribbling, or interrupted flow of urine
  • Painful or burning urination
  • Difficulty in having an erection
  • A decrease in the amount of fluid ejaculated
  • Painful ejaculation
  • Blood in the urine or semen
  • Pressure or pain in the rectum
  • Pain or stiffness in the lower back, hips, pelvis, or thighs

Living with Prostate Cancer

If you have been diagnosed with prostate cancer, it will affect your life in ways that it would not for straight men. This includes your sexual life. Understanding what your challenges may be before you choose a treatment option is best. We recommend considering your sexual positions as well as your general lifestyle.

If you are a receptive partner, you need to know that radiation can cause rectal fibrosis and pain with receptive anal intercourse. This seriously affects some men’s ability to have receptive sex ever again. Suppose you are a candidate for either prostatectomy or radiation therapy. In that case, you need to consult with your urologist and a radiation oncologist doctor about the extent and location of your cancer and which form of treatment will work best for you. If you are considering brachytherapy, you need to understand that all radioactive seeds are not the same:  Palladium has a shorter half-life than iodine, and if you engage in receptive anal intercourse, this may be a better choice. “A condom is not going to help protect your partner from radiation,” says Amarasekera. “Every treatment has its complications, and with brachytherapy, the potential complication is the effect of radiation on your partner, which is four months shorter with palladium.”

If you are the insertive partner, you need to discuss with your doctor the impact on erectile function in the short term. The recovery of erectile function after surgery depends on several key factors:  your cardiovascular health, whether or not you were having any erectile dysfunction (E.D.) before surgery, the extent of your cancer (whether one or both neurovascular bundles, the nerves on the outside of the prostate that control erection, were able to be spared during surgery) – and, frankly, the skill of your surgeon. E.D. can also occur after radiation, but it may be more gradual. Again, if you are a candidate for either surgery or radiation, you must discuss your needs and goals with your doctors.

If you practice both, you need to discuss both procedures’ risks and benefits and determine which is best for you.

Information booklet


Anyone can get skin cancer, INCLUDING PEOPLE OF COLOR. But people who spend a lot of time in the sun or use tanning beds have a higher risk for skin cancer. People with fair skin, especially those with blond or red hair, are at greater risk than people with darker coloring. Those who have weakened immune systems or close family members with skin cancer are also at higher risk for skin cancer.

Gay and bisexual men may also be at increased risk: Though research about cancer risks for the LGBTQ+ community is lacking, a 2020 study indicates that gay and bisexual men report skin cancer rates nearly twice that of heterosexual men.

Risk Factors

  • Fair skin (If you also have blond or red hair, your risk is even higher.)
  • A history of bad sunburns at a young age
  • Current or past use of tanning beds
  • Frequent and prolonged sun exposure
  • A weakened immune system
  • Close family members with skin cancer


The U.S. Preventive Services Task Force (USPSTF) has concluded there is not enough evidence to recommend for or against routine screening (complete body examination by a doctor) to find skin cancers early. This recommendation is for people who do not have a history of skin cancer and who do not have any suspicious moles or other spots.


  • Changes in the appearance of a mole
  • Skin changes after a mole has been removed
  • Itchiness & oozing
  • A sore or spot that won’t go away
  • Scaly patches
  • Vision problems
  • Changes in your fingernails or toenails


About half of testicular cancers occur in men between the ages of 20 and 34, but it can be diagnosed in males of any age, including children and older men. White men have a higher risk than men of other ethnic groups.

One of the main risk factors for testicular cancer is cryptorchidism, or undescended testicle(s). A personal or family history of testicular cancer also increases a man’s risk. Some evidence suggests that men with HIV, especially those with AIDS, are at greater risk for testicular cancer. 

Risk Factors

  • Are white
  • Have undescended testicles
  • Have a family history of testicular cancer


There are no recommended screening tests for testicular cancer, but the American Cancer Society recommends men be aware of changes in their bodies.

How to perform a self-exam:

  • Set aside five minutes while you’re in the shower. A warm shower will relax the scrotum and the muscles holding the testicles, making an exam easier.
  • Starting with one side, gently roll the scrotum with your fingers to feel the surface of the testicle.
    • Check for any lumps, bumps, or unusual features. Contrary to what many assume, cancerous tumors typically aren’t painful.
    • Make a note of any changes in size over time. While the most common symptom of testicular cancer is a painless mass, some men experience swelling of the testicles and scrotum.
    • Be aware of any dull soreness or heaviness.
  • Switch sides and check the other testicle.

Some experts doubt the usefulness of testicular self-exams, but these checkups can help men catch testicular cancer early.


  • A lump or swelling in either testicle
  • A feeling of heaviness in the scrotum
  • A dull ache in the lower belly or groin
  • Sudden swelling in the scrotum
  • Pain or discomfort in a testicle or the scrotum
  • Enlargement or tenderness of the breast tissue
  • Back pain

Before you go…

When thinking about your gay male health, it is essential to go beyond just your sexual health. Having a medical provider that you are able to discuss your total healthcare needs, including your sexual habits, can help you reduce your risks for cancer as well as assist you in being properly screened and tested for ones our community is most at risk of developing.

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