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I’m Dr. Rob Winn and you're listening
to Real Cancer Talk

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from VCU Massey
Comprehensive Cancer Center.

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I am Community Clo.

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Welcome to Community Conversations.

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We've got another one.

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My very special guests are joining me
on the show.

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Our topic is about LGBTQIA+
when it comes to cancer disparities.

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You want to turn us all the way up.

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James Milner,
Director over at Virginia Pride.

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How are you?

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I'm well.

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How are you?

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I'm doing great.

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And, you know,
we're in a win win situation.

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We got Doctor Robert Winn of the VCU
Massey Comprehensive Cancer Center.

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How are you doing?

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Yo, you know, when I'm with you,
I'm always much better.

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That's right.

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And for folks who are joining us,

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it's a day of no copays, no white coats,
and, yes, Doctor Winn is a doctor.

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He doesn't have that stone face.

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We're going to keep it real with you.

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Are you ready?

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All right, so again, if you're
just joining us, we're talking about

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the LGBTQIA+ and cancer disparities.

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Now I'm going to start with this stat
from the population.

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An estimated 7% of US

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population, according to the 2022
Pew Research Center survey.

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Sexually and gender minority, SGM,

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is all inclusive term used
by the National Institute of Health, NIH.

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So these are the populations
that we're talking about.

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Now I'm going to go
into the history of this.

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And after I do that throw this out.

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Doctor Winn is going to step in.

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The history of disparities among SGM.

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There's info about cancer incidence,
mortality among SGM

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individuals is limited.

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Now we're talking about sexual and gender
minority.

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Today's report often look to small
studies for data which is really good.

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We talked about that last month.

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Urgent need for comprehensive data

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collection for accurate estimate of SGM
cancer burden.

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All right.

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So Dr.

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Winn, I threw all of this information out,
as per

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the Pew Research Center
survey of 2022, what does this all mean?

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Yeah.

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So so
here's this up, I think, decades ago.

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You know, we, really did not think about,
my brothers

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and sisters and others within the SGM
community of getting cancers.

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And in fact, what we now know
is that the new data shows

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that there are elements within the SGM,

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sort of community
that there increase rates of cancers.

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In fact, you know,
we have data from the, recent report

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from the American Association of Cancer
Research that actually sort of

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says that it is a concern
throughout the entire SGM community.

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And what I think is happening
is we're finally one finding the courage

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to talk about it.

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And that beyond the cancers associated
with HIV Aids, that the other thing

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that lung cancer increase
rates of liver cancer or cervical cancer,

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these types of deals
that we also have to pay attention to.

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And what I love
about having James on today

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is that we really are trying to make sure

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that there isn't these invisible cancers
in our communities anymore,

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that we're talking that
we are not actually happy until everyone

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benefits from the science, the molecules
that become miracle medicines.

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And particularly
this is a true within the SGM community.

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Now, James, I want you to come on in.

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I know you want to come from
the social perspective of all of this.

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What exactly
does this research mean to you

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and the LGBTQIA+ population?

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Well, I think first and foremost,
this research shows us,

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what we don't know,
right? I think it's highlighting,

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some some

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holes in the data that we have, in terms
of how we can,

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better address cancer within the, SGM
communities.

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I think that there are a lot of reasons
why there are some disparities

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here, though.

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I think a lot of it has to do
with trust of the medical system,

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whether people are treated,
are treated, authentically.

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And whether there is inclusion
within the medical system

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for when people show up, whether
they might be a transgender person,

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whether they might be an LGBT, gay
or lesbian or bisexual person,

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and what kind of treatment
they're going to receive when they show up

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and whether their provider is going to be
affirming of, of their identities.

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And I think that's a big factor
in why people may not seek,

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initial care
and or preventative care or screening.

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But I think it also impacts,
how people ultimately get treated

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if there is a cancer diagnosis.

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And and, and so I think there are,
there are a lot of,

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barriers and a lot of opportunities
for us to do better in those ways.

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And that's why we have Massey
Comprehensive Cancer Center

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and, and Doctor Winn, just having you here
and James Milner as well.

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Doctor Winn, you want to jump in here?

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Yeah.

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I think it's important
to note that within the SGM community,

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we tend to still not actually be creative
in the context

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of our connectedness
to the community. Right?

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So we still have people
who come in to our offices afraid, right.

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Afraid to tell us about things.

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And I think that one of the things

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we are learning is that
we have to actually create the safe spaces

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so that we can talk about
the entire person in the context of,

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in some cases, right.

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In fact, you know,
we have these old, or old ideas

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that, you know, for, you know, people
within SGM they don't get cancer.

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They do get cancer. Yeah.

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That's
what the new literature is sort of saying.

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And in fact, for example,
we know that, bisexual

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women are at higher rates
of getting breast cancer.

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So we're still trying to figure out why

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then, you know,
someone who's heteronormative.

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We know that, there are certain cancers
within the transgender community

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that are actually increased.

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And so that really is not being able
can you imagine

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being able to go to your doctor
and not feeling comfortable

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with talking about your whole self?

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This is why I think that
this is an important conversation, because

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cancer doesn't care
what community it impacts.

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It impacts all of us.

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Thank you for that, Doctor Winn.

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Disparities included in the 2024
American Association for Cancer Research

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disparities progress report
and and stop me Doctor

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Winn if you would like to expound on
any of these.

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Breast cancer higher among sexual minority
women versus heterosexual women.

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Late stage lung cancer
and that's a really high number,

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76% higher among transgender individuals
versus cisgender.

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So what is the science saying
when it comes to this Doctor Winn?

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When I think the science is saying
we got more to learn.

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I think cases actually on point.

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And for the for the record,
I think that when we think about SGM

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communities, there’s
lots of intersectionality, right?

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There are a lot of,
you know, African-Americans, right?

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That could be lesbian
and gay, etcetera, etcetera. Right.

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So the reality is we need to really start
thinking about this,

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in the context of the wholeness

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of our SGM community, because it matters.

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If we can get this right

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and start doing the right research
and start looking at the right data.

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All I care about is a cancer doc
is that we can save more lives.

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Yeah I was just going to say
I really want to, on

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this commend Doctor Winn
and the folks at Massey Cancer Center.

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Oh absolutely.
About how they're approaching this issue.

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Because for all the reasons
that the Doctor Winn just identified,

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they're doing all the right things
to help build trust,

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which I think is really the foundation
of this conversation.

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It's about trust.

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And they are partnering
with organizations like Virginia Pride,

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like Black Pride RVA,
to build relationships.

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And connections within their communities
that they know they need to serve better

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and that they want to be able to as I,
as as, Doctor Winn said, that

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show up as their full self
when they come in for screening,

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when they come in for treatment.

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And I think, you know,
this is a model that other cancer centers

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and everyone in the, in the cancer
community should be emulating.

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Well, James,
I do know what you saying, you know.

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But I brag or,

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you know, it's easy to be a good partner
when you got great partners.

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Through Virginia Pride
and in fact, always,

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you know, advocating always, you know,
sort of open to sort of engaging.

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And, man, I got to give props to you
from the very first time I came into town.

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You've been very open and supportive of,
you know, sort of saying, hey,

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I want to help.

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And you're being there to say, well,
here's how we can help each other

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together.

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So James, I gotta give Virginia Pride
like a shout out, I just do.

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Yeah.

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James Milner,
we got to give you a shout out

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for Virginia Pride
in being the director over there.

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We thank you so much for all you do.

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And of course we always in a win win
situation James when we got Doctor Winn.

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So I want to get through
a few more of these disparities

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so we can talk about the causes.

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And we can do a call to action.

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Prostate cancer higher risk among gay
bisexual men.

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Prostate cancer 60% lower incidence
among transgender women,

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but double mortality rate
HPV associated with anal cancer.

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Higher risk among men who have sex with
men versus heterosexual 40 times higher

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among those who are HIV positive, 20 times

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higher among those who are HIV negative.

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Now, Doctor Winn and James, I'm
pretty sure you're familiar with this.

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Let's talk about the disparity causes.

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Let's get to the root.

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You know, Sister Clo, first
and really trying to bring information

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to all of our community
and what I really love about what you do

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is that, you really have been out there
with us at the Massey Cancer Center

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talking literally about,
making sure that we raise the awareness

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and raise the
the level of all of us about cancer.

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So appreciate you, Sis.

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Oh man, thank you, Doctor Winn.

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So we've talked about.

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Something here because, you know, James
is actually out there, I mean, listen.

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That's what you got to.

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Out here
trying to talk about doing advocation.

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Yeah.

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Other people who are advocates,
I mean to the next level.

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So I am on with two amazing people.

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So, you know, I'm good. Yeah.

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And you know, another thing
I gotta mention, since we're we're

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singing all of our praises
all by the grace of God,

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whenever I text you about anything
when it comes to us getting closer

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or doing some type of outreach

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when it comes to cancer prevention,
you always respond to the text message.

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And that says a lot about you, Doctor Winn
because I know you're busy.

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You're all over the place.

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You know, you
you comprehensive cancer center.

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You see what I'm saying? Please.

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But but you know,
like covering a topic around SGM Yeah.

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You know, I would dare say that
many cancer centers around the country,

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which has 72 designated cancer centers
and many, many more across the country,

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this topic doesn't even come up.

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No. You know, and what I really want
to thank both of you guys

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for bringing the attention
that there is a community

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of people who get cancer
that we need to pay more attention to.

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And the reality is,
one size does not fit all.

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So the amount of research I have to
I'm laughing now, but it wasn't

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that much of a laughing matter.

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In 2020,
when we first published the first, AACR

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report on health disparities,
the American Associate Cancer Research.

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Yeah, we had so little data in the SGM
community and in our rural communities.

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You know what we decided to do?

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We didn't publish anything about it.

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We just mentioned it.

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In 2024, however, this report is expanded.

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And so what I'm saying to you
that as we expand our minds,

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we expand the possibilities of actually
having the science benefit everyone.

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And that's, again, you can't do that
without people bringing awareness to it.

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So again, I'm really in, great awe
and respect to you both. Oh,

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thank you so much.

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And when we talk about
the LGBTQIA+ communities, guess what?

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They are family members.

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Those are someone's children.

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Exactly.

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So we talked about the cancer disparities.

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We went over the numbers.

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Now we're going to talk about the root
causes of the disparities.

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According to the American Cancer Society
for Cancer Research, disparities

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Progress report.

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And I'll run through these really quick.

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And, James,

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I want you to do some comments
because we got some good news on the way.

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But the call to action,
transgender questions about interplay

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between hormone therapy,
likelihood of developing cancer,

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SGM, higher prevalence of certain risk

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factors, tobacco alcohol use,

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higher rates of HPV, HIV

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infections, lower rates of cancer
screening, health care workers

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not as educated about SGM
health needs and discrimination

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in the health care settings.

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And as you did mention it, James,
I can see it here.

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When we look at the root causes, folks
are feeling afraid to go to the doctor.

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Well, I mean, I think that that's that's
definitely a big piece of it.

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And it's also because I don't know that
that that SGM folks, people in the SGM

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community always see themselves
fully represented and in,

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in the health care system,
whether it be through marketing, whether

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it be through clinical trial recruitment,
whether it be through,

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you know, prevention
campaign or whatever.

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And we, you know, look,
let's look at the, at HPV, for example.

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And we know that that is

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that there is a higher rate of,
of that among, gay and bisexual men.

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And there is among heterosexual men.

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And, you know,
when the research was first done

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and when those clinical trials were first,
were first started, to develop

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the HPV vaccine, I don't know that
there was really intentionality around,

00;13;36;04 - 00;13;41;23
including, gay and bisexual men
in those in that research.

00;13;41;23 - 00;13;47;24
And there certainly isn't, intentionality
around including gay and bisexual men

00;13;47;24 - 00;13;51;10
in marketing of that vaccine, 
as a preventative measure.

00;13;51;10 - 00;13;55;15
So, and, you know, because sometimes
this can be an uncomfortable topic.

00;13;55;15 - 00;13;58;00
And I think that, you know,
pharmaceutical companies

00;13;58;00 - 00;14;01;03
are sometimes reticent
to wade into those things.

00;14;01;04 - 00;14;06;05
I think that, even health care
providers are sometimes uncomfortable

00;14;06;05 - 00;14;07;16
having those conversations.

00;14;07;16 - 00;14;11;14
And, you know, those are
those are the types of barriers that we

00;14;11;14 - 00;14;16;10
really need to work on breaking down
because, you know, HPV is preventable.

00;14;16;10 - 00;14;20;11
Now. And, and, and,
but a lot of gay and bisexual men

00;14;20;11 - 00;14;25;03
don't even understand their risk factors
for it, or that a vaccine is available

00;14;25;03 - 00;14;28;15
and that they are eligible for a vaccine
to be for it to be prevented.

00;14;28;21 - 00;14;31;24
VCU Massey Comprehensive Cancer Center.

00;14;32;04 - 00;14;35;01
They've been doing the research,
talking about it, and Doctor

00;14;35;01 - 00;14;40;20
Winn is not he he is going to end this
this cancer disparity on all spectrums.

00;14;40;25 - 00;14;41;26
And so one of the things

00;14;41;26 - 00;14;44;26
that I really hope
that we're going to do beyond even this,

00;14;45;07 - 00;14;48;23
you know, this show is to be able
to have a recurrent theme

00;14;48;23 - 00;14;51;10
and hopefully James and others
wil come back,

00;14;51;10 - 00;14;54;01
to make sure
that we're raising the awareness

00;14;54;01 - 00;14;58;15
that within the SGM community,
there are increasing rates of cancers

00;14;58;21 - 00;15;01;07
and as James,
put an exclamation point on that,

00;15;01;07 - 00;15;03;03
there are cancers
that really shouldn't be.

00;15;03;03 - 00;15;05;25
Head and neck cancers,
other cancers. Right.

00;15;05;25 - 00;15;10;20
You know, rectal cancer and
all the things that could be prevented.

00;15;11;01 - 00;15;12;04
And we're not.

00;15;12;04 - 00;15;15;01
That's why I think that
this is an important conversation today.

00;15;15;01 - 00;15;16;16
And you know something, James?

00;15;16;16 - 00;15;17;17
When we talk about health

00;15;17;17 - 00;15;20;26
care workers and providers,
if they are not trained on that,

00;15;21;02 - 00;15;25;01
and I don't know if we have like support
groups that we can go in to

00;15;25;01 - 00;15;28;01
our health care facilities
to just understand.

00;15;28;03 - 00;15;30;26
Because if you don't know,
you don't know. James.

00;15;30;26 - 00;15;33;20
So if someone is transgender,

00;15;33;20 - 00;15;37;17
right, do we, when we address them
the way they want to be addressed.

00;15;37;24 - 00;15;41;09
But then we might look at prostate
cancer or breast cancer.

00;15;41;10 - 00;15;44;25
So how do we approach that conversation
with the patient.

00;15;45;14 - 00;15;47;23
Well,
I think that's a really key part of this.

00;15;47;23 - 00;15;51;04
It's how do you
how do you, start a conversation?

00;15;51;04 - 00;15;54;25
How do you create a safe space
for a conversation to occur?

00;15;55;05 - 00;15;59;00
How do you train health care providers
so that they can pick up on cues?

00;15;59;00 - 00;16;04;08
Even if somebody isn't,
it doesn't come in and identify, outwardly

00;16;04;08 - 00;16;08;02
and say that I am transgender or say that
I am gay or lesbian or bisexual.

00;16;08;14 - 00;16;10;20
What are other cues that you can pick up?

00;16;10;20 - 00;16;13;29
How can you create an environment
in which they feel safe

00;16;13;29 - 00;16;15;19
revealing that information?

00;16;15;19 - 00;16;17;26
What are the
what are the intake forms look like?

00;16;17;26 - 00;16;20;03
What information you collecting there?

00;16;20;03 - 00;16;21;24
And then how do you ensure that

00;16;21;24 - 00;16;25;19
that information is going to be protected
if people aren't out, for example?

00;16;25;19 - 00;16;27;19
And, you know, those are simple.

00;16;27;19 - 00;16;31;29
I mean, not simple, but those are concrete
steps that we can take.

00;16;31;29 - 00;16;35;01
And that's a matter of screening
that doesn't require,

00;16;35;10 - 00;16;37;01
you know, medical research,

00;16;37;01 - 00;16;41;02
that doesn't require laboratories,
that doesn't require all of that.

00;16;41;02 - 00;16;43;11
That's
just a matter of creating a safe space.

00;16;43;11 - 00;16;49;11
And, and, and empowering health care
providers, to initiate a conversation

00;16;49;11 - 00;16;54;24
and to communicate,
whether overtly or or or not.

00;16;54;24 - 00;16;58;26
So that, you know, that they,
that they are a safe person with which

00;16;58;26 - 00;17;02;28
a person can have a conversation
about their identity and who they are.

00;17;03;07 - 00;17;04;25
James, thank you so much for that.

00;17;04;25 - 00;17;08;23
And and that's more community outreach,
as you said, hey, we don't need to

00;17;08;29 - 00;17;09;27
make it a law.

00;17;09;27 - 00;17;11;26
These are just policies
that we can change.

00;17;11;26 - 00;17;14;08
We can get together in a group
and make these things happen.

00;17;14;08 - 00;17;17;25
For folks who are just joining us,
we are talking about cancer disparities

00;17;18;01 - 00;17;22;04
in the LGBTQIA+ communities.

00;17;22;08 - 00;17;26;26
What can we do collectively
to help this community?

00;17;26;27 - 00;17;27;20
James.

00;17;27;20 - 00;17;31;22
Well, I think one thing that can happen
is for health care providers,

00;17;31;22 - 00;17;36;01
cancer centers, treatment centers,
hospitals, whatever it happens to be,

00;17;37;03 - 00;17;39;17
to reach
out in their in their communities, to,

00;17;39;17 - 00;17;42;29
community-based organizations
that are connected to

00;17;42;29 - 00;17;46;06
or serve the LGBTQ community
and ask them for their help

00;17;46;21 - 00;17;50;09
because and and provide
funding to allow them to help you.

00;17;50;20 - 00;17;54;21
So come to these organizations
like Virginia Pride, like Black Pride

00;17;54;22 - 00;17;57;29
RVA, and say,
hey, we need some help here.

00;17;57;29 - 00;17;59;04
We need some guidance.

00;17;59;04 - 00;18;02;06
And,
and you're the experts in this place,

00;18;03;25 - 00;18;08;21
and, and partner with your organizations
to conduct outreach campaigns to collect

00;18;08;21 - 00;18;14;08
data to, to use their channels
of communication to, let people know

00;18;14;08 - 00;18;18;07
what services are available,
what risk factors exist, things like that.

00;18;18;28 - 00;18;21;10
You know, that's
that's not a really hard thing to do.

00;18;21;10 - 00;18;25;00
And community organizations
like Virginia Pride and like, Black Pride

00;18;25;08 - 00;18;29;17
exist all over this country and every city
and every town, big or small.

00;18;29;17 - 00;18;32;17
So I think that's one thing
that folks could really do.

00;18;32;28 - 00;18;33;12
That's right.

00;18;33;12 - 00;18;34;03
Coming together

00;18;34;03 - 00;18;38;08
collectively with Virginia Pride
Black Pride RVA and several other groups.

00;18;38;14 - 00;18;40;16
Doctor Winn, would you like to say
something about that?

00;18;40;16 - 00;18;43;16
In reference
to VCU Comprehensive Cancer Center?

00;18;43;18 - 00;18;46;26
Yeah, I think the first step
to making a difference

00;18;46;26 - 00;18;50;08
is actually the awareness
that we can do something about it.

00;18;50;08 - 00;18;53;14
And I really want to
say that I think you and James,

00;18;53;21 - 00;18;55;14
particularly in Pride Month,
and hopefully we won't

00;18;55;14 - 00;18;58;25
just do this once a month,
that this will be all year round.

00;18;58;25 - 00;19;02;21
Yeah, that we bring awareness to,
you know, our focus and our communities

00;19;02;21 - 00;19;06;26
with the SGM community about cancer
and cancer is real.

00;19;07;02 - 00;19;07;29
But guess what?

00;19;07;29 - 00;19;09;09
We can learn more about it.

00;19;09;09 - 00;19;11;16
And the more we learn about it,
we can do more about it.

00;19;11;16 - 00;19;13;04
So that's what I'm super excited about.

00;19;13;04 - 00;19;15;22
And by the way, you know what
I love about this conversation?

00;19;15;22 - 00;19;16;07
And we

00;19;16;07 - 00;19;19;10
I was just thinking about Doctor Fauci,
and I was thinking about back in the day

00;19;19;10 - 00;19;24;06
when I was a young doctor, in the context
where you know, HIV Aids was coming

00;19;24;12 - 00;19;29;17
and we had a group, called Act Up, right,
AIDS Coalition to Unleash Power.

00;19;29;21 - 00;19;33;08
And I always thought about
that whole thing about not being victims,

00;19;33;12 - 00;19;36;07
but that we were unleashing power
as a community.

00;19;36;07 - 00;19;40;06
I say today
that we need to take that same ethos

00;19;40;11 - 00;19;45;04
in unleashing our power as a community,
that we can make change, and we will.

00;19;45;13 - 00;19;50;03
One team, One community,
one big cancer fight, and we win.

00;19;50;13 - 00;19;51;06
All right.

00;19;51;06 - 00;19;55;09
Doctor
Robert Winn is director of the VCU Massey

00;19;55;09 - 00;19;59;21
Comprehensive Cancer Center, and James
Milner is Director over at Virginia Pride.

00;19;59;21 - 00;20;02;08
God bless you.
Thank you for all you do. Be safe.

00;20;02;08 - 00;20;07;16
This has been Community Conversations
and I am Community Clo.