Editor’s note: This article was updated to add a reference for the statistic regarding the number of men who are victims of completed or attempted rape.
Sexual assault is a pervasive issue in the United States. Data suggest that 1 in 5 women and 1 in 38 men are victims of completed or attempted rape in their lifetime, and 47% of transgender persons report sexual assault in their lifetime.1-3
There are no comprehensive statistics about the number of people with cancer who have a history of sexual trauma, but there is likely a large overlap due to high rates of both cancer and sexual assault in the United States.
A history of sexual trauma can have major impacts on a person’s mental and physical health. Those with a history of sexual trauma are more likely to be diagnosed with various mental health disorders, including anxiety, depression, post-traumatic stress disorder, and more.4
A meta-analysis showed a moderate association between people who experienced 4 or more adverse childhood experiences (eg, witnessing violence in the home; exposure to neglect or abuse, including sexual abuse) and various physical health problems including heart disease, respiratory disease, and cancer.5
Furthermore, people with sexual trauma are less likely to be screened for cancer. Women are 31% less likely to undergo a pap smear and 30% less likely to undergo mammography, and men are 51% less likely to be screened for prostate cancer.6 This may lead to delayed detection of cancer, cancer being diagnosed at a later stage, and a decrease in treatment options.7
Cancer and health care interactions can be uniquely triggering to those with a trauma history. Cancer care may lead to re-experiencing feelings that were experienced during or after their trauma, including feelings of powerlessness, lack or loss of control, lack of choice or agency, vulnerability, and feeling out of control.
Procedures and health care interactions can be challenging, especially being touched by unfamiliar health care providers, or having pain inflicted by another — as is the case with surgery or other procedures.8 Aspects of a health care interaction may mirror the sexual trauma itself, including the patient being in darkness, immobilized, or silenced during various examinations or treatments.9 It can be especially triggering for patients whose cancer is in a site related to where they may have experienced sexual trauma (such as breast, gynecologic, prostate, and anal cancers) as these sites of the body may require frequent exposure or touch during treatment.
Cancer patients with a history of sexual trauma may exhibit different trauma-related behaviors. These can include missing treatment appointments, having a hard time remembering instructions or integrating information, having fear toward staff, and panic in enclosed or confined spaces.6 There may also be increased interpersonal issues between the patient and the health care team. Multiple studies show that patients with a history of sexual abuse are less likely to feel supported by their health care teams, and providers are more likely to identify these patients as more difficult to help.10 Patients may have worse health care outcomes if they miss appointments or do not follow treatment as instructed.
This article originally appeared on Oncology Nurse Advisor