Behavioral and lifestyle factors have been identified as contributing to cancer disparities based on race/ethnicity [22]. In the general population, modifiable health risk behaviors with strong links to cancer include tobacco and alcohol use, level of physical activity, and body weight status [23]. Sexual minority individuals have numerous behavioral risks for cancer including high rates of obesity, high rates of alcohol and tobacco use; and among women, reproductive risk factors such as nulliparity; lower rates of birth control use, and older age of first birth [24–30]. The negative impact of these factors may be compounded by the combined influences of a sexual minority status and a racial minority status. For example, 78.2 % of African American women meet criteria for being overweight and 49.6 % for obesity, while 61.2 % of White women meet the criteria for being overweight and 33.0 % for obesity [31]. A more recent study [32], found that compared with heterosexual women of the same race/ethnicity, White and African American sexual minority women had an increased likelihood of being overweight and maintaining that overweight status overtime. However, sexual minority status was unrelated to weight among Latinas and inconsistently linked to weight among Asian women. Among men, sexual minority status was protective against unhealthy weight among all major racial/ethnic groups examined.

Cancer screening behaviors may directly contribute to elevated risk for late-stage diagnosis and poor cancer outcomes. Primary among the target strategies for reducing cancer health disparities is increasing access to and participation in cancer screening by racial and ethnic minorities [38]. In the general population, racial/ethnic minorities are more likely to be diagnosed with more advanced stages of cancer compared to Whites [39]. Racial/ethnic minorities are also less likely to follow up on abnormal mammography results in a timely fashion, which leads to a decreased likelihood of being diagnosed at earlier stages of cancer formation [40]. Sexual minority women have also been identified as a population at risk for late-stage diagnosis of cancer [25]. Grindel et al. [41] found that among lesbians, rates of breast cancer screening in the past two years ranged from 58 to 84 %. Additionally, rates of cervical cancer screening continue to be lower than expected for women in the general population [42]. Charlton et al. [43] reported that compared to heterosexual women, sexual minority women (SMW) are significantly less likely to report past year and ever having cervical cancer screening. However, one review article found the literature to be mixed as to whether there are sexual orientation group disparities in mammographic screening [44]. In one of the few studies reporting on African American SMW, Ramsey et al. [45] found that 35 % of a sample of 1596 African American lesbians, age 18–70 years, reported they did not see a gynecologist regularly. Matthews et al. [42] reported on cancer risk and screening behaviors of African American SMW. Eighty-five percent of women over the age of forty reported ever having a mammogram and 69 % reported having been screened in the previous year. The majority of participants reported ever having a Pap test but reports of past year screening were low (68 %). A limitation of the two previous studies was the lack of a heterosexual comparison group. At least one study did not find differences based on sexual orientation in samples of women of color in having recent mammograms [46].

Individual experiences within the health care system influence attitudes about receipt of health care services and potentially also the utilization of health care services [57, 58]. The quality of the patient-provider interaction is one important component of a patient’s experience within a health care setting [59]. Research suggests that health care providers who are more informative, give more explanations, show more sensitivity to the patient’s concerns, and offer more reassurance and support tend to have patients who are more satisfied with care, have a greater understanding of health issues, and are more committed to treatment recommendations [60]. Problems within the patient-provider relationship have been shown to contribute to a reduction in treatment seeking [61], engagement in health care [62], perceptions of the quality of health services received [63], as well as treatment satisfaction and emotional adjustment to illness [64]. The hypothesized mechanism for the relationship between patient-provider relationship variables and health outcomes is thought to stem from the links between positive patient-provider interactions which leads to patient satisfaction and adherence to recommended treatments [65].

Cancer treatments have advanced significantly in the past thirty years. Currently, about 65 % of all people with cancer can expect to live at least 5 years after their diagnosis. Nevertheless, cancer survival may be associated with short- and long-term physical and psychological morbidity secondary to the effects of cancer and related treatment. The Institute of Medicine (IOM) highlighted the importance of mental health services for cancer patients and survivors [76]. The IOM report noted that psychosocial problems are common and may include fear of cancer recurrence and death, anxiety and depression, feelings of alienation and isolation, problems with interpersonal relationships, and economic hardships related to cost of care, job loss, and employment and insurance discrimination. Given the rapidly increasing number of cancer survivors, more research looking at the impact that cancer diagnosis and treatment have on quality of life, and factors that affect the quality of cancer survivorship, is highly warranted.