All women are at risk for breast cancer, but lesbian and bisexual women (LBT) experience higher rates of breast cancer than heterosexual women. While research into the reasons behind this greater prevalence is limited, there appears to be a combination of factors contributing to lesbian and bisexual women’s elevated risk of the disease. Studies show that they are more likely to drink alcohol, smoke, and be overweight or obese — all factors that increase breast cancer risks.
They are also less likely to have any or as many pregnancies as heterosexual women so they don’t receive the protective benefits against breast cancer that a pregnancy before age 35, as well as breastfeeding, provides. Transgender women may be at higher risk due to hormone replacement therapies used as part of their sex change treatment.
The LBT community also has higher rates of depression, stress and anxiety, which while not directly correlated with breast cancer, can lead to behaviors like smoking and drinking that do elevate that risk. Additionally, and very importantly, many in this community have suboptimal healthcare, both because of inadequate insurance coverage, as well as a less than trusting relationship with the healthcare system.
Out of fear of discrimination or prior bad experiences, many LBT women are hesitant to discuss their sexual orientation with healthcare providers and often delay or avoid medical care altogether including routine breast exams and screenings. A trusting relationship between a doctor and patient is at the heart of good medical care.
While some patients may arrive at the doctor’s office with fears and expectations that present barriers to an open relationship, it’s critical that physicians set a welcoming and accepting tone for all patients. This is particularly necessary for starting an honest dialogue with LBT patients since they may feel that sharing their sexual identity will be met with disapproval.
During these important conversations, the patient should feel heard, respected and not judged, but free to talk about all aspects of her life including her sexual orientation and relationships. To facilitate these discussions doctors should ask open-ended questions and offer solutions without being judgmental.
Caring for LBT women requires an understanding of the unique and often complicated issues they face which, in some cases can include their own conflicted feelings toward their breasts. Such feelings can prevent women from getting annual breast exams or recognizing changes in their breast that could be signs of cancer. It can also result in a woman avoiding regular mammograms once she reaches age 40.
Our medical training should do a better job educating us on how to address LBT issues and properly care for these patients. We also need to have better research on how to reduce the breast cancer risks impacting this community. Few studies have looked specifically at the LBT population and those that have, tend to be very small in scale.
That said, we do have a great deal of evidence on the steps every woman can take to reduce her risks of breast cancer which include keeping a healthy weight, exercising regularly, drinking 3 or fewer alcoholic drinks a week, not smoking and eating a mostly vegetarian-based diet. These modifiable factors can substantially reduce a woman’s breast cancer risks — by as much as 50 percent. But to support women in making these changes, there needs to be an open and honest dialogue — one that only comes from a trusting relationship between doctor and patient.
Lack of insurance coverage and access to medical care could also account for a higher incidence of breast cancer among LBT women. It most definitely impacts the ability to identify breast cancer at its earliest stage and provide timely treatment. Fortunately, there have been significant legal and policy changes in recent years that have expanded insurance coverage and access including the Affordable Care Act (ACA) and the Supreme Court’s ruling legalizing same-sex marriage nationwide which requires health insurers to provide same-sex spouses the same coverage options as opposite-sex spouses.
More access to medical care and a greater understanding of the factors driving breast cancer risks for LBT women are essential to reducing the disproportionate incidence of breast cancer in this community. But just as important is the need for stronger relationships between doctors and their LBT patients to ensure these women have a true medical home. Each patient is unique and deserves the best care possible.
By Marisa Weiss, M.D., Breast Oncologist and Founder and Chief Medical Officer of Breastcancer.org.
The views expressed by contributors are their own and not the views of The Hill.