The Centers for Disease Control (CDC) and the Gay and Lesbian Medical Association (GLMA) have developed the top ten health issues lesbian and bisexual women, gay and bisexual men, and transgender people need to discuss with their providers. Among those issues is a high occurrence of and concern about breast cancer.
In the US, breast cancer is one of the most common cancers among women, the most common cancer for African American women, and the leading cause of cancer death for Hispanic women (Source: CDC).
Lesbian and Bisexual Women
Breast cancer is the number one health concern for lesbian and bisexual women. According to the National LGBT Cancer Network, the risks of breast cancer are increased because of lifestyle and access to care. Research has shown that the lesbian/bisexual community tends to smoke more, uses higher rates of alcohol, and is more likely to have a body mass index (BMI) over 25 (25 and over is considered overweight to obese). These lifestyle issues are shown to increase a person’s risk for breast cancer.
In addition, lesbians who choose to have children tend to have them later in life. Pregnancy before the age of 30 has been shown to reduce a woman’s risk of breast cancer.
Moreover, barriers to care for lesbians and bisexual women still exist. Many companies and health insurance policies do not offer same-sex partner benefits, leaving many women uninsured. As it is for anyone who is uninsured, health care becomes an added (and huge) expense saved only for emergencies, limiting women’s access to preventive care and critical screenings, such as mammograms.
And not all lesbian and bisexual women are being honest with their providers about their sexual orientation. Some fear discrimination. Some have had negative experiences when they’ve “come out” to their provider. What results is a tenuous relationship with the provider, a hesitancy to see a provider, or a decision to forgo health care altogether.
As is the case for cisgender women, transgender men’s risk for breast cancer increases with age, race, family history, and lifestyle risks.
Transgender men who don’t have their reproductive organs removed are also at risk for cancer of those organs. Many transgender men find the idea of routine screenings, like clinical breast exams, at the very least uncomfortable, but because these screenings can save your life, finding a safe, affirming provider is crucial.
The data to show the incidence of breast cancer in transgender men is not extensive. Often, a person’s gender identity is not tracked by health care professionals, or the patient doesn’t disclose their gender identity, making research and appropriate care difficult. The importance of disclosure cannot be understated: if your provider does not know your sexual orientation and/or gender identity, your provider won’t screen you appropriately.
Some link between hormones and an increased risk of breast cancer is also suggested as the body turns excess testosterone into estrogen (Source: Mautner Project); estrogen can increase the risks for some types of breast cancer. Testosterone levels should be monitored by a primary care provider.
For transgender men who have gone through breast reduction or removal surgery (top surgery), generally the breast tissue is not completely removed during this surgery so screening for breast cancer is still suggested.
Transgender women’s risk of breast cancer is unclear; there is very little research on the subject. The risk for natal males is low—about 1 percent (Source: CDC). The Center for Excellence for Transgender Health at the University of California, San Francisco, suggests transgender women who have past or current use of hormones begin screening at 50 years of age if their weight is greater than 35 BMI and/or they’ve used estrogen/progestin for five or more years.
For both transgender women and transgender men, the risk becomes more complex because of delay of seeking treatment because of past discrimination, the difficulty in finding and accessing care, and (horrifically) denial of treatment by a provider because of the patient’s gender identity.
What Can You Do?
While there are no proven methods of preventing breast cancer, you can reduce your risks and it is a detectable cancer.
- Keep the conversation about health care inequalities in the public realm.
- Breasts come in a variety of shapes and sizes. Don’t be afraid—get to know yours. Any changes should not be ignored.
- Find a trustworthy, affirming provider. Both GLMA and the Human Rights Campaign list LGBT “friendly” providers. Some providers are able to provide care to those who are uninsured—community health centers in particular. Ask about case management services—these are services designed to help patients get access to care and treatment.
- See your provider regularly, not just when you’re sick. Regular visits are preventive visits.
- Learn your family’s history and talk with your provider about your risks.
Oh, and let’s end this with just a little nagging: quit the smokes, eat your greens, drink alcohol responsibly, exercise, and maintain a healthy weight. ■