In 2006, while in my 20s, I was diagnosed with breast cancer. As many people know first-hand, a cancer diagnosis changes your life overnight. I went from being, I thought, a healthy young singer-actress with a day job, to being a full-time medical patient who still had to hold onto that day job for dear life because I needed the money and health insurance. And, once again, the difficulty of being a lesbian in a heterosexual world reared its ugly head. Some people question whether being a young lesbian is all that different, in the cancer setting, from being a young straight woman. I say, it isn't and it is. On one hand, young women of any sexual identity going through breast cancer face many of the same difficulties. Many of us lose body parts which, to society, define the female gender: our breasts and sometimes our ovaries. Some of us are thrust into early, draconian menopause. Many worry that our options for having or adopting children have been drastically reduced. Many struggle with the decimation of our short-life savings.
But there are differences. The forms I filled out in most doctors' offices had no category for me when asking about marital status, which made me feel isolated, and had no questions at all about sexual and gender identification. I have had to deal with coming out, time and again, to doctors, nurses and medical personnel; to explain that my female "girlfriend" is my partner, and thus a prime member of my support system, not just a friend who happens to be female. Any discussion of the side effects of treatment on fertility and sexuality has begun with the assumption that I am having sex with men.
Normally, correcting people doesn't faze me. Added to a new cancer diagnosis, everything fazed me. Coming out to a doctor requires an extra step that heterosexuals don't have to take, and this step requires extra energy. As anyone who's been through the horrors of cancer diagnosis and treatment knows, any extra expenditure of energy can be the tipping point between hanging in there and plummeting off a metaphorical cliff.
In addition, when coming out to a medical professional even in the seen-it-all city of New York, there is the worry that I may receive substandard care, that my partner may be barred from visiting me in the hospital, or, most likely, that I may receive care that does not adequately address my different circumstances as a woman partnered with a woman.
For example, one day, years after my diagnosis, my oncologist told me out of the blue to "be careful," meaning to use contraception so as not to get pregnant while on Tamoxifen. I corrected her, but I was horrified that she had been treating me for three years and yet knew nothing about my sexuality, and, when I came out to her, had no reaction other than to make a note in my file.
I suppose, in retrospect, that in those blurry early days I never mentioned to my oncologist that I am a lesbian. But the onus should not have been on me. I should not have had to expend extra energy to correct a widespread assumption that I was heterosexual. The way I identify my sexuality and gender, and the gender of my partner(s), is extremely relevant to my treatment and long-term survivorship. When medical personnel or layperson supporters automatically assume that patients are heterosexual or have conventional gender identities, then they are not, for example, likely to discuss increased cancer risk among lesbians, or the need for ovarian health awareness among both lesbians and those who identify as Female-to-Male transgender, or the potential toll on emotional health that adding another layer of difference in gender or sexuality can take on a cancer patient. And they risk alienating patients and discouraging them from sharing information that would aid them in providing the best care possible.
Culturally competent medical care and support for LGBT cancer patients needs to start with the elimination of assumptions about sexuality and gender, and the inclusion of language, on intake forms and in conversation, that signals to patients that being LGB and/or T is an accepted and embraced possibility, from the beginning.
Mimi has worked as a consulting LGBT Outreach Coordinator for SHARE. She is also a singer/songwriter/actress and yoga teacher in NYC.