Not long ago, I sat in on a SHARE Helpline training session that focused on supporting LGBT callers. When the trainer said that lesbians have higher cancer rates than our straight peers, incredulity swept the room. I understood their surprise: cancer is a disease, not a prejudice. It can strike anyone. Why should the LGBT community be more at risk?
The reasons are complicated, and involve a long history of marginalization of these communities – not only within society at large, but within the medical system and the socio-economic realm. The first thing to know is that the higher risk among lesbians does not spring from innately physiological or biological differences. Nevertheless, a "perfect storm" of interlocking social issues – and unhealthy behaviors that can be linked to those issues – disproportionately affects lesbians.
For example, studies show that lesbians are more likely to smoke, drink too much, and be overweight. These are all known breast cancer risk factors for anyone, heterosexual or otherwise. And that's not all: not having children, or having them after the age of 30, increases risk – often the case with lesbians. And we tend to see our doctors less often for routine check-ups (for a number of reasons) when other issues, such as smoking or weight, might be discussed.
According to The National LGBT Cancer Network, the increased prevalence of risky behaviors in the lesbian community – a "cluster of risks" known as a health disparity – can be "traced to the stress of living as a sexual/gender minority in this country." Pondering this idea, I also wonder: Are lesbians so oppressed in education and healthcare that we have fewer tools to take care of ourselves? How much does an often indifferent or even sometimes hostile medical system inhibit our willingness or ability to seek care? How much of a role does our lower rate of insurance coverage play in our higher rate of cancer?
I have my opinions, but no conclusive answer. As usual, our people and our issues sorely need more study. And, while we wait, we need to make sure that we, and our friends, loved ones, and queer peers are given the most up-to-date recommendations for taking care of our own bodies, and that we have the best access possible to healthcare. To that end, I've summarized below screening guidelines for breast cancer that lesbians, bisexual women, transmen and transwomen need to know.
IMPORTANT SYMPTOMS AND SCREENING GUIDELINES FOR LBGT PEOPLE:
All Lesbian and Bisexual Women: The National LGBT Cancer Network recommends that all women, including transgender women with breast tissue, have a mammogram every year starting at age 40. I would add that, if you have a family history of breast or ovarian cancer, you should start screening earlier; if you are well under 40, you may want to investigate alternate screening methods such as MRIs, which may be better at detecting cancer in the denser breasts of younger women. If you notice any changes in your breasts – a lump, discharge, skin puckering or discoloration, pain – get it checked by a culturally competent, sensitive doctor. (For a different view about mammography screening, see Alice Yaker's blog post on this topic.)
Transgender Female to Male: According to The Mautner Project, those who identify as FTM but have not had top surgery should follow the same guidelines as those for lesbian and bi women, above. I add that even those who have had top surgery should, during their yearly physical (which should include what is commonly referred to as a gyn exam), have their doctor perform a clinical exam of their chest area: "[T]here may still be risk of breast cancer even after sexual reassignment surgery…because breast muscle wall tissue remains. Breast tissue cells might be present in the nipple area as well as throughout the chest area."
Transgender Male to Female: Those who identify as MTF also need to be proactive about breast cancer risk. There no confirmed studies of this group, but estrogen is central to the mystery of breast cancer, so it makes sense that the good people at Mautner note that "transgender women (MTF) who are on high levels of estrogen may be at increased risk of breast cancer" and should act accordingly. Moreover, a small number of men, straight or potentially transgender (there are not stats on this) get breast cancer. So MTFs need to know their bodies, see their doctors, ask for clinical breast exams, know the signs of early cancer, and seek treatment if necessary.
NEXT POST: What we need to know about ovarian cancer incidence and symptoms.
Mimi has worked as a consulting LGBT Outreach Coordinator for SHARE. She is also a singer/songwriter/actress and yoga teacher in NYC.