Special considerations for breast cancer risk in the LGBTQ community

Breast cancer is the most common cancer among women in the US and the second most common cause of cancer-related death. Researchers have attempted to identify those who may be at greater risk and develop strategies for reducing disparities among specific populations of women.¹ Thus far, they have found success in identifying differences in breast cancer risk based on racial and socioeconomic factors,¹ but what about for sexual orientation?

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Clinicians are encouraged to be aware of their patients’ sexual orientation and how this might factor into disparities in breast cancer risk and breast cancer outcomes.

Clinicians are encouraged to be aware of their patients’ sexual orientation and how this might factor into disparities in breast cancer risk and breast cancer outcomes.

Among lesbians, bisexual women, and transgender men, there have long been concerns about increased breast cancer risk.² These longstanding concerns are based on evidence that people in these groups have higher rates of certain risk factors, such as nulliparity, alcohol consumption, smoking, and obesity.² Official policy documents in the US and UK have echoed this concern, but research to date has been limited, and the existing data are contradictory.^1,2

In addition to the possibility that lesbians, bisexual women, and transgender men have higher rates of certain behavioral risk factors for breast cancer, there is also evidence of disparities in access to health care, including lower rates of health insurance and breast cancer screening.¹

A 2016 overview of research on breast cancer among women identified as sexual minority, lesbian, bisexual, or transgender sought to address clinical questions regarding risk stratification, breast cancer mortality, breast reconstruction, and transgender issues.¹ Based on a review of articles published from 2000 to 2015, the researchers found that behavioral risks (obesity, alcohol use, tobacco use), reproductive risks (nulliparity, less use of oral contraceptives), and decreased access to health care (lack of health insurance, less frequent screening) may all affect outcomes for lesbians, bisexual women, or transgender men who have breast cancer.¹

Overall, the researchers concluded that the evidence remains limited, most likely because sexual orientation is rarely reported in large health-related databases, which makes it difficult to conduct effective research on a large scale.¹

Despite these limitations, researchers offer a number of suggestions, such as using education and structured support groups to help sexual minority women gain greater access to breast cancer screening.¹ They also urge health care professionals to consider breast and chest examinations in addition to mammography for transgender patients.¹

In addition, clinicians are encouraged to be aware of their patients’ sexual orientation and how this might factor into disparities in breast cancer risk and breast cancer outcomes.¹ The as-needed inclusion of supportive individuals, such as the patient’s family, friends, caregivers, or allied health care professionals, can help the clinician obtain a clear understanding of the patient’s healthcare goals when discussing treatment options, including breast reconstruction after cancer surgery.¹

• See Also: Tips to help meet the needs of LGBTQ patients in your practice

“Consistent documentation of gender preferences as part of the medical record could improve the delivery of personalized care,” researchers stated.¹

They suggest that developers of large-scale health-related databases consider adding information about sexual orientation to the demographic data, thereby facilitating “more robust” research.¹ One might add gender identity as well, although these researchers do not use this term; they do, however, call for researchers to “consider standardizing terminology regarding sexual minority patients to allow for more cohesive dialogue in the scientific literature.”¹

Writing in BMC Public Health, a pair of researchers from the UK state, “Given the available evidence, it remains uncertain as to whether there is a higher incidence of breast cancer in lesbian and bisexual women or not, but the balance of evidence is starting to suggest a higher incidence.”²

• See Also: Special considerations for ovarian cancer among women in the LGBTQ community

They also cite a recent survey funded by the US government indicating that lesbian and bisexual women are three times more likely to die from breast cancer compared to women in the general population. In calling for information on sexual orientation to be included in medical research studies, they state, “It is vital that sexual orientation be measured in order that health inequalities such as these can be found and addressed.”²

References:

1. Mattingly AE, et al. Cancer Control. 2016;23(4):373-382.

2. Meads C, Moore D. BMC Public Health. 2013;13:1127.