About 22,000 women will receive a diagnosis of ovarian cancer in 2017, and some 14,000 women will die from it, according to the American Cancer Society (ACS). Women’s lifetime risk of ovarian cancer is about 1 in 75, according to ACS. It is the fifth leading cause of cancer deaths among women, accounting for more deaths than any of the other gynecologic cancers (cervical, ovarian, uterine, vaginal, and vulvar cancers, also known as reproductive cancers).
But women in the LGBTQ community may be at an even greater risk for ovarian cancer than women in the general population. This is due to both higher rates of some risk factors among women in the LGBTQ community, as well as lower rates of some protective factors in these individuals.
Some of these factors include:
• Obesity and smoking: Studies have shown that obesity and smoking tobacco are associated with increased ovarian cancer risk, and lesbians as a group have a higher body mass index (BMI) than heterosexual women, as well as higher rates of either current or past tobacco use.
• Oral contraception: A number of studies have shown that oral contraceptive use decreases a woman’s risk of ovarian cancer, and lesbians are less likely than heterosexual women to use oral contraceptives. Pregnancy and breastfeeding, particularly before age 30, have been shown to decrease ovarian cancer risk; again, lesbians are less likely than heterosexual women to become pregnant, bear children, or breastfeed.
• Medical/gynecologic care: Because early detection is so important for successful treatment of ovarian cancer, regular medical and gynecologic care is associated with lower risk, and women in the LGBTQ community are less likely than heterosexual women to access such care. Studies have identified a number of barriers to routine medical and gynecologic care for women in the LGBTQ community, including lower rates of cancer screening tests. These barriers include less access to health insurance, concerns about discrimination, and negative experiences with the healthcare system.
• Health care coverage: Many health insurance policies do not cover unmarried partners. While this may be less of a problem since the legalization of same-sex marriage, many older women in the LGBTQ community may have spent the better part of their lives unable to access health insurance through a partner’s employer. (Plus, ovarian cancer occurs mainly in older women, with about half of cases diagnosed in women aged 63 or older.) Despite the legalization of same-sex marriage by the United States Supreme Court in 2015, social and cultural barriers continue to prevent many same-sex couples from marrying, thereby continuing to limit access to health insurance through a partner’s employer.
• Poverty: A recent report by a coalition of research and advocacy groups found that women in the LGBTQ community in the US are at greater risk of poverty, posing yet another barrier to access to health care. The report found that access to health care for such women is limited by a range of factors, including discriminatory laws, discrimination by providers, insurance exclusions for transgender people, and inadequate reproductive health coverage.
“Lesbians and bisexual women encounter barriers to health care that include concerns about confidentiality and disclosure, discriminatory attitudes and treatment, limited access to health care and health insurance, and often a limited understanding as to what their health risks may be,” wrote the members of the Committee on Health Care for Underserved Women of the American College of Obstetricians and Gynecologists (ACOG) in a committee opinion published in 2012.
The opinion continues, “Health care providers should offer quality care to all women regardless of sexual orientation. The American College of Obstetricians and Gynecologists endorses equitable treatment for lesbians and bisexual women and their families, not only for direct health care needs, but also for indirect health care issues.”
The same caveats and imperatives apply to transgender men, whose health concerns have only begun to be more widely recognized in recent years.