LGBTQ-specific teachings are very limited in medical schools. This means any additional training is on the onus of the practitioner. One statistic that is often quoted, but not discussed in detail, is that Lesbian women have a higher chance of developing breast cancer. But why?
At this point in the research, the consensus suggests several environmental factors, often coined “cluster of risk factors”, as the cause of the higher rates of breast cancer among Lesbians. Let’s look at the environmental risk factors that place Lesbian women at a higher risk of developing breast cancer.
It has been argued that the stress and stigma of living in a society where homophobia is still so prevalent can have an effect on our immune response. We know that traumatic events can alter our immune response which can give the opportunity for cancer cells to grow. Clearly every person’s story is unique, and healthcare practitioners need to inquire and appreciate each of their patients' process of coming out.
Research suggests that alcohol abuse and regular heavy drinking is more prevalent among lesbian women. We know from studies that there is a 40% increased risk of breast cancer with moderate to heavy drinking, which is around 2-5 drinks daily. Even light drinking of 1 drink a day can increase risk of developing breast cancer up to 6%.
Body weight plays a role in breast cancer risk. Studies suggest that lesbians, on average, have higher body weight. Why this is the case is not well understood. But knowing that weight gain can play a role in both developing and dying from breast cancer is important in treating all people with breasts. We know that obesity before menopause increases our chance of dying from breast cancer while postmenopausal obesity increases the risk of developing breast cancer.
Pregnancy and breastfeeding
Breastfeeding and pregnancy lower the risk of developing both pre- and -post menopausal breast cancer. A full-term pregnancy before age 30 confers the greatest protection. It is more likely that a heterosexual woman will experience pregnancy and breast feeding and gain this cancer protective property.
There are some conflicting reports regarding the frequency of cancer screening tests in lesbians. Some studies show that a lower percentage of lesbians receive mammograms compared to heterosexual women. Other studies contradict this and find no significant difference in mammography between white lesbians and heterosexual women. However, there is like a race component to this as well and further studies looking at mammography frequency among Black and Latina lesbian women should be explored. Also, lesbians, even if in a long-term relationship, are less likely to have health insurance coverage since her partner may not be seen as a spouse. Lack of insurance coverage is a clear barrier to obtaining routine screening tests. Also, many lesbians report a fear of discrimination or having had a negative experience with a health care provider as a deterrent to wanting to seek medical care.
We need to consider all the environmental risks when understanding each of our patient’s unique susceptibility for developing breast cancer. Our health care system must have a collective understanding of the healthcare needs of lesbians. The standard of care for addressing the health care needs of the LGBQT community needs to improve.
A 2019 study published in the Journal of Clinical Oncology reported that fewer than 40% of the 450 oncologists they surveyed said they were adequately informed to treat cancer in patients who identify as LGBTQ.
Fewer than a third of the physicians questioned felt knowing a patient’s sexual orientation was important. But knowing that there are these unique risk factors for lesbians make knowing a patient’s sexual orientation very relevant.
Doctors and patients need to understand why lesbians have an increased chance of developing breast cancer so that doctors can be more sensitive and thorough during visits and patients know they need to self-advocate and seek out healthcare practitioners who can deliver the thorough healthcare they deserve.
Dr. Maggie Ney is a naturopathic doctor and director of the Women’s Clinic at the Akasha Center for Integrative Medicine. She specializes in hormones, perimenopause, menopause, and healthy aging.