About 13% of American women will develop invasive breast cancer over the course of their lifetimes, but the prevalence of breast cancer and other types of cancer may be greater among lesbian and bisexual women, according to the American Cancer Society.
This is due, in part, to medical barriers, fear of discrimination, lower rates of health insurance, and the enduring societal stigmas surrounding sexual orientation.
An estimated 287,850 new cases of invasive breast cancer are expected to be diagnosed in American women in 2022. Breast cancer death rates are higher than those for any other cancer among women in the United States aside from lung cancer.
Lesbian and bisexual women may be at increased risk for breast, cervical, and ovarian cancer compared to heterosexual women. Identifying risk factors, prevention strategies, and warning signs are all vital to early detection.
Existing Barriers
Research suggests that lesbian and bisexual women are less likely than other women to receive routine health care — including breast, colorectal, and cervical cancer screenings — due to fear of discrimination. Some women report reluctance to share their sexual orientation to medical providers, believing it will reduce their overall quality of care, and seek no care at all, the American Cancer Society reports. There also may be a knowledge gap among oncology providers regarding LGBTQIA+-specific needs.
Lesbian and bisexual women may fear having a negative experience with a health provider, prompting them to avoid or delay receiving care like early detection tests. This could lead to a delayed cancer diagnosis, making the disease more difficult to treat.
Additionally, LGBTQIA+ people are less likely to have jobs that provide a health insurance option, and those who do may not have a policy covering unmarried partners. The LGBTQIA+ community is more likely to face other financial barriers that keep many from seeking preventive care. This further contributes to the resource gap among lesbian and bisexual women. Transgender men and women are at risk of breast cancer, too, and often face higher barriers to care.
For transgender men, mammography is recommended per cisgender guidelines if there has been no chest reconstruction. Those who have received a bilateral mastectomy are encouraged to have conversations with their provider about whether or not to receive regular screenings. Transgender women over the age of 50 who have received feminizing hormones for at least five years should also be screened.
The American College of Radiology and the Society of Breast Imaging recommend a risk assessment at age 30 for anyone born with breasts to determine if screening before age 40 is necessary; those at average breast cancer risk can begin screening at age 40. They also recommend continuing screening past age 74.
Who Is at Risk of Developing Breast Cancer?
Another barrier to early breast cancer detection is that many women do not have symptoms, such as a lump that they can feel or see.
Some risk factors for breast cancer include being a woman and getting older. A woman whose immediate family member has or had breast cancer is at higher risk. Other risk factors include:
- Being overweight, or not being physically active.
- Drinking alcohol.
- Using certain types of birth control.
- Taking hormone therapy after menopause.
Women who haven’t had children, haven’t breastfed, and who are older than 30 when they first gave birth are also at a slightly higher risk.
The Importance of Breast Cancer Screenings
Breast cancer screening can be a lifesaving tool to catch the disease at an early stage.
Women at high risk for breast cancer – because of their family history, a genetic mutation, or other factors – should be screened with guidance from a provider.
Screening methods include:
- Mammograms — A mammogram is an x-ray of breast tissue that can help doctors find cancer. For most women, it is the most common and effective way to search for breast cancer. UPMC provides screening tomosynthesis-based mammography.
- Magnetic resonance imaging — An MRI takes photos of breast tissue. Doctors may order this test along with a mammogram to detect cancer in women who are at a higher risk or have dense breasts. Abbreviated MRI scans — shortened versions of a breast MRI — also are available.
- Clinical and self-exams — You or your medical provider can conduct a physical exam of your breasts by using touch to feel for lumps or other possible signs of cancer. If you notice any changes in your breasts, you should notify your doctor immediately.
To learn more about the importance of breast cancer screenings and whether they’re right for you, visit UPMC Hillman Cancer Center or the UPMC Magee-Womens Hospital Breast Cancer Program.
Read more about screening guidelines for LGBTQIA+ persons here.