Barriers to Care: Addressing Breast Cancer in the LGBTQIA+ Community

Breast cancer is the most common type of cancer in the United States. The American Cancer Society estimates that nearly 310,000 people will receive breast cancer diagnoses in 2024. Further, 42,250 people will die from breast cancer in 2024, the society says.

Breast cancer impacts all genders, including people who are transgender, nonbinary, or another gender minority. Experts estimate that more than 7.6% of the U.S. population is LGBTQIA+. These include those who identify as lesbian, gay, bisexual, transgender, queer, intersex, asexual, or another sexual minority.

That means about 23,600 LGBTQIA+ people will develop breast cancer in the coming year.

Higher LGBTQIA+ Breast Cancer Risk

In fact, LGBTQIA+ people tend to have a higher risk for breast cancer than cisgender straight people. This is not because of differences in biology. The increased risk is due in part to lifestyle risk factors.

For example, smoking and drinking alcohol increase the risk of breast and other cancers. LGBTQIA+ people are more likely to smoke and more likely to drink alcohol than cisgender straight people.

Breast cancer risk is also slightly lower in individuals who have given birth. LGBTQIA+ people are less likely to have biological children.

But the biggest reason for the higher risk is access to inclusive health care. LGBTQIA+ people don’t receive cancer screenings as often as cisgender straight people. Cancer screenings can find changes in the breast tissue before it becomes cancer.

Regular breast cancer screenings include breast exams, mammograms, and MRI scans. These screenings can find cancer and pre-cancerous cells early. Cancer is easier to treat and has better outcomes when found early.

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Lower Screening Rates in LGBTQIA+ People

A 2022 study found that transgender people were half as likely to get breast cancer screenings than cisgender people. That study, from the American Journal of Clinical Oncology, also found transgender people were less likely to have a primary care doctor. People without a primary care doctor are less likely to get cancer screenings.

A different 2022 study found that breast cancer screening rates of trans and non-binary people ranged from only 2% to 50%. Reasons for lower screening rates include stigma and a history of poor treatment from health care workers. A bad experience may stop a person from regularly visiting a doctor or getting screened.

Even if an LGBTQIA+ person hasn’t had a bad experience, they might fear how a healthcare provider will treat them. One study from 2021 found that LGBTQIA+ people had the greatest distrust of the health care system. The rates of distrust were highest in Black LGBTQIA+ women.

Another reason for low screening rates is that many healthcare providers do not understand how to screen LGBTQIA+ people for breast cancer. One 2022 study found that 70% of radiologists were unsure about the guidelines for breast cancer screening in transgender people.

That same study found that 65% of radiologists did not offer breast cancer screening for transgender men. Only 13% of radiologists in the study even noted a patient’s gender and the sex assigned at birth.

Breast Cancer Screening Guidelines in Transgender People

In transgender and non-binary people, breast cancer screening guidelines depend on three things:

  • The sex that doctors assigned a person at birth.
  • Whether they use hormones.
  • Their other risk factors include a family history of breast cancer or genetic cancer syndrome.

For example, a transgender woman who doesn’t use hormones and doesn’t have a family history of breast cancer doesn’t need screening. But if they have a family history of breast cancer, even with no hormone use, they may need to undergo screening. And transgender women age 40 and older who have used hormones for at least five years also need screening mammograms.

Some transgender men get top surgery, removing both breasts through a double mastectomy. For transgender men who have had top surgery, a breast cancer screening is usually not necessary, but you should always discuss your individual risk with your primary care doctor. Transgender men who have not had top surgery need regular breast cancer screening.

You should talk to your doctor for recommendations on screenings based on your own medical history.

Barriers to Good Health Care for Breast Cancer

LGBTQIA+ people, especially transgender people, have a higher risk of death from breast cancer than cisgender straight people. One reason is that when they find cancer, it is further along. They also don’t always receive high-quality care after their diagnosis.

Even after LGBTQIA+ people receive a breast cancer diagnosis, they are less likely to receive care as quickly as cisgender straight people. For example, a 2021 study found that delays in care are more common for Black women who are also LGBTQIA+. Black LGBTQIA+ women with breast cancer were five times more likely to have a delay in their care than white cisgender straight women.

LGBTQIA+ people with cancer often have more difficult experiences than cisgender straight people with cancer. There are several reasons for these experiences, according to a 2022 study:

  • LGBTQIA+ people are more reluctant to seek health care for cancer or other health problem.
  • They are more likely to continue smoking or drinking alcohol after a cancer diagnosis.
  • They have higher rates of emotional and psychological stress than cisgender straight people.
  • They are less satisfied with the health care they receive.
  • They receive less care or have more or bigger gaps in their care.
  • They have more anxiety, depression, and social isolation than cisgender straight people.
  • They have less emotional and social support than cisgender straight people.
  • They are less likely to become healthy again.

But LGBTQIA+ people with breast cancer can receive the support and health care they need. Resources are available for LGBTQIA+ people who have breast cancer or have survived breast cancer.

Breast Cancer Support for LGBTQIA+ People

The higher rates of LGBTQIA+ breast cancer risk mean it’s very important that LGBTQIA+ people with breast cancer can find support. If you feel comfortable with your doctor, you can come out to them and ask them for local support options. But there are also many other groups that can offer breast cancer support to LGTBQIA+ people.

Here are websites and organizations that can offer breast cancer care especially for LGBTQIA+ people:

Editor's Note: This article was originally published on , and was last reviewed on .

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