Breast cancer is the most common type of cancer in the United States. The American Cancer Society estimates that nearly 300,000 people will receive breast cancer diagnoses in 2023. Further, 43,170 people will die from breast cancer in 2023, the society says.
Breast cancer impacts all genders, including people who are transgender, nonbinary, or another gender minority. Experts estimate that more than 7% 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 up to 21,108 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:
- National LGBT Cancer Network and their resources
- CancerCare and their LGBTQIA+ support groups
- The Fenway Institute
- CoppaFeel!: Resources for Trans and Non-Binary People with Breast Cancer
- Family Caregiver Alliance: LGBT Caring Community Online Support Group
- The National LGBT Cancer Project
- Young Survival Coalition Virtual Hangout for LGBTQIA+ Survivors
- CancerCare LGBTQ+ Support Group – Women Caregivers
- Queering Cancer, based in Canada
- Live Through This, based in the UK
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Emily B. Sonnenblick, et al. Breast Imaging for Transgender Individuals: Assessment of Current Practice and Needs. February 2022. Journal of the American College of Radiology. Link
Lesbians and Breast Cancer Risk. LGBT Cancer Information. National LGBT Cancer Network. Link
Lesbian, Gay, Bisexual, and Transgender (LGBT) People. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Link
Lorraine T. Dean, et al. Beyond Black and White: race and sexual identity as contributors to healthcare system distrust after breast cancer screening among US women. July 2021. Psychooncology. Link
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Natalie Luehmann, et al. A Single-Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients. March 2022. Annals of Surgical Oncology. Link
Nykole Sutherland, et al. Unanswered Questions: Hereditary breast and gynecological cancer risk assessment in transgender adolescents and young adults. August 2020. Journal of Genetic Counseling. Link
Oluwadamilola T. Oladeru, et al. Breast and Cervical Cancer Screening Disparities in Transgender People. March 1, 2022. American Journal of Clinical Oncology. Link
Ryan Lockhart and Aya Kamaya. Patient-Friendly Summary of the ACR Appropriateness Criteria: Transgender Breast Cancer Screening. January 25, 2022. Journal of the American College of Radiology. Link
Tonda L. Hughes, et al. The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems. 2016. Alcohol Research. Link
Tonia C. Poteat, et al. Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States. October 1, 2021. Cancer. Link
Ulrike Boehmer, et al. Sexual minority population density and incidence of lung, colorectal and female breast cancer in California. March 26, 2014. BMJ Open. Link
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