THERE IS VERY little specific research on breast cancer in people who identify as lesbian, bisexual, gay, trans, intersex, queer and other sexual orientations (which we’ll abbreviate as ‘LGBT+’). This is mainly because cancer registries (the big databases that hold details of everyone with cancer in the UK, unless they’ve asked for their details to be withheld) do not routinely record details of people’s sexual orientation. Some LGBT+ pressure groups are campaigning for such data to be collected so that any inequalities of provision and differences in outcome can be highlighted. At the moment, however, the evidence base on this subject is very limited – so please read this chapter with that in mind.
Being lesbian, gay or bisexual doesn’t appear to increase your risk of getting breast cancer – but it doesn’t decrease that risk either. Since breast cancer is very common in women, many women who get it are lesbian or bisexual. Breast cancer is rare in men but it happens, and some of those men will be gay. For the general risk factors for breast cancer (and hence an answer to the question ‘why me?’), see Chapter 1 for women and Chapter 20 for men.
Statistically speaking, lesbians are slightly more likely than straight women to be overweight and to drink more than the recommended levels of alcohol – both of which increase the risk of breast cancer. They are also more likely to have never had children (another risk factor).
If you are a gay man (and not trans), your risk of breast cancer and how it is likely to affect you appears to be very similar to how it affects any man (see Chapter 20).
If you are transsexual – either female to male or male to female, and at any stage in your transition – there is very little published research. We found only two major studies. One – by Louis Gooren’s team in the Journal of Sexual Medicine (December 2013) – was from the Netherlands. These researchers collected data on 2,307 male-to-female and 795 female-to-male transsexuals who had been exposed to cross-sex hormones (that is, oestrogens in the former and androgens in the latter) for between 5 and 30 years. Reassuringly, they found only one proven case (and another possible case) of breast cancer in male-to-female transsexuals and one case in the female-to-male transsexuals. The second study – by Brown and Jones in Breast Cancer Research and Treatment (November 2014) – was of 5,135 transgender US veterans; 10 cases of breast cancer were detected: 7 in male-to-female and 3 in female-to-male transsexuals.
The absolute numbers of breast cancers found in these studies are small but they are consistent with the conclusion that the risk of developing breast cancer in both trans men and trans women is approximately the same as it is in cis men – and a lot less than it is in cis women.
In surveys, a minority of LGBT+ people have felt that health professionals caring for them have sometimes ‘treated me differently’, ‘refused to care for me’, ‘blamed me for my condition’ or ‘used excessive precautions’. Worrying (consciously or subconsciously) whether we’re going to encounter this kind of behaviour in health professionals would make most of us reluctant to come forward. Research has shown that lesbian and trans people are less likely to attend for breast screening, so breast cancer may be less likely to be picked up early. And for the same reasons, some LGBT+ people (though by no means all) may feel less comfortable attending a health check-up or seeing their GP with symptoms that could be breast cancer.
Some blogs by LGBT+ people with cancer have commented on ‘heteronormative’ and ‘cis-normative’ assumptions made by healthcare staff. A woman’s lesbian partner, for example, may be treated as her ‘friend’ or ‘sister’ by staff who assume that her husband is at work. This can be particularly upsetting when you’re in a vulnerable state waiting for cancer test results or a dose of chemotherapy. You will need to play it by ear, but as a general rule we recommend that you introduce your partner as your partner, explain that s/he is a partner, not just a friend, and (if this is your wish) that you’d like her/him involved in your decision-making discussions. But we’re aware that the power dynamics and attitudes of staff may not always be conducive to open and honest dialogue. We hope that most – and ideally all – of your encounters with healthcare staff are supportive and non-judgemental (doctors and nurses are certainly expected to be open and accepting as part of their job).
The bottom line is: breast cancer is no respecter of sexual orientation. Whether you identify as gay, straight, bi, trans, intersex or queer, follow the general advice in this book and elsewhere for having breast screening, seeking prompt advice on breast symptoms and asking for help (if you need it) in making your choices about treatment. Try to identify a health professional you feel comfortable with and (to the extent that you trust them) be honest with them about your concerns about your wider care.
You may find it incredibly isolating having breast cancer as an LGBT+ person. Most cancer charities include sections on their websites for LGBT+ people and, of course, all the information and general support is relevant to everyone. Macmillan, for example, has a downloadable booklet on LGBT people with cancer (www.macmillan.org.uk/_images/lgbt-people-with-cancer_tcm9-282785.pdf), as do Breast Cancer Care (www.breastcancercare.org.uk/sites/default/files/files/lesbian_and_bisexual_women_and_breast_cancer_report.pdf) and Living Beyond Breast Cancer (www.lbbc.org/get-support/print/guides-to-understanding/breast-cancer-infocus-getting-care-you-need-lesbian-gay-or).
Breast Cancer Care and Macmillan may have forum entries for LGBT+ people, but there is a chance that they won’t be active when you need them. There are a few specific LGBT+ websites that you might want to look at to get immediate support for you and your loved ones. In the UK, both the National LGBT Cancer Project (https://lgbtcancer.org/about/) and the LGBT Foundation (www.lbbc.org/lgbt-breast-cancer/your-medical-needs/disparities-breast-cancer-risk-and-care-lesbian-gay-and) offer support and advice for LGBT+ people with cancer. In the US, the National LGBT Cancer Project (https://lgbtcancer.org) provides support, services and research for LGBT+ cancer patients.