LGBTQ+ issues

The most common types of cancer among the LGBTQ+ community include skin, colon, endometrial (uterine), cervical, lung, and breast cancer. Lesbian, gay, bisexual and transgender people have a greater risk of breast cancer than their heterosexual counterparts – this is not because of their sexual orientation or gender identification. The risk is linked to breast cancer risk factors that tend to be more common in these people. Examples include never having children or having them later in life, and higher rates of obesity and alcohol use (via Facts for Life: Lesbian, Gay, Bisexual and Transgender People).

LGBTQ+ communities are also less likely to get screened than heterosexual non-trans individuals (via Get Screened). This means that the LGBTQ+ community experience a higher risk of dying from these cancers because the cancer is often caught in later stages due to lack of screening.

LGBTQ+ individuals face unique challenges within the healthcare system that can cause poorer mental and physical health because of lack of specialized care. Many doctors, nurses, and other healthcare providers have not had sufficient training to understand the specific health experiences of the LGBQT+ community.

There can be barriers to optimal health for the LGBTQ+ community such as:

• Fear of negative reactions from their doctors if they disclose their sexual orientation or gender identity
• Doctors’ lack of understanding of the LGBTQ+ community and their health care needs
• The patient may avoid the health system entirely because of negative past experiences with health care providers

Healthcare providers can do a great deal to eliminate these barriers by creating a welcoming, culturally competent, sensitive and educated environment for LGBTQ+ clients and their families. This requires (via Get Screened):

• Understanding cancer screening information and considerations for LGBTQ+ clients
• Staff training and education
• Creating a welcoming physical and administrative environment for LGBTQ+ clients and their families

It is difficult to find health information that speaks to the LGBTQ+ community. Everyone deserves quality health care, but as an LGBTQ+ individual with cancer, you may feel that there aren’t many resources out there that are suited for you.

Please refer to the resources below for more information on finding the best health care provider, coming out to your health care provider and LGBTQ+ online and in-person support groups.

LGBTQ+ Resources and Information

Get screened campaign – Run by the Canadian Cancer Society, the campaign aims to reach out to LGBTQ+ individuals in Hamilton, Ottawa and Toronto to get screening done for breast, colon, and cervical cancers.

Trans people and cancer – An online pamphlet discussing medical cancer issues in transgender individuals, a section covers prostate cancer in transgender women.

Rainbow Health Ontario provider directory – A province-wide program designed to provide access to services for LGTBQ+ individuals; includes a directory of LGBTQ+ friendly programs and services.

Sherbourne Health Centre – Offers a safe and non-judgmental healthcare environment for LGBTQ+ individuals in Toronto.

Juravinski Hospital and Cancer Centre A list of LGBTQ+ cancer networks, groups, books, caregiver education, and information.

Cancer Facts for Lesbians and Bisexual Women A Printable educative PDF booklet for Lesbian and Bisexual Women with Cancer compiled by the American Cancer Society.

Human Rights Campaign Information and tips about coming out to your doctor and/or health care providers.

Making Us Visible An online resource for starting a breast cancer support group for lesbian and bisexual women in your area.

Cancer’s Margins This arts and community-based LGBTQ+ research project explores sexual and gender diversity, experiences of breast and gynecologic cancer health, support/care, and the ways we locate and share cancer health knowledge.

National LGBT Cancer Network The National LGBT Cancer Network works to improve the lives of LGBTQ+ cancer survivors and those at risk by educating, training and advocating.

Finding Your True Voice: A Guide to Gender-Affirming Verbal Communication – For anyone looking to improve communication with their healthcare team

LGBTQ+ People and Breast Cancer

LGBTQ+ people face unique challenges within the healthcare system that can cause poorer mental and physical health because of lack of specialized care.

Lesbian, gay, bisexual, and transgender people have a greater risk of breast cancer than their heterosexual counterparts – this is not because of their sexual orientation or gender identification. The risk is linked to breast cancer risk factors that tend to be more common in these people. Examples include never having children or having them later in life, and higher rates of obesity and alcohol use.

LGBTQ+ people are also less likely to get screened than heterosexual cisgender people. This means that LGBTQ+ people experience a higher risk of dying from these cancers because the cancer is often caught in later stages due to lack of screening.

When seeking treatment for breast cancer, it is best to make your cancer care team aware of your sexual orientation.

Transgender

It’s best to tell your doctor about your gender identity and your transition. This allows your health care team to

• Use your preferred pronouns and name
• Take your transition into account in determining the best treatment plan for you¹

For advice on coming out to your doctor, read Coming Out to your Doctor (Human Rights Campaign).

Since there have been relatively few documented cases of breast cancer in transgender people, it is not clear whether transgender men or women are more or less at risk for breast cancer than cisgender men or women. It is also unclear whether breast cancer in transgender people is more likely to have certain characteristics than in cisgender people. As health professionals and organizations become better at caring for transgender people, more transgender people seek medical care, and more research is conducted, the state of knowledge of breast cancer in transgender people will improve a great deal.

Trans women

It is not clear whether trans women have a greater or lesser risk of breast cancer than cis women. Some studies have suggested that their risk is significantly lesser; others claim that it is much higher.²

Trans women are more likely to have dense breasts, which is a risk factor for breast cancer on its own. Dense breast also make mammograms harder to read, meaning that many cancers go undetected.³

Gender-affirming hormones may add to your risk of breast cancer over time. If you have taken gender-affirming hormones for more than five years and you are between 50 and 69 years old, you should get a screening mammogram every two years. Otherwise you do not need regular screening mammograms.⁴ (This is because estrogen and similar hormones gradually increase the risk of breast cancer the more the breast is exposed to them).

Trans men

It’s generally recommended that you have screening mammograms between 50 and 69 years of age. This is true

• even if you have had top surgery, since usually some chest tissue remains
• even if you have taken testosterone.⁵

In general, trans men should be screened for breast cancer in much the same way as non-trans women.

You can often still get a mammogram if you don’t have very much chest tissue. In some cases you may need to have an ultrasound or an MRI instead.⁶