By Richard A. Zmuda, cancerpage.com
(Aug. 23, 2000) Way back in 1996 the American Medical Association (AMA) took the bold step of issuing a report which concluded that gay women and men may not be receiving the care they require. Dr. James Allen, of the AMA's Council on Scientific Affairs, said patients are often hesitant to reveal their sexual orientation out of fear-in some cases, well founded-of prejudice or lack of sensitivity on the part of physicians.
The report called on physicians to be "nonjudgmental with all patients in terms of obtaining information about sexual orientation and sexual practice." It recommended that doctors be educated about the needs of gay patients and that homosexuals be informed about their health risks.
Breast Cancer
According to a study presented at a 1998 meeting of the Gay and Lesbian Medical Association and published in the Medical Tribune, lesbian women may be at higher risk of developing breast cancer than heterosexual women. A large part of this potentially increased risk comes from the fact that only 37 percent of lesbian women report ever having been pregnant, compared with 83 percent of heterosexual women.
Studies have shown that breast cancer is more likely to develop in women who have never been pregnant than in those who have, possibly because of a cancer preventive effect from hormones released during pregnancy.
Along with being less likely to have been pregnant, other studies have shown that lesbians in general may be slightly heavier than heterosexual women. Heavier women have a higher risk of developing breast cancer after menopause. Lesbians are also less likely to use oral contraceptives and more likely to have smoked cigarettes than heterosexual women-all risk factors for breast cancer.
Conversely, lesbians are no more likely than heterosexual women to have a family history of breast cancer or to be younger when they had their first period-factors that similarly convey increased risk.
Studies on the number of lesbian and bisexual women having mammography compared with heterosexual women are contradictory, with one national survey showing the former population more likely to have had a mammogram-although most respondents were white and well educated-and others showing they were less likely to either have had a mammogram or to have examined their own breasts.Cervical Cancer
While breast cancer is probably the most researched topic in lesbian health, gay women are also at increased risk for cervical and other cancers, primarily because they are simply not screened as often.
Just as with heterosexual women, lesbians are at risk for cervical cancer because many women carry human papilloma virus (HPV), the sexually transmitted virus that causes most cervical cancer. A Pap test detects HPV and cell changes in the cervix that can develop into cancer. Pap tests are important because early detection of HPV allows for treatment that can prevent cancer from developing.
The risk of cervical cancer drops dramatically with regular screening. However, in a recent national survey, only 54 percent of lesbian and bisexual women had been given a Pap smear within the past year, and 7.5 percent had never had a Pap smear. This is partially due to unfounded-and stubbornly pervasive-misconceptions by both lesbians and health care professionals that lesbians are not at as great a risk for cervical cancer.Fear of Doctors / Doctors' Fears
A study published in the Journal of the American Medical Association found that almost three-quarters (72 percent) of gay women do not tell their primary care physician about their sexual orientation, and just under half (44 percent) of gay men withhold this information.
According to a survey by the Lesbian Community Cancer Project, almost 25 percent of lesbian and bisexual women said they avoid seeking health care because of their fear of a negative attitude on the part of providers.
And some of that fear may be justified. One study found that 45 percent of the gynecologist-members of the Gay and Lesbian Medical Association said they had observed colleagues giving their homosexual patients substandard care. Another survey found that 40 percent of doctors said they were uncomfortable with lesbian patients.
As many as two-thirds of physicians simply never ask patients about their sexual orientation. Some health care professionals assume that their patients are heterosexual. Others may be homophobic or prefer to avoid the issue.Targeting the Message
According to The Mautner Project for lesbians with cancer, a number of factors contribute to this greater risk for breast, cervical and other cancers: Lesbians are less likely to seek health care because of the discomfort of coming out to health care providers.Lesbians are less likely to visit a doctor for routine gynecological services such as birth control and prenatal care. Therefore, lesbians are less likely to have cancers detected at earlier, more treatable, stages.Lesbians are at higher risk of breast, cervical and ovarian cancers because they are less likely to have children by age 30, if at all.Lesbians are affected more directly by women's lower earning power and do not have the benefit of a spouse's health insurance coverage.
Without question, new education campaigns emphasizing breast and cervical screening should be directed toward lesbian women. Regular screening has a proven impact on dramatically reducing cancer incidence.
While it is a tragedy that fears and biases-on the part of both patients and doctors-still exist, it is an even greater tragedy if the end result is a cancer that could have been treated effectively-or avoided-if simply caught earlier.
SOURCES:Journal of the American Medical Association, 1996; 275: 1354-1359Western Journal of Medicine, 2000; 172(6):403-408Medical Tribune, Internist & Cardiologist Edition, 1998; 39(17):7The Mautner ProjectLesbian Community Cancer ProjectJournal of Infectious Diseases, December 1998 Content Provided By: CancerPage.com
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