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Breast Cancer and the Lesbian Community     

 

October is Breast Cancer Awareness Month. Breast cancer is the most common cancer among women and over the last 50 years, the incidence of breast cancer has risen. Even so, the mortality rate has declined somewhat, owing to improved survival with early detection and more effective treatments.

Risk factors. There are several known risk factors for breast cancer among women. Age is one: while breast cancer is rare in women under 25, the risk increases steadily thereafter, especially in women over 50. Older women also have a higher risk of breast cancer if they delayed having children until after age 30, had fewer pregnancies or no pregnancies, if they had an early age of first menstruation, or had a late age at menopause. A personal history of breast cancer increases the later chance of developing a new cancer in the same or the other breast. And a history of breast cancer in a very close relative--a mother or sister--may carry added risk if this relative was diagnosed at an early age. Finally, the use of birth control pills or estrogen hormone replacement may also slightly increase the risk of breast cancer.

Lesbians appear to have an increased risk of breast cancer. One reason may relate to a risk factor just described: lesbians are more likely to delay bearing children, and to bear fewer children, if they have children at all. Lesbians are also less likely to visit doctors for routine gynecological services such as birth control. As a result, lesbians may miss opportunities to detect breast cancer at its most treatable early stages. And access to health care may also play a role, when lesbians do not have the benefit of their partners’ health insurance coverage.

Preventing and treating breast cancer. Some of the known risk factors of breast cancer (age, for example) are traits that cannot be changed or prevented. Other possible risk factors (diet and environmental exposures, for example) are still unproven and need further study. Currently the most effective means of controlling breast cancer involve early detection. Early detection requires:

regular self examinations of the breast to detect a developing lump or thickening. (Remember that many lumps so detected are actually benign, but still require a medical evaluation to be sure.)
examinations by a physician
mammography. Mammography is the most sensitive screening test to detect breast cancer early. Mammography can substantially reduce the breast cancer mortality rate. Women should have mammograms every 1 or 2 years from age 40 to 50 and every year after age 50.

With early detection, most patients can be successfully treated for breast cancer with "local treatment" alone--that is, surgery or radiation therapy focused specifically on the breast. With current practices, the surgery itself is usually not extensive, often involving only a "lumpectomy" plus removal of a few nearby lymph nodes to check for early evidence of spread. When there is evidence or a higher risk of the cancer spreading, systemic chemotherapy or hormone therapy is important to eliminate other sites of cancer, even when these are too small to be detected. Various medications have shown benefit, often being more effective when used in combinations. Treatment must be individualized under the care of a specialist. The overall survival rates for women with breast cancer is about 84%, measured five years after diagnosis. This 5-year survival rate is about 97% when cancer is diagnosed at an early stage without spread.

Research in the prevention and treatment of breast cancer is continuing. A new type of drug, a "monoclonal antibody" called trastuzumab (Herceptin®), has just been approved by the FDA and shows considerable benefit in women with certain types of breast cancer. It has few side effects compared to many of the other drugs used in chemotherapy. Research on another drug, tamoxifen, is underway to assess its benefit in preventing breast cancer in women who are known to have a high risk of developing the disease.

Personal and social needs. In general, the health care system pays insufficient attention to the personal and social needs of women facing breast cancer, especially the needs of lesbians. Lesbians may feel uncomfortable in support groups composed mainly of heterosexual women. Lesbians in a relationship may find that their partner is ignored by health care providers. It is important to find physicians who are sensitive to the partner’s needs for involvement and the partner’s own fears about the disease.

 

 

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