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
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:
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.)
by a physician
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 partners needs for involvement and the partners own
fears about the disease.