Dr. Susan Love on Lesbians and Breast Cancer: OP-ED

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Whenever I speak at an event specifically for lesbians, this is the first question I am inevitably asked to answer: Is it true that lesbians are at greater risk of getting breast cancer?

The root of this question dates back to 1993, and a lesbian cancer researcher’s hypothesis that lesbians might be two-to-three times more likely to develop breast cancer than heterosexual women. This was primarily due to three breast cancer risk factors that appeared to be more prevalent among lesbians: drinking alcohol, being overweight, and not having been pregnant.

At the time, there was virtually no research on lesbians and breast cancer. And that’s really what the researcher, Suzanne Haynes, was trying to draw attention to—the need to study this group of women. The good thing is that, as a result of her work, these studies are now being done. The bad thing is that that her hypothesis led to headlines that screamed “1 in 3 Lesbians Get Breast Cancer,” and a great deal of fear and concern.

Dr. Love and her Army of Women

There is nothing about being a lesbian, per se, that puts you at higher risk of developing breast cancer. But some of the lifestyle factors that Haynes identified in the lesbian community were and remain a problem. However, there are things you can do to address them:

• Studies have shown that being overweight not only puts you at greater risk of getting breast cancer but of being less likely to survive the disease. So, if you are overweight, make this the year you decide to do something about it by exercising more and eating a healthy, well-balanced diet. You don’t need to run a marathon. Just start walking around the block a few times instead of sitting down to watch TV.

• Drinking more than one drink a day just isn’t good for you—for many reasons. We all know that lesbians tend to congregate at bars. But just because you’re in a bar, doesn’t mean you have to drink alcohol. Start by trying to alternate an alcoholic drink with a non-alcoholic one.

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•        Next, don’t use hormones to treat menopausal symptoms for more than three to five years. This means ignore Suzanne Somers or anyone else who tells you that “natural” or “bio-identical” hormones are safe to use after menopause.

•        Most importantly, find a doctor you like, and can trust, and who accepts you for who you are. Not getting regular breast cancer screening puts you at greater risk of having a breast cancer diagnosed later, when it is harder to treat. There are, to be sure, doctors out there who you would never in a million years want to come out to. But there are an increasing number of lesbian docs who would welcome the opportunity to have you as a patient. So, work those lesbian networks and find a doctor, and make an appointment.

I’m often also asked by transgender women and men about their risk of breast cancer. The bottom-line up front: We don’t know. That’s because we have no data on the incidence of breast cancer in transgender individuals. Very little research has been done in this regard and it is not a good idea to extrapolate from what we know about non-trans women. In the absence of this much-needed data, this is what the leading experts in transgender health provision recommend:

•        If you are MTF, it is recommend that you begin having an annual chest/breast exam and mammography screening at age 50. We can’t assume that MTFs who have used hormones (estrogen and/or progestin) for five years or more are at higher risk that non-trans men. The hormones are different, are generally given at different ages, and are not usually associated with puberty. This is an area that desperately needs more research.

•        If you are an FTM who has not had chest surgery, begin having mammograms at age 50. If you have used testosterone, which the body converts to estrogen, you may be at higher risk than the average non-trans man of developing breast cancer. This is true even for FTMs who have had top surgery, because of breast tissue that remains in the chest wall after surgery. (It’s the same reason why non-trans women who have had a prophylactic mastectomy still have a small risk of developing breast cancer.) Understandably, it may be difficult to have a mammogram, so it’s important to be aware of any lumps that occur in the skin or under the scars and have them checked out.

•        Of course, for transgender individuals, as for everyone else, there are other factors, like family history, that influence breast cancer risk. Be sure to tell your doctor if you have any family members who have had breast cancer. Also, be open and honest about your past and current hormone use, even if you obtained these hormones in unconventional ways. And if your provider dismisses your concerns, find a new provider. You deserve excellent health care.

As you can see, there is still a lot that we need to learn about breast cancer risk among lesbians and transgendered individuals. But you don’t just have to sit back and wait for this research to happen. You can get actively involved in the research by signing up to be part of two amazing projects I’ve spearheaded:

•        The Love/Avon Army of Women, which is enrolling women and men who are interested in taking part in research focused on what causes breast cancer and how to stop it.

•        The Health of Women study, which will focus on uncovering breast cancer risk factors.

You can sign up for both of these programs on the Army of Women website: armyofwomen.org. You can get more information about breast cancer on the Dr. Susan Love Research Foundation website: www.dslrf.org

On Saturday, January 29, Dr. Susan Love will be the keynote speaker at "Lesbians & Breast Cancer: A Town Hall Forum" at the San Diego Lesbian, Gay, Bisexual and Transgender Community Center. In this article, Dr. Love talks about why breast cancer research is important to the lesbian and transgender community.