October is Breast Cancer Awareness Month. It’s hard to imagine there are many people not aware of this fact. Thanks to some incredibly successful awareness-raising efforts in recent years, we have become accustomed to seeing pink ribbons in all kinds of places — from ballpoint pens to water bottles, running shoes to NFL jerseys — even drill bits.
There has been considerable debate in recent years about what the actual value or impact of raising awareness — and whether the very success of the pink-ribbon campaign may have oversimplified the disease — is on detection and treatment in people’s minds. (A recent NPR story posed the question: “Amid Breast Cancer Month, is there pink fatigue?”)
And in my role as a health-care provider — and a feminist — I have heard plenty of legitimate criticism over women’s health issues being “reduced” to body parts. I will admit that a T-shirt proclaiming “Save the Ta-Tas” or “I Heart Boobies,” however well-intentioned, doesn’t feel like an empowering or particularly sophisticated message to me.
The truth is that breast cancer remains a terrifying diagnosis, and treatments for it are grueling, at times brutal, experiences. Even those who are fortunate enough to have their cancer detected early will face some difficult decisions and a journey that is both physically and emotionally punishing.
The debate about pink ribbons will continue, but it’s hard to argue that being more aware of our risks, and the ways we can reduce them, hasn’t had a significant positive impact overall. Years ago there was a definite stigma in talking about cancer, and about breast cancer in particular. We now know that talking about cancer — who has it, who is at risk, what it feels like, how it is treated, how it can be prevented or detected early on — can make a real difference.
We also know that people tend to respond better to health messages that are tailored to them, and reflect some understanding of their particular needs and concerns.
There are no physiological differences between lesbian/bisexual women and straight women. And yet there is a higher incidence of breast cancer (and other cancers) within the lesbian and bisexual communities.
Breast-cancer awareness is still important because this disease continues to impact so many people, of all ages and backgrounds. We probably all know someone close to us who has dealt with this disease; one in eight American women will be diagnosed in her lifetime.
We know there are some risk factors that are simply beyond our control, such as gender (while men do get breast cancer, women are 100 times more likely to); aging (risk of invasive breast cancer goes up sharply after age 55); genetics (between 5-10 percent of breast cancers are believed to be caused by genetic mutations passed along by a parent); and family history (having a “first-degree” relative, meaning a mother, sister or daughter, with breast cancer approximately doubles a woman’s risk, while two first-degree relatives increases the risk about three-fold).
However, it’s important to note that only about 15 percent of women diagnosed with breast cancer have a family history, which means the vast majority (85 percent) do not have any family history of the disease.
And it’s also important to note that breast cancer impacts lesbian and bisexual women in particular ways. The four most-cited cancer risk factors in the research on lesbians and breast cancer risk are cigarette smoking (since data suggest that lesbians smoke cigarettes at a substantially higher rate than heterosexual women); alcohol use (since lesbians also tend to report higher rates of heavy drinking); obesity (some studies report that lesbians are more likely to be overweight or have a BMI over 25); and pregnancy (since lesbians are less likely to have biological children before age 30, which would offer some protection against cancer).
Breast cancer impacts transpeople in different ways, which are complicated and important to recognize. The risks for MTFs and FTMs depend on hormones and surgery, which makes them difficult to address in a short column. This is another reason it’s so important to establish a good relationship with your health provider, and discuss your individual health history with them. In general, we would recommend annual chest/breast exam for anyone (starting in their 20s) and regular screening mammography for MTFs who have taken estrogen/progestin, are 50 or older and have other potential risk factors for breast cancer (such as taking estrogen/progestin for more than five years, family history of breast cancer and high body-mass index) and for FTMs 50 and over who have not had chest surgery.
For all of the above populations, another key factor is access to care. Lesbians, bisexuals and trans folks often lack access to consistent and culturally competent health care and, in some cases, avoid accessing care all together due to negative experiences with the health-care system in the past. As a result, they are less likely to receive screenings that are critical to detection and prevention of breast and other forms of cancer.
The Affordable Care Act has made some important steps toward closing the access gap and encouraging preventive care — but it’s still up to us to make the appointments, have the conversations, follow through with the screenings and make the changes we need to minimize our individual risk.
My hope is that we will learn much more about prevention in the years to come, so that fewer women (and men) are subject to the harsh treatments that breast cancer, like other forms of cancer, requires. Until that time, it’s important to know your risks and maintain a close relationship with your health-care provider. (And if you don’t currently have one, feel free to call us at Mazzoni Center!)
The good news is that research advances in recent years have made things like genetic screening possible, along with a number of highly promising clinical trials and other developments that mean many women who are detected early can be treated successfully. According to the National Cancer Institute, when breast cancer is detected early, in the localized stage, the five-year survival rate is 98 percent.
Still, this disease continues to claim far too many of our partners, wives, mothers, sisters, daughters and friends. As I write this, our community has just lost one of our most-admired and dedicated champions, Gloria Casarez, to breast cancer. She chronicled her experience in a series for PGN a few years ago, a courageous act that reminds us of the power of making our lives visible, and the importance of sharing our stories and experiences, even when the outcomes are uncertain.
For more information, visit the National LGBT Cancer Network at www.cancer-network.org.