Throughout October, Philadelphia has highlighted Breast Cancer Awareness Month. Liberty Place, 8th and Market, the fountains at Logan Circle and the Avenue of the Arts are all lit a vibrant, pulsating pink to remind Philly’s women to get a mammogram and save their own lives. Breast cancer accounts for 12.5% of all new annual cancer cases worldwide, making it the most common cancer in the world.
Breast Cancer Awareness Month is drawing to a close, once again with no outreach to lesbians, bisexual and queer women. Yet it has been true for decades that LBQ women are at greater risk than their heterosexual peers. According to the American Cancer Society, “Lesbian and bisexual women may be at increased risk for breast, cervical and ovarian cancer compared to heterosexual women. Knowing about these cancers and what you can do to help prevent them or finding them early (when the cancer is small, has not spread, and might be easier to treat) may help save your life.”
These women are both at higher risk for breast cancer and have a lower likelihood of getting the same standard of care as their heterosexual peers. LBQ women often feel invisible in the discourse on breast cancer. The disparities in how LBQ women are treated by the healthcare system is an impediment to care and that can translate into lives lost.
Fear of discrimination is key. It remains difficult for many queer women to reveal to their health care providers their sexual orientation, because they fear discrimination will affect the quality of health care they receive. This can make an honest and open relationship with a health care provider fraught from the outset.
Fear of having a negative experience with a health care provider can also lead some women to delay or avoid medical care, especially routine care such as early detection tests. Missing routine cancer screening tests can lead to cancer being diagnosed at a later stage, when it can be harder to treat and where treatment is more extensive.
Another problem for LBQ people can be a lack of health insurance coverage due to affordability. Lower incomes can make it harder for many LBQ women to get quality health care.
The risk factors for breast cancer include being a woman and getting older. A woman whose mother, sister or daughter has or had breast cancer is at higher risk. Being overweight, especially after menopause, not being physically active, drinking alcohol, or using certain types of birth control may add to the risk.
There may be a higher breast cancer risk for women who have used some hormone therapy after menopause. Women who haven’t had children or haven’t breast-fed and women who are older than 30 when they first give birth are also at a slightly higher risk.
The LGBT Cancer Network acknowledges that lesbians especially are “invisible” because the large national cancer registries and surveys do not collect data about sexual orientation. So while racial, ethnic and other groups of women can discern their risk and how to address it from specific data, lesbians cannot. The prevalence of breast cancer makes this lack of data especially problematic for lesbians.
The LGBT Cancer Network says that the community has a “disproportionate cancer burden” and notes, “There is adequate research to confirm that lesbian, gay, bisexual and transgender people have a unique ‘cluster of risk factors’ that would lead us to have both greater cancer incidence and later stage diagnosis. We estimate that there are over 1 million LGBT cancer survivors in the country today. This disproportionate burden of disease is referred to as ‘health disparities.’”
Women also have those “disparities.” About 13% — 1 in 8 — of U.S. women will develop invasive breast cancer in the course of their life.
In 2023, an estimated 297,790 new cases of invasive breast cancer are expected to be diagnosed in U.S. women, along with 55,720 new cases of DCIS breast cancer.
In 2023, an estimated 2,800 new cases of invasive breast cancer are expected to be diagnosed in men. A man’s lifetime risk of breast cancer is about 1 in 833, but this statistic can still impact many trans women in terms of genetic predisposition.
There are currently more than 4 million women with a history of breast cancer in the U.S. This includes women currently being treated and women who have completed treatment. Breast cancer is the most commonly diagnosed cancer among U.S. women. About 30% of all newly diagnosed cancers in women each year are breast cancer.
Local LGBTQ+ activist and former industrial spy Suz Atlas, spoke to PGN about her experience with breast cancer. She said that in her relationship with her activist wife Mary Groce — also a cancer survivor — it was essential that the couple fight cancer as a united front.
Atlas said, “Sick from hiding our lesbian selves, right from the get-go, our relationship was out and proud. Going through cancer was to be no exception. At the beginning of this cancer journey, Mary and I did look for that occasional side-eye or knowing smirk or downright hostility but the staff at Fox Chase Cancer Center treated us with compassion and respect.”
That fact made her experience less terrible, Atlas said, explaining, “No cancer is easy. Surgery, chemo and radiation are not fun. And when dealing with the medical establishment, any attempt to retain your dignity is left on the changing room floor. I had the ‘good kind of breast cancer’ and escaped chemo.”
For Atlas’s wife Groce, her cancer experience and her coming out experience were synchronous. Groce says she had come out to herself in 1976, but, like Atlas, she was married to a man and her fear of losing her child to a custody battle caused her to “slam the closet door, with me and my son inside.”
Life changed for her in 1993 and as Groce explains, the stress of being closeted impacted her health and, she and Atlas believe, Atlas’s as well. Groce said, “I had a breast cancer scare which turned out to be a benign cyst soon after I came out to myself for the second time. Suz had the same lumpy experience. The conscious knowledge, finally, that we were lesbians, would always be lesbians, with no turning back, was enough to physically manifest in both of us, causing breast lumps and pain.”
Groce continued, “On one hand, I was so relieved to finally be able to breathe again, but the weight of knowing who I was and having to deal with it was life-altering and stressful, plunging me back into the trauma of the past, and the same was true for Suz. So it wasn’t easy to be out and proud in 1993 — not yet, anyway. Thank the Goddess we finally met in the spring of 1994.”
In 2008, Groce was diagnosed with the most common gynecological cancer. She said, “I was diagnosed with cervical cancer, which was resolved with a hysterectomy — no chemo or radiation were necessary. However I was out of commission for a good two months before I could start performing again.”
Groce and Atlas were both “independent contractors,” Groce a harpist and singer and Atlas an industrial spy. Like many LGBTQ+ people, neither woman had sick leave or employee benefits. Groce said, “This setback caused the beginning of a financial spiral that resulted in my going bankrupt in 2011.”
Both women have endured several health crises, including heart attacks and a second cancer for Atlas, which she is currently in treatment for. Groce says the couple “were already impoverished by being underpaid women with seven kids and vicious ex-husbands who wielded their wealth as weapons against us,” and their cancer battles just added to their plight.
The couple now lives at John C. Anderson Apartments — a complex for LGBTQ+ people over 60 “where we can now survive on our Social Security, Medicare and Medicaid, and be out and proud in the Gayborhood,” said Groce — and has had positive experiences with Jefferson’s cancer program for Atlas’s treatment.
The LGBT Cancer Network suggests accessing LGBT-friendly care and support if possible. The National LGBT Cancer Network is currently running cancer peer-support groups. These are free Zoom peer-support groups for LGBTQ+ individuals who have or have had cancer.
The American Cancer Society recommends lesbians and bisexual women begin annual mammograms at 45 but earlier if they have family history, a genetic mutation, or other risk factors. ACS also recommends those women receive an MRI as well.
ACS says, “All women should understand what to expect when getting a mammogram for breast cancer screening — what the test can and cannot do. They should also be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.”