Overview of Cancer Risk in Women
Lesbian, bisexual and other women who have sex with women (WSW) may be at greater risk for certain cancers due to certain behaviors and social factors. Breast cancer and uterine/endometrial cancer may be associated with nulliparity, the state of not having given birth. Some evidence suggests that uterine/endometrial cancer and ovarian cancer are more prevalent among women who have never used oral contraception (the pill).
Cervical cancer, uterine/endometrial cancer, and breast cancer rates have dropped significantly as a result of routine Pap smears and mammograms. But risks are greater for lesbian women who avoid preventive health care because they fear discrimination and insensitivity by health care providers.
Other factors that may put lesbian women at greater risk than the general population include a prevalence of smoking, alcohol consumption, and obesity, all of which are associated with cancer. Women who have or have had sex with men are at greater risk for human papillomavirus (HPV), an STD associated with cervical cancer. Cervical cancer accounts for 6 percent of all cancers in women in the United States and breast cancer is considered relatively common in the general population.
Although more research will help us better understand the correlation between these risks and cancer rates in lesbian and bisexual women, attention must also focus on educating and sensitizing health care providers to the needs of this population.
Risk Factors for Cancer in Women
Although the exact causes for many types of cancer are not known, several risk factors are identified as described below.
Breast, Uterine/Endometrial Cancer
Factors that may put lesbian women at greater risk for breast cancer and uterine/endometrial cancer include the prevalence of:
- Childbirth after age 30
- Hormone replacement therapy (HRT)
- Nulliparity (not bearing children)
The risk for breast cancer increases for women who give birth after age 30. Women who do not bear children share this risk. Due to lifestyle choice and limited access, lesbian women who give birth using alternative insemination are less likely to do so before age 30 or later. Breast, uterine, and endometrial cancer in nulliparous and late-pregnancy women are often diagnosed at a late stage, when large tumors have developed and metastasized to nearby lymph nodes.
HRT, which is used by some lesbians, bisexual women, and transgendering female to males, may be associated with breast cancer. The risk for breast, uterine, and endometrial cancer is decreased by as much as 20 percent for lesbian women who never used or who discontinued use of oral contraceptive pills.
Obesity and alcoholism resulting from social pressures and subsequent identity conflicts are identified as health concerns for lesbian and bisexual women. Other factors, like a diet high in fat and tobacco use, are associated with several cancers, including breast, uterine, and endometrial.
Evidence suggests that women who have never used oral contraceptive pills or other hormonal contraceptives are at a 50 percent greater risk for ovarian cancer than women who use hormonal contraceptives. Many women take the pill to regulate menses, treat acne, or to reduce symptoms related to PMS and endometriosis.
Women who took the pill for at least 6 years before discontinuing its use may experience its cancer-fighting benefits. As studies continue to look at the possible protective effect of hormonal contraceptives, it will be interesting to see if the rates for ovarian cancer differ greatly between lesbian and heterosexual women.
The increased risk for cervical cancer among lesbians lies mostly in their risk for exposure to two particular strains of HPV. Certain other strains of HPV cause anogenital warts and can be transmitted through sex with men and women. A history of sex with men, multiple male partners, sexual intercourse at a young age, unprotected sex, and inadequate or delayed access to health care are associated with an increased risk of cervical cancer. Sensitive providers inquire into the sexual history and activity of a lesbian patient to determine appropriate treatment and preventive care.
Routine Pap smears are an effective means of detecting and limiting cervical cancer. Women who are sexually active or over 18 years of age are advised to have an annual Pap smear. Once a woman has three consecutive, normal Pap smears, she may need to have one only every 2 to 3 years, unless past results warrant annual screening.