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Lesbians May Be at Greater Risk for Some Cancers

Originally published by Reuters Health, April 9, 2001

NEW YORK (Reuters Health) — Lesbian and bisexual women may be at higher risks for some cancers because of a number of risk factors and because they may miss out on cancer screenings in a system geared towards heterosexual women, study results suggest.

According to the report in the April issue of the American Journal of Public Health, journal of the American Public Health Association, lesbians and bisexual women were less likely to have health insurance and to have had a pelvic exam or mammogram—important cancer screening exams—within the past year, compared with women in general.

Lesbian and bisexual women also have higher rates of smoking, alcohol use and obesity, which may put them at increased risk for certain cancers and chronic diseases, the report indicates.

“We show that as a group, lesbians tend to have a cluster of risk factors for negative health outcomes,” Dr. Susan D. Cochran, the study’s lead author, told Reuters Health. “Healthcare for women is organized around contraceptive needs, which bring women periodically into the health system. But lesbians typically don’t have contraceptive needs,” said Cochran, from the University of California, Los Angeles.

The study of more than 11,800 lesbian and bisexual women in the US found that the rate of obesity was significantly higher than would be expected, based on a national sample of women. About 28% of the lesbians and bisexual women were obese.

Lesbians were also much less likely than US women in general to report that they considered themselves to be overweight, a finding that may reflect a more positive attitude toward their bodies, the authors explain.

Similarly, alcohol abuse and past and current smoking rates were higher among lesbians and bisexual women, who were also less likely to undergo health screening for breast and cervical cancers. For instance, about 85% of these women had a pelvic examination in the past 5 years. Another survey of US women found that 87% had a pelvic exam within the last 3 years.

“Lower rates of screening … might result in later detection of cancers, thereby increasing morbidity and mortality rates,” Cochran’s team explains. There was no difference in rates of breast cancer among women, however.

Not surprisingly, lesbians and bisexual women were less likely to have given birth or to have used oral contraceptives, both of which are associated with lower risk of certain cancers.

Cochran suggested that negative past experiences with the healthcare system may make lesbians more reluctant to get regular care.

“For lesbians, experiences during late adolescence and early adulthood are likely to include exhortation to use contraceptives, disclosure of sexual orientation and provider discomfort or negative behaviors,” she said.

While the findings underscore the need to target health education to lesbian and bisexual women, the study has limitations that should be considered, the researchers note. For example, the majority of lesbian and bisexual women in the study were white, highly educated, and ranged from 18 to 50 years. And because they volunteered for the study, they may have been healthier than lesbians and bisexual women on average.