(WOMENSENEWS)–Lesbian women may be at higher risk than women in the general U.S. population for some forms of cancer, as well as for cardiovascular and other chronic diseases, according to a new study.
The reasons for the possible heightened risks are that lesbians are more likely to be overweight, to smoke and to drink alcohol, even moderately, than women overall, and they are less likely to bear children or to use birth control pills, both of which may provide some protective benefits against cancer, according to the study published this month in the prestigious American Journal of Public Health.
Moreover, the study found, lesbians are less likely than other women to have health insurance and less likely to have regular preventive cancer screening tests such as mammograms, pelvic exams and pap smears because many are reluctant to seek out health care in a system that seems designed for heterosexual women.
"If you think about how health care for women is organized, most women become annual users of health care because they have contraceptive needs," said Dr. Susan Cochran, an epidemiologist at the University of California at Los Angeles, and lead author of the study.
"It’s very common for a provider to write a one-year prescription for birth control pills, and this brings women back in every year to get their prescription renewed. Lesbians don’t do that."
This study is a "big wake-up call to our own community to look at ourselves and see what we’re doing," said Kathleen DeBold, executive director of the Mautner Project for Women With Cancer in Washington, D.C. The organization is a leader in smoking prevention efforts for lesbians.
Study Covered 12,000 Women Volunteers, Mostly White, Well-Educated
The study pooled and analyzed data from seven other large health surveys of lesbian women conducted between 1986 and 1997. The researchers note that of the nearly 12,000 women surveyed, all were volunteers who self-identified as lesbian; most were white, highly educated and between the ages of 18 and 50. They acknowledge that, given what they call the "hidden nature" of the lesbian population, it is difficult to know whether the findings are truly representative of lesbians and bisexual women in the United States.
The researchers found:
- About 28 percent of lesbians are obese, compared to about 19 percent of women in general.
- About 55 percent of lesbians are current or former smokers, compared with 36 percent of women in general.
- Lesbians are slightly more likely to be moderate drinkers–that is, averaging four drinks a day–than women overall.
- Only 36 percent of lesbians and bisexual women have ever used birth control pills, compared to almost 80 percent of the general female population.
- Eighty-six percent of lesbians had health insurance coverage, while almost 93 percent of women in general were covered.
- Seventy-three percent of lesbians had pelvic exams within the past two years, compared to more than 87 percent of women overall.
- Seventy-three percent of lesbians ages 40 to 49 had ever had a mammogram, compared to almost 87 percent of women of the same age in the general population.
The study did not find higher rates of breast cancer among lesbians than among women in general.
The researchers added that "none of these individual risk factors is exclusive to lesbians, however, the possible concentration of these risks within a single group is unique." In other words, lesbians as a group are more likely than the general population to combine habits that are risky and avoid regular medical care.
Cochran said it is not clear why lesbians engage in more frequent behavior that may place their health at risk.
Lesbian women were found to be less likely to consider themselves overweight and more accepting of their bodies even when they were overweight.
Lesbian Social Network Accepts Moderate Drinking
Also, Cochran said, "Lesbians are in a social network that thinks moderate drinking is OK, so they’re more likely to be moderate drinkers." They may face less pressure to cut back on or cut out smoking and drinking because they are less likely to be parents, which often prompts people to change their unhealthy habits, she said.
DeBold, of the Mautner Project, said lesbians, especially young women who may be just coming to terms with their sexuality, are very vulnerable to smoking because "the tobacco industry has positioned smoking as an accessory for all attitudes."
"If you want to be tough and butch, light up a cigarette," DeBold said. "You want to be femme and sexy? Blow out a nice curl of smoke." Moreover, she said, because "there aren’t a lot of places lesbians can go to be ourselves," much of lesbian social life has always taken place in bars, where smoking and drinking are normal and expected. The Mautner Project has been a leading advocate of lesbian-specific smoking prevention efforts by the federal government.
Both Cochran and DeBold said the study clearly points to the need for better education about and greater sensitivity to the specific health needs of lesbian patients who often avoid regular medical care because they fear discrimination or because it is simply awkward and uncomfortable to disclose one’s sexual orientation to many health care providers.
Most HMOs, for example, do not keep lists of lesbian or lesbian-friendly providers, so "even though attitudes towards lesbians and gay men have improved, it’s still not unusual for lesbians to come up against people who disapprove of them," according to Cochran.
Lesbians Discouraged by Bias, Awkwardness, From Seeking Treatment
DeBold described one Mautner Project client who asked that her female partner be included in conversations with her and the doctor about her breast cancer diagnosis. When her partner entered, DeBold said, the doctor walked out and a nurse told the women, without explanation, that a different doctor would be taking the case. Another lesbian patient, DeBold said, found an anti-gay religious pamphlet included in what was supposed to be a cancer information packet given to her at her doctor’s office.
Other patients have described more subtle forms of bias. Marge Tolchin, a 54-year-old speech pathologist from suburban Maryland, was diagnosed with aggressive B-cell non-Hodgkin’s lymphoma after several years of undiagnosed symptoms for which she saw several different health care providers.
"On every intake form, there was always something about a ‘spouse,’" she recalled. "I would fill in my partner’s name. I’d watch the receptionist read it over, see her eyebrows shoot up, see her poke her colleague at the next computer terminal. I got the treatment I needed, no one showed us the door. There were no horror stories. But there was a constant state of tension."
The central message, Cochran said, is that lesbians are placing themselves at higher risk for breast cancer and other health problems associated with obesity, smoking, drinking and lack of regular exams and screening tests, adding:
"We need to start building some interventions to get these women to come in for care."
Barbara Raab is a writer and television producer in New York City who contributes regularly to NBC News and the Web site PlanetOut.
For more information, visit:
The Mautner Project for Lesbians With Cancer:
Healthy People 2010 Companion Document for LGBT Health: