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Investigating disparities in LGBTQ breast cancer care

Researchers at Stanford Medicine investigate cancer disparities in LGBTQ populations and how to address them.

In the United States, members of the LGBTQ community experience both higher occurrences of cancer and lower survival rates than their heterosexual peers.

The increased burden largely stems from the stigmatization of living as a sexual or gender minority in this country, according to the National LGBT Cancer Network. For example, people who identify as LGBTQ are more likely to live below the poverty line and lack health insurance, making it more challenging for them to get adequate care. Also, even after controlling for insurance status and income, LGBTQ people have greater difficulty accessing this breast* cancer screenings, according to a 2020 study.

Given this imbalance, Erik Eckhert, MD, a fellow in hematology and oncology at Stanford Medicine, and his colleagues conducted a study to better understand disparities in breast cancer treatment, specifically whether differences in health outcomes existed between sex and gender minority patients and cisgender heterosexual patients.

"We wanted to better understand how our health care system is failing this population," said Eckhert, the first author of the study, which was published Feb. 2 in JAMA Oncology.

Measuring health disparities

The researchers collected data from 92 sexual and gender minority patients who were diagnosed with breast cancer from 2008 to 2022. The study pulled anonymized data from Oncoshare, a national breast cancer database led by Allison Kurian, MD, professor of medicine and of epidemiology and population health, and the study's senior author.

They matched these people with cisgender heterosexual breast cancer patients based on the individuals' age, year of diagnosis, tumor stage and type of breast cancer.

Next, they compared treatment quality between the two groups, measuring factors including missed breast cancer screenings, if the patient refused treatment recommended by the oncologist, time from symptom onset to diagnosis, and time from breast cancer diagnosis to cancer recurrence.

Eckhert and colleagues found that, compared with cisgender heterosexual people, it took sexual and gender minority patients almost twice as long to receive a diagnosis after the onset of symptoms.

"Queer people are less likely to seek care through medical providers when they have had past discriminatory experiences in health care," Eckhert said. "LGBTQ patients who did go to their providers promptly also had delays in their care."

The researchers also discovered that 38% of sexual and gender minority patients declined conventional treatments recommended by their oncologist, compared with 20% of cisgender heterosexual patients. LGBTQ patients were also more likely to use alternatives to conventional medicine. Patients who decline conventional cancer treatment are known to have worse outcomes, including increased risk of death. Again, Eckhert pointed to a lack of trust in health care professionals among LGBTQ patients as a possible reason for refusal.

The researchers also found that LGBTQ patients were nearly three times as likely to experience breast cancer recurrence than their cisgender heterosexual peers.

The study is retrospective, which means it used preexisting data derived from electronic health records. "This approach provided important, real-world evidence of disparities in breast cancer outcomes," Kurian said. It also raises many questions for future study, such as why LGBTQ patients wait longer for a cancer diagnosis and why they are more likely to experience cancer recurrence.

The findings underscore the need for more clinician education on sexual and gender minority cancer patients, Eckhert said. Better training of health care professionals on fostering trust and effective communication should allow them to provide more competent care.

Major gaps in scientific knowledge must also be resolved to help this community of high-risk patients. Currently, most state and national cancer databases do not include information about patients' sexual orientation or gender identity. Eckhert hopes his study will serve as an impetus for physicians to gather this data in a comprehensive manner, allowing researchers to answer more vital questions.

"There are still many unknowns," Eckhert said. "But if you're not collecting data on health disparities affecting LGBTQ populations, or the factors that perpetuate them, you won't know how to fix the problem."

Photo by adragan

* Editor's note: Breast is used as the anatomical reference in this story. There are people in the LGBTQ+ community who use and are affirmed by the term chest instead.

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