Having someone assume you’re heterosexual can be annoying, frustrating, and alienating. If you’re a lesbian, it can also be life-threatening.
For women -- one in eight of whom face the prospect of developing breast cancer -- visits to the doctor often lead to questions about birth control and sexuality. That leaves many lesbians with a dilemma: Should you out yourself to a straight doctor or ignore the lump in your breast?
Whether lesbians are at greater risk for the disease -- the second leading cause of cancer death among women -- is still a subject of debate. But on the eve of National Breast Cancer Awareness Month in October, experts say the bigger issue is that lesbians are not getting into the health care system for early screenings.
“The piece that should stand out is that lesbians don’t get screened as often as heterosexual women because we’re not in the family planning or child health care system,” says Donna Knutson, a section chief in the cancer division of the federal Centers for Disease Control and Prevention in Atlanta. “It’s not necessarily the sexual orientation that puts you at risk, but for whatever reason we don’t go to providers as often.”
The reasons, according to lesbians who have had bad experiences with health care providers, are all too clear. “When you get to a health care provider, the first thing they do is an intake of medical history,” says Beverly Baker, executive director of the Mautner Project, a lesbian cancer service organization in Washington, D.C. “You get to questions like, 'Are you married?' and you have to decide whether to say you’re in a life' relationship. Then, 'Are you sexually active, and are you on birth control? If you say no, you get a big, long lecture from the person doing the intake asking if you are crazy.”
Tania Katan, who was diagnosed with breast cancer four years ago at age 21, says her treatment, while impersonal, was not affected by her being openly lesbian. Still, she adds, the assumption was that she was heterosexual. “[The topic of] birth control was always on the questionnaires you had to fill out,” she says, “and when I said I didn’t use any, it always made them cock their heads.”
Katan used the moment to come out to her physician. But many lesbians, says Liza Rankow, a physician assistant and lesbian health advocate, find it easier to lie. “We tend not to walk in the door, and if we do, a lot of women tend to be dishonest,” says Rankow. “Lots of lesbians will leave the doctor with prescriptions for birth control pills rather than say their partner is a woman.”
No wonder. Physicians often refuse to acknowledge that female partners exist. “Partners are crucial, but they tend to be left out,” says Linda McGehee, a cofounder of the Atlanta Lesbian Cancer Initiative and a professor of nursing at Georgia State University who has studied lesbians with breast cancer. “One survivor said the only thing that made her uncomfortable was when she went to the physician’s office. He would look at her all the time and not at her partner. When her partner asked questions, he would look at her as if to say, What are you doing here?”
Beverly Saunders Biddle, executive director of the National Lesbian and Gay Health Association, which represents gay clinics and providers, adds, “It is such an ordeal for a lesbian to even consider health care, because we have to figure out: Do we or do we not come out? Do I have to educate another provider? What happens to my records once I come out? What impact is coming out going to have on the care I receive? Because breast cancer is such an emotionally laden issue for women, it compounds any fear or distrust of the medical system in general.”
For many heterosexual women, access to the medical system is through birth control; indeed, the system seems geared toward that purpose. Without the need for birth-control measures, however, many lesbians can easily neglect contact with a health care provider and subsequently neglect their health. The problem is not only breast cancer; lesbians may be less likely to get Pap smears to detect cervical cancer because doctors may not feel they need the test.
Without a doubt, breast cancer among lesbians has attracted attention the likes of which it barely had five years ago. “There’s been a huge explosion,” says Nancy Lanoue, 45, a founder of the Lesbian Community Cancer Project in Chicago and herself a breast-cancer survivor. “It’s something that is not a secret anymore. The activism has resulted in creating visibility for the disease.” The effort even attracted the attention of the federal government, which declared lesbians an underserved population in 1994 and provided money for four pilot screening projects to perform outreach to lesbians at local YWCAs.
“We surveyed women in the lesbian community about different issues -- whether or not they were being screened, those kinds of things,” says Connie Winkle, director of women’s health services at the YWCA in Dallas. Last year 190 women, most of them lesbians, were screened for breast cancer through the project.