LGBTQ People With Breast Cancer Have Delayed Diagnoses, Higher Recurrence Rates
When LGBTQ people are diagnosed with breast cancer, they experience delays in diagnosis and are three times more likely to have the breast cancer come back (recurrence) than people who are heterosexual and cisgender, according to a study.
The research was published online on Feb. 2, 2023, by the journal JAMA Oncology. Read “Breast Cancer Diagnosis, Treatment, and Outcomes of Patients From Sex and Gender Minority Groups.”
Breast cancer in LGBTQ people
Very little research has been done on breast cancer in LGBTQ people, which includes people who identify as:
lesbian
gay
bisexual
queer
transgender
gender non-conforming
gender fluid
non-binary
asexual
This study refers to LGBTQ people as people from sex and gender minority groups.
Only 24% of National Cancer Institute (NCI) Community Oncology Research Program practice groups collect information on sexual orientation and only 10% collect information on gender identity.
To address this knowledge gap, a 2020 report by the U.S. National Academies called for adding information about sexual orientation and gender identity to cancer studies.
About the study
“This project was prompted by my prior research in LGBTQ+ health disparities, as well as by my time spent designing and teaching the Stanford Internal Medicine LGBTQ Health Curriculum for resident physicians,” Erik Eckhert, MD, MS, post-doctoral fellow in hematology and oncology at Stanford University Hospital, said in an interview. “From these experiences, I came to understand that our healthcare apparatus is primarily designed by and for cisgender heterosexual people. As a corollary, LGBTQ+ people are often discriminated against in healthcare settings or have difficulty finding a provider who is knowledgeable about caring for populations of sex and gender minority groups.”
The study compared breast cancer care among 92 LGBTQ people with breast cancer care among 92 cisgender heterosexual people who had similar socioeconomic backgrounds and types of health insurance. All the people received care at Stanford University between Jan. 1, 2008, and Jan. 1, 2022.
Among the 92 LGBTQ people diagnosed with breast cancer:
80% were lesbian
13% were bisexual
6% were transgender men, including four who were heterosexual, one who was gay, and one who was asexual
They had an average age of 49 when they were diagnosed with breast cancer.
The researchers looked at the medical histories and health-related behaviors of all the people in the study. The people in the LGBTQ group were:
slightly more likely to drink alcohol and use cannabis than the people in the cisgender heterosexual group
less likely to have been pregnant than the people in the cisgender heterosexual group
more likely to have fewer children than the people in the cisgender heterosexual group
The two groups had no differences in:
age at first period
age at menopause
oral contraceptive use
hormone replacement therapy (HRT) use
breast cancer screening
Nearly all of the people in both groups had breast cancer symptoms, such as a lump in the breast, before being diagnosed.
Still, LGBTQ people waited nearly twice as long to receive a diagnosis as cisgender heterosexual people:
LGBTQ people waited 64 days
cisgender heterosexual people waited 34 days
This delay in diagnosis wasn’t affected by:
race or ethnicity
socioeconomic status
type of health insurance
Once everyone was diagnosed, both groups waited the same amount of time between diagnosis and first treatment, and both groups received appropriate treatments and genetic testing.
LGBTQ people were more likely to use complementary therapies than cisgender heterosexual people and were also slightly more likely to refuse a doctor-recommended breast cancer treatment:
38% of LGBTQ people refused a treatment
20% of cisgender heterosexual people refused a treatment
Still, this difference was not statistically significant, which means that it could be due to chance and not because of differences between the two groups.
Hormonal therapy was the most commonly refused treatment.
LGBTQ people had higher rates of breast cancer recurrence than cisgender heterosexual people:
32.2% of LGBTQ people had a recurrence
13.3% of cisgender heterosexual people had a recurrence
Among people who had a recurrence:
17.3% of LGBTQ people had a local recurrence
2.5% of cisgender heterosexual people had a local recurrence
24.7% of LGBTQ people had a metastatic recurrence
13.6% of cisgender heterosexual people had a metastatic recurrence
Local recurrence means the breast cancer has come back in an area near the breast, such as nearby lymph nodes. Metastatic recurrence means the breast cancer has come back in a part of the body away from the breast, such as the bones or liver.
The researchers’ analysis showed that breast cancer recurrence rates in LGBTQ people were three times higher than rates in cisgender heterosexual people.
“The [LGBTQ] patients had higher rates of substance use, but apart from having fewer children than cisgender heterosexual patients, they had similar hormonal risk factors (ages at menarche and menopause; oral contraceptive and hormone replacement therapy use),” the researchers wrote. “These small differences in risk factors do not explain the magnitude of the difference in recurrence rates between the two patient groups. In the absence of clear biological rationale for this difference in outcomes, the reasons for it appear to be associated with structural or social factors.”
What this means for you
The results of this study are concerning for anyone in the LGBTQ community, but sadly, not surprising. Many anecdotal studies have documented LGBTQ patient-reported experiences of subtle to overt discrimination.
All people — no matter their gender identity, sexual orientation, race, ethnicity, age, economic status, or other health conditions — deserve the best breast cancer care and the best prognosis possible. Any differences that negatively affect prognosis must be eliminated.
The U.S. Centers for Disease Control and Prevention (CDC) offers a list of LGBTQ health clinics by state and city, as well as referral services and hotlines, if you need an LGBTQ-affirming doctor, medical professional, or healthcare provider who is knowledgeable about and sensitive to your needs.
There is only one of you, and you deserve the best care possible.
Updated on July 7, 2025