Cancer Causes & Control

, 19:1009 | Cite as

Lesbians and cancer: an overlooked health disparity

  • Jessica P. Brown
  • J. Kathleen TracyEmail author
Review Article



To evaluate the breast, cervical, ovarian, lung, and colorectal cancer literatures using a novel application of the cancer disparities grid to identify disparities along domains of the cancer continuum focusing on lesbians as a minority population.


Computerized databases were searched for articles published from 1981 to present. Cumulative search results identified 51 articles related to lesbians and disparities, which were classified by domain.


The majority of articles identified were related to breast and cervical cancer screening. Barriers to adequate screening for both cancers include personal factors, poor patient-provider communication, and health care system factors. Tailored risk counseling has been successful in increasing lesbian’s mammography and Pap screening. Ovarian, lung, and colorectal cancer have been virtually unexplored in this population. An “Adjustment to Illness/Quality of Life” domain was added to capture literature on psychosocial aspects of cancer.


This review revealed a lack of research for specific cancers and for specific aspects of the cancer continuum. The limited number of studies identified focused on issues related to screening/prevention in cervical and breast cancers, with almost no attention to incidence, etiology, diagnosis, treatment, survival, morbidity, or mortality. We present implications for social and public health policy, research, and prevention.


Lesbians Cancer disparities Health disparities Review article 



Supported in part by grant# K12 HD43489 (NICHD and ORWH).


  1. 1.
    Bigby J, Holmes MD (2005) Disparities across the breast cancer continuum. Cancer Causes Control 16(1):35–44. doi: 10.1007/s10552-004-1263-1 PubMedCrossRefGoogle Scholar
  2. 2.
    American Cancer Society (2008) Cancer facts and figures 2008. American Cancer Society, AtlantaGoogle Scholar
  3. 3.
    Case P, Austin SB, Hunter DJ, Manson JE, Malspeis S, Willett WC, Spiegelman D (2004) Sexual orientation, health risk factors, and physical functioning in the Nurses’ Health Study II. J Womens Health (Larchmt) 13(9):1033–1047. doi: 10.1089/jwh.2004.13.1033 Google Scholar
  4. 4.
    Aaron DJ, Markovic N, Danielson ME, Honnold JA, Janosky JE, Schmidt NJ (2001) Behavioral risk factors for disease and preventive health practices among lesbians. Am J Public Health 91(6):972–975PubMedGoogle Scholar
  5. 5.
    Cochran SD, Keenan C, Schober C, Mays VM (2000) Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population. J Consult Clin Psychol 68(6):1062–1071PubMedCrossRefGoogle Scholar
  6. 6.
    Diamant AL, Wold C (2003) Sexual orientation and variation in physical and mental health status among women. J Womens Health (Larchmt) 12(1):41–49Google Scholar
  7. 7.
    Cochran SD, Mays VM, Bowen D, Gage S, Bybee D, Roberts SJ, Goldstein RS, Robison A, Rankow EJ, White J (2001) Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. Am J Public Health 91(4):591–597PubMedGoogle Scholar
  8. 8.
    Ryan H, Wortley PM, Easton A, Pederson L, Greenwood G (2001) Smoking among lesbians, gays, and bisexuals: a review of the literature. Am J Prev Med 21(2):142–149. doi: 10.1016/S0749-3797(01)00331-2 PubMedCrossRefGoogle Scholar
  9. 9.
    Hughes TL, Jacobson KM (2003) Sexual orientation and women’s smoking. Curr Womens Health Rep 3(3):254–261PubMedGoogle Scholar
  10. 10.
    Gruskin EP, Hart S, Gordon N, Ackerson L (2001) Patterns of cigarette smoking and alcohol use among lesbians and bisexual women enrolled in a large health maintenance organization. Am J Public Health 91(6):976–979PubMedGoogle Scholar
  11. 11.
    Matthews AK, Brandenburg DL, Johnson TP, Hughes TL (2004) Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women. Prev Med 38(1):105–113. doi: 10.1016/j.ypmed.2003.09.034 PubMedCrossRefGoogle Scholar
  12. 12.
    Valanis BG, Bowen DJ, Bassford T, Whitlock E, Charney P, Carter RA (2000) Sexual orientation and health: comparisons in the women’s health initiative sample. Arch Fam Med 9(9):843–853PubMedCrossRefGoogle Scholar
  13. 13.
    White JC, Dull VT (1997) Health risk factors and health-seeking behavior in lesbians. J Womens Health 6(1):103–112PubMedCrossRefGoogle Scholar
  14. 14.
    Boehmer U, Linde R, Freund KM (2007) Breast reconstruction following mastectomy for breast cancer: the decisions of sexual minority women. Plast Reconstr Surg 119(2):464–472. doi: 10.1097/01.prs.0000246402.79334.3b PubMedCrossRefGoogle Scholar
  15. 15.
    Dibble SL, Roberts SA, Nussey B (2004) Comparing breast cancer risk between lesbians and their heterosexual sisters. Womens Health Issues 14(2):60–68PubMedCrossRefGoogle Scholar
  16. 16.
    Kerker BD, Mostashari F, Thorpe L (2006) Health care access and utilization among women who have sex with women: sexual behavior and identity. J Urban Health 83(5):970–979. doi: 10.1007/s11524-006-9096-8 PubMedCrossRefGoogle Scholar
  17. 17.
    Diamant AL, Schuster MA, Lever J (2000) Receipt of preventive health care services by lesbians. Am J Prev Med 19(3):141–148. doi: 10.1016/S0749-3797(00)00192-6 PubMedCrossRefGoogle Scholar
  18. 18.
    American Cancer Society (2006) Cancer in our lives: raising awareness in the LGBTQI community. San Francisco, CAGoogle Scholar
  19. 19.
    Gay and Lesbian Medical Association (2001) Healthy people 2010 companion document for Lesbian, Gay, Bisexual, and Transgender (LGBT) health. San Francisco, CAGoogle Scholar
  20. 20.
    Krieger N (2005) Defining and investigating social disparities in cancer: critical issues. Cancer Causes Control 16(1):5–14. doi: 10.1007/s10552-004-1251-5 PubMedCrossRefGoogle Scholar
  21. 21.
    Gilligan T (2005) Social disparities and prostate cancer: mapping the gaps in our knowledge. Cancer Causes Control 16(1):45–53. doi: 10.1007/s10552-004-1291-x PubMedCrossRefGoogle Scholar
  22. 22.
    Palmer RC, Schneider EC (2005) Social disparities across the continuum of colorectal cancer: a systematic review. Cancer Causes Control 16(1):55–61. doi: 10.1007/s10552-004-1253-3 PubMedCrossRefGoogle Scholar
  23. 23.
    Newmann SJ, Garner EO (2005) Social inequities along the cervical cancer continuum: a structured review. Cancer Causes Control 16(1):63–70. doi: 10.1007/s10552-004-1290-y PubMedCrossRefGoogle Scholar
  24. 24.
    Agrawal R, Sharma S, Bekir J, Conway G, Bailey J, Balen AH, Prelevic G (2004) Prevalence of polycystic ovaries and polycystic ovary syndrome in lesbian women compared with heterosexual women. Fertil Steril 82(5):1352–1357. doi: 10.1016/j.fertnstert.2004.04.041 PubMedCrossRefGoogle Scholar
  25. 25.
    Mravcak SA (2006) Primary care for lesbians and bisexual women. Am Fam Physician 74(2):279–286PubMedGoogle Scholar
  26. 26.
    Roberts SJ (2006) Health care recommendations for lesbian women. J Obstet Gynecol Neonatal Nurs 35(5):583–591PubMedCrossRefGoogle Scholar
  27. 27.
    Garcia TC (2003) Primary care of the lesbian/gay/bisexual/transgendered woman patient. Int J Fertil Womens Med 48(6):246–251PubMedGoogle Scholar
  28. 28.
    Boehmer U, Case P (2004) Physicians don’t ask, sometimes patients tell: disclosure of sexual orientation among women with breast carcinoma. Cancer 101(8):1882–1889. doi: 10.1002/cncr.20563 PubMedCrossRefGoogle Scholar
  29. 29.
    Ott C, Eilers J (1997) Breast cancer and women partnering with women. Nebr Nurse 30(3):29PubMedGoogle Scholar
  30. 30.
    Ries LAG, Melbert D, Krapcho M, Mariotto A, Miller BA, Feuer EJ, Clegg L, Horner MJ, Howlader N, Eisner MP, Reichman M, Edwards BK (eds) (2007) SEER cancer statistics review, 1975–2004. National Cancer Institute, Bethesda, MD., based on November 2006 SEER data submission, posted to the SEER web site
  31. 31.
    Hulka BS, Moorman PG (2001) Breast cancer: hormones and other risk factors. Maturitas 38(1):103–116. doi: 10.1016/S0378-5122(00)00196-1 PubMedCrossRefGoogle Scholar
  32. 32.
    Denenberg R (1995) Report on lesbian health. Womens Health Issues 5(2):81–93. doi: 10.1016/1049-3867(95)00030-8 PubMedCrossRefGoogle Scholar
  33. 33.
    Haynes S (1995) Breast cancer risk: comparisons of lesbians and heterosexual women. In: Bowen DJ (ed) Cancer and cancer risks among lesbians. Fred Hutchinson Cancer Research Center Community Liaison Program, Seattle, WAGoogle Scholar
  34. 34.
    Kavanaugh-Lynch MHE, White E, Daling JR et al (2002) Estimate of relative risk of breast cancer in lesbians using surrogate correlates of sexual orientation. J Gay Lesbian Med Assoc 6(3–4):91–95. doi: 10.1023/B:JOLA.0000011064.00219.71 CrossRefGoogle Scholar
  35. 35.
    Powers D, Bowen DJ, White J (2001) The influence of sexual orientation on health behaviors in women. J Prev Interv Community 22(2):43–60Google Scholar
  36. 36.
    Burnett CB, Steakley CS, Slack R, Roth J, Lerman C (1999) Patterns of breast cancer screening among lesbians at increased risk for breast cancer. Women Health 29(4):35–55. doi: 10.1300/J013v29n04_03 PubMedCrossRefGoogle Scholar
  37. 37.
    Mays VM, Yancey AK, Cochran SD, Weber M, Fielding JE (2002) Heterogeneity of health disparities among African American, Hispanic, and Asian American women: unrecognized influences of sexual orientation. Am J Public Health 92(4):632–639PubMedGoogle Scholar
  38. 38.
    Lauver DR, Karon SL, Egan J, Jacobson M, Nugent J, Settersten L, Shaw V (1999) Understanding lesbians’ mammography utilization. Womens Health Issues 9(5):264–274PubMedCrossRefGoogle Scholar
  39. 39.
    Dibble SL, Roberts SA (2002) A comparison of breast cancer diagnosis and treatment between lesbian and heterosexual women. J Gay Lesbian Med Assoc 6(1):9–17. doi: 10.1023/A:1020384614817 CrossRefGoogle Scholar
  40. 40.
    Matthews AK, Peterman AH, Delaney P, Menard L, Brandenburg D (2002) A qualitative exploration of the experiences of lesbian and heterosexual patients with breast cancer. Oncol Nurs Forum 29(10):1455–1462. doi: 10.1188/02.ONF.1455-1462 PubMedCrossRefGoogle Scholar
  41. 41.
    Dibble SL, Roberts SA (2003) Improving cancer screening among lesbians over 50: results of a pilot study. Oncol Nurs Forum 30(4):E71–E79PubMedCrossRefGoogle Scholar
  42. 42.
    Bowen DJ, Powers D, Greenlee H (2006) Effects of breast cancer risk counseling for sexual minority women. Health Care Women Int 27(1):59–74. doi: 10.1080/07399330500377119 PubMedCrossRefGoogle Scholar
  43. 43.
    Fobair P, O’Hanlan K, Koopman C, Classen C, Dimiceli S, Drooker N, Warner D, Davids H, Loulan J, Wallsten D et al (2001) Comparison of lesbian and heterosexual women’s response to newly diagnosed breast cancer. Psychooncology 10(1):40–51. doi: 10.1002/1099-1611(200101/02)10:1≤40::AID-PON480≥3.0.CO;2-S PubMedCrossRefGoogle Scholar
  44. 44.
    Arena PL, Carver CS, Antoni MH, Weiss S, Ironson G, Duran RE (2006) Psychosocial responses to treatment for breast cancer among lesbian and heterosexual women. Women Health 44(2):81–102. doi: 10.1300/J013v44n02_05 Google Scholar
  45. 45.
    Fobair P, Koopman C, DiMiceli S, O’Hanlan K, Butler LD, Classen C, Drooker N, Davids HR, Loulan J, Wallsten D et al (2002) Psychosocial intervention for lesbians with primary breast cancer. Psychooncology 11(5):427–438PubMedCrossRefGoogle Scholar
  46. 46.
    Boehmer U, Case P (2006) Sexual minority women’s interactions with breast cancer providers. Women Health 44(2):41–58. doi: 10.1300/J013v44n02_03 PubMedGoogle Scholar
  47. 47.
    Schiffman M, Brinton L, Devasa S, Fraumeni J, Joseph F (1996) Cervical cancer. Cancer epidemiology and prevention. Oxford University Press, New York, pp 1090–1116Google Scholar
  48. 48.
    Rankow EJ, Tessaro I (1998) Cervical cancer risk and Papanicolaou screening in a sample of lesbian and bisexual women. J Fam Pract 47(2):139–143PubMedGoogle Scholar
  49. 49.
    Hughes C, Evans A (2003) Health needs of women who have sex with women. Br Med J 327(7421):939–940. doi: 10.1136/bmj.327.7421.939 CrossRefGoogle Scholar
  50. 50.
    Marrazzo JM (2000) Genital human papillomavirus infection in women who have sex with women: a concern for patients and providers. AIDS Patient Care STDS 14(8):447–451. doi: 10.1089/108729100416669 PubMedCrossRefGoogle Scholar
  51. 51.
    Clark MA, Bonacore L, Wright SJ, Armstrong G, Rakowski W (2003) The cancer screening project for women: experiences of women who partner with women and women who partner with men. Women Health 38(2):19–33. doi: 10.1300/J013v38n02_02 PubMedCrossRefGoogle Scholar
  52. 52.
    Bailey JV, Kavanagh J, Owen C, McLean KA, Skinner CJ (2000) Lesbians and cervical screening. Br J Gen Pract 50(455):481–482PubMedGoogle Scholar
  53. 53.
    Marrazzo JM, Stine K, Koutsky LA (2000) Genital human papillomavirus infection in women who have sex with women: a review. Am J Obstet Gynecol 183(3):770–774. doi: 10.1067/mob.2000.106681 PubMedCrossRefGoogle Scholar
  54. 54.
    Marrazzo JM, Koutsky LA, Stine KL, Kuypers JM, Grubert TA, Galloway DA, Kiviat NB, Handsfield HH (1998) Genital human papillomavirus infection in women who have sex with women. J Infect Dis 178(6):1604–1609. doi: 10.1086/314494 PubMedCrossRefGoogle Scholar
  55. 55.
    Fethers K, Marks C, Mindel A, Estcourt CS (2000) Sexually transmitted infections and risk behaviours in women who have sex with women. Sex Transm Infect 76(5):345–349. doi: 10.1136/sti.76.5.345 PubMedCrossRefGoogle Scholar
  56. 56.
    Dibble SL, Roberts SA, Robertson PA, Paul SM (2002) Risk factors for ovarian cancer: lesbian and heterosexual women. Oncol Nurs Forum 29(1):E1–E7PubMedCrossRefGoogle Scholar
  57. 57.
    Durfy SJ, Bowen DJ, McTiernan A, Sporleder J, Burke W (1999) Attitudes and interest in genetic testing for breast and ovarian cancer susceptibility in diverse groups of women in western Washington. Cancer Epidemiol Biomarkers Prev 8(4 Pt 2):369–375PubMedGoogle Scholar
  58. 58.
    National Cancer Institute (2007) What you need to know about lung cancer. [Web Page] May 2007Google Scholar
  59. 59.
    Garofalo R, Wolf RC, Wissow LS, Woods ER, Goodman E (1999) Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med 153(5):487–493PubMedGoogle Scholar
  60. 60.
    Garofalo R, Wolf RC, Kessel S, Palfrey SJ, DuRant RH (1998) The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics 101(5):895–902. doi: 10.1542/peds.101.5.895 PubMedCrossRefGoogle Scholar
  61. 61.
    Remafedi G, Carol H (2005) Preventing tobacco use among lesbian, gay, bisexual, and transgender youths. Nicotine Tob Res 7(2):249–256. doi: 10.1080/14622200500055517 PubMedCrossRefGoogle Scholar
  62. 62.
    Tomeo CA, Colditz GA, Willett WC, Giovannucci E, Platz E, Rockhill B, Dart H, Hunter DJ (1999) Harvard report on cancer prevention. Volume 3: prevention of colon cancer in the United States. Cancer Causes Control 10(3):167–180PubMedCrossRefGoogle Scholar
  63. 63.
    IARC (2003) Fruits and vegetables. IARC handbook of cancer prevention. IARC Press, LyonGoogle Scholar
  64. 64.
    Matthews AK (1998) Lesbians and cancer support: clinical issues for cancer patients. Health Care Women Int 19(3):193–203PubMedCrossRefGoogle Scholar
  65. 65.
    Sinding C, Barnoff L, Grassau P (2004) Homophobia and heterosexism in cancer care: the experiences of lesbians. Can J Nurs Res 36(4):170–188PubMedGoogle Scholar
  66. 66.
    Sinding C, Grassau P, Barnoff L (2006) Community support, community values: the experiences of lesbians diagnosed with cancer. Women Health 44(2):59–79. doi: 10.1300/J013v44n02_04 PubMedGoogle Scholar
  67. 67.
    Smolinski KM, Colon Y (2006) Silent voices and invisible walls: exploring end of life care with lesbians and gay men. J Psychosoc Oncol 24(1):51–64. doi: 10.1300/J077v24n01_05 PubMedCrossRefGoogle Scholar
  68. 68.
    Saulnier CF (2002) Deciding who to see: lesbians discuss their preferences in health and mental health care providers. Soc Work 47(4):355–365PubMedGoogle Scholar
  69. 69.
    Meckler GD, Elliott MN, Kanouse DE, Beals KP, Schuster MA (2006) Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth. Arch Pediatr Adolesc Med 160(12):1248–1254. doi: 10.1001/archpedi.160.12.1248 PubMedCrossRefGoogle Scholar
  70. 70.
    Klitzman RL, Greenberg JD (2002) Patterns of communication between gay and lesbian patients and their health care providers. J Homosex 42(4):65–75. doi: 10.1300/J082v42n04_04 PubMedCrossRefGoogle Scholar
  71. 71.
    McNair R (2003) Outing lesbian health in medical education. Women Health 37(4):89–103. doi: 10.1300/J013v37n04_07 PubMedCrossRefGoogle Scholar
  72. 72.
    Fish J, Wilkinson S (2003) Understanding lesbians’ healthcare behaviour: the case of breast self-examination. Soc Sci Med 56(2):235–245. doi: 10.1016/S0277-9536(02)00022-9 PubMedCrossRefGoogle Scholar
  73. 73.
    Fish J, Anthony D (2005) UK national lesbians and health care survey. Women Health 41(3):27–45. doi: 10.1300/J013v41n03_02 PubMedCrossRefGoogle Scholar
  74. 74.
    McTiernan A, Kuniyuki A, Yasui Y, Bowen D, Burke W, Culver JB, Anderson R, Durfy S (2001) Comparisons of two breast cancer risk estimates in women with a family history of breast cancer. Cancer Epidemiol Biomarkers Prev 10(4):333–338PubMedGoogle Scholar
  75. 75.
    Rankow EJ (1995) Lesbian health issues for the primary care provider. J Fam Pract 40(5):486–496PubMedGoogle Scholar
  76. 76.
    Cochran SD, Ackerman D, Mays VM, Ross MW (2004) Prevalence of non-medical drug use and dependence among homosexually active men and women in the US population. Addiction 99(8):989–998. doi: 10.1111/j.1360-0443.2004.00759.x PubMedCrossRefGoogle Scholar
  77. 77.
    Roberts SJ, Patsdaughter CA, Grindel CG, Tarmina MS (2004) Health related behaviors and cancer screening of lesbians: results of the Boston Lesbian Health Project II. Women Health 39(4):41–55. doi: 10.1300/J013v39n04_03 PubMedCrossRefGoogle Scholar
  78. 78.
    Roberts SJ, Sorensen L (1999) Health related behaviors and cancer screening of lesbians: results from the Boston Lesbian Health Project. Women Health 28(4):1–12. doi: 10.1300/J013v28n04_01 PubMedCrossRefGoogle Scholar
  79. 79.
    Wells BE, Bimbi DS, Tider D, Van Ora J, Parsons JT (2006) Preventive health behaviors among lesbian and bisexually identified women. Women Health 44(2):1–13. doi: 10.1300/J013v44n02_01 PubMedGoogle Scholar
  80. 80.
    Boehmer U, Linde R, Freund KM (2005) Sexual minority women’s coping and psychological adjustment after a diagnosis of breast cancer. J Womens Health (Larchmt) 14(3):214–224. doi: 10.1089/jwh.2005.14.214 Google Scholar
  81. 81.
    Boehmer U, Freund KM, Linde R (2005) Support providers of sexual minority women with breast cancer: who they are and how they impact the breast cancer experience. J Psychosom Res 59(5):307–314. doi: 10.1016/j.jpsychores.2005.06.059 PubMedCrossRefGoogle Scholar
  82. 82.
    Marrazzo JM (2004) Barriers to infectious disease care among lesbians. Emerg Infect Dis 10(11):1974–1978PubMedGoogle Scholar
  83. 83.
    Frisch M (2004) Health needs of women who have sex with women: evidence is lacking that women who have sex with women are high risk group for cancer. BMJ 328(7437):464. doi: 10.1136/bmj.328.7437.464 PubMedCrossRefGoogle Scholar
  84. 84.
    Phillips-Angeles E, Wolfe P, Myers R, Dawson P, Marrazzo J, Soltner S, Dzieweczynski M (2004) Lesbian health matters: a pap test education campaign nearly thwarted by discrimination. Health Promot Pract 5(3):314–325. doi: 10.1177/1524839903257307 PubMedCrossRefGoogle Scholar
  85. 85.
    Patnick J, Davison CM (2004) Health needs of women who have sex with women: cervical screening is offered without asking for sexual preferences. BMJ 328(7437):464. doi: 10.1136/bmj.328.7437.464-a PubMedCrossRefGoogle Scholar
  86. 86.
    McNair RP (2003) Lesbian health inequalities: a cultural minority issue for health professionals. Med J Aust 178(12):643–645PubMedGoogle Scholar
  87. 87.
    Price JH, Easton AN, Telljohann SK, Wallace PB (1996) Perceptions of cervical cancer and Pap smear screening behavior by women’s sexual orientation. J Community Health 21(2):89–105. doi: 10.1007/BF01682301 PubMedCrossRefGoogle Scholar
  88. 88.
    Grindel CG, McGehee L, Patsdaughter CA, Roberts SJ, Tarmina MS (2006) Cancer prevention and screening behaviors in lesbians. Women Health 44(2):15–39. doi: 10.1300/J013v44n02_02 Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  1. 1.Department of Epidemiology and Preventive MedicineUniversity of Maryland School of MedicineBaltimoreUSA

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