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Coming out about breast cancer in lesbian and bisexual women

Coming out about breast cancer in lesbian and bisexual women. Julie Fish Reader in Social Work and Health Inequalities De Montfort University Leicester.

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Coming out about breast cancer in lesbian and bisexual women

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  1. Coming out about breast cancer in lesbian and bisexual women Julie Fish Reader in Social Work and Health Inequalities De Montfort University Leicester. © Julie Fish. Please cite: Fish, J. (2009) Coming out about breast cancer in lesbian and bisexual women. 4th national LGBT health summit. Newcastle. Oct 6th 2009

  2. Wider context • Little research – Boehmer conducted a PubMed search – found only 0.1% of articles addressed LGBT health issues; • No previous research in UK on LB women with experience of breast cancer; • Survey by DH found that projects tackling cancer inequalities were least likely to be targeted to LGBT people. • Third sector orgs. – less emphasis on cancer; • 3 UK studies on men and breast cancer; • Invisibility of LB women in health services.

  3. Inequality projects - DH survey (77 projects surveyed)

  4. Why cancer? • Inequalities in cancer outcomes are experienced by a range of different groups in society including LGB people. • Cancer inequalities are differences in the burden of cancer or in access to treatment, support and care.

  5. LB women and breast cancer • Increased prevalence of breast cancer among LB women; • Breast cancer risk? • Heterosexual women more likely to report current involvement in cancer support groups than LB women; • Heterosexual women report greater satisfaction with healthcare interactions.

  6. Current study • Stakeholder steering group: • 3 ‘communities of interest’ • Cancer organisations (Macmillan, Breast Cancer Care, Cancer Research UK) • LB women’s social care organisations (Age Concern Camden, Metro centre, BOLGAF) • Women with breast cancer and their carers Knowledge transfer and sustainability • Prescription for Change & Lesbian Health Care Survey

  7. Experiences of cancer support groups “Mastectomy support groups inevitably get around to discussing intimacy with partners - I have no idea how women with female partners cope with such groups… I did have counselling at our Oncology Centre and it was during my breast cancer experience I first started to accept that I am gay…. During that period, that concerned my body so intimately, I would have liked to have had the chance to attend a gay-friendly women’s group”. Prescription for Change 2008.

  8. Involving partners in care “My partner had breast cancer and although the care she received generally was good, our relationship was never acknowledged and at best I was treated as her 'friend' which at times we found difficult and stressful. I think if I had been a male partner, the health professionals would have included me more in discussions rather than turning their back to me and seeing me as 'irrelevant' when I went with her to the hospital etc”. Prescription for Change 2008 Cynthia Dixon - actor

  9. Breast cancer risk No children: • Kathy: Women who haven’t had children (…) and what I’m suspicious of is: is that doctors saying ‘go and get a child dear, you know you’ll be all right’. Is this an interpretation or are the figures really demonstrative that that’s the risk? LHCS 2002 Melissa Etheridge - singer

  10. Breast cancer risk Late child bearing • Donna: I do think lesbians on the whole if they’re in a lesbian relationship and choose to have children like I did, they do tend to leave it till they’re older anyway. I was 38 when I had my daughter …and late child bearing is the same thing. ..Now I think this is really [inaudible] I thought I was quite clued up, well obviously crikey. LHCS 2002 Dusty Springfield - singer

  11. Breast cancer risk Alcohol consumption • Kate: Maybe historically I don’t know about now. I know that all the socialising 20 years ago was based around bars. That was probably more the pressures of not being able to be out for part of one’s life or the whole of one’s life (it) made for a lot of alcohol problems. But then it would be interesting (to know) whether younger dykes are also drinking as much I don’t know. LHCS 2002 Audre Lorde –poet, writer, activist

  12. Early findings • Few of the women interviewed so far have chosen to have reconstructive surgery; • Some chose not to ‘come out’ to health professionals; • They talked about the effect on the relationship with their partner or future partners; • Only one had accessed specific support/ information for LB women.

  13. Dahlgren and Whitehead’s (1991) the Social Determinants of Health

  14. Using the social determinants of health model • Individual lifestyle factors - no children, late childbearing. • Social and community influences - alcohol consumption (lack of social spaces) • Living and working conditions - Involving partner in treatment decisions (access to healthcare services) • General socio-economic, cultural and environmental conditions - access to mastectomy support groups, few services, lack of research

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