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National LGBT Cancer Network Speaks Out


October 2012


A new Study Finds that Cancer-Pink Clashes with the Rainbow Flag.


Each October, the autumn colors are hidden beyond a wall of pink, as well-meaning health care workers and activists decorate their scrubs and offices in cancer-pink ribbons. In addition, fundraising walks, runs and breast cancer educational programs will take place in cities across the U.S.


“Somehow, the country has collapsed all meaningful support for breast cancer survivors into the Wearing of the Pink.”, said Liz Margolies, LCSW, the executive director of the National LGBT Cancer Network, “And this one-color-fits-all approach does not meet the needs of lesbian and transgender breast cancer survivors.”


Margolies is the co-investigator, along with Marilyn Smith-Stoner, nursing professor at California State University, San Bernadino, of a recent national study of lesbian, gay, bisexual and transgender cancer survivors. Their findings suggest that supporters of breast cancer awareness month should “Pause before they Pink”.


The study, “The Experience of Being Diagnosed with Cancer by Lesbian, Gay, Bisexual, Transgender People” reported that many LGBT cancer survivors in the study reacted negatively to the feminization of breast cancer care. “Many lesbians and transgender men are offended by the values inherent in the pinking of breast cancer. It becomes a source of further isolation and may diminish the caring relationship”, says Dr. Smith-Stoner.


As one responded phrased it: "Reproductive cancers are loaded with gender issues. For example, not all women (or men) with breast cancer want to wear pink. I think over-feminizing BC is problematic."


Another wrote: “There's a hell of a lot of emphasis in breast cancer awareness about helping women look stereotypically feminine. I personally have no interest in breast reconstruction, and it irked me that I was automatically referred to a plastic surgeon at the time of my mastectomy.”


A lesbian survivor wrote: “Being a Lesbian facing having your breasts cut off, it would be good if they did not assume you were concerned about how "men" would see you in the future!”


While the military has finally ended the Don’t Ask Don’t Tell policy, healthcare workers have not yet done so. LGBT patients are rarely asked about their gender identity and sexual orientation. When they are, clinicians have not been trained to respond appropriately. Few are equipped to discuss the impact of cancer on LGBT sexuality and relationships.


“Our research highlights the critical need to inquire about patients’ sexual orientation and gender identity and to include “families of choice” in treatment. You cannot offer significant and tailored support otherwise.”, said Margolies.


LGBT cancer survivors are often more isolated and frightened than their heterosexual counterparts.

As one respondent wrote: “I was never out during the whole process to anyone. I had no one in the hospital or doctor visit with me for fear of my gayness being discovered and then the doctors "accidentally" not removing all the cancer lesions. It would have been nice to have my partner with me. My family refused to come and told me they hoped I would die from the cancer.”


As another said: “My support system, many of whom are trans and gender variant people, were made to feel very uncomfortable by my doctors and medical staff due to disregard for pronoun use, sideways glances, and overall awkward responses.”


One respondent summed it up well, “Don't assume all patients are straight. Don't assume they have a support network. Don't assume ANYTHING”.


“We can do better than that. We must do better than that. The voices of the LGBT survivors must be heard and their needs addressed with the respect offered other people with breast cancer.”, said Dr. Smith-Stoner.

Further results of the study will be released soon. In the meantime, Margolies and Smith-Stoner ask that, beginning in October, healthcare workers ASK all their patients about sexual orientation, RESPECT the unique needs of lesbian and transgender survivors, and INVITE their support system into treatment.


“As we begin breast cancer awareness month we ask that you Pause before you Pink. Don’t forget the needs of lesbian and transgender breast cancer survivors”, said Margolies.


The study was funded by The DAISY Foundation’s Patrick J. Barnes Grant for Nursing Research and Evidence-Based Practice Projects.


For more information:


National LGBT Cancer Network
Liz Margolies, Executive Director


Marilyn Smith-Stoner
Professor of Nursing
California Sate University, San Bernardino



New Resource Lists LGBT Friendly Centers


May 2012


A new resource has been published that lists over 400 LGBT friendly cancer screening centers nationwide.  According to the National LGBT Cancer Network, this resource has removed many of the barriers to LGBT cancer screenings


No one looks forward to being screened for cancer.  It's scary, uncomfortable and pricey.  But, for those in the LGBT community the list of barriers to cancer screening is even longer, including...   Low rates of health insurance coverage...   Feared discrimination...   Previous negative experiences...   Provider ignorance about LGBT health needs.


The National LGBT Cancer Network's mission is to improve the lives of LGBT people with cancer and those at risk. We educate the LGBT community, train healthcare providers and advocate for LGBT inclusion in national cancer organizations, research and the media.


With a generous grant from the Palette Fund, the National LGBT Cancer Network, headed up by Executive Director Liz Margolies, spent the last year investigating cancer screening facilities across the country, seeking free or affordable places where LGBT people would be safe and respected.  In all, they found over 400 LGBT-friendly facilities, covering nearly all 50 states, that offer mammograms, cervical paps, colonoscopies, anal paps and prostate screenings.  They found many places where you don't need health insurance and, if you do, your body need not match the gender on your card.  In some places, you don't have to have any legal documentation at all.


The directory can be found on the National LGBT Cancer Network website.  It is the newest addition to their Take Care of That Body campaign.


Most listings in the directory include the name, phone number and email of a staff person at the facility. These people have agreed to personally shepherd you through the screening process.  If, for example, you are a transgender man seeking a mammogram, the guide will make sure you are not given a pink robe or asked to sit in the women's waiting room.  These guides are committed to making the experience a decent one for all LGBT persons.  If the facility has no designated guide, it is because ALL of the staff meets the high standard for LGBT cultural competence.


The yellow highlighted facilities in our directory are places that have shown an exceptional commitment to transgender health.  But, you can be confident that every single place listed satisfies the rigorous criteria of the National LGBT Cancer Network. 






National LGBT Cancer Network
Huffington Post: Breaking Down Barriers with Resources for Accessible Care



Medical Concerns

Lesbian, gay, bisexual, and transgender (LGBT) individuals are as diverse as the general population in terms of race, ethnicity, age, religion, education, income, and family history. A number of health concerns are unique to or shared by the LGBT community, however, including an increased risk of certain cancers, infectious and sexually transmitted diseases (STDs), and mental health disorders; issues relating to nutrition and weight, tobacco use, and substance abuse; and discrimination by health care and insurance providers.


The definitions of different sexual identities have shifted over the years, as have the perceptions and stereo-types of the general population. Because of the wide range of behaviors and identities that exist in the LGBT community, it is difficult to develop an inclusive definition. It is generally accepted, however, that gay men and lesbians are sexually attracted to or participate in sexual behaviors with individuals of the same gender, while bisexual men and women are sexually attracted to or participate in sexual behaviors with individuals of both genders. Transgender individuals live part- or full-time in a gender role opposite to their genetic sex.


It is estimated that approximately 2.8% of men and1.4% of women identify as being gay, lesbian, or bisexual while 9.1% of men and 4.3% of women have participated in sexual behavior with someone of the same gender at least once. The true extent of the transgender community has not been well researched in the United States; one study from the Netherlands in 1993 found that one in 11,900 males and one in 30,400 females are transgender.




LGBT and Public Health
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LGBT Health Communities
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Gay Health
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Reporting on Health: LGBT Health Issues
NAMI: LGBT Mental Health Resources
Healthline: Gay and Lesbian Health

Why do Gay People Smoke More than Straight People?
LGBT Health Awareness Campaign



Sexual Concerns


There are a number of issues that arise when trying to define sexual orientation. Many gay men and lesbians have participated in or continue to participate in sexual activities with members of the opposite sex but choose not to identify as heterosexuals or bisexuals. Others have never participated in sexual activities at all yet still identify as gay, lesbian, or bisexual. Some men and women identifying as bisexuals are in long-term, monogamous relationships with individuals of the same or opposite sex. Male-to-female (MTF) or female-to-male (FTM) transgender individuals may or may not identify themselves as gay or lesbian.


The implications of these identity issues are far-reaching. Misdiagnoses or improper medical recommendations might come from health care providers who have mistakenly assumed sexual behaviors or risks from the patient's stated identity. For example, a provider might incorrectly assume that a lesbian patient has never had sexual intercourse with a male and therefore would not have contracted STDs not normally transmitted by sexual activities between women. It has been difficult to closely estimate the numbers of LGBT individuals in the United States because of varying definitions. Likewise, the statistics in medical or social studies and surveys on LGBT issues might vary widely depending on what definitions were provided for the respondents. Because of this, many researchers have opted for the more inclusive terms of "men who have sex with men" (MSM) and "women who have sex with women" (WSW) to categorize gay, lesbian, and bisexual respondents.



Revealing Sexual Identity


Many LGBT individuals have difficulty revealing their sexual identity ("coming out") to their health care providers. They may fear discrimination from providers or believe that their confidentiality might be breached. In some cases health care workers have been poorly trained to address the needs of LGBT individuals or have difficulty communicating with their LGBT patient (one study indicated that 40% of physicians are uncomfortable providing care for gay or lesbian patients). In addition, many questions posed in questionnaires or examinations are heterosexually biased (e.g. asking a lesbian which birth control methods she uses or a gay man if he is married, single, or divorced).


Other reasons why LGBT individuals are often hesitant to share their sexual identity are more logistical. Many insurance companies deny benefits to long-term partners on the basis that they are not married. LGBT patients may have inadequate access to health care, either because they live in a remote rural area or in the crowded inner city. Some same-sex partners encounter discrimination in hospitals and clinics when they are denied the rights usually given to spouses of a patient such as visiting, making medical decisions, and participating in consultations with physicians.



Risk Factors


Some of the health concerns and risk factors that are relevant to LBGT individuals may be shared by the general population, while others are more specific to the LGBT community, and still others are specific to different subgroups of LGBT individuals. These health concerns may be grouped into the following areas of concern:


Sexual behavior issues: STDs such as human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), hepatitis A virus (HAV), hepatitis B virus (HBV), bacterial vaginosis, gonorrhea, chlamydia, and genital warts (human papillomavirus or HPV); anal, ovarian, and cervical cancer.


Cultural issues: body image, nutrition, weight, and eating disorders; drug and alcohol abuse; tobacco use; parenting andfamily planning.

Discrimination issues: inadequate medical care; harassment at work, school, or home; difficulty in obtaining housing, insurance coverage, or child custody; violence.


Sexual identity issues: conflicts with family, friends, and work mates; psychological issues such as anxiety, depression, and suicide; economic hardship.






A L G B T I C A L    Association for Lesbian, Gay, Bisexual & Transgender Issues in Counseling of Alabama