Affirming Care in Action:
Honoring the LGBTQIA+ Community During a Breast or Gynecologic Cancer Diagnosis
By Helana Shumway, Public Relations Coordinator
While cancer does not discriminate in the sense that anyone can be impacted by a diagnosis, cancer affects people and communities differently. Health disparities in cancer care and outcomes exist based on many social identities like race, ethnicity, age and socioeconomic status, along with sexual orientation and gender identity. For those in the LGBTQIA+ community, a breast or gynecologic cancer diagnosis may present unique challenges that do not impact heterosexual or cisgender people in the same ways.
Even before a cancer diagnosis, cancer screening rates are lower among the LGBTQIA+ community due to feared or lived discrimination and a lack of affirming health care.(1) Breast cancer screening rates are lower for sexual minority women (women who identify with a sexuality other than heterosexual).(2) For transgender and gender nonconforming people, rates of screening are lower for breast, cervical and colorectal cancers.(1)
To address these disparities, there must be a focus on gender-affirming care that is patient-centered and individualized so that LGBTQIA+ people diagnosed with breast or gynecologic cancer feel seen, valued and respected during their treatment and care.
Affirming, Patient-Centered Care
Charles Kamen, PhD, MPH
Al Asante-Facey, PA-C, MBA
“From a clinical standpoint, there are reasons to know a patient’s sexual orientation and gender identity so that you can provide high-quality cancer care,” says Charles Kamen, PhD, MPH. As an Associate Professor in the Department of Surgery and Psychiatry in the Division of Cancer Control at the University of Rochester and the Associate Director for Community Outreach and Engagement at the Wilmot Cancer Institute, Dr. Kamen’s research focuses on cancer inequities in the LGBTQIA+ community.
For breast and gynecologic cancers, this is particularly important, as the cancer is affecting organs (breasts, cervix, ovary, uterus, etc.) that are often associated with one’s identity. However, for transgender and gender nonconforming individuals, the cancer affecting their organs may not align with their gender identity, such as a trans man who receives a gynecologic cancer diagnosis. Or a trans woman on gender-affirming hormone therapy who is diagnosed with hormone-sensitive breast cancer. The clinical recommendation may be an aromatase inhibitor that depletes estrogen in the body to reduce recurrence.
Such diagnoses can be highly distressing and exacerbate gender dysphoria for individuals, says Al Asante-Facey, PA-C, MBA, Associate Director of Advanced Practice Providers at Memorial Sloan Kettering in New York City.
“Providers should create space for open, respectful conversations about these experiences rather than making assumptions about anatomy, identity, relationships, or goals of care,” says Asante-Facey.
Dr. Kamen agrees. He recommends that providers take an “organ inventory,” using intentional language like “a patient with a cervix” to identify the need for cervical cancer screenings while reducing the risk of gender dysphoria for trans or gender nonconforming people.
It is helpful for a provider to know their patient’s sexual orientation, as this also has implications in cancer diagnosis and treatment, says Dr. Kamen. For example, a sexual minority woman who receives pelvic radiation for gynecologic cancer may engage in different types of sexual intimacy than a heterosexual woman who has received this treatment. A provider who knows their patient’s sexual orientation will help to guide patient-centered care for tools and resources relating to intimacy following pelvic radiation.
When it comes to patient-centered cancer care for the LGBTQIA+ community, it is important to remember that everyone will have their own unique experience. As Dr. Kamen asserts, “[Care] doesn’t look the same for every person based on their constellation of identities.”
A Survivor and Caregiver’s Journey
Carol M. with Lori G.
Lori G. is a breast cancer survivor who underwent a double mastectomy following her diagnosis. She chose to have a type of reconstructive surgery that required her body to heal for several months after her mastectomies before her reconstruction.
“I was essentially flat for about 10 months,” shares Lori. “I think it was a really important time to go through to have that experience and know what it feels like not to have any breasts and to help me decide if I wanted them back or not.”
She decided to proceed with reconstruction as someone who is, in her words, “deeply rooted in my femininity.” To Lori, having her breasts reconstructed was a form of gender-affirming care, but she acknowledges that this is not everyone’s experience.
She and her partner and primary caregiver, Carol M., journeyed through her diagnosis and treatment together. As a lesbian couple, affirming, patient-centered care looked different for them than for heterosexual couples. Lori would always start doctor’s appointments by introducing Carol as her partner to identify their relationship as a same-sex couple.
Medical providers, like all of us, have implicit biases. In a heteronormative society, it is important to acknowledge that those biases exist and can have implications in clinical care. Making assumptions that a patient is heterosexual invalidates their lived experience if they have a different sexual orientation.
Lori and Carol are also a biracial couple. It is critical to acknowledge intersectionality – or the way in which our social identities overlap and interact with systems of privilege and oppression – in cancer care. Lori’s experience as a white patient differed from Carol’s experience as an Afro Latina caregiver.
Both Lori and Carol encourage providers to show genuine curiosity and validation for their patients and caregivers. A rainbow flag in the office, for example, may be a sign of solidarity, but it is important to put that solidarity into practice in the medical setting.
The Whole Person
Affirming care is fully appreciating and valuing each patient’s (and each caregiver’s) individual experience through a trauma-informed lens. On the importance of trauma-informed, affirming care, Asante-Facey reflects, “Using a patient’s chosen name and pronouns, explaining exams before performing them, giving patients control and choice whenever possible, and acknowledging that these cancers do not only impact women can significantly improve trust and psychological safety.”
When providers are curious and ask questions to learn more, patients feel safe and empowered to answer them honestly. This is seeing the whole person. Carol describes this as “medical empathy.”
“People need empathy, because we’re going through a lot,” says Carol, “and we go through a lot just as multi-faceted humans.”
A cancer diagnosis throws a wrench into our multi-faceted existences. For members of the LGBTQIA+ community experiencing a breast or gynecologic cancer diagnosis, it is essential to recognize the added layers of minority stress, fear of discrimination from providers, and potential for gender dysphoria that can be at play.
Honoring the whole person and their “constellation of identities,” as Dr. Kamen puts it, is affirming care in action.
References:
https://www.cancer.org/content/dam/cancer-org/cancer-control/en/booklets-flyers/lgbtq-people-with-cancer-fact-sheet.pdf
https://pmc.ncbi.nlm.nih.gov/articles/PMC12320750/
Published in the Summer 2026 issue of “Voices of the Ribbon.”
