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Dear
Dr. Lipstick
(continued,
page 2)
Dear
Dr. Lipstick: I heard there is a big epidemic of breast cancer
in the queer community, but I've also heard we don't need regular
[gynecologic] checkups cause we're not with men. Can you tell
me what's up with that? I hate going to the doctor and my butch
refuses, but I am getting…
Worried
in Waco
Dear
Worried:
Oh
my, you've got one of those yummy (but oh so stubborn) Texas butches…me
too! Oh excuse me….
Well,
you're talking about two different things here…one is breast cancer
and the other is cervical cancer. You are in luck, though, because
the Institute of Medicine (IOM) just published a report on Lesbian
Health: Current Assessment and Directions for the Future. And
just last year, Jeanne Marrazzo, a Seattle physician and researcher,
published a study about the incidence of cervical cancer and genital
warts in 'women who have sex with women'. (Please forgive the
terms 'lesbians' and 'women who have sex with women' used here….
medical research, for the most part, does not include gender analysis.)
Breast
cancer is the most common cancer for black and white (these are
the terms used in the report and in most public health journals)
women, according to the IOM report. For all females, risk increases
with age and a family history of breast cancer. Studies reviewed
in the IOM report found that queer females may be at higher risk
of breast cancer than heterosexual females due to higher levels
of certain cancer risk factors. These risk factors include higher
rates of smoking, alcohol use, poor diet, greater body mass index,
and less oral contraceptive use and childbearing. However, the
studies that found these risk factors in queer females are not
necessarily accurate. The IOM report critiqued these studies and
found that some had inadequate methods or were not generalizable
to all queer females (the sample population studied was not representative
of us as a whole). They state there are no epidemiological studies
supporting a conclusion that we are at increased risk for breast
or other cancers.
The
perception of risk, though, may differ between heterosexual and
queer females. Women in one study (including a sample of lesbians
and women from a general sample) cited by the IOM report perceived
themselves as being at a much higher risk for breast cancer than
they actually were. In this study, lesbians had a slightly lower
perception of their actual risk overall than did women in the
general sample. When only women with a family history of breast
cancer were selected, the two groups did not differ.
Nevertheless,
many in the lesbian/queer female community believe that we are
experiencing a cancer epidemic. No one knows if this belief drives
us to seek breast cancer screening or drives us away….sometimes
fear of disease stops people from seeking care as well. In the
study mentioned here, health care seeking behavior was not addressed.
In
their Seattle study, Jeanne Marrazzo and colleagues found that
women who had never had sex with a male partner were nearly three
times more likely to have had fewer than two routine Pap smears
(test for cervical cancer) in the preceding 5 years than women
who had had sex with male partners. Other studies cited by Marrazzo
have found that self-perception of low risk for STD and cervical
cancer, and reduced need for birth control contribute to fewer
visits to providers that perform Pap smears. Lack of health care
coverage also plays a part in access to health care, although
in many communities local health department clinics and community
clinics offer health care at low cost or for free.
Some
health care providers have actually told queer females that they
don't need Pap smears because they were not sexually active with
men. Wrong! In Marrazzo's study, cervical cancer associated with
human papillomavirus (HPV - genital wart virus) and HPV alone
was detected in queer females without a history of heterosexual
sex. One of Marrazzo's colleagues, Kathleen Stine, reported in
the Journal of the Gay and Lesbian Medical Association that most
people who have had more than two partners or who have a sex partner
who has been with more than two partners have been infected with
HPV, and that one-third of women infected with HPV may have cervical
dysplasia (a pre-cancerous condition).
So
please please please y'all…talk to a knowledgeable health care
provider about your risks for breast and cervical cancer. And
once you determine what tests you need and how often, please get
them done! Success rates in treating cancer are higher when detected
early or in a pre-cancerous stage! Take your partners with you…or
at least share this information with them.
Note:
The IOM report can be found at http://books.nap.edu/
(search for the title 'Lesbian Health'). Marrazzo's study can
be found online at http://www.journals.uchicago.edu/JID/journal/issues/v178n6/980244/980244.html
If
you would like to write Dr. Lipstick please send mail to lipstick@stonefemme.com
For
more information on the Author
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