Specialized clinics aim to improve cancer outcomes for LGBTQ+ people

By Jessica Saenz

Every part of the cancer journey, from prevention to survivorship, requires medical professionals to understand and support their patient population. When they don't, outcomes suffer.

Cancer experts know a lack of specialized care has contributed to poorer outcomes for people in the LGBTQ+ community. While current standards of care fail to consider the unique barriers, risk factors and experiences of LGBTQ+ people, limited research makes it challenging to implement changes to improve their cancer care.

Elizabeth Cathcart-Rake, M.D., a Mayo Clinic medical oncologist specializing in breast cancer, is working to combat this through the Rainbows Breast Cancer Clinic, an LGBTQ-focused breast cancer clinic in Rochester, Minnesota.

Dr. Cathcart-Rake and the Rainbows Breast Cancer Clinic team have set three goals to better understand LGBTQ+ disparities and find answers that can improve patients' cancer care beyond the clinic:

1. Create a welcoming, affirming, safe space for LGBTQ+ people to receive cancer care.

A recent survey included in the American Association for Cancer Research Cancer Disparities Progress Report 2022 found that 16% of people who identify as sexual and gender minorities reported discrimination while seeking healthcare, and nearly 1 in 5 of those who identify as sexual and gender minorities said they have avoided getting healthcare out of fear of discrimination.

Dr. Cathcart-Rake says safety is a concern for many LGBTQ+ people, including her patients, and it takes precedence over healthcare. "If you don't feel safe leaving your house to go to the convenience store — and we know that Black trans women are at the highest risk of violence out of any minority group in the United States — are you going to feel safe going to get a cancer screening? We've heard this from our patients: Thinking about cancer prevention and screening is a luxury. That is hugely impactful."

Avoiding or delaying cancer screenings, in combination with a lack of awareness of other risk factors, can lead to later detection of cancer and poorer outcomes.

To create a more welcoming environment that encourages LGBTQ+ people to actively participate in their cancer care, Dr. Cathcart-Rake says Rainbows Breast Cancer Clinic staff use affirming, culturally appropriate language, wear rainbow pins on their badges and offer gender-neutral bathrooms. LGBTQ+ signage can also be found around the clinic. "Every single person that patients interact with is either part of this community or very much wants to be engaged in care for this community. They have elected to be part of this clinic and have undergone cultural sensitivity training."

2. Provide cancer clinical expertise that's tailored to LGBTQ+ needs.

Cancer care is never one-size-fits-all. To provide adequate care for LGBTQ+ people, the clinic considers individual needs related to gender-affirming hormones, surgical and screening history and preferences, and past healthcare experiences.

"This is a diverse community. Our goal is to individualize care, so we're not going to be talking about the same issues with patients who are gay and lesbian as we will with people who are trans," says Dr. Cathcart-Rake. "For example, trans people might have gender-affirming hormones and different surgical preferences."

While research findings regarding the cancer risk of gender-affirming hormone therapy are mixed, Dr. Cathcart-Rake says hormone therapy needs to be considered, along with other cancer risk factors, when determining screening recommendations for each person.

Dr. Cathcart-Rake says gender dysphoria is another consideration for her and her team when making screening recommendations. Gender dysphoria is the feeling of discomfort or distress that might occur in people whose gender identity differs from their sex assigned at birth or sex-related physical characteristics.

"Gender dysphoria can be brought on by screening — mammograms in particular. This is often the case for trans men because it's not affirming. Many trans men who have had top surgery don't need mammograms. However, some do, including folks who still have significant breast tissue and those with a family history of cancer, genetic predisposition or chest radiation at an early age."

"We also need to think about lifestyle interventions like reducing smoking and alcohol use," she says. "Unfortunately, people who are part of a minority group are at higher risk for these risk-taking behaviors because they've been dealing with constant discrimination and stigma."

3. Drive and advance research that improves cancer care for LGBTQ+ people.

Research on many aspects of cancer care for LGBTQ+ people is limited. "Particularly in the trans and gender-diverse community, we know there are late-stage diagnoses of lung, prostate and bladder cancer, and we also see poor outcomes," says Dr. Cathcart-Rake. "Trans and gender-diverse people with non-Hodgkin lymphoma are two times more at risk of death compared to the cisgender population. For other cancer types, the numbers just aren't there."

To close the cancer care gap and address disparities that contribute to late diagnoses and poor outcomes, cancer researchers need to understand the full scope of disparities LGBTQ+ people face. "From the disparities we know exist, there's a whole underlying level of disparities that we suspect but haven't even been able to pinpoint or understand. That's a huge reason I think this work is so important," says Dr. Cathcart-Rake.

She adds that beyond understanding the root causes of these disparities, cancer experts must continue to research prevention measures.

"We need to act and be proactive in trying to make sure that cancer outcomes are good despite someone's identity. Much of my research focuses on improving early detection, access, safety and the affirmative nature of screening mammograms. I also research the interactions between gender-affirming hormone therapy and endocrine therapy and how we can support shared decision-making with our patients," she says.

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Dr. Cathcart-Rake says so far, her patients have been grateful that the clinic eliminates the worry of healthcare discrimination, which has allowed them to focus on the most critical parts of their cancer journey.

"I just had a visit with a patient — I gave her our supportive care materials, and I addressed the specific LGBTQ+ aspects of care — but what she was most thankful for was that she didn't have to worry about whether or not her significant other would be treated with respect; that she didn't have those added stressors on top of a cancer diagnosis."

How to make an appointment

Housed on the 10th Floor of the Gonda Building on Mayo Clinic's campus in Rochester, Minnesota, the Rainbows Breast Cancer Clinic is open to anyone who wishes to be seen in an LGBTQ-focused breast clinic.

To make an appointment, call the Medical Oncology Appointment Office in Rochester, Minnesota, at 507-284-8815 and mention "Rainbows."

Virtual visits will be allowed for any patient, as laws allow.

Learn more

Read these articles to learn more about cancer and LGBTQ+ people:

• Mayo Clinic launches Rainbows, an LGBTQ-focused breast cancer clinic
• Addressing cancer concerns in the LGBTQ+ community
• The importance of cancer screenings for the LGBTQ community
• What people who identify as LGBTQ should know about cancer

Join the LGBTQIA Health Support Group on Mayo Clinic Connect, an online community moderated by Mayo Clinic for patients and caregivers.

Dr. Cathcart-Rake also recommends these resources for LGBTQ+ people with breast cancer:

• LGBTQ+ Healthcare Directory
• Living Beyond Breast Cancer – LGBTQ+ with breast cancer
• National LGBT Cancer Network Resources

Mayo Clinic also offers an Inflammatory Bowel Disease Pride Clinic on its Rochester campus for LGBTQ+ adults.