Communicating with your breast cancer care team as an LGBTQ+ person

The basis for any good relationship is communication. This is especially true if you’ve been diagnosed with breast cancer and you’re communicating with your breast cancer care team about your treatment plan.

A cancer diagnosis comes with a lot of new information and concerns. The first days, weeks, and months can be overwhelming. Trusting your healthcare team and talking with them openly is often key to getting the best care, treatment, and quality of life possible, and easing your worries and fears.

If you are a person who belongs to a sexual and gender minority (SGM) group, finding a doctor and a care team you can trust and feel comfortable with can be challenging. This may be especially true if you live in rural areas or in places with limited health care options.

Coming out to your care team as LGBTQ+

As an LGBTQ+ person with breast cancer, you may be comfortable sharing your sexual orientation or gender identity (SOGI) with your breast care team. It may not be something you’d consider keeping to yourself.

On the other hand, you may be considering if you feel safe and ready to come out to, or share your SOGI with, your care team. Deciding whether to come out to your care team will likely be based on many things, including where you are in the coming out process to family, friends, and coworkers; your past experiences in the healthcare system; and where you live.

Deciding if coming out to your care team is right for you

Some members of your care team may ask you about your sexual orientation. Some forms you fill out before you meet with a doctor may ask your gender identity as well as sex assigned at birth. Some waiting rooms may have designated gender-neutral bathrooms. These things may be a way of letting you know you and the people supporting you are safe and welcome.

For some people, being asked about their SOGI makes it easier to discuss how a breast cancer diagnosis and treatment affect body image, physical relationships, and ability to have children in the future.

Still, some providers may not ask about your SOGI. It may be up to you to let your healthcare team know, if you choose to do so.

Talking with healthcare providers about your SOGI is a highly individual experience—it brings up different feelings for different people. Some people feel that coming out is important to working well with their care team. For others, coming out might seem unnecessary, or like it may make communication more complicated. And for a lot of people, even if coming out feels important, it can also trigger some anxiety.

Keep in mind that there are many general health and cancer centers across the U.S. that are welcoming of LGBTQ+ people.

There are factors that may help you decide whether to come out to your doctor. Feeling safe, welcome, and confident that a team of breast health professionals will be able to offer you the care and respect you need may be chief among them.

Possible benefits of coming out to your care team

Below are some possible benefits of coming out:

• The more healthcare professionals know about you, the better they can help you stay healthiest during breast cancer treatment and beyond.
• Your care team may be better able to help you address specific sexual and relationship concerns related to your diagnosis.
• If you plan to get pregnant in the future, your concerns may be different than those of your heterosexual and/or cisgender peers.
• It may ease the stress of feeling like you must hide your true self.
• Your doctor may be able to refer you to specialists or mental health professionals who are LGBTQ+ welcoming.

If you can’t come out, or choose not to

Coming out is a personal choice—if you decide not to come out for any reason, that’s OK. You may see it as an extra burden on top of the stress of a breast cancer diagnosis. Maybe you feel you can communicate well without your doctor knowing these personal details.

Sharing with your doctor may not be an option for you if:

• You aren’t ready to or simply don’t wish to come out
• You want to focus on your breast cancer and immediate medical needs
• You feel that your hospital isn’t LGBTQ+ friendly or lacks resources and training specific to LGBTQ+ patients

Coming out to your care team as transgender

If you identify as transgender and you’ve been diagnosed with breast cancer, your experience is likely to be different than that of lesbian, gay, and bisexual people. It’s helpful to let your doctors know your gender identity, and if you’re physically transitioning, it’s also helpful to let your doctors know where you are in the process. Telling your healthcare team whether you use transitioning hormone therapies and if you’ve had gender-transitioning surgery helps your doctors to find the most precise treatment options for your unique situation.

Talking about your gender identity and transition may help for several reasons:

• Talking about your gender identity may help your cancer care team to use the name and pronoun you prefer, if those things do not match your medical records. For example, if you have not legally changed your name, the name on your medical records may not match the name you wish to be called. Communicating your preferences and your expectations to your healthcare team may make you feel more comfortable discussing things that are important to you.
• If you have been diagnosed with estrogen receptor-positive breast cancer, the hormone estrogen can trigger the breast cancer to grow. If estrogen hormone therapy is part of your transition regimen and your doctor is aware of this, they can give you more information about how your risk and treatment options may impact that therapy.
• If you want to have children in the future, your options may depend on doctors knowing your anatomy.

Finding a care team that supports the LGBTQ+ community

The internet is a great tool to help identify doctors who are not only experts in the treatment of breast cancer, but also open to the needs of the LGBTQ+ community. One great resource is the Human Rights Campaign’s Healthcare Equality Index. In this guide, you will find a comprehensive list of doctors and healthcare facilities that are ranked in their sensitivity to the needs of patients who are LGBTQ+.

Other helpful resources include:

• Coming out to your doctor (Human Rights Campaign)
• Do ask, do tell: Talking to your healthcare provider about being LGBTQ+ (National LGBTQIA+ Health Education Center)
• Talking to your doctor about your LGBTQ+ sex life (Harvard Health Publishing)

If you are uncomfortable with a healthcare professional’s response to your LGBTQ+ status

Respect is a vital part of communicating with your healthcare team, and though you may take steps to be open and clear about your SOGI, and/or transition, not all healthcare professionals respond in a sensitive way. If you feel uncomfortable with the reaction of any member of your cancer care team, and if it feels safe to do so, speak up. If your concerns are not met to your satisfaction, speaking with a patient and family advocate at your clinic or switching to another practice or care center may be a next step.

There are healthcare providers who are sensitive to the needs of LGBTQ+ community members. It’s OK to call ahead and ask if the doctors and care team have treated LGBTQ+ patients before your appointment. If you think a doctor is unfair or disrespectful, you have the option to move on to a different one.

Coming out and metastatic breast cancer

If you are diagnosed with metastatic breast cancer (MBC), you may feel added pressure to decide whether you’ll come out to your breast cancer care team. Unlike people with early-stage disease, if you have a diagnosis of MBC you will actively manage breast cancer for the rest of your life.

Your treatment will focus on controlling and slowing the cancer’s growth, as well as managing your symptoms and side effects. Your team’s goal will be to help you live the best possible life while managing the disease. You and your care team will meet regularly to monitor your treatment.

Being able to talk openly about your SOGI may help relieve some of the pressure during a vulnerable time, and in the future as feelings may change. The cancer characteristics, including hormone receptor status, may also change over time.

No matter what your unique experience is, communicating with your healthcare team is likely to benefit your health, care, and well-being. Bringing a friend, partner, spouse or other loved one to an appointment may help you come out or talk to your doctor and put your mind at ease.