A friend who is a lesbian was startled when a doctor suggested she might be at greater risk for breast and ovarian cancer because of her sexual orientation. The comment was not meant to indict her in anyway, but sadly based on statistical fact; in the United States breast and ovarian cancer appear to be more prevalent in lesbians and bisexual women than in straight women. Understanding this phenomenon may not immediately affect those suffering from ovarian cancer but it will influence how you approach the health care system and might even help you to save the life of a gay friend.

The reasons for higher cancer rates among lesbians are complex, as much (maybe more) socio-political as physiological. While the most conservative and radical fundamentalist members of any belief system will say the cancer rates reflect punishment for lifestyle choices, the fact is lesbians are not being punished by God. They are being punished by poverty and bigotry. The National Survey of Family Growth found 24% of lesbian and bisexual women between 18-44 are living in poverty compared to 19% of heterosexual women. This means many lesbians don’t have access to affordable health care. For those who do, fear of discrimination can prevent them from venturing into a medical office any more than seems absolutely necessary. Enter breast and ovarian cancer, both of which are like the oil change light in your car; by the time it goes on you’ve already done damage to your engine. By the time a woman is symptomatic enough to take on a medical system that requires she come out of the closet and face potential prejudice she likely already will have advanced disease.

On the physiological front, some evidence suggests ovarian and uterine/endometrial cancers are more prevalent among women who have not used oral contraception. Some researchers go as far as to say women who have never used the pill or other hormonal contraceptives are at a 50% greater risk for ovarian cancer than those who have. Other research cites never having been pregnant and never having breast fed as risk factors for breast and ovarian cancers (pregnancy and breastfeeding lower a women’s estrogen level which can protect against some forms of breast cancer and decrease ovulation which can protect against ovarian cancer). Obesity also puts a woman at higher risk, as does heavy alcohol use, and smoking. Whether these perhaps more lifestyle-specific traits are higher among lesbians is not clear. What is clear is their greater prevalence among the impoverished and disenfranchised members of our society.

All of these risk factors are indirect ramifications of sexual orientation; they are by no means caused by it.

In a society in which quality health care is not equally and unconditionally available to all, it is simplistic at best – incendiary at worst – to suggest any minority group is at greater risk for disease without elucidating the reasons why this might be true. Women like my friend could be spared the terror such a comment evokes. And lesbians overall could be spared the attacks such news becomes in the hands of the homophobic.

In the meantime, women are women first; the objects of our passion are second to the desire to live life healthfully and to survive long enough to kick cancer to the ground.