Bowen's research team now asks about sexual orientation in both paper surveys and telephone interviews. They ask whether subjects identify as heterosexual, bisexual, lesbian, or other, and also about sexual behavior. If we only ask the former, we lose women who have sex with women but don't identify as lesbian, and if we just ask about sexual behavior we lose women who are not currently sexually active. Bowen thinks there are two camps of thought about breast cancer in the lesbian community. One has to do with reproductive factors.
Fewer lesbians have children than do heterosexual women.
We know that if cancer is caught at a later stage when it has had more chance to grow and spread to other parts of the body, it's harder to treat. The theory goes that if lesbians have a harder time finding affordable, affirmative check-ups, they may be less likely to have mammograms or interact with a health provider in a way that would help with early diagnosis. So it may be that lesbians aren't at higher risk, just that they don't get good health care and are likely to be diagnosed with breast cancer when it is harder to treat. I asked what she would recommend that health care professionals do to increase the comfort of lesbian patients. The person who comes to a doctor has to trust that doctor and has to feel comfortable bringing scary problems there.