Risk factors, poor access to health care can mean catastrophe


Tammye Nash  |  Managing Editor

“Hello. This is Dr. Nxxx. I was just calling to let you know we have received the biopsy results and yes, you have cancer.”

That’s not a call anyone wants to receive. Not ever. But I got that call; it came for me on the afternoon of Wednesday, June 3.


Richard Wender, M.D.

I have been diagnosed with uterine cancer, also called endometrial cancer. My gynecologist tells me the biopsy shows that the cancer cells are “well differentiated.” Having cancer is never good, he told me, but if you have to have endometrial cancer, then well-differentiated cells are the best ones to have.

The oncologist told me that I have a “type 1” cancer that is slow growing, and the most treatable. Hopefully, the surgery I am scheduled to have next week will be enough to “cure” the disease and I won’t need any follow-up treatment such as radiation.

According to the National Cancer Institute, more than 1.65 million new cases of cancer will be diagnosed in the United States this year, and nearly 600,000 people will die from the disease.

The American Cancer Society notes that cancer of the endometrium — the endometrium being the lining of the uterus — is the most common cancer of the female reproductive organs. This year, ACS estimates, there will be about 54,870 new cases of cancer of the body of the uterus diagnoses. About 1,240 of those new cases will be in Texas, noted Joy Donovan Brandon, the spokeswoman for the ACS’ Dallas/Fort Worth office.

About 10,710 women nationwide will die of those kinds of cancer.

I am one of the lucky ones, especially considering that I waited more than eight months after I first noticed symptoms to actually go to the doctor. If I had a more aggressive type of cancer, I would probably be in very bad shape right now.

Why did I wait? A lot of reasons, starting with the fact that I just was not well educated about my own health. When the most obvious symptom started — bleeding after I had already gone through menopause — I just marked it down as part of the process of menopause. It wasn’t until a couple of months later that I mentioned it to my partner and she informed me how wrong I was.

Go to the doctor, she told me. I said OK, but then I postponed it: Doctors are too expensive, I told myself.

They’ll just poke and prod and charge me a lot of money to finally say nothing’s wrong, stop being such a baby.

CigaretteFinally, when the symptoms persisted, in late January I called my doctor and to make an appointment, telling them I wanted to get an “annual physical.” When the woman on the phone said the next available appointment for a physical was May 8, I accepted it — even though I should have told them then that I was having some issues that needed more immediate attention.

I didn’t want to make a fuss. I figured, honestly, that insurance would cover the “annual physical” more completely, so it would be less money out of my pocket. Expenses are always a worry, just like with most people.

And that’s a big problem, one that puts the lesbian community as a whole at a higher risk for cancer of all types.

Lesbians, Brandon said, tend to access health care less frequently, which means they often miss out on the routine screenings that can detect cancers early. There are a number of reasons for that, including the fact that lesbians tend to be uninsured or under-insured, although, Brandon added, “hopefully the Supreme Court’s recent marriage equality ruling will help remedy that.”

In addition, Brandon continued, fear of discrimination often keeps lesbians from either going to the doctor or from being completely open and honest with their doctor. “When a patient is worried about encountering discrimination [in a health care setting], it’s certainly less likely that will seek out routine health care,” she said. “Fear leads people to put off the cancer screenings that, in some cases, could save their lives.”

But there are also other, more concrete physical factors that put lesbians at higher risk for certain kinds of cancer.

“There are three areas of major increased risk [for the lesbian community] that we are investigating,” said Dr. Richard Wender, chief cancer control officer for the ACS.

The first, he said, is a higher rate of tobacco use, and tobacco use is the No. 1 risk factor for a number of different cancers, not just lung cancer. “There are 20 different cancers for which tobacco use is a risk factor,” Wender said. “That includes colon, bladder and esophageal cancers.”

Studies have also shown that the rates of being overweight or obese are higher in the lesbian community than in the population as a whole, and being obese or overweight is another high-risk factor for several cancers.

Wender urged caution in considering the studies and surveys that seemed to indicate a higher rate of overweight/obesity among lesbians, noting that the results varied widely depending on several factors, including the racial and ethnic background of the individuals surveyed.

Still, he added, “Obesity is just behind tobacco use” in terms of being a risk factor for cancer. “There’s no debate about that. The link has been firmly established” between overeating/obesity and at least 15 different kinds of cancer.

The third major factor, Wender continued, is “hormonal issues in general.” Since lesbians tend to have fewer — much fewer! — pregnancies than women in general, and often those lesbians who do get pregnant do so later in life, they are exposed to higher levels of estrogen over longer periods of time. That means lesbians in general are at a higher risk for a number of estrogen-sensitive cancers, like breast cancer and, in my case, endometrial cancer.

Put it all together and, as Wender said, “it’s not difficult to see that lesbians and LGBT people in general face some unique barriers” in getting the proper health care. The American Cancer Society recognizes that, both Wendy and Brandon said, and is dedicated to making sure that the LGBT community has access to healthcare, access to the navigational help necessary to make it through the maze of the health care system, and “health equity for everyone.”

Let me put it to you plainly: Take care of yourselves. Go to the doctor when you feel like something’s wrong. Hell, don’t wait until something’s wrong; go in for regular check-ups, get those mammograms and those pap smears and those other preventive screenings.

And when you go to the doctor, talk to them openly and honestly; don’t let fear of discrimination or disapproval hold you back. If your doctor — or nurse, or physician’s assistant or the front desk receptionist or whomever — treats you badly because you are LGBT, go somewhere else. There are plenty of LGBT and LGBT-friendly health care professionals out there.

Take care of yourself. Trust me, cancer is no fun.

This article appeared in the Dallas Voice print edition July 10, 2015.