Leading Boston Healthcare Researchers are Looking to Make Breast Cancer Care More Inclusive of The LGBTQIA+ Community

After a breast cancer diagnosis, trust in your doctor is critical to sustain hope. Kay Coleman, who was diagnosed with breast cancer in 1998, quickly realized this as she found herself in the midst of completely uncharted territory. 

“I didn’t know another soul who had ever had breast cancer,” she says. From the outset of her treatment, Coleman depended on her relationships with her doctors at Beth Israel in Boston. As a lesbian woman (17 years before the federal legalization of gay marriage) she needed to know they had her best interests at heart. They earned her trust, and now cancer-free, she remains in contact with several members of her medical team to this day. 

Unfortunately, Coleman’s experience of comfort and support is not guaranteed for all members of the LGBTQIA+ community. It’s a widespread problem: LGBTQIA+ adults are more likely to be diagnosed with cancer in the first place, and according to the American Cancer Society Cancer Action Network, there could be nearly 152,000 new cancer cases and 50,000 cancer deaths among LGBTQIA+ adults in 2023. It’s a problem compounded by the fact that people in the community are at higher risk because of the lower rates at which they seek care—about 30 percent of LGBTQIA+ adults don’t seek health care or have a provider, compared to 10 percent of heterosexual, cisgender adults. 

Why? According to Brittany Charlton, associate professor of population medicine at Harvard Medical School, they may not feel comfortable seeking care in a health system that has historically failed to embrace the LGBTQIA+ community. 

“A lot of it goes back to a need to train providers on how to competently and humbly care for LGBTQ patients,” says Charlton, who focuses on issues of reproductive health and cancer disparities affecting sexual and gender minorities. “Even something as simple as not training our providers to ask for our patients’ pronouns absolutely impacts whether or not that patient wants to return for care.” 

Researchers like Charlton are looking into how health care systems can create an environment that invites and welcomes LGBTQIA+ community members. She maintains that one aspect of a physician’s education needs to be developing a “culturally humble” mindset, which is about “reflecting on one’s own background and other people’s backgrounds and how that may impact the care you provide.” 

Twenty-five years ago, when Coleman was diagnosed, cultural humility had room for growth, to say the least. But humble physicians still found a way into her life. “My surgeon, she was so nervous,” says Coleman. “She seemed as if she had never dealt with a lesbian couple before. And my partner was with me every single visit and through every single treatment.” 

Coleman says this didn’t make her uncomfortable because of one essential behavior. “Even though my surgeon was uncomfortable, she wasn’t disrespectful,” she says. “She was always trying to get the terminology correct, so she was one of those who cared enough to try.” Her cultural humility made the difference.

Coleman was originally given an expectation of up to five years to live, but today she’s thriving–and values the relationships she developed. “I was actually talking to [her former doctor] yesterday,” she says. “My surgeon in Boston, I continued to see her once or twice a year for follow up for 20 years.”