LGBTQ+ Patients Have Higher Risk of Breast Cancer Recurrence

LGBTQ+ patients with breast cancer experience delays in diagnosis and have worse outcomes than cisgender heterosexual patients, according to research published in JAMA Oncology.

Researchers found that LGBTQ+ patients have a higher risk of cancer recurrence, and they are more likely to decline their oncologist’s recommended course of treatment.

This retrospective, case-control study included 92 LGBTQ+ patients and 92 matched cisgender heterosexual patients. All patients were diagnosed with breast cancer in a single health care system between January 2008 and January 2022.

The demographic characteristics of the cohorts were similar, except for race and ethnicity. The LGBTQ+ group had more non-Hispanic White patients (78.3% vs 63.0%) and Hispanic patients (14.1% vs 7.6%) but fewer Asian or Pacific Islander patients (3.3% vs 25.0%) than the cisgender heterosexual group.

In both groups, the median age at diagnosis was 49 years, and most patients had private insurance. Baseline disease characteristics were similar between the groups.

Among the LGBTQ+ patients, 74 (80.4%) were cisgender lesbians, 12 (13%) were cisgender bisexuals, 4 (4.3%) were heterosexual transgender men, 1 (1.1%) was a gay transgender man, and 1 (1.1%) was an asexual transgender man. 

The median time from symptom onset to diagnosis was longer for LGBTQ+ patients than for cisgender heterosexual patients — 64 days and 34 days, respectively (adjusted hazard ratio [aHR], 0.65; 95% CI, 0.42-0.99; P =.04). 

However, the time from diagnosis to treatment was similar between the groups. In addition, there were no differences in rates of mastectomy, chest reconstruction, adjuvant radiation, neoadjuvant chemotherapy, antiestrogen therapy, or HER2-targeted treatment between the groups. 

LGBTQ+ patients were more likely than cisgender heterosexual patients to decline oncologist-recommended treatment — 38% and 20%, respectively (adjusted odds ratio, 2.27; 95% CI, 1.09-4.74; P =.03). The use of alternative medicine was higher in LGBTQ+ patients than in cisgender heterosexual patients as well — 46% and 30%, respectively.

The rate of recurrence was higher in LGBTQ+ patients than in cisgender heterosexual patients — 32.2% and 13.3%, respectively. Local recurrence rates were 17.3% and 2.5%, respectively. Rates of metastatic recurrence were 24.7% and 13.6%, respectively.

In a multivariable analysis, the risk of recurrence was 3-fold higher for LGBTQ+ patients (aHR, 3.07; 95% CI, 1.56-6.03; P =.001).

The researchers recommended that these disparities be further investigated in prospective, population-based studies, with the goal of informing health care interventions and improving quality of care for LGBTQ+ patients with breast cancer.

Reference

Eckhert E, Lansinger O, Ritter V, et al. Breast cancer diagnosis, treatment, and outcomes of patients from sex and gender minority groups. JAMA Oncol. Published online February 2, 2023. doi:10.1001/jamaoncol.2022.7146

This article originally appeared on Cancer Therapy Advisor