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Lesbian, bisexual and other women who have sex with women (WSW) may be at greater risk for certain cancers due to certain behaviors and social factors. Breast and uterine cancer may be associated with nulliparity, the state of not having given birth. Some evidence suggests that uterine and ovarian cancer is more prevalent among women who have never used oral contraception (the pill). These risks may be particularly high for women with an exclusive same-sex partner history.

Cervical, uterine, and breast cancer rates have dropped significantly as a result of routine Pap smears and mammograms. But risks are greater for lesbian women who avoid preventive health care because they fear discrimination and insensitivity. Other factors that may put lesbian women at greater risk than the general population include a prevalence of smoking, alcohol consumption, and obesity, all of which are associated with cancer. Lesbian women who have or have had sex with men are at greater risk for human papillomavirus (HPV), an STD associated with cervical cancer. Cervical cancer accounts for 6% of all cancers in women in the United States and breast cancer is considered relatively common in the general population.

Although more research will help us better understand the correlation between these risks and cancer rates in lesbian and bi women, attention must also focus on educating and sensitizing health care providers to the needs of this population.

Risk Factors
Although the exact causes for many types of cancer are not known, several risk factors are identified as described below.

Breast, Uterine, and Endometrial Cancer
Factors that may put lesbian women at greater risk for breast, uterine, and endometrial (endometrium; lining of the uterus) cancer include the prevalence of:

• Alcoholism
• Childbirth after age 30
• Hormone replacement therapy (HRT)
• Nulliparity (not bearing children)
• Obesity

HRT, which is used by some lesbians, bisexual women, and transgendering female to males, may be associated with breast cancer. The risk for breast, uterine, and endometrial cancer is decreased by as much as 20% for lesbian women who never used or who discontinued use of oral contraceptive pills.

Obesity and alcoholism resulting from social pressures and subsequent identity conflicts are identified as health concerns for lesbian and bisexual women. Other factors, like a diet high in fat and tobacco use are associated with several cancers, including breast, uterine, and endometrial.

Ovarian Cancer
Evidence suggests that women who have never used oral contraceptive pills (OCPs) are at a 50% greater risk for ovarian cancer than women who use the pill. Many lesbian women take OCPs to regulate menses, treat acne, or to reduce symptoms related to PMS and endometriosis. Women who took the pill for at least 6 years before discontinuing its use may experience its cancer-fighting benefits. As studies continue to look at the possible protective effect of OCPs, it will be interesting to see if the rates for ovarian cancer differ greatly between lesbian and heterosexual women.

Cervical Cancer
The increased risk for cervical cancer among lesbians lies mostly in their risk for exposure to two particular strains of HPV. Certain other strains of HPV cause anogenital warts and can be transmitted through sex with men and women. A history of sex with men, multiple male partners, sexual intercourse at a young age, unprotected sex, and inadequate or delayed access to health care are associated with an increased risk of cervical cancer. Sensitive providers inquire into the sexual history and activity of a lesbian patient to determine appropriate treatment and preventive care.

Routine Pap smears are an effective means of detecting and limiting cervical cancer. Women who are sexually active or over 18 years of age are advised to have an annual Pap smear. Once a woman has three consecutive, normal Pap smears, she may need to have one only every 2 to 3 years, unless past results warrant annual screening.

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Overview
Risk Factors
Breast, Uterine & Endometrial Cancer
Ovarian Cancer
Cervical Cancer

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