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to Section One | to Arts & Entertainment
posted Friday, July 1, 2016 - Volume 44 Issue 27
LGBTQ Health - Part II
Section One
ALL STORIES
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LGBTQ Health - Part II

by Dr. Kevin Wang, MD, Faculty
Swedish First Hill
Family Medicine
Residency Program
Special to the SGN

Before I begin this month's article, I just want to take a moment to mourn the horrific event that happened in Orlando, FL at Pulse Nightclub on June 12, 2016. I know that what happened there is certainly beyond the scope of a medical article but I simply want to share my grief with our LGBTQA community. Thank you for giving me this opportunity to be a part of Seattle Gay News and the Seattle LGBTQ families.

This month is the second part of our focus on healthcare maintenance for our LGBTQ population. Last month, we wrote about health care for our Gay, Bisexual and Trans-male populations. If you missed it, check it out online at http://www.sgn.org/sgnnews44_23/page10.cfm. In this article, we'll focus on Lesbian, Bisexual and Trans-female healthcare maintenance.

Like I mentioned last month, whether you are cisgender or Transgender, Lesbian/Bisexual or straight, the vast majority of healthcare maintenance is almost all the same. Swedish offers these screening options for our patients based upon recommendations from multiple organizations including the United States Preventive Services Taskforce (USPSTF). It's primarily based on age, sex, tobacco use and sexual activity. Here are some general recommendations listed below:

Age 21 to 29:
o Cervical Cancer Screening for those with a cervix

o Folic Acid Supplementation for those who plan on getting pregnant

o Blood Pressure Screening

o HIV Screening (we'll get more into that below)

o STD Screening (ditto)

o Counseling to Quit Smoking

o Screening for Alcohol and Substance Use/Abuse

o Depression Screening

o Counseling on Diet & Exercise

o Hepatitis Screening

o Domestic Violence Screening

Age 30 to 39 - same as the above with the addition of:
o Cervical Cancer Screening with the addition of HPV Testing

Age 40 to 49:
o Diabetes Screening Based on Body Mass Index and other risk factors

o Breast Cancer Screening (more information below)

o Cholesterol Screening starting at age 45 (earlier if risk factors)

Age 50 to 64:
o Colon Cancer Screening - Recommend to start at age 50 with either an annual stool test or a colonoscopy every 10 years (more frequently depending on what they see)

o Daily Aspirin

Age > 65:
o Fall Prevention with Exercise and Vitamin D Supplementation

o Osteoporosis Screening

There are always exceptions to these recommendations and other organizations may offer alternatives but, for us family doctors, we usually follow the above guidelines. There may also be reasons why these recommendations may not apply to certain folks and you will need to have a discussion with your primary care provider to make that determination.



Healthy People 2020, a document created by the Office of Disease Prevention and Health Promotion, highlighted areas regarding the healthcare disparities impacting Lesbian, Bisexual and Trans-women. One of the biggest highlights in this document is the need to have more research done to help provide better care for the LGBTQ population. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health/objectives But here is what we do know.

In general, Lesbians typically have fewer preventive health screenings when compared with heterosexual women. It's difficult to say why although it's most likely due to insensitive encounters with healthcare providers or a lack of health insurance (although this has gotten better with the Affordable Care Act, a.k.a. Obamacare). Therefore, screening rates for cervical cancer, breast cancer and colon cancer are lower when compared to rates in the heterosexual population. Let's break these down one by one.

In regards to cervical cancer, limited studies suggest that health providers along with Lesbians believe that Lesbians are at lower risk for acquiring human papilloma virus (HPV). In fact, some studies suggest that among those Lesbians who are diagnosed with cervical cancer, up to 50% of these people never had cervical cancer screening and up to 10% have not been screened in the previous 5 years. The Women's Health Initiative Study found that the rates of cervical cancer were higher for Bisexual women (2.1%) and Lesbians (2.2%) when compared with heterosexual women (1.3%). Based upon current recommendations, women should be screened at least every 3 years with the option to extend to 5 years once patients reach the age of 30 and have tested negative for HPV. Please see your healthcare provider about getting a Pap smear to get screened for cervical cancer.

Next up is breast cancer. Based upon information found during the Women's Health Initiative Study, Bisexual women and Lesbians had higher rates of breast cancer when compared with heterosexual women. Part of this may be due to the fact that Lesbian and Bisexual women may obtain mammograms less often than heterosexual women reducing the chance of detection at an earlier age. Other factors that may result in higher risks for breast cancer include weight, having a full term delivery after the age of 30, alcohol use and tobacco use. There is some debate on when to start breast cancer screening and how frequently to perform mammograms. Please see your healthcare provider to discuss your personal risk factors, including family history, along with when you start breast cancer screening.

Lesbian women generally have a higher body mass index as found in multiple limited studies. Surveys have found that a higher body mass index may be more acceptable to Lesbians since they may not share the same mainstream physical goals, as compared with heterosexual women. This is an important discussion to have with your provider since obesity is a growing epidemic that results in increased risks of diabetes, high blood pressure, heart disease, strokes and many other chronic conditions.

Tobacco and alcohol use are more prevalent in the LBT population. If you're looking for statistics, 28.7% of Lesbians and 26.9% of Bisexual women smoke as compared with the 12.2% in the general population. In regards to alcohol, rates of heavy drinking defined as 60 drinks or more per month are 4.5% for Lesbians when compared with the 2.3% for heterosexual women. I won't go into a whole discussion on why smoking and excessive alcohol use is bad for you so we'll save it for a future article. If you're looking to cut down or quit, look to your primary care provider for help and support!

In regards to STDs, the risk of infection varies widely depending on number of partners and specific sexual practices. We do know that STDs can be transmitted between women through vaginal secretions on hands or objects, genital-to-genital contact or sharing objects without condoms. HIV screening should still be offered to Lesbian women as woman-to-woman transmission has been documented. Although bacterial vaginosis (BV) is technically not an STD, it may be transmitted between partners. We don't know if partners should be treated but should be encouraged to look out for symptoms.



There are also some pretty specific screening recommendations for the Trans-female population, too.

Breast cancer screening is still recommended although there are no official studies evaluating routine screening. It seems that breast cancer risk may increase with a longer length of hormone exposure. Mammograms should be performed in Trans-females over the age of 50 with additional risk factors including the use of hormones for more than 5 years, a family history, a body mass index greater than 35. Of note, there may be a higher rate of false positive results, resulting in further testing, but current recommendations state we should follow the same guidelines as those for cis females.

Prostate cancer screening should be the same as cis males. Hormone therapy may decrease the risk of prostate cancer but the percentage is unknown. However, prostate cancer screening in itself is a controversial topic and is something that you should discuss with your healthcare provider to come up with your own individualized plan.



So that is Lesbian, Bisexual and Trans-female healthcare maintenance in a nutshell. There are other things to consider, as well, including dental and vision health along with community resources for those who don't have adequate support. I always wish I could write more about these sorts of support services that we call social determinants of health. And, as I mentioned in last month's article, this doesn't address the issue of provider discomfort but know that we're working to educate our healthcare providers on how to provide culturally competent and excellent LGBTQ care! We, at Swedish, are continuing to work hard to provide the Western Washington LGBTQ community with the best care possible. Please visit our website to find a primary care provider near you at www.swedish.org/primarecare or by calling 1-800-SWEDISH.

Thank you for reading - I'll see you at the end of the year for a wrap up article. Please don't hesitate to contact Seattle Gay News at sgn2@sgn.org if you have any questions for me, or any suggestions for future articles!

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