Breast Cancer Presentation and Treatment Patterns in Sexual and Gender Minorities

The aim of this study was to examine differences in breast cancer presentation, management, and outcomes between sexual and gender minority (SGM) patients and cisgender heterosexual women (CHW).

A prospective institutional database was reviewed to identify patients who had surgical management for clinical stage 0-III breast cancer from 2016 to 2023. SGM patients were identified as those who had self-documented in the medical record as lesbian, gay, bisexual, transgender, nonbinary, queer, intersex, asexual, nonbinary, or pansexual. Descriptive statistics were used to compare characteristics of SGM patients and CHW.

Among 5346 patients, 5204 (97.3%) identified as CHW and 142 (2.7%) identified as SGM. There were no differences in presenting symptoms, stage, grade, or subtype between groups. SGM patients were more likely to be diagnosed under the age of 50 (38.7% SGM vs. 30.0% CHW, p=0.03) and to undergo mastectomy (42.6% SGM vs. 34.3% CHW, p=0.04). Among those undergoing mastectomy, SGM patients were less likely to have reconstruction (53.3% vs. 73.2%, p<0.01). Rates of adjuvant radiation and systemic therapy were similar. At a median follow-up of 30 months, there were no differences in the rate of invasive disease recurrence (0.8% SGM vs. 1.3% CHW, p=0.66).

SGM and CHW patients with breast cancer treated in a tertiary cancer center had similar breast cancer presentation, treatment, and outcomes. SGM patients were less likely to undergo breast conservation and reconstruction after mastectomy, suggesting that SGM identity may play a role in preference for type of local therapy.