Why Inclusive, Informed & Culturally Competent Healthcare Matters More Than Ever
Early detection and prevention are critical when it comes to breast cancer. However, not everyone is starting from the same baseline.
A landmark NIH study cited by the CDC tracked more than 87,000 premenopausal women across more than a million person-years. The study found that both lesbian and bisexual women had a slightly elevated predicted breast cancer incidence compared to their heterosexual counterparts — with rates of 131.61 and 131.72 per 100,000 person-years respectively, compared to 122.55 for heterosexual women.
Researchers concluded that this increased risk persists throughout the entire premenopausal phase of life, raising major implications for care accessibility and awareness in this population.
How To Make Sense Of This Disparity
There are many potential reasons behind this trend; none of which are inherent to identity, but instead tied to social and lifestyle factors. For instance, factors that increase the risk of breast cancer like lower rates of childbirth, later childbirth or less frequent breastfeeding are more common among lesbian and bisexual women. Additionally, behaviors that might be reduced during parenthood (like alcohol use, smoking or high stress levels) may remain more prevalent.
Why Some Patients Are Misdiagnosed or Underserved
Many healthcare settings still lack training in LGBTQ+ health, leading to incorrect assumptions, overlooked symptoms or generalized treatment plans that don’t reflect the needs of each individual. For example, a transgender patient may not be screened for conditions that align with their biology, or a gay woman may not feel comfortable disclosing her sexual activity, leading to missed preventative care opportunities.
Even the most compassionate, well-trained provider may never get the chance to make a difference if a patient has faced discrimination from authority figures in the past. Those lived experiences shape how safe someone feels, and whether they even show up for care in the first place.
“When people don’t feel safe being honest with their provider, important health issues can go unspoken and untreated. That’s why culturally competent, affirming healthcare isn’t just a value. It isn’t a luxury. It’s a necessity.”
–Bess Hagans | Thriving Beyond Breast Cancer
Why This Is Important: When Patients Feel Respected, Great Things Happen!
When patients feel seen and respected by their providers, they’re more likely to be honest, ask questions and return for follow-up care — all of which are essential to great outcomes. Studies show that feeling understood improves trust, lowers stress and increases adherence to medical advice — especially during complex journeys like cancer care. Respectful communication also leads to more accurate lifestyle and health disclosures, which can be life-saving.
In short: when patients feel safe, they show up more fully and care becomes truly collaborative.
How To Support Your Mental Health
What Does Culturally Competent Care Look Like?
Culturally competent care goes beyond checking a box. It’s about creating an experience that feels safe, affirming and personalized at every step. This can include:
- Using inclusive language naturally and without overcorrection
- Avoiding assumptions about sexual orientation, gender identity or relationship status
- Understanding the unique health risks and disparities LGBTQ+ people face
- Updating intake forms and EMR systems to include gender identity and sexual orientation
- Creating welcoming physical spaces — from waiting room signage to restroom access
- Offering easy-to-find digital resources that directly speak to the needs of underrepresented communities
- Asking about pronouns and chosen names, and using them consistently
- Encouraging ongoing provider education around bias, trauma and affirming care
- Practicing active listening, empathy and genuine respect in every interaction
- Hosting public-facing events that allow teams to learn more about the emerging challenges facing their patient base
Questions Providers Can Ask To Create Safe, Affirming Spaces
Small shifts in language can lead to major shifts in trust. Providers can start with:
- “Are there any aspects of your identity or background you want me to be aware of during your care?”
- “Can you tell me about your sexual health history and any practices you’d like to discuss?”
- “How supported do you feel by your community or family?”
- “How supported do you feel by our practice? How could I work to improve that trust?”
These questions signal openness and help patients feel safe enough to share the full picture.
Creating Your Own Therapeutic Alliance
Building a network of trusted support can make all the difference. A “therapeutic alliance” refers to a core group of people who are invested in your healing: family, friends, mental health providers, medical specialists and others who truly get it.
These are the people that get you.
“This alliance becomes your rock. This is your core support team that sees the full picture of your health. Your identity. Your goals. They do what they know best to help you move forward with clarity.”
–Bess Hagans | Thriving Beyond Breast Cancer
Thriving Beyond Breast Cancer Wants To Be A Part Of Your Therapeutic Alliance
Our nonprofit offers financial stipends, emotional support and real-world guidance rooted in our own lived experiences. Whether you need help navigating this unexpected financial chaos or simply need someone who understands what you’re going through, we’re here to walk beside you.
Additional Ways Patients Can Advocate For Themselves
While the responsibility should never fall solely on the patient, it can be helpful to:
- Bring a support person to appointments when possible
- Write down key health concerns or identity-related details ahead of time
- Ask your provider: “Have you worked with LGBTQ+ patients before?”
- Know that you have the right to switch providers if you’re not being treated with dignity
- Understand that a learning curve still exists and that some providers may need overt cues (such as a rainbow pin, sharing a light-hearted story involving your same-sex partner, etc.) to grasp the importance
What We All Gain From Inclusive Healthcare
When care is inclusive, everyone benefits. Patients are more likely to seek preventive services, disclose symptoms sooner and stick to their care plans. Providers gain deeper trust, stronger relationships and better outcomes for all.
Culturally competent care isn’t just good practice — it’s life-saving!
About The Author
Bess Hagans is the Chief Executive Officer of Thriving Beyond Breast Cancer, a nonprofit dedicated to meeting the needs of young women facing a breast cancer diagnosis. As a patient herself, Bess knows firsthand how overwhelming it can be to navigate treatment and daily life — especially at a young age. She now channels that lived experience into meaningful advocacy, working to uplift and support patients, while championing the unique challenges faced by members of the LGBTQ+ community.
