Trying to reduce stigma, Mayo launches LGBTQ-focused breast cancer clinic

ROCHESTER – People who identify as LGBTQ can face major disparities and stigma when it comes to cancer care, often resulting in later-stage diagnoses and poorer outcomes than other patients.

Dr. Elizabeth Cathcart-Rake, an oncologist at Mayo Clinic in Rochester, is determined to change that.

This summer, Cathcart-Rake and a team at Mayo launched Rainbows, a cancer clinic tailored to meeting the needs of lesbian, gay, bisexual, transgender, queer, gender-diverse and intersex patients. Rainbows will initially focus on supporting patients with breast cancer, with the goal of eventually expanding to include other types of tumors already treated at Mayo.

“This is embedded within our oncology clinic, which is a real plus because that means folks have the same access to multidisciplinary teams that they would in our general clinic,” Cathcart-Rake said.

Cathcart-Rake said the idea for starting Rainbows is not only the right thing to do — it’s personal. Her close friend, a transgender man, endured “unbelievable discrimination and stigma” in the health care setting, she said. The experience prompted her to consider how she could improve results for her friend, who has a family history of breast cancer.

“Our job is to serve the patient in front of us and to really help people, and it just felt like this is not right,” Cathcart-Rake said. “There really should be a safe space for folks seeking care regardless of their background, regardless of their sexual orientation or gender identity.”

In addition to stigma, Cathcart-Rake pointed to other areas of concern. LGBTQ patients, for instance, are less likely to be offered fertility preservation before cancer treatment, she said. There is also evidence suggesting that LGBTQ people are less likely to seek early care, leading to cancers being diagnosed at more advanced stages.

In one recent study by the American Cancer Society, researchers found that only 70% of medical students would feel comfortable caring for transgender patients. The same study showed that discrimination in health care has led to 18% of LGBTQ adults avoiding necessary care.

“If you don’t feel comfortable seeking medical care, then you are likely going to delay care,” said Tyler Kratzer, a researcher with the American Cancer Society and lead author on the study.

As Rainbows works to create a welcoming environment for LGBTQ patients, it will also double as a research clinic. Even with more attention being drawn to the issues of disparities, additional research is needed to understand how providers can better serve the LGBTQ community, said Cathcart-Rake.

“There’s such an absence of data out there to help guide decision-making that it’s a real opportunity for us to better understand disparities,” Cathcart-Rake said.

Rainbows will operate on a referral basis, meaning patients can “opt in” to seek care through the clinic, Cathcart-Rake said. The team also includes another oncologist, a nurse practitioner, a social worker and a registered nurse.

The opening of Rainbows comes as the number of adults in the U.S. who identify as LGBTQ has doubled over the past decade. About 7.6% of American adults now identify as part of the LGBTQ community, according to Gallup.

“There’s an increasing number of folks who feel comfortable coming out … particularly among young people,” Cathcart-Rake said. “And so, to me, that really increases the importance of creating this clinic.”