Relationships and communication

The basis for any good relationship is communication. Whether it’s your romantic partner, family, friends, co-workers, or acquaintances, communicating builds trust and connects you to others. This is especially true when you’re dealing with a diagnosis of breast cancer.

For some people, talking about breast cancer can feel scary, uncomfortable or embarrassing. These are all normal reactions. It’s OK to hold back and not tell everyone everything right away. But over time, you may want to let some people who care about you know:

• what you’re going through
• how you’re feeling
• how they can help

Learning how to make the most of your relationships may help you build trust with your support circle, and protect you when you want to avoid certain comments or conversations. Understanding your rights at work will help you if you want to tell your boss or co-workers, or if you need some time off or other accommodations.

View more resources and information in our family and relationships section.

Coming out to your care team as lesbian, gay, or bisexual

A breast cancer diagnosis comes with a lot of new information and concerns. The first days, weeks and months can be overwhelming. Trusting your healthcare team and communicating with them openly is often key to easing your worries and fears.

As a lesbian, gay or bisexual person with breast cancer, you may be considering if you feel safe and ready to share your sexual orientation with your breast cancer care team. You may be familiar with the phrase coming out, the process through which you share your sexual orientation with others. There are many reasons you may or may not decide to share this information with your providers.

Deciding if coming out to your care team is right for you

Some members of your care team may ask you about your sexual orientation. This lets you know you and your identified family are safe and welcome. Asking you about your sexual identity may make you feel at ease discussing how a breast cancer diagnosis and treatment affect your physical relationships, fertility and ability to have children in the future.

Other providers may not ask, or it may be up to you to bring it up.

You may feel coming out is important to working well with your care team, whether they ask you or not. Or you may feel nervous coming out, feel it may not be needed or see it as added burden.

There are many general health and cancer centers across the U.S. that are welcoming of LGBT people affected by cancer.

There are many factors that may help you decide whether to come out to them. Feeling safe, welcomed and confident that a breast cancer provider will be able to offer you the care and respect you need may be chief among them. The information below may help you decide what’s best for you.

Why you might come out to your care team

Below are some of the benefits of coming out:

• Your care team may be better able to help you address specific sexual and relationship concerns related to your diagnosis
• It may ease the stress of feeling like you must hide your true self
• The more a healthcare provider knows about you, the better he or she can help you stay healthiest during breast cancer treatment and beyond

Keep in mind that telling others about your sexual orientation will not limit everything they assume about you. You may have to help educate them about your specific concerns.

If you can’t come out, or choose not to come out

Coming out is your personal choice – if you decide not to come out for any reason, that’s OK. You may see it as an extra burden on top of the stress of a breast cancer diagnosis. Maybe you feel you can communicate well without your doctor knowing such personal details.

Sharing with your doctor may not be an option for you because:

• You aren’t ready to or simply don’t wish to come out
• You want to focus on your breast cancer and immediate medical needs
• You feel that your hospital isn’t LGB-friendly or lacks LGB-specific resources and training
• An LGB-friendly treatment center is too far away from where you live
  • This may be especially true for people in rural areas or in places with limited healthcare options. If you don’t have a lot of choice in who you can see for treating breast cancer, you may want to take extra time to consider whether you want to come out

Coming out and metastatic breast cancer

If you are diagnosed with metastatic breast cancer, you may feel added pressure to decide whether you’ll come out to your breast cancer care team. Unlike your counterparts with early-stage disease, this diagnosis means you will actively deal with breast cancer for the rest of your life.

Your treatment will focus on shrinking the cancer and stopping it from spreading further, as well as managing your symptoms and side effects. You and your care team may meet regularly to monitor your treatment.

As a result, you may see extra benefit in coming out. Or you may feel more anxious.

Coming out as transgender to your breast cancer care team

When seeking treatment for breast cancer, it is best to make your cancer care team aware of your gender identity and your transition. Discussing your use of hormone replacement therapies and the details of your transition allows your health care providers to offer you the most comprehensive and informed care choices.

Talking about your transition may help because:

• Some breast cancers can grow in the presence of estrogen. If your doctor is aware of the use of estrogen as part of your hormone replacement therapy regimen he or she can give you more information about how treatment may impact HRT.
• Talking about your gender identity may help your cancer care team to use the name and pronoun you prefer. For example, if you have not legally changed your name, the name on your medical record may not match the name you wish to be called. Communicating your preferences and your expectations to your health care providers is key in your cancer care.

Your doctor’s reaction

Respect is a vital part of the healing process and though you may take steps to be open and clear about your gender identity and transition, your doctor may not react in a sensitive way. If you feel uncomfortable with the reaction of any member of your cancer care team, speak up. If your concerns are not met to your satisfaction, switching providers may be a next step.

There are LGBT-friendly healthcare providers available in many places. It’s OK to ask tough questions before your first appointment to be assured that the doctor you see will be open and professional when it comes to your gender identity. If you think that a provider is unfair or disrespectful, move on to the next physician on your list.

Locating a trans-friendly healthcare provider

The Internet is a great way to identify and choose a doctor. Locate doctors that are not only experts in the treatment of breast cancer, but are also open to the needs of the LGBT community. One great resource is the Human Rights Campaign’s “Healthcare Equality Index”. In it and other guides like it, you will find a comprehensive list of doctors and healthcare facilities that are ranked in their sensitivity to the needs of patients who are lesbian, gay, bisexual or transgender.

Other helpful resources include:

• Coming out to your doctor (Human Rights Campaign)
• Center of Excellence for Transgender Health (University of California San Francisco)
• Do ask, do tell: Talking to your healthcare provider about being LGBTQ+ (National LGBTQIA+ Health Education Center)
• Primary care protocol for transgender patient care (University of California San Francisco)