ROCHESTER — Dr. Elizabeth Cathcart-Rake's passion for practicing LGBTQ-affirming health care is inspired by a childhood friend. "His experiences were just really eye-opening for me, and that he faced unbelievable discrimination and stigma when he came out and then, on top of that, he had some health care challenges and again experienced stigma," Cathcart-Rake said.
Her friend, who is transgender, also shared that he has a family history of breast cancer. As a medical oncologist who specializes in breast cancer, Cathcart-Rake wondered what that meant for him. "I started digging into the literature, and there is such a dearth of information there about cancer care and trans folks," she said.
To address these needs, Cathcart-Rake and a handful of her colleagues formed the Rainbows Breast Cancer Clinic, which is embedded within the Mayo Clinic Comprehensive Cancer Center in downtown Rochester. Patients officially began receiving care through the Rainbows clinic in June. "We offer patients the multidisciplinary, resource-filled team that our general breast oncology patients get as well," Cathcart-Rake said.
"It's just that their care is tailored to their gender identity, sexual orientation. It's really individualized." For patients, that individualized care can include fertility preservation, something that isn't discussed as often with queer cancer patients, Cathcart-Rake said.
There are also discussions about cancer treatment's side effects that impact one's sexual health. "For trans folks in particular, we talk about the interplay between gender-affirming hormone therapy or gender-affirming surgeries and breast cancer risk, and we do share decision-making with the patient to find the right treatment plan for them," Cathcart-Rake said. The members of the Rainbows team, which includes another oncologist, a nurse practitioner, a social worker and nurse Gina Schultz, have not only had cultural sensitivity training but are also interested in understanding and researching LGBTQ+ health care.
Schultz brings an even more personal touch to the Rainbows clinic — she makes colorful cloth tote bags for patients, Cathcart-Rake said. Inside each bag is a binder full of resources, from information about Mayo's Transgender and Intersex Specialty Care Clinic to local queer support groups. Beyond the core Rainbows team, Cathcart-Rake said the clinic has connections with other LGBTQ-affirming specialists who breast cancer patients might be referred to.
"There is someone specifically in the Breast Clinic who is interested and focused on providing quality care to trans folks," she said. "There's someone in breast surgery, there's someone in radiation oncology — so we have a multidisciplinary team, surrounding ourselves with folks who really can provide quality care for this group." The Rainbows clinic is open to people who have been diagnosed with breast cancer.
Cathcart-Rake said patients who opt-in to being seen in the Rainbows clinic don't necessarily have to self-identify as LGBTQ+ in their medical record, and on the flip side, LGBTQ+ patients who prefer to be seen in the general breast oncology clinic can still do so. "I think of this clinic as having three tenets," Cathcart-Rake said. "The first is this welcoming, affirming, supportive environment where people feel safe, but they also feel like their identity is respected and accepted and welcomed.
" The other two tenets, she said, are providing individual, quality care and doing community-engaged research. "Part of that is learning from the community exactly what they need and being able to help provide that and move forward research in this area," Cathcart-Rake said..
