Differences in Risk Factors for Breast Cancer: Lesbian and Heterosexual Women

Purpose/Objectives: To compare differences in risk for developing breast cancer between lesbian and heterosexual women. Design: Retrospective medical record review. Setting: Lyon-Martin Women's Health Services (LMWHS) in San Francisco, California. Sample: Women age 35 or older, seen at LMWHS in 1995, 1996, or 1997, who described themselves as either lesbian or heterosexual. The typical participant (n = 1019) was 42.9 years old (SD = 6.85, range 35–75), white (70%), and employed (49.9%). Most were without health insurance and 99% were poor (<$15,780 annual income). Of this sample, 57.6% (n = 586) described themselves as heterosexual and 42.4% (n = 433) as lesbian. Measurements: Medical Record Audit Form completed by two research assistants with an interrater reliability of more than 95%. Results: There were no significant differences between the lesbian and heterosexual women in family history of breast cancer, current or past alcohol use and history of blackouts or alcohol problems, age at menarche and menopause, use of hormone replacement therapy, ever having had a mammogram or age at most recent mammogram, nor the prevalence of breast cancer. The lesbians reported more breast biopsies and had a higher body mass index; the heterosexuals had higher rates of current smoking, pregnancy, children, miscarriages, abortions, and use of birth control pills. Conclusions: There were significant differences between lesbian and heterosexual women in some of the risk factors for the development of breast cancer. Future studies should sample women of different ages, economic groups, and geographic regions. In particular, the finding that lesbians report more breast biopsies should be further explored.     

Breast cancer risk and screening: a comparison of lesbian and heterosexual women

OBJECTIVES: Using data collected as part of the Multisite Women's Health Study, we examined the differences between lesbians and heterosexual women on objective breast cancer risk calculations using the Gail Model. Health risk behaviors and screening behaviors for breast cancer were also examined. It was hypothesized that lesbians would have higher objective cancer risk estimates and report more behavioral and screening risk factors for breast cancer than heterosexual women. METHODS: Secondary data analyses were conducted using data from a study of women's health conducted from 1994 to 1996. Using a cross sectional design, a convenience sample of lesbian (n = 550) and heterosexual (n = 279) women was recruited from Chicago, New York City and Minneapolis-St. Paul. Data were collected using a self-administered questionnaire. RESULTS: Estimates of 5-year and lifetime breast cancer risk were higher for lesbians compared to heterosexual women. Groups did not differ in self-perceptions of being overweight, but more lesbians reported heavier drinking and more reported abstinence from alcohol. Group differences in adherence to breast cancer screening were not significant. CONCLUSIONS: Findings suggest a small but statistically significant difference in the calculated breast cancer risk estimates of lesbian and heterosexual women, which seem to be largely accounted for by differences in reproductive risk factors.     

Comparing breast cancer risk between lesbians and their heterosexual sisters.

PURPOSE: The purpose of this study was to explore the similarities and differences between lesbians and their heterosexual sisters in the established risks for developing breast cancer. METHODS: The design for this study was a matched (lesbian with heterosexual sister) cross-sectional, mail-back, anonymous survey. We distributed the surveys throughout the state of California to English-speaking women who identified themselves as lesbians, age 40 and older, and their sisters. Using the modified Gail Breast Cancer Risk model as well as other well-established factors associated with the development of breast cancer, we compared the breast cancer risk potential for 324 sister pairs (N = 648). Data were analyzed using paired t-tests, analysis of covariance (ANCOVA), McNemar's chi(2), or the Bowker statistic, as appropriate for the level of data. MAIN FINDINGS: The lesbians had significantly higher 5-year (p <.0001) and lifetime (p =.001) risk for developing breast cancer. The reasons for lesbians' predicted rate of breast cancer were most likely their higher scores on all pregnancy-related variables and the relatively high number of breast biopsies they reported. The lesbians had used birth control pills less (p <. 0001), had significantly fewer pregnancies (p <.0001), children (p <.0001), abortions (p <.0001), and miscarriages (p <.0001) as well as significantly more breast biopsies (p =.02) than did their heterosexual sisters. CONCLUSIONS: A lesbian who comes out to her clinician is relying on the clinician to be informed and be open to discuss her life. When a lesbian has a lump or a suspicious mammogram, she needs her clinician to advocate for her within the health care system because she is at higher risk for having cancer than a heterosexual woman.     

Effects of Attractiveness and Status in Dating Desire in Homosexual and Heterosexual Men and Women

The present study examined partner preferences of homosexual and heterosexual men and woman, focusing on attractiveness and status. Homosexual (N = 591 men; M age = 28.87 years, SD = 10.21; N = 249 women; M age = 33.36 years, SD = 13.12) and heterosexual participants (N = 346 men; M age = 39.74 years, SD = 14.26; N = 400 women; M age = 35.93 years, SD = 13.72) rated the importance of attractiveness and social status of potential partners and then, in a vignette test, expressed their desire to date hypothetical potential partners based on photographs that varied in attractiveness and status-related profiles. With ratings, heterosexual men valued attractiveness the most, followed by homosexual men, heterosexual women, and homosexual women. Heterosexual women rated social status as most important. When status profiles were manipulated and accompanied with photographs of faces, the pattern of differences between homosexuals and heterosexuals supported the self-reported results. Overall, homosexual men and women have similar mate preferences to heterosexual men and women by showing more dating desire for attractive and high social status persons. Compared to attractiveness, status played a smaller role in dating desire.     

Correlates of Lesbian Sexual Orientation and the Risk of Breast Cancer

Objectives: This study describes an attempt to estimate the relative risk of breast cancer for lesbians from existing case–control data, using surrogate correlates of sexual orientation. Design: Three different theoretical correlates of sexual orientation were constructed from data available from a population-based case–control study. Setting: Participants were 747 invasive breast cancer cases and 961 control women aged 21–45 years in three counties in western Washington State. Measurements: The correlates used were: Measure 1, no male sexual partners ever; Measure 2, never married and not currently using contraception; Measure 3, not currently married and not using contraception. Results: The relative risk of breast cancer for lesbians as compared to women who were not lesbians for each of the three surrogate measures was estimated to be 1.74 [95% confidence interval (CI): 0.62–4.91], 1.62 (95% CI: 1.04–2.52), and 1.13 (95% CI: 0.84–1.51), respectively. The elevated risks in all cases were largely, but not entirely, explained by suspected differences between lesbians and nonlesbians in demographic, social, and reproductive factors. Conclusions: This hypothesis-generating study suggests that lesbians may be at an increased risk of breast cancer as compared to nonlesbians. In light of the documented barriers to health care access for lesbians, efforts to educate lesbians and provide culturally appropriate preventive care and screening services should be considered.     

Psychosocial responses to treatment for breast cancer among lesbian and heterosexual women

This study compared the experiences of 39 self-identified lesbians and 39 heterosexual women who had recently been treated for breast cancer. They were matched by age, stage of disease, time since diagnosis, and ethnicity. Data were collected by a questionnaire completed at home and returned by mail. Variables assessed included emotional adjustment, thought intrusion and avoidance, perceived quality of life, concerns about breast cancer, benefit finding, relationship and sexual disruption, psychosexual adjustment, social support, and coping. Compared to the heterosexual women, lesbians reported less thought avoidance, lower levels of sexual concern, less concern about their appearance, and less disruption in sexual activity, but also substantially lower perceptions of benefit from having had cancer. Lesbians reported less social connection to family, but no group difference emerged in connection to friends. Lesbians reported less denial coping, and more use of support from friends, more venting, and more positive reframing. Better understanding of the similarities and differences between groups will help address the relevant clinical issues appropriately, in order to optimize psychosocial adjustment to breast cancer. .     

Gender-Related Traits of Heterosexual and Homosexual Men and Women

Two studies investigated the relation between sexual orientation and gender-related traits. Analyzing data from an Internet survey, Study 1 found that gay men and lesbians differed from same-sex heterosexuals most strongly on gender diagnosticity (GD) measures, which assess male- versus female-typicality of occupational preferences (effect sizes were 1.14 for men and 0.53 for women) and least strongly on instrumentality (I) and expressiveness (E). Study 2 found that GD measures showed large differences between 289 gay and 200 heterosexual men (d = 0.95) and between 296 lesbian and 435 heterosexual women (d = 1.32), whereas I and E showed much smaller differences. In Study 2 homosexual–heterosexual diagnosticity measures, computed from men's and women's occupational preferences, correlated very strongly with GD measures (r = 0.88 for men and 0.89 for women), indicating that occupational preference items that distinguished men from women also tended to distinguish heterosexual from homosexual individuals. LISREL 8 analyses showed that self-ascribed masculinity–femininity did not mediate the strong relation between sexual orientation and GD for men or for women.     

Communicating about breast cancer: rural women's experience of interacting with their surgeon

Objective: This study examined rural women's satisfaction with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Differences in satisfaction were investigated between treatment groups (mastectomy and breast conservation surgery) and demographic variables (age, marital status, education level, employment status and place of residence). Practice was compared with clinical practice guidelines. Design: The study was designed as a cross‐sectional survey. Setting: The study was set in Eastern regional Victoria, Australia. Participants: Seventy women diagnosed with early breast cancer participated in the study. Main outcome measures: The main outcome measures used by the study were satisfaction in three areas of practice: (i) telling a woman she has breast cancer; (ii) providing information and involving the woman in the decision‐making; and (iii) preparing the woman for specific management. Results: No differences in satisfaction were found between treatment groups and demographic variables. Overall, women in this study were highly satisfied (>93%) with the interaction and communication with their surgeon. Women reported that the surgeon created a supportive environment for discussion, that they were provided with adequate information and referrals, and that they were actively involved in the decision‐making. Practice could have been improved for women who were alone at diagnosis as women without a partner made a quicker decision about treatment. Conclusion: Rural women in Victoria Australia were largely satisfied with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Current practice was predominately in line with clinical practice guidelines.     

Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women

BACKGROUND: Study aims were to examine cervical cancer risk factors, screening patterns, and predictors of screening adherence in demographically similar samples of lesbian (N=550) and heterosexual women (N=279). METHODS: Data are from a multisite survey study of women's health conducted from 1994 to 1996. RESULTS: Differences in sexual behavior risk factors for cervical cancer were observed with lesbians reporting earlier onset of sexual activity (P<0.05), more sexual partners (P<0.001), and lower use of safer sex activities (P<0.01). Lesbian and heterosexual women were equally likely to have ever had a Pap test; however, lesbians were less likely to report annual (P<0.001) or routine (P<0.001) testing. Multivariate analyses were used to determine the associations between demographics, health care factors, health behaviors, and worry about health and screening behaviors. Individual predictors of never screening included younger age, lower income, and lack of annual medical visits. Independent predictors of both recent and annual screenings included history of an abnormal Pap test, being heterosexual, and annual medical visits. CONCLUSION: Data indicate that lesbians are at risk for cervical cancer, yet underutilize recommended screening tests. Findings have implications for research, education, and cancer control among lesbians.     

Physical Development and Sexual Orientation in Men and Women: An Analysis of NATSAL-2000

In the present study, three physical development characteristics—weight, height, and age of menarche—were examined for their relation to sexual orientation. Participants were men and women comprising the National Survey of Sexual Attitudes and Lifestyles-2000 (N > 11,000). Participants completed self-report measures of sexual orientation, height, weight, and, for women, age of menarche. Results indicated that gay/bisexual men were significantly shorter and lighter than heterosexual men. There were no significant differences between lesbians and heterosexual women in height, weight, and age of puberty. The results add to literature suggesting that, relative to heterosexual men, gay/bisexual men may have different patterns of growth and development because of early biological influences (e.g., exposure to atypical levels of androgens prenatally). However, the present results do not support a number of studies suggesting that lesbian/bisexual women are taller and heavier than heterosexual women.     

The effect of physical activity on breast cancer risk: A cohort study of 30,548 women

Background: In epidemiological studies abundant physical activity has been related to decreased breast cancer risk, though the results have been inconsistent. The purpose of this paper was to study the association of physical activity at leisure and commuting to work and incidence of breast cancer. Methods: The study cohort consisted of 30,548 female participants of the Finnish adult health behaviour survey, based on annual random samples of Finns aged 15–64, collected in 1978–1993. By the end of 1995, 332 breast cancer cases had been diagnosed in the cohort. Relative risks of breast cancer were adjusted for age at survey, body mass index (BMI), education, length of follow-up, parity and age at first birth using Poisson regression models. Results: Compared to women exercising less than once a week, the adjusted relative risk of breast cancer for women exercising once a week was 0.80 (95% confidence interval (CI): 0.58–1.10), for women exercising 2–3 times per week 0.92 (95% CI: 0.78–1.22) and for women exercising daily 1.01 (95% CI: 0.72–1.42). Women who reported commuting, walking or bicycling to work 30 min or more daily had slightly lower adjusted risk of breast cancer (RR: 0.87, 95% CI: 0.62–1.24) than women working at home, being unemployed or driving a car to working place. Conclusion: Although a small protective effect of regular physical activity for breast cancer incidence was found in physical activity when commuting to work, the role of the physical activity in breast cancer prevention is still an open question.     

Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women

OBJECTIVES: This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care. METHODS: Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women. RESULTS: In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates. CONCLUSIONS: Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.     

Health-related quality of life in breast cancer survivors of different sexual orientations

Purpose  

Sexual minority women, e.g., lesbians and bisexuals, are an underserved population but not much is known about their quality of life (QOL) after a breast cancer diagnosis. For this reason, this study examines the physical and mental QOL and its association with sexual orientation in a cohort of long-term nonrecurring breast cancer survivors.     

Understanding lesbians' healthcare behaviour: the case of breast self-examination

Lesbians' risk of breast cancer is a much-debated issue in health research because lesbians are believed to be at higher risk of the disease than are heterosexual women. This belief is based upon particular risk factors for breast cancer, which are said to be more prevalent in lesbians; and upon differences in preventive health behaviours: in particular, lesbians are said to be less likely to practise breast self-examination (BSE). This paper presents data collected as part of the UK Lesbians and Healthcare Survey (n = 1066) focusing on lesbians who report never practising BSE (n = 218, 20%) and the explanations they offer for their healthcare behaviours. It identifies six types of explanation for not practising BSE: (i) "I don't know what I'm looking for"; (ii) "I've never got into the habit"; (iii) "I'm frightened in case I find something"; (iv) "I don't think I'm at much risk"; (v) "I'm uncomfortable with my body"; and (vi) "My partner does it for me". These findings are important for increasing understanding of lesbians' healthcare behaviour and for developing health promotion materials relevant to their needs.     

Validation of a Dutch Version of the Reproductive Concerns Scale (RCS) in Three Populations of Women

We investigated the psychometric properties of a Dutch version of the Reproductive Concerns Scale (RCS). Questionnaires (N = 515) were administered to 90 women with breast cancer, 227 women with fertility problems, and 198 healthy controls. Principal axis factor analysis suggested a one-factor structure with 11 items (breast cancer patients R² =.48, α =.87, ICC =.95; women with fertility problems R² =.45, α =.89, ICC =.86). Women with fertility problems reported the most concerns (M = 21.8, SD = 9.6), followed by breast cancer patients (M = 14.8, SD = 10.0) and healthy controls (M = 6.4, SD = 7.0). Theoretically related constructs were correlated to the RCS (.33 < r >.73). The RCS seems to be a valid tool for assessing women's reproductive concerns.     

Women’s Sexual Responses to Heterosexual and Lesbian Erotica: The Role of Stimulus Intensity,Affective Reaction,and Sexual History

Past research has demonstrated that women do not show a “category-specific” genital response to erotic stimuli. That is, on average, heterosexual and lesbian women are indistinguishable in terms of their physiological genital responses to heterosexual versus lesbian erotica. In two studies with heterosexual women (n = 28 for Study 1; n = 30 for Study 2) and lesbians (n = 24 for Study 1; n = 25 for Study 2), results confirmed that, on average, women did not show category-specific genital responses or category-specific subjective sexual arousal. However, there was evidence of notable within-group variability; many women did respond to the stimuli in a category-specific manner. Heterosexual women were more likely than lesbian women to demonstrate category-specificity. Findings also revealed that category-specificity was associated with multiple factors, including affective responses to the erotic stimuli and sexual history. Results of this study highlight the complexity of women’s sexual identities and sexual responses.     

What determines the health‐related quality of life among regional and rural breast cancer survivors?

Objective: To assess the health‐related quality of life (HRQoL) of regional and rural breast cancer survivors at 12 months post‐diagnosis and to identify correlates of HRQoL. Methods: In 2006/07, 323 (202 regional and 121 rural) Queensland women diagnosed with unilateral breast cancer participated in a population‐based, cross‐sectional study. HRQoL was measured using the Functional Assessment of Cancer Therapy, Breast plus arm morbidity (FACT‐B+4) self‐administered questionnaire. Results: In age‐adjusted analyses, mean HRQoL scores of regional breast cancer survivors were comparable to their rural counterparts 12 months post‐diagnosis (122.9, 95% CI: 119.8, 126.0 vs. 123.7, 95% CI: 119.7, 127.8; p>0.05). Irrespective of residence, younger (<50 years) women reported lower HRQoL than older (50+ years) women (113.5, 95% CI: 109.3, 117.8 vs. 128.2, 95%CI: 125.1, 131.2; p<0.05). Those women who received chemotherapy, reported two complications post‐surgery, had poorer upper‐body function than most, reported more stress, reduced coping, who were socially isolated, had no confidante for social‐emotional support, had unmet health care needs, and low health self‐efficacy reported lower HRQoL scores. Conclusions and Implications: The results underscore the importance of supporting and promoting regional and rural breast cancer programs that are designed to improve physical functioning, reduce stress and provide psychosocial support following diagnosis. Further, the information can be used by general practitioners and other allied health professionals for identifying women at risk of poorer HRQoL.     

Effects of Sex and Sexual Orientation on Self-Reported Attraction and Viewing Times to Images of Men and Women: Testing for Category Specificity

In a paradigm that asked participants to rate the sexual attractiveness of male and female swimsuit models, Lippa, Patterson, and Marelich (2010) showed that heterosexual men’s category specificity exceeded heterosexual women’s in two ways: (1) Heterosexual men showed much larger differences in their attraction and viewing times to male versus female photo models than heterosexual women, and (2) heterosexual men’s attractions to female but not male models increased with model attractiveness whereas heterosexual women’s attractions to both sexes increased with model attractiveness. The current study used the same paradigm to study category specificity in homosexual and heterosexual participants. In addition to replicating previous findings for heterosexual men and women, the results showed that homosexual men were high on category specificity, like heterosexual men, whereas lesbians showed lower levels of category specificity than men, but sometimes higher levels than heterosexual women.     

Original Research: Physician–Patient Relationships Among the Lesbian and Gay Community

Objective: To document the concerns, perceptions, and experiences gays and lesbians bring to the physician–patient relationship, including their perspectives related to disclosure of sexual orientation. Design: Completion of a 64-item survey instrument. Setting: Participants were recruited through community-based health care and social service organizations serving the lesbian and gay community. Subjects: 575 lesbians and gay men, primarily from the New York metropolitan area. Measurements: Responses to questionnaire consisting of 64 scaled, multiple choice, and open-ended questions. Results: Most (87%) reported that their primary health care provider gives them the same quality of care as heterosexual patients, treats them with respect equal to heterosexual patients (87%), and is sensitive to gay and lesbian concerns (71%). Although 70% disclosed their sexual orientation to their provider, only 29% were asked their sexual orientation by their provider. Among reasons for nondisclosure, 47% were concerned about bad reaction or treatment. A sizable minority (17%) avoided or delayed seeking health care because of reasons having to do with their sexual orientation. Conclusions: The data demonstrate significant problem areas in physician-initiated communication about sexual orientation; in concerns about antigay discrimination in health care, insurance, and employment; and in avoidance of health services. It is hypothesized that these results represent a baseline for the most favorable health care environments for gays and lesbians. This study also highlights the importance of training medical students and clinicians to communicate better with patients, conduct in-depth sexual and family histories, and consider issues related to sexual orientation and homophobia, including identifying and confronting personal and institutional bias.