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

Abstract

A B S T R A C TObjectives. 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. Whether or not lesbians are at higher risk than other women for breast and gynecologic cancer is an emerging controversy.1-8 A recent Institute of Medicine report 9 documented the potential for double to triple the risk of breast cancer, in particular, among lesbians in comparison with other women. Possible reasons are greater prevalence rates of known reproductive-related risk factors, including nulliparity or older age at first childbirth, 10-12 and behavioral risk factors, including more frequent alcohol consumption [13][14][15][16] and perhaps obesity.11,17 Although none of these individual risk factors is exclusive to lesbians, the possible concentration of these risks within a single group is unique.Coupled with worries about patterns of higher risk are concerns that lesbians may be less likely than heterosexual women to use preventive cancer-related screening services such as mammography or Papanicolaou (Pap) tests. 1,11,18,19 Lower rates of screening, if they exist, might result in later detection of cancers, thereby increasing morbidity and mortality rates. 20 Several factors have been hypothesized as barriers to the use of routine screening in this population, including experiences with discrimination in health care settings, lower rates of insurance in the absence of the safety net of spousal health benefits, and fewer cues, such as contraceptive needs, to trigger seeking of routine gynecologic care. 1,9,19,[21][22][23] Nevertheless, little is known empirically about behavioral risks in this population.9 Most existing surveys of lesbian health and health care behaviors have relied on relatively small convenience samples drawn from local community settings without heterosexual controls. Methodological barriers to population-based sampling are daunting, given that lesbians represent both a hidden and a small subpopulation, est...

Investigating the Needs and Concerns of Lesbian, Gay, Bisexual, and Transgender Older Adults: The Use of Qualitative and Quantitative Methodology

“…There continues to be health disparities among LGBT persons, and LGBT elders specifically. Although a major goal that was highlighted in the Department of Health and Human Services’ Healthy People 2010 was the elimination of health disparities of LGBT individuals, research has suggested that LGBT persons are disproportionately at risk for violent hate crimes, sexually transmitted infections including HIV/AIDS, a variety of mental health conditions (Cochran, 2001; Cochran & Mays, 2000, 2009; Fergusson, Horwood, & Beautrais, 1999; Herek, 2009; Institute of Medicine, 2011; Koh & Ross, 2006), body weight problems (Carlat, Camargo, & Herzog, 1997; Carpenter, 2003; Deputy & Boehmer, 2010), substance use and abuse (Cochran & Mays, 2006; Skinner & Otis, 1996; Stall & Wiley, 1988), smoking (DuRant, Krowchuk, & Sinal, 1998; Stall et al, 1999; Tang et al, 2004), and certain cancers (Cochran et al, 2001; Daling et al, 1987; Dibble, Vanoni, & Miaskowski, 1997; Koblin et al, 1996; Zaritsky & Dibble, 2010). These same health risks were reported by members of the focus groups.…”

Lesbian and bisexual women's gynaecological conditions: a systematic review and exploratory meta‐analysis

“…Increased BMI is a risk factor for conditions such as ovarian cancer and PCOS 16, 17. Accordingly, journal articles and public health sources have suggested the combination of increased risk factors may lead to LB women having increased rates of gynaecological conditions 18, 19, 20. Nevertheless, a paucity of research actually measures gynaecological disorder incidence and prevalence in this population.…”

Sexual Orientation Identity Disparities in Awareness and Initiation of the Human Papillomavirus Vaccine Among U.S. Women and Girls

“…Because U.S. cancer registries do not collect data on sexual orientation, researchers are unable to definitively assess cervical cancer incidence by sexual orientation identity. Nonetheless, multiple studies have consistently shown that regular Pap test use, which is critical for cervical cancer prevention (20), is lower among lesbians relative to their heterosexual counterparts (21–27). Additionally, lesbians may be at higher risk of cervical cancer compared to heterosexual women because of a higher prevalence of smoking (28), a risk factor for cervical cancer morbidity (29), and obesity (30), which has been linked to cervical cancer mortality (31), and a lower prevalence of health insurance (21, 32–35) and access to health care (34, 36).…”