Breast cancer in lesbians and bisexual women: systematic review of incidence, prevalence and risk studies

Catherine Meads · David Moore

107 citations0/0 files storedBMC Public Health

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LGBTQ Health, Identity, and Policy Global Cancer Incidence and Screening Cancer Risks and Factors

Abstract

BACKGROUND: The UK Parliamentary Enquiry and USA Institute of Medicine state that lesbians may be at a higher risk of breast cancer but there is insufficient information. Lesbians and bisexual (LB) women have behavioural risk-factors at higher rates compared to heterosexuals such as increased alcohol intake and higher stress levels. Conversely, breast cancer rates are higher in more affluent women yet income levels in LB women are relatively low. This systematic review investigated all evidence on whether there is, or likely to be, higher rates of breast cancer in LB women. METHODS: Cochrane library (CDSR, CENTRAL, HTA, DARE, NHSEED), MEDLINE, EMBASE, PsychINFO, CAB abstracts, Web of Science (SCI, SSCI), SIGLE and Social Care Online databases were searched to October 2013. Unpublished research and specific lesbian, gay and bisexual websites were checked, as were citation lists of relevant papers. Included were studies in LB populations reporting breast cancer incidence or prevalence rates, risk model results or risk-factor estimates. Inclusions, data-extraction and quality assessment were by two reviewers with disagreements resolved by discussion. RESULTS: Searches found 198 references. No incidence rates were found. Nine studies gave prevalence estimates - two showed higher, four showed no differences, one showed mixed results depending on definitions, one had no comparison group and one gave no sample size. All studies were small with poor methodological and/or reporting quality. One incidence modelling study suggested a higher rate.Four risk modelling studies were found, one Rosner-Colditz and three Gail models. Three suggested higher and one lower rate in LB compared to heterosexual women. Six risk-factor estimates suggested higher risk and one no difference between LB and heterosexual women. CONCLUSIONS: The only realistic way to establish rates in LB women would be to collect sexual orientation within routine statistics, including cancer registry data, or from large cohort studies.

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References

2012The Health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding 2001Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women 2000Sexual Orientation and Health: Comparisons in the Women's Health Initiative Sample 2004Sexual Orientation, Health Risk Factors, and Physical Functioning in the Nurses' Health Study II 2004Comparing breast cancer risk between lesbians and their heterosexual sisters

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2016Disparities in Physical Health Conditions Among Lesbian and Bisexual Women: A Systematic Review of Population-Based Studies 2016Identifying Lesbian, Gay, Bisexual, and Transgender Search Terminology: A Systematic Review of Health Systematic Reviews 2021The Politics of LGBT+ Health Inequality: Conclusions from a UK Scoping Review 2023Breast Cancer Diagnosis, Treatment, and Outcomes of Patients From Sex and Gender Minority Groups 2018Intersectionality and the LGBT Cancer Patient 2019A Systematic Review of Sexual Minority Women’s Experiences of Health Care in the UK 2022Communication about sexual orientation and gender between clinicians, LGBT+ people facing serious illness and their significant others: a qualitative interview study of experiences, preferences and recommendations

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