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

This article is made available through the Brunel Open Access Publishing Fund. © 2013 Meads and Moore; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.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 Unpublished research and specific lesbian, gay and bisexual websites were checked, as were citation lists of relevant papers.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

The potential contribution of disruptive low-carbon innovations to 1.5 °C climate mitigation

This paper investigates the potential for consumer-facing innovations to contribute emission reductions for limiting warming to 1.5 °C. First, we show that global integrated assessment models which characterise transformation pathways consistent with 1.5 °C mitigation are limited in their ability to analyse the emergence of novelty in energy end-use. Second, we introduce concepts of disruptive innovation which can be usefully applied to the challenge of 1.5 °C mitigation. Disruptive low-carbon innovations offer novel value propositions to consumers and can transform markets for energy-related goods and services while reducing emissions. Third, we identify 99 potentially disruptive low-carbon innovations relating to mobility, food, buildings and cities, and energy supply and distribution. Examples at the fringes of current markets include car clubs, mobility-as-a-service, prefabricated high-efficiency retrofits, internet of things, and urban farming. Each of these offers an alternative to mainstream consumer practices. Fourth, we assess the potential emission reductions from subsets of these disruptive low-carbon innovations using two methods: a survey eliciting experts’ perceptions and a quantitative scaling-up of evidence from early-adopting niches to matched segments of the UK population. We conclude that disruptive low-carbon innovations which appeal to consumers can help efforts to limit warming to 1.5 °C