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 Unpublished research and specific lesbian, gay and bisexual websites were checked, as were citation lists of relevant papers.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

Differential response effects of data collection mode in a cancer screening study of unmarried women ages 40–75 years: A randomized trial

<p>Abstract</p> <p>Background</p> <p>Little is known about the impact of data collection method on self-reported cancer screening behaviours, particularly among hard-to-reach populations. The purpose of this study is to examine the effects of data collection mode on response to indicators of cancer screenings by unmarried middle-aged and older women.</p> <p>Methods</p> <p>Three survey methods were evaluated for collecting data about mammography and Papanicolaou (hereafter, Pap) testing among heterosexual and sexual minority (e.g., lesbian and bisexual) women. Women ages 40–75 were recruited from June 2003 – June 2005 in Rhode Island. They were randomly assigned to receive: Self-Administered Mailed Questionnaire [SAMQ; N = 202], Computer-Assisted Telephone Interview [CATI; N = 200], or Computer-Assisted Self-Interview [CASI; N = 197]. Logistic regression models were computed to assess survey mode differences for 13 self-reported items related to cancer screenings, adjusting for age, education, income, race, marital status, partner gender, and recruitment source.</p> <p>Results</p> <p>Compared to women assigned to CATI, women assigned to SAMQ were less likely to report two or more years between most recent mammograms (CATI = 23.2% vs. SAMQ = 17.7%; AOR = 0.5, 95% CI = 0.3 – 0.8) and women assigned to CASI were slightly less likely to report being overdue for mammography (CATI = 16.5% vs. CASI = 11.8%; AOR = 0.5, 95% CI = 0.3 – 1.0) and Pap testing (CATI = 14.9% vs. CASI = 10.0%; AOR = 0.5, 95% CI = 0.2 – 1.0). There were no other consistent mode effects.</p> <p>Conclusion</p> <p>Among participants in this sample, mode of data collection had little effect on the reporting of mammography and Pap testing behaviours. Other measures such as efficiency and cost-effectiveness of the mode should also be considered when determining the most appropriate form of data collection for use in monitoring indicators of cancer detection and control.</p

Understandings of cervical screening in sexual minority women: A Q-methodological study

Discursive perspectives argue that cervical screening carries social and moral meaning. Overlooked by research into the health needs of sexual minority women, previous literature that has examined uptake of cervical screening has instead targeted increasing attendance via information and service provision. In order to explore the diversity of meanings that British sexual minority women have about cervical screening, the Q-sorts of 34 sexual minority women were factor analysed by-person and rotated to simple structure using Varimax. The five factors are interpreted and discussed relative to competing discourses on information provision within cervical screening. The five accounts are labelled 'cervical screening is': an essential health check that women have the right to refuse; a woman's health entitlement; a vital test but degrading experience; a sensible thing to do; and an unnecessary imposition for some women. Critical approaches to informed choice are explored with attention to recent developments in cervical cancer prevention. Findings highlighting the need for affirmation of diversity within healthcare are considered in relation to existing criteria for UK national screening programmes

SCHEMA OF LEARNING DISABLED AND NONDISABLED YOUNGSTERS ON A STORY RETELLING TASK (RECALL, LANGUAGE, ADOLESCENTS)

It has been noted that stories have a structure or schema much the same as sentences have. When stories are well ordered and have a logical progression of events, they are better recalled than less well ordered stories, and a structure is brought to the story so that a schema develops. Students who are having difficulty with learning, such as learning disabled adolescents, may have trouble with the schema of stories. In order to find out how learning disabled adolescents differ in their use of schema, a story retelling task was devised. The aim of this study was to compare the schema of learning disabled adolescents with that of nondisabled adolescents, and with students at least two grades below the adolescents, or in grade four. There were a total of 63 students in this study, 20 in group one, 21 in group two, and 22 in group three. All students had average intelligence, adequate articulation, and could hear within normal limits. The students classified as learning disabled were adolescents in grades six to eight who were reading at least two years below grade level and were receiving support services in a resource setting, or were in self-contained special education programs. The nondisabled students were reading on grade level. For this study, there were four stories, all in the fairy tale or folk-tale genre that were either read or listened to by the students. One was a practice story while the other three were analyzed. Responses were analyzed according to the systems devised for this study which were called, Correct Production, Rules, and Probe Questions. All student responses were recorded on a cassette player for later analysis. Although not all analyses proved significant, there were several significant findings when responses to the three stories were combined. Separate analyses of each story also indicated that the learning disabled group had significantly more errors, fewer correct responses, and had difficulty recalling specific rules, depending upon the story. There were indications that learning disabled adolescents produced more errors and fewer Correct utterances than did the nondisabled middle school groups of students. There was also indication that Rule Deviation 8 (Internal Plan) was used less frequently by the learning disabled group than by the nondisabled middle school students. One can conclude that the learning disabled adolescents are less capable than nondisabled students in utilizing some schema in story retelling