Patterns of breast cancer screening among lesbians at increased risk for breast cancer

Background: Women with a family history of breast cancer (i.e., in a mother , sister or daughter) are at increased risk for this disease. Previous data also suggest that lesbians are at increased risk for breast cancer. While the screening behaviors of women with a family history have been described, little is known about factors that influence screening behaviors of lesbia ns with the same risk factor profile. Purpose: The purpose of this study was to characterize the perceptions of s usceptibility to breast cancer and describe factors that influence adherenc e to breast cancer screening guidelines in a sample of lesbians with a firs t-degree relative with a diagnosis of breast cancer. Methods: Structured telephone interviews were conducted on a sample of 139 self-identified lesbians who had a first-degree relative with a diagnosis o f breast cancer, were between the ages of 35 to 75 and had no previous hist ory of cancer. Cross-sectional data obtained, included socio-demographics, breast cancer risk factors, breast cancer screening patterns, breast cancer perceptions, worries, and knowledge, and barriers and access to health car e factors. Individual subject characteristics were examined for their assoc iation with adherence to mammography guidelines followed by a multivariate analysis to evaluate the most important combinations of factors. Outcome me asures were age-specific adherence to ACS guidelines for both mammography a nd overall adherence (i.e., mammography, clinical breast examination and br east self-examination). Results: The 139 lesbians interviewed for this study were young (mean age = 43), almost exclusively white (94%), highly educated (78% = college gradua te and beyond), and partnered (68%). In the bivariate analysis of individua l factors, being employed and reporting breast cancer worries were signific antly and positively associated with adherence to mammography guidelines. H igher income and insurance type were significantly associated with mammogra phy adherence. No factors were significantly associated with overall adhere nce. Multivariate logistic regression analyses revealed that only income le vel and degree of breast cancer worries were significantly and positively a ssociated with mammography adherence. However, since there was a high corre lation between income level and employment status, a regression model with employment status and worry was also significantly related to mammography a dherence. Conclusions: In lesbians who are at an increased risk for breast cancer bec ause of family history, breast cancer worries may motivate, rather than det er, adherence for mammography use. High income levels also appear to enable adherence in this population, Implications: Additional studies are needed to validate these findings, ide ntify the prevalence of lesbians in general samples of women at increased r isk for breast cancer, and prospectively test lesbian sensitive educational intervention strategies designed to facilitate adherence to mammography sc reening guidelines in this population.