Abstract
OBJECTIVES: Lesbian, gay, bisexual, and queer (LGBQ) women have increased risk of breast cancer yet lower use of early detection screening than heterosexual women. This lower use may be due in part to sexual stigma. The study purpose was to explore correlates of past two-year clinical breast examination (CBE) among LGBQ women to better understand screening disparities, particularly among gender non-conforming LGBQ women.
METHODS: A cross-sectional Internet-based survey was conducted with LGBQ women in 2011–2012. We conducted multivariate logistic regression to assess the associations between individual, social/structural and health care factors and past two-year CBE among LGBQ women (n = 414), including a subsample of gender non-conforming LGBQ women (n = 148).
RESULTS: In multivariate analyses, significant correlates of past two-year CBE among the full sample included sexually transmitted infection knowledge (OR: 1.12, 95% CI: 1.05,1.19), sexual risk practices (OR: 0.92, 95% CI: 0.87, 0.98), past two-year Papanicolaou test (OR: 8.36, 95% CI: 4.24,16.45), having a regular source of health care (OR: 4.84, 95% CI: 2.60, 9.01), and health care provider knowing one’s sexual orientation (OR: 3.60, 95% CI: 2.29, 5.81). Among gender non-conforming LGBQ women, perceived gender non-conformity stigma (OR: 0.85, 95% CI: 0.74, 0.99) and belief that one’s health care provider is uncomfortable with one’s sexual orientation (OR: 0.33, 95% CI: 0.11, 1.00) were also associated with lower screening.
CONCLUSION: These findings enhance understanding of individual, social/structural, and health care factors correlated with CBE among LGBQ women. More research is needed to understand the complex interplay of these factors to inform multi-level interventions to address screening disparities for diverse LGBQ women.
Key words: Lesbian, bisexual, cancer screening, breast cancer, masculinity, social stigma
Résumé
OBJECTIFS: Les femmes lesbiennes, gaies, bisexuelles et allosexuelles (LGBA) ont un risque accru de cancer du sein, mais elles ont moins recours au dépistage précoce que les femmes hétérosexuelles. Ce moindre recours pourrait s’expliquer en partie par la stigmatisation sexuelle. Le but de notre étude était d’explorer les corrélats de l’examen clinique des seins (ECS) au cours des deux années antérieures chez les femmes LGBA pour mieux comprendre les disparités dans le dépistage, en particulier chez les femmes LGBA au genre non conforme.
MÉTHODE: Nous avons mené une enquête transversale sur Internet auprès de femmes LGBA en 2011–2012. Au moyen d’une régression logistique multivariée, nous avons estimé les associations entre les facteurs individuels, sociaux/structurels et liés à l’accès aux soins de santé d’une part, et l’ESC d’autre part, au cours des deux années antérieures chez les femmes LGBA (n = 414), y compris dans un sous-échantillon de femmes LGBA au genre non conforme (n = 148).
RÉSULTATS: Dans les analyses multivariées, les corrélats significatifs de l’ESC au cours des deux années antérieures dans l’échantillon complet étaient les connaissances sur les infections transmissibles sexuellement (RC: 1,12, IC de 95%: 1,05, 1,19), les pratiques sexuelles à risque (RC: 0,92, IC de 95%: 0,87, 0,98), le fait d’avoir subi un test de Papanicolaou au cours des deux années antérieures (RC: 8,36, IC de 95%: 4,24, 16,45), le fait d’avoir une source régulière de soins de santé (RC: 4,84, IC de 95%: 2,60, 9,01) et le fait que le dispensateur de soins de santé connaisse l’orientation sexuelle de la répondante (RC: 3,60, IC de 95%: 2,29, 5,81). Chez les femmes LGBA au genre non conforme, la perception d’une stigmatisation sociale liée au genre non conforme (RC: 0,85, IC de 95%: 0,74, 0,99) et la croyance que le dispensateur de soins de santé n’était pas à l’aise avec l’orientation sexuelle de la répondante (RC: 0,33, IC de 95%: 0,11, 1,00) étaient aussi associées au moindre recours au dépistage.
CONCLUSION: Ces constatations améliorent notre compréhension des facteurs individuels, sociaux/structurels et liés à l’accès aux soins de santé corrélés avec l’ECS chez les femmes LGBA. Il faudrait pousser la recherche pour comprendre l’action réciproque complexe de ces facteurs afin d’éclairer des interventions à niveaux multiples pour réduire les disparités entre les femmes LGBA sur le plan du dépistage.
Motsclés: homosexualité féminine, bisexualité, dépistage du cancer, tumeurs du sein, masculinité, isolement social
Footnotes
Conflict of Interest: None to declare
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