Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States

Abstract

Background: Despite known differences in breast cancer by both race and sexual orientation, data on the intersectional experiences of Black sexual minority women (BSMW) along the care continuum are scant. This study sought to understand delays in breast cancer care by examining the intersection of race and sexual orientation.

Methods: This online, cross-sectional survey enrolled racially and sexually diverse women aged ≥ 35 years who had been diagnosed with breast cancer within the prior 10 years or had an abnormal screening in the prior 24 months. The authors calculated summary statistics by race/sexual orientation categories, and they conducted univariate and multivariable modeling by using multiple imputation for missing data.

Results: BSMW (n = 101) had the highest prevalence of care delays with 5.17-fold increased odds of a care delay in comparison with White heterosexual women (n = 298) in multivariable models. BSMW reported higher intersectional stigma and lower social support than all other groups. In models adjusted for race, sexual orientation, and income, intersectional stigma was associated with a 2.43-fold increase in care delays, and social support was associated with a 32% decrease in the odds of a care delay.

Conclusions: Intersectional stigma may be an important driver of breast cancer inequities for BSMW. Reducing stigma and ensuring access to appropriate social support that addresses known barriers can be an important approach to reducing inequities in the breast cancer care continuum.

Keywords: African Americans; breast neoplasms; continuum of care; female; intersectionality; sexual and gender minorities.

Figure 1.. Types of reasons for delaying care among participants who delayed care by race/sexual orientation groups

Notes: Structural includes cost, transport, childcare, and insurance. Institutional includes no appointment soon enough, unable to reach doctor, unaware of how to follow-up. Interpersonal includes not trusting the doctor, discomfort with the doctor, fear of being treated rudely. Intrapersonal includes not wanting to make a fuss, embarrassment, prefer not to know, and felt it was pointless. Minimization includes other priorities, no pain, disbelief of results, forgot. Any barrier represents the number of barriers selected out of all 18 listed.

Figure 2.. Conceptual Framework for Delay in Breast Cancer Care for Black Sexual Minority Women