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.

Adherence to adjuvant endocrine therapy among White British and ethnic minority breast cancer survivors in the United Kingdom

“…Comorbidity is typically higher and evident at a younger age in ethnic minority groups as a result of socio‐economic inequality (Ellis et al, 2018 ; Lundqvist et al, 2016 ; Sparano & Brawley, 2021 ), which may impact on medication beliefs and adherence. Stigma, perceived discrimination and lack of social support (Jones et al, 2014 ; Kang et al, 2020 ) might be associated with adherence due to mistrust of healthcare professionals (Fujisawa & Hagiwara, 2015 ) and have been found to be higher in African American women compared to White women (Jones et al, 2014 ; Poteat et al, 2021 ) with perceived empathy from healthcare professionals being lower in women from minority ethnic groups (Moon et al, 2020 ).…”

Sexual and gender diversity in cancer care and survivorship

“…For an example, an editorial stated that SGD African Americans face multiple healthcare disparities due to the role racism and discrimination has played over decades in policy making and medical practice [5 ▪▪ ]. This notion was confirmed in a recent cross-sectional survey which revealed that 29% of Black sexually diverse (SD) women with breast cancer chose to delay care due to barriers such as past negative healthcare encounters, other priorities or struggles relating to scheduling an appointment [6 ▪ ]. Those Black SD women with breast cancer who engaged in cancer treatment often faced Healthcare Provider (HCP) assumptions, mistreatment and felt misunderstood during their care according to a review on the topic [7].…”

Relationship between intersectionality and cancer inequalities: a scoping review protocol

“…Unemployment influences behaviours towards cancer care (eg, people may not find time to take up cancer screening; or patients might prioritise work over treatment if absenteeism implies loss of income) 24. Mistrust of healthcare professionals by people from minority ethnic populations and sexual minority groups,25–27 and perceptions and experiences of discrimination and racism28 29 impact uptake of health services.…”