Sexual-Minority Females' Perceived Barriers to Utilizing Mammography: An Exploratory Study

Background and Purpose: Sexual-minority females have a two to three times higher lifetime risk of developing breast cancer than heterosexual females, but are utilizing mammography at lower rates than their straight counterparts. An estimated 40-70% of sexual-minority females are up-to-date in utilizing mammography, falling below the rate of mammography usage estimated for all females (70-74%). Sexual-minorities often initiate mammography after the recommended age of 40 and are less consistent in receiving mammography after initiation. Previously identified barriers to sexual-minority females using mammography include: mistrust of health care providers; internalized homophobia; lower rates of health insurance; and lower perceived risk of developing breast cancer.

The goal of this project wass to further explore and understand the challenges perceived and beliefs held by sexual-minority females in utilizing mammography services.

Methods: Six participants were recruited using convenience and respondent-driven sampling. Eligibility criteria for this study included: sexual-minority females (lesbian and/or transgender) who lived in the St. Louis region, were low or middle SES, and 40-75 in age. (Due to this project receiving funding from ACS, this project followed ACS in lieu of US Preventive Services Task Force mammography guidelines.) An LGBT identifying team member administered 30-60 minute, semi-structured interviews to assess the participants’ understanding of and perceived barriers to mammography. The transcripts were analyzed using thematic analysis and grounded theory. Through the use of a qualitative codebook, two graduate-level team members analyzed the transcripts and explored themes using NVivo 10.

Findings: Participant-identified barriers to mammography utilization fell under two overarching themes: insufficient resources and ineffective provider communication. Participants voiced that being uninsured, finding low-cost or free mammography services, and the lack of provider-driven outreach efforts to sexual-minorities to be resource-related barriers to utilization. They also felt that hetero-normative language used by physicians, non-inclusive language on health forms, fear of being stigmatized and judged by providers, gender presentation, the era in which the participant “came-out,” and negative previous interactions with providers to be provider-related communication barriers to utilization.

Conclusions and Implications: Due to participants’ fear of disclosure, providers should create more inclusive intake forms, which will help in tailoring dialogues around participants’ sexuality and increase provider and patient alliance, and should use more culturally competent language when dialogues with sexual minorities around topics of cancer prevention and screening. Providers should also engage with sexual minorities to create more tailored advertisements and educate them in how to find free or low-cost screenings. Since this is a largely unexplored topic, researchers should further examine sexual-minority cancer across the various domains of the cancer continuum.