Breast reconstruction following mastectomy for breast cancer: the decisions of sexual minority women.

BACKGROUND: Prior research on decision-making for reconstructive surgery after mastectomy has not addressed the specific considerations of sexual minority women (women who partner with women, and lesbian or bisexual identified women). The purpose of this study is to explore which issues sexual minority women considered when making decisions on reconstructive surgery and to understand the influence and perspectives of these women's most important support persons. METHODS: Study participants were recruited through targeted community-based sampling. The authors conducted individual semistructured interviews with 15 sexual minority women who had been treated with mastectomy after breast cancer diagnosis and 12 support persons who were identified by these women as their most important source of support. Using qualitative data analysis software, transcribed interviews were analyzed. Through constant comparison methods, themes related to the decision on and experiences and satisfaction with reconstructive choice were identified from the narrative data. RESULTS: The considerations of women who decided for or against reconstruction are rooted in a value system and body image shaped by their sexual minority identity. Women who chose reconstruction experienced difficulties and regrets, whereas women without reconstruction adjusted well after time. Partners of sexual minority women matched the level of satisfaction with reconstructive choice achieved by the women themselves. CONCLUSION: Providers who treat sexual minority women might benefit from knowing about issues important to this population to provide more comprehensive care.

Support providers of sexual minority women with breast cancer: who they are and how they impact the breast cancer experience.

OBJECTIVE: The aim of this study was to identify the factors associated with adjustment to breast cancer among sexual minority women with breast cancer and their support person. METHODS: In a cross-sectional study, sexual minority women with breast cancer and their support provider were asked to self-report social support, distress, and coping, using standardized measures. RESULTS: Twenty-three (77%) women had a support provider participating in the study. Disclosure of sexual orientation, less helpless-hopeless coping, and support provider perception of high fighting spirit were related to lower patient distress. Lower support provider distress was related to more patient disclosure of sexual orientation, a larger social network, and an underestimation of fatalistic patient coping. An overestimation of patients' anxious preoccupation coping was linked to higher support provider distress. CONCLUSIONS: Providing opportunities to sexual minority patients and their support providers to focus on issues such as disclosure of sexual orientation and coping may lower patient and support provider distress.

Sexual minority women's coping and psychological adjustment after a diagnosis of breast cancer.

OBJECTIVE: To determine factors that influence sexual minority women's coping responses and adjustment to breast cancer. METHODS: We conducted a cross-sectional study with 64 sexual minority women with breast cancer who were recruited through targeted community-based sampling. In this study, sexual minority women consisted of three sexual orientation groups: those who self-reported partnering with women and those with a lesbian or bisexual identity. We determined the number of years of sexual minority status and disclosure of sexual orientation and used standardized measures to assess these women's coping and adjustment to breast cancer. Data were analyzed using statistical methods as appropriate for the level of data. RESULTS: We determined that sexual minority factors, such as sexual orientation group, influenced coping and adjustment even after illness and social support factors were controlled. In multivariate analyses, women who identified as lesbians or bisexuals used less maladaptive coping compared with women who reported partnering with women. The association between reporting a lesbian identity and lower distress approached significance in multivariate regression equations. CONCLUSIONS: Of the sexual minority factors that were considered, sexual orientation group, number of years of sexual minority status, and disclosure of sexual minority status, only sexual orientation group was related to coping and lower distress. Contrary to expectations, disclosure of sexual orientation did not relate to coping and lower distress. The findings support the need for future studies to include different aspects of sexual minority status, in particular, clearly defined sexual orientation groups.

Comparing women of differing sexual orientations using population-based sampling.

OBJECTIVES: Area probability sampling was used to conduct a women's health survey in Boston, MA. Sexual minority women (SMW) and heterosexual adult women were compared on a variety of health-related measures. METHODS: SMW-rich census tracts were identified and mapped onto zip code boundaries. Eligible respondents were women 18 and older who lived within the defined area, who were able to complete a personal interview or self-administered questionnaire in English. Differences in significant health-related outcomes by sexual orientation were examined. RESULTS: SMW and heterosexual women differed on access to health care and utilization of screening tests. There were no significant differences in smoking rates, eating less calories or fat, and intentions to follow mammography recommendations. CONCLUSIONS: In certain respects, study results are congruent with previous non-probability surveys, while in others the results are different. It is likely that real differences exist in some health-related variables by sexual orientation category.