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Breast cancer disparities by sexual orientation and socioeconomic status
Breast Cancer Disparities
a) Background: Studies suggest sexual minority women have a higher level of risk factors for breast cancer. This has resulted in the hypothesis that sexual minority women have greater breast cancer incidence, later stage, and higher breast cancer-related mortality. However, in the absence of reliable population-based data that include sexual orientation, this hypothesis has never been tested. b) Objective/Hypothesis: The objective of this study is to test the hypothesis of breast cancer disparities due to sexual orientation. We will test the hypotheses that geographic areas in which sexual minority women are concentrated have higher breast cancer incidence, more advanced stage, different treatment patterns, and greater breast cancer mortality compared to areas with few sexual minority women. A secondary goal is to consider the economic structure of the neighborhoods in which sexual minority women live to examine breast cancer disparities due to economic differences. c) Specific Aims: We have four specific aims to identify breast cancer disparities: 1. Examine the relationship of breast cancer incidence to the percentage of sexual minority women in a geographic area. 2. Determine the rate of late stage breast cancer diagnoses to the percentage of sexual minority women in a geographic area. 3. Determine breast cancer treatment patterns, including breast reconstruction to the percentage of sexual minority women in a geographic area. 4. Compare breast cancer mortality as a function of percentage of sexual minority women in a geographic area. 5. Compare breast cancer incidence, stage of diagnosis, treatments, and mortality in the geographic areas where sexual minority women are concentrated as a function of per capita income in these areas. d) Study Design: This secondary data analysis study will link US Census 2000 and SEER data for the purpose of examining disparity in breast cancer due to sexual orientation. By linking US Census data that include information on same-sex households with cancer registry data, we will be able to test the hypothesis of breast cancer disparity due to sexual orientation. The US Census also includes information about the economic structure of neighborhoods. These data will allow us to assess the role of socioeconomic status on disparities.
It has been hypothesized that sexual minority women have higher incidence of breast cancer, later stage disease, and higher breast cancer mortality. Since the existing cancer surveillance data do not collect information on sexual orientation, the hypothesis of breast cancer disparity in sexual minority women cannot be tested and confirmed. Without reliable population-based estimates that indicate sexual minority women?s breast cancer disparity, policymakers, health professionals, and researchers will not dedicate the necessary resources to eliminate disparities in this subpopulation. In the proposed 2-year study, we will use cancer registry data and the US census to test the hypothesis of breast cancer disparities in sexual minority women. This secondary data analysis will identify disparities in breast cancer incidence, stage, treatment, and mortality due to sexual orientation and consider the role of socioeconomic status on disparities. The results will inform follow-up intervention studies. If our analyses identify disparities in incidence, stage, treatment, or mortality, follow-up intervention studies should target the reduction of risk factors, screening, or treatment decision-making, respectively. These findings will close an important knowledge gap about the subpopulation of sexual minority women and is likely to impact their health. The findings will be of great relevance to policymakers, health professionals, and researchers, in that these results will inform program development and implementation.