The impact of COVID-19 on sexual minority women seeking breast cancer screenings and treatment: An analysis of the OUT national cancer survey data

Breast cancer is the most frequently diagnosed female cancer in the U.S. and now globally. Early detection of breast cancer through screening is well established to reduce mortality. Despite the substantial benefits, sexual minority women (e.g., lesbians and bisexual women) are significantly less likely to access breast cancer screenings, have lower lifetime prevalence of screening mammography, and undergo less timely screening as compared to sexual majority women (i.e., heterosexual women). Some reasons for the low utilization of screenings include negative beliefs about care, lower perceived severity, lack of health insurance, costs of care, and perceptions of heterosexism and homophobia among providers. Hesitancy in breast cancer screenings for sexual minority women is compounded by culturally-specific risk factors that place many sexual minority women at higher risk for breast cancer. Risk factors identified as those sexual minority women are more subject to include: tobacco use and smoking, higher alcohol consumption, drug use, obesity, low levels of physical activity, less likely to undergo routine preventive screenings, less likely to have insurance coverage, less satisfaction with medical interactions, higher rates of psychological distress (likely due to the fear of homophobia and bias), and nulliparity or not bearing offspring. Hesitancy and delays were increased during the COVID-19 era even with the temporary transition to telehealth (online, virtual) appointments with healthcare practioners. Using data from the National LGBT Cancer Network's OUT National Cancer Survey, this study analyzes the experiences of sexual minority women who faced breast cancer diagnoses. This dataset is the first large, nationwide sample to target LGBTQ+ populations regarding their cancer diagnoses. Survey items included demographics, behavioral questions about cancer treatment and social support, and structural and psychosocial barriers to or facilitators of seeking care. A total of 2,700 respondents completed the National LGBT Cancer Network survey. Of those 2,700 respondents, 503 had had breast cancer diagnoses. The sample for this study included the 490 females (since birth), 359 were lesbian or gay and 62 were bisexual, of those 503 respondents. Findings highlight experiences with social isolation, levels of optimism versus pessimism, whether doctors or medical clinics delayed cancer screenings, experiences and satisfaction with telemedicine, and other impacts of COVID-19.