E8: Breast Cancer Care Disparities in Sexual Minority Women: An Analysis of the National Institutes of Health All of Us Research Program

Currently, sexual orientation data is not collected nor defined by any national cancer database. Little is known about breast cancer (BC) disparities in sexual minority women (SMW). Our objective was to study this question in the NIH All of Us database.


Methods:

We analyzed data from the All of Us research program, a national open enrollment database that registers diverse subjects medical and survey data. We compared risk factors and preventative and procedural healthcare utilization between SMW and straight women (StW) as they relate to BC care. Results were expressed as odds ratios (OR) with a 95% confidence interval [CI].


Results:

Of 229,917 cisgender women, 27,302 (12%) chose “non-straight orientation, prefer not to answer, or skipped” and thus were defined as SMW. 6,905 (3.0%) had received a BC diagnosis, including 423 (6.1%) SMW. SMW were less likely to have a BC diagnosis (OR 0.48 [0.43-0.53]). There were differences in medical visits and procedures: SMW were less likely to undergo annual history & physicals (0.79 [0.73-0.85]), mammography (0.61 [0.53-0.69]), breast biopsy (0.55 [0.41-0.72]), and breast surgeries (mastectomy 0.53 [0.30-0.93]; lumpectomy 0.53 [0.38-0.74]). Survey data revealed differences in lifestyle factors related to BC risk: while StW were more likely to answer yes to being an “alcohol participant” (0.79 [0.77-0.82]), SMW reported higher rates of alcohol intake on a daily, weekly, and monthly basis, and to consume 6 or more drinks in one sitting; SMW also showed significantly increased smoking/nicotine usage. On healthcare access and utilization, StW were more likely to receive advice from primary care providers (0.65 [0.65-0.69]), while SMW were more likely to utilize urgent and emergency care (1.44 [1.34-1.54]). SMW were also more likely to report being unable to afford care (1.82 [1.72-1.93]), medication (1.69 [1.61-1.76]), specialty care (1.98 [1.89-2.08]), and follow-up care (1.85 [1.75-1.95]), as well as to delay care due to cost concerns about the copay (2.13 [2.02-2.23]), deductible (1.64 [1.56-1.73]), paying out of pocket (1.70 [1.63-1.77]) or because they were nervous (2.80 [2.69-2.91]). SMW reported being more likely to experience discrimination based on questions about healthcare provider interactions (Table 1).


Conclusions:

Discrimination, lack of access, and underutilization of preventative and screening services likely explains an underestimation of the true number of BC among SMW in All of Us. Further studies on screening, treatments, and survival are needed to address how these disparities affect SMW BC outcomes.