title: Breast Cancer Risk in Sexual Minority Women during Routine Screening at an Urban LGBT Health Center.
abstract: BACKGROUND
  Sexual minority women (SMW) may experience elevated breast cancer risk, yet limited research has assessed the utility of the Gail breast cancer risk model in this population. Using data from screening mammography patients at an urban health center specializing in sexual minority health, we calculated and compared Gail risk scores of SMW with heterosexual women and identified factors associated with elevated risk.
  
  
  METHODS
  This retrospective study reviewed medical records from all patients who underwent screening mammography during 12 months (2013-2014) at a federally qualified community health center in the Northeast United States. Descriptive statistics compared risk scores and other characteristics of patients reporting female only or female and male sex partners ("SMW") with patients reporting only male sex partners ("heterosexual"). Linear regression identified correlates of increased lifetime risk.
  
  
  RESULTS
  Among 423 patients, SMW (n=162) were more likely to be nulliparous than heterosexual women (79% vs. 40%; p<.01) and had significantly higher lifetime Gail scores (10.7% vs. 8.9%; p<.01). In multivariable regression, being SMW was independently associated with 1.43% higher lifetime Gail scores (95% CI, 0.69%-2.17%), and having private health insurance was associated with 1.52% higher lifetime Gail scores (95% CI, 0.62-2.42).
  
  
  CONCLUSIONS
  Using the Gail model to assess breast cancer risk routinely in a clinical setting is feasible. Risk scores may be higher among SMW, who are more likely to be nulliparous, and among patients who are privately insured. Additional research on breast cancer risk assessment among SMW is needed.
authors.affiliation: Medical Department, Fenway Health, Boston, Massachusetts.
authors.forename: Kasey
authors.initials: K
authors.lastname: Clavelle
authors.affiliation: The Fenway Institute, Fenway Health, Boston, Massachusetts.
authors.forename: Dana
authors.initials: D
authors.lastname: King
authors.affiliation: The Fenway Institute, Fenway Health, Boston, Massachusetts; Department of Community Health Services, Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Angela R
authors.initials: AR
authors.lastname: Bazzi
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Valerie
authors.initials: V
authors.lastname: Fein-Zachary
authors.affiliation: Medical Department, Fenway Health, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts. Electronic address: jpotter@bidmc.harvard.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Potter
mesh_terms: D000328:Adult; D000368:Aged; D001727:Bisexuality / Q000706:statistics & numerical data*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility; D020010:Heterosexuality / Q000706:statistics & numerical data*; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D015233:Models, Statistical; D015999:Multivariate Analysis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D014505:Urban Population; D016387:Women's Health