title: Correlates of clinical breast examination among lesbian, gay, bisexual, and queer women.
abstract: Lesbian, gay, bisexual, and queer (LGBQ) women have increased risk of breast cancer yet lower use of early detection screening than heterosexual women. This lower use may be due in part to sexual stigma. The study purpose was to explore correlates of past two-year clinical breast examination (CBE) among LGBQ women to better understand screening disparities, particularly among gender non-conforming LGBQ women.
  
  
  
  A cross-sectional Internet-based survey was conducted with LGBQ women in 2011-2012. We conducted multivariate logistic regression to assess the associations between individual, social/structural and health care factors and past two-year CBE among LGBQ women (n = 414), including a subsample of gender non-conforming LGBQ women (n = 148).
  
  
  
  In multivariate analyses, significant correlates of past two-year CBE among the full sample included sexually transmitted infection knowledge (OR: 1.12, 95% CI: 1.05, 1.19), sexual risk practices (OR: 0.92, 95% CI: 0.87, 0.98), past two-year Papanicolaou test (OR: 8.36, 95% CI: 4.24, 16.45), having a regular source of health care (OR: 4.84, 95% CI: 2.60, 9.01), and health care provider knowing one's sexual orientation (OR: 3.60, 95% CI: 2.29, 5.81). Among gender non-conforming LGBQ women, perceived gender non-conformity stigma (OR: 0.85, 95% CI: 0.74, 0.99) and belief that one's health care provider is uncomfortable with one's sexual orientation (OR: 0.33, 95% CI: 0.11, 1.00) were also associated with lower screening.
  
  
  
  These findings enhance understanding of individual, social/structural, and health care factors correlated with CBE among LGBQ women. More research is needed to understand the complex interplay of these factors to inform multi-level interventions to address screening disparities for diverse LGBQ women.
authors.affiliation: Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON. ashley.lacombe.duncan@utoronto.ca.
authors.forename: Ashley
authors.initials: A
authors.lastname: Lacombe-Duncan
authors.forename: Carmen H
authors.initials: CH
authors.lastname: Logie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001727:Bisexuality / Q000523:psychology* / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D018452:Homosexuality, Female / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009864:Ontario; D000072339:Sexual and Gender Minorities / Q000523:psychology* / Q000706:statistics & numerical data; D057545:Social Stigma; D055815:Young Adult