Scoping review of experiences of sexual minority women treated for breast cancer

Figures & data

Table 1. Summary table describing studies included in the review.

Authors & Year	Sexual Minority Population	Gender Minority Population	Other Population	Aim	Findings	Limitations	Average JBI Score
Boehmer, Linde, & Freund, 2007	15 SMW (12 lesbian, 1 bisexual, 2 women who partner with women)	Not assessed	12 support persons (8 lesbian, 1 bisexual, 3 heterosexual)	To explore which issues SMW considered when making decisions on reconstructive surgery and to understand the influence and perspectives of these women’s most important support persons	1. Decisions for or against reconstruction are rooted in a value system and body image shaped by their sexual minority identity. 2. Women who chose reconstruction experienced difficulties and regrets, whereas women without reconstruction adjusted well after time. 3. Partners of SMW matched the level of satisfaction with reconstructive choice achieved by the women themselves.	Small convenience sample Cannot make inferences regarding prevalence of themes identified Recall bias due to retrospective design	8
Brown & McElroy, 2018	54 lesbian, bisexual or same-gender loving; 8 queer, questioning, or not listed	10 genderqueer or transgender	N/A	To better understand factors that affect sexual and gender minority (SGM) breast cancer patients embracing the choice to "go flat" or opt out of reconstruction after bilateral mastectomy	1. Flattoppers® were significantly more likely to have been diagnosed in the past five years, to identify as genderqueer, to have disclosed their sexual orientation or gender identity (SOGI) to providers, and to report participating in lesbian, gay, bisexual, or transgender cancer support groups, compared to other participants. 2. More flattoppers® believed that SOGI mattered in terms of getting the support they needed regarding their cancer; this difference was not statistically significant.	Limited generalizability Survivors self-selection bias Inadequate statistical power (small sample size) Limited sociodemographic variables collected	6
Bryson et al., 2018	6 lesbian, 46 queer, 9 bisexual; breast or gynecologic cancer patients	7 transgender, 3 gender non-conforming, 38 genderqueer	N/A	To examine how sexuality and gender are intersectionally constitutive of complex biopolitical mappings of cancer health knowledge that shape knowledge access and its mobilization in health and treatment decision-making	1. Transgender folks encounter and navigate a system of breast and gynecological cancer care practices and knowledge utterly unprepared to include them. 2. Trans cancer patients’ awareness of overlaps in cancer surgeries and gender affirming surgeries and of the lack of coordination of cancer and gender affirming care appears to be a problem of which care providers are woefully unaware.	Limitations not discussed	8
Greene et al., 2021	15 cisgender, SMW who had a breast cancer diagnosis or recent abnormal mammogram	N/A	N/A	To use constructs from self-determination theory (SDT) to explore the nature of health care provider interactions in breast cancer screening and care among Black SMW.	1. Themes aligned with the SDT constructs of relatedness and autonomy. 2. Some participants discussed feeling most understood by Black and/or female providers who shared at least 1 of their identities. Feeling understood through shared identity contributed to participants feeling seen and heard by their providers. 3. Participants who discussed negative experiences with providers believed that the provider made negative assumptions about them based on their race and/or sexual orientation.	Small sample size Well educated sample Limited range of socioeconomic status	8
Matthews et al., 2002	13 lesbian women	Not assessed	28 heterosexual women	To explore similarities and differences between lesbian and heterosexual survivors of breast cancer regarding cancer experiences, medical interactions related to cancer treatment, and quality of life (QOL)	1. Lesbians reported higher stress associated with diagnosis, lower satisfaction with care received from physicians, and a trend toward lower satisfaction with the availability of emotional support. 2. Lesbians and heterosexual women reported similar levels of overall QOL.	Small sample size Sample from a large urban setting Most of sample received care in large metro areas	7
Rubin & Tanenbaum, 2011	11 lesbian and 2 bisexual women	Not assessed	N/A	To examine the processes through which SMW negotiate concerns regarding appearance, sexuality, and identities (e.g. sexual, professional, and illness identities, among other intersecting identities and roles) in the context of breast reconstruction decisions	1. Although participants described sexual, gender, and political identities and orientations as influences on their decision making, for most participants, experiences with physicians who encouraged reconstruction and concerns about stigmatization of illness in romantic, professional, and social contexts were also central. 2. Reasons for/against reconstruction reflected themes identified in prior studies among heterosexual women.	Majority of participants had reconstruction Participants were younger than average BC patient Surgeons are more likely to discuss reconstruction with younger women Self-selection bias Recruited from support groups Not culturally diverse	8
Taylor & Bryson, 2016	Not assessed	10 transgender and gender nonconforming participants with breast or gynecologic cancer	N/A	To investigate experiences of cancer health and care, and access to knowledge for trans* and gender nonconforming people diagnosed with and treated for breast and/or gynecologic cancer	1. One’s knowledge of a felt sense of gender is closely interwoven with knowledge concerning cancer treatment practices. 2. Cisgender models concerning changes to the body that occur as a result of biomedical treatment for breast and/or gynecologic cancer are wholly inadequate in order to account for trans* and gender nonconforming peoples’ experiences of cancer treatments, and access to and mobilization of related knowledge.	Small sample size	8
Wandrey, Qualls, & Mosack, 2016	168 posts submitted by 53 users of Lesbians with Breast Cancer online discussion board	Not assessed	N/A	To explore lesbian breast cancer survivors’ attitudes toward breast reconstruction	1. Attitudes related to rejection of breast reconstruction were pervasive online support forum posts. 2. Five important themes related to breast reconstruction attitudes were revealed: (a) rejecting being defined by their body image, (b) privileging sensation over appearance, (c) believing that being breastless is protective, (d) perceiving their social context as supportive of nonreconstruction, and (e) feeling pressured by social norms to undergo reconstructive surgery	Discussions self-initiated No way of verifying if forum participants were lesbians with breast cancer Could not clarify meaning of posts Likely a more highly educated and computer literate group than general population	7

*All samples are breast cancer survivors unless otherwise noted; Samples are divided into sexual or gender minority to illustrate disproportionately larger number of sexual minority participants. The authors acknowledge that participant identities may fall anywhere along gender and sexual orientation spectrums.

Figure 1. PRISMA diagram of literature search and study selection.

Table 2. SGM survivor characteristics of reviewed papers within the scoping review.

Authors & Year	Location	Race n (%)	Ethnicity n (%)	Age	Educational Status n (%)	Employment Status n (%)	Health Insurance n (%)
Boehmer, Linde, & Freund, 2007	Bosten and Bedford, Massachusetts, US	African American 1 (0.7) White 14 (93.3)	Hispanic 0 (0)	50.7 years (no reconstruction) 47.3 years (reconstruction) (mean)	High School 0 (0) College 9 (60) Graduate School 6 (40)	12 (80)	14 (93.3)
Brown & McElroy, 2018	Social media/online recruitment	White 62 (91)	NR	35 and younger: 8 (11.7) 35 to 44: 10 (14.7) 45 to 54: 30 (44.1) 55 to 64: 7 (10.3) 65 and older: 5 (7.4)	NR	NR	NR
Bryson et al., 2018	San Francisco Bay Area and the Canadian provinces of British Columbia, Manitoba, Ontario, Quebec, and Nova Scotia	Asian 6 (7.4) Black 3 (3.7) Indigenous 6 (7.4) Mixed race 5 (6.2) Caucasian 58 (71.6)	Hispanic 3 (3.7)	33 to 46: 19 (23.5) 47 to 56: 34 (42) 57 to 66: 21 (25.9) 67 to 75: 7 (8.6)	NR	NR	NR
Greene et al., 2021	Social media, grassroots organizations, Black churches, and referrals from participants/national recruitment	Black or African American 15 (100)	NR	50.2 years (mean)	High School 3 (20) Some College 4 (26.7) College/Advanced Degree 8 (53.3)	13 (86.7)	NR
Matthews et al., 2002	Chicago, Illinois, US	African American 1 (8) European American 11 (84) Other 1 (8)	NR	51 years (mean)	High school 0 (0) Some college or college degree 8 (61) Advanced degree 5 (39)	9 (69)	11 (85)
Rubin & Tanenbaum, 2011	New York City, New York, US	White 12 (92.3)	NR	44.5 years (median)	Some College 5 (38.5) Graduate or Professional Degree 8 (61.5)	NR	13 (100)
Taylor & Bryson, 2016	San Francisco Bay Area and the Canadian provinces of British Columbia, Manitoba, Ontario, Quebec, and Nova Scotia	Caucasian 7 (70) Asian 1 (10) Native American/Filipino 1 (10) Jewish 1 (10)* French Canadian 1 (10)*	Latina 1 (10)	53.4 years	NR	NR	NR
Wandrey, Qualls, & Mosack, 2016	Online “Lesbians with Cancer” discussion board of breastcancer.org website	NR	NR	NR	NR	NR	NR

NR Not Reported; *While not standard race or ethnicity terms, these terms are how the authors (and presumably participants) described themselves.

Table 3. Major themes and subthemes for SMW breast cancer survivors’ experiences.

Individual: Effects of treatment on the body and identity, and vice versa Appearance and function Self-image, identity, and gender
Interpersonal: Partnerships and support networks, support for decisions, and coping Partners and dating Social support
Healthcare System: Healthcare access, quality, culturally responsive care, and patient education Clinician level Institutional level
Sociocultural and Discursive: Influence of narratives and cultural lenses Politics of gender Culture of breast cancer survivors