Objective To explore the reasons for lesbians' practice of breast self-examination (BSE). Previous research in the USA has suggested that lesbians are less likely than heterosexual women to practise BSE on a
Design A combined quantitative and qualitative research instrument was designed to map patterns of breast health behaviour and to elicit qualitative explanations for those behaviours.
Setting The study used a multiple sampling frame in order to achieve a socially and geographically diverse sample of participants living throughout the UK from Cornwall to the Outer Hebrides. Results Thirteen per cent (n=137) of lesbians in the sample report monthly practice of BSE. Their stated reasons for regular BSE fall into five main categories: (i) 'Experiences of problems'; (ii) Awareness of particular risks'; (iii) 'Established routine'; (iv) 'Knowledge about BSE'; (v) 'Other'.
Conclusion Lesbians' explanations for their regular practice of BSE may offer valuable insights into their decision making and help to inform the decisions of others to practise monthly BSE. The paper concludes by suggesting ways in which lesbians' explanations may be used to develop lesbian-specific health education and promotion.
Hill D., White V., Jolley D., Mapperson K.Self-examination of the breast: Is it beneficial? Meta-analysis of studies investigating breast self-examination and extent of disease in patients with breast cancer. British Medical Journal, 1988 : 297: 271-275.
2.
Boston S., Louw J.Disorderly Breasts: A Guide to Breast Cancer, Other BreastDisorders and their Treatments. London: Camden Press , 1987.
3.
Hailey BJ, Lalor KM, Byrne HA, Starling LMThe effects of self-reinforcement and peer-reinforcement on the practice of breast self-examination. Health Education Theory Practice , 1992: 7(2): 165-174.
4.
Persson K., Svensson P., Ek A.Breast self-examination: An analysis of self-reported practice. Journal of Advanced Nursing, 1997: 25: 886-892.
5.
Selvin B.One in three lesbians risks death from breast cancer. The Guardian, 6th February 1993, 11.
6.
Haynes S.Are lesbians at high risk of breast cancer? Presentation at the 14th National Gay and Lesbian Health Foundation Conference, Los Angeles, CA, 9-10th July 1992. 7 Rankow E.Lesbian health issues for the primary care provider. The Journal of Family Practice, 1995: 40(5): 486-496.
7.
O'Hanlan K.Lesbian health and homophobia: Perspectives for the treating obstetrician/gynecologist . Current Problems in Obstetrics, Gynecology and Fertility , 1995: 18(4): 97-133.
8.
O'Hanlan K.Homophobia and the health care system: Solutions for the future. In: J White, M Martinez (Eds), The Lesbian Health Book: Caring for Ourselves, 23-38. Seattle : Seal Press, 1997.
9.
Dean L., Meyer I., Robinson K., Sell RL, Silenzio VM, Bowen DJ, Bradford J., Rothblum E., Scout, White J, Dunn P., Lawrence A., Wolfe D., Xavier J.Lesbian, gay, bisexual, transgender health: Findings and concerns. Journal of the Gay and Lesbian Medical Association, 2000: 4(3): 102-151.
10.
Rankow EJ, Tessaro I.Mammography and risk factors for breast cancer in lesbian and bisexual women . American Journal of Health Behavior, 1998 : 22(6): 403-410. 12 Bybee D.The Michigan Lesbian Health Survey. Lansing, Michigan: Michigan Organization for Human Rights,1991.
11.
Bradford J., Ryan C.The National Lesbian Health Care Survey. Washington DC : National Gay and Lesbian Health Foundation, 1988.
12.
Roberts SJ, Sorensen L.Health related behaviors and cancer screening of lesbians: Results from the Boston lesbian health project. Women and Health, 1999: 28(4):1-12.
13.
Diamant AL, Wold C., Spritzer K., Gelberg L.Health behaviors, health status, and access to and use of health care. Archives of Family Medicine, 2000: 9( 10): 1043-1051.
14.
Gruskin EP, Hart S., Gordon N.,Ackerson L.Patterns of cigarette smoking and alcohol use among lesbians and bisexual women enrolled in a large health maintenance organization. American Journal of Public Health, 2001: 91 (6): 976-979.
15.
Aaron DJ, Markovic N., Danielson ME, Honnold JA, Janosky JE, Schmidt NJBehavioral risk factors for disease and preventive health practices among lesbians. American Journal of Public Health, 2001: 91 (6): 972-975.
16.
Deevey S.Older lesbian women: An invisible minority. Journal of Gerontological Nursing, 1990: 16(5): 35-39.
17.
Cochran SD, Mays VM, Bowen D., Gage S., Bybee D., Roberts SJ, Goldstein RS, Robison A., Rankow EJ, White J.Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. American Journal of Public Health, 2001: 91(4): 591-597.
18.
Roberts SA, Dibble SL, Scanlon JL, Steven PM, Davids H.Differences in risk factors for breast cancer: Lesbian and heterosexual women . Journal of the Gay and Lesbian Medical Association, 1998:2(3):93-101.
19.
Valanis BG, Bowen DJ, Bassford T., Whitlock E., Charney P., Carter RASexual orientation and health: Comparisons in the WHI sample. Archives of Family Medicine, 2000: 9(9): 843-853.
20.
Dunbar J., Begg L., Yasko J., Belle S.Breast self-examination compliance among older high risk women. Patient Education and Counselling, 1991: 18: 223-230.
21.
Stillman M.Women's health beliefs about breast cancer and breast self-examination. Nursing Research, 1977: 26(2): 121-127.
22.
Calnan M.Women and medicalisation: An empirical examination of the extent of women's dependence on medical technology in the early detection of breast cancer. Social Science and Medicine, 1984: 18(7): 561-569.
23.
Owens RG, Daly J., Heron K.Psychological and social characteristics of attenders for breast screening . Psychology and Health, 1987: 1: 303-313.
24.
Grady K.Older women and the practice of breast self-examination. Psychology of Women Quarterly, 1988:12:473-487.
25.
Ellingson LA ,Yarber W.Breast self-examination, the health belief model, and sexual orientation in women. Journal of Sex Education and Therapy, 1997: 22(3): 19-24.
26.
Burnett CB, Steakley CS, Slack R., Roth J., Lerman C.Patterns of breast cancer screening among lesbians at increased risk for breast cancer. Women and Health, 1999: 29(4): 35-55.
27.
Fish J., Wilkinson S.Understanding lesbians' healthcare behaviour: The case of BSE. Social Science and Medicine, 2003: 56: 235-245.
28.
Solarz AL (Ed). Lesbian Health: Current Assessment and Directions for the Future. Washington, DC: National Academy Press, Institute of Medicine, 1999.
29.
Savage SA, Clarke VAFactors associated with mammography and breast selfexamination intentions . Health Education Research: Theory and Practice, 1996:11(4): 409-421.
30.
Rosvald EO, Hjartaker A., Bjertness E., Lund E.Breast self-examination and cervical cancer testing among Norwegian female physicians: A nation-wide comparative study. Social Science and Medicine, 2001: 52: 249-258.
31.
O'Connell Davidson J., Layder D.Methods, Sex and Madness. London: Routledge,1994.
32.
Fish J.Sampling lesbians: How to get 1000 lesbians to complete a questionnaire. Feminism and Psychology, 1999: 9(2): 229-238.
33.
Fish J.Sampling issues in lesbian and gay psychology: Challenges in achieving diversity . Lesbian and Gay Psychology Review, 2000: 1(2): 32-38.
34.
Lindzey G., Aronson E.The Handbook of Social Psychology, Volume Two. Reading, Massachusetts: Addison-Wesley Publishing, 1968.
35.
Lierman LM, Young HM, Kasprzyk D., Benoliel JQPredicting breast self-examination using the theory of reasoned action. Nursing Research, 1990: 39(2): 97-101.
36.
Alagna DM, Reddy SWPsychological aspects of cancer prevention and early detection among women . In: BL Anderson (Ed), Women with Breast Cancer: Psychological Perspectives, 136-170. New York: Springer Verlag,1996.
37.
Calnan M.The health belief model and participation in programmes for the early detection of breast cancer: A comparative analysis. Social Science and Medicine, 1984: 19(8): 823-830.
38.
Champion VL , Scott CRReliability and validity of breast cancer screening belief scales in African American women. Nursing Research, 1997: 46(6): 331-337.
39.
Stillman M.Women's health beliefs about breast cancer and breast self-examination. Nursing Research, 1977: 26(2): 121-127.
40.
Van Dam MA, Koh AS, Dibble SLLesbian disclosure to health care providers and delay of care. Journal of the Gay and Lesbian Medical Association, 2001: 5(1): 11-19.
41.
Stevens P.Protective strategies of lesbian clients. Research in Nursing and Health, 1994: 17: 217-229.
42.
Trippet S., Bain J.Reasons American lesbians fail to seek traditional health care. In: P Noerager Stern (Ed), Lesbian Health: What are the Issues?, 55-63. Washington, DC: Taylor and Francis, 1993.
43.
White JC, Dull VTHealth risk factors and health-seeking behavior in lesbians. Journal of Women's Health, 1997: 6(1): 103-112.
44.
VanScoy H.Health Behavior in Lesbians. In: D Goochman (Ed), Handbook of Health Behavior Research III: Demography, Development and Diversity, 141-162. New York: Plenum Press, 1997.
45.
Saphira ME, Glover M.New Zealand National Lesbian Health Survey. Journal of the Gay and Lesbian Medical Association, 2000: 4(2): 49-56.
46.
Diamant AL, Schuster MA, Lever J.Receipt of preventive health care services by lesbians. American Journal of Preventive Medicine, 2000: 19(3): 141-148.
47.
Agars J., McMurray A.An evaluation of comparative strategies for teaching breast self-examination . Journal of Advanced Nursing, 1993: 18: 1595-1603.
48.
Rutledge DNFactors related to women's practice of breast self-examination. Nursing Research, 1987: 36(2): 117-121.
49.
McCaul K., Reid P., Rathge R., Martinson B.Does concern about breast cancer inhibit or promote breast cancer screening ? Basic and Applied Psychology, 1996:18(2):183-194.
50.
Austoker J.Screening and self examination for breast cancer. British Medical Journal, 1994: 309:168-174.
51.
Grove V.Trying to piece together the jigsaw of breast cancer. The Valerie Grove Interview with Michael Baum. Sunday Times, 6th Oct 1991 , 3.
52.
Heyderman E.Coping with Breast Cancer: London: Sheldon Press, 1996.
53.
Salazar MK, Carter WBA qualitative description of breast self-examination beliefs. Health Education Research: Theory and Practice, 1994: 9(3): 343-354.
54.
Fresco A.Support for cancer checks. The Times, 20th Sept 1991.
55.
Fallowfield L. , Clark A.Breast Cancer. London: Routledge, 1991.
56.
Stoppard M.The Breast Book: The Essential Guide to Breast Care and Breast Health for Women of all Ages. London: Dorling Kindersley, 1996.
57.
Nettles-Carlson B.Problems of the breast. In: CI Fogel, NF Woods (Eds), Women's Health Care: A Comprehensive Handbook, 673-700. Thousands Oaks, CA: Sage, 1995.
58.
Burns J.The psychology of lesbian health care. In: P Nicolson, J Ussher (Eds), The Psychology of Women's Health Care, 225-248. Basingstoke : Macmillan, 1992.
59.
Coward C.Lesbian cancer risk is steep. The Advocate, 17th Nov 1992, 22.
60.
Masters W., Johnson V., Kolodny R.On Sex and Human Loving. Mumbai: Jaico Publishing, 1997.
61.
Phillips A, Rakusen J (Eds). The New Our Bodies Our Selves: A Health Book by and for Women. London: Penguin, 1989.
62.
Hastie N., Porch S., Brown L.Doing it ourselves: Promoting women's health as feminist action. In: G Griffin (Ed), Feminist Activism in the 90s , 13-27. London: Taylor and Francis, 1995 .
63.
The Mautner Project for Lesbians with Breast Cancer. Why are lesbians at greater risk of cancer? http://www.mautnerproject.org/barriers.html (accessed 14th Mar 2003).
