S.F. summit looks at lesbian health issues

[XemaSab]

For reasons that are not yet well understood, studies show that lesbians weigh more than their heterosexual counterparts, smoke more, drink more, abuse drugs more often, and have more fat around their midsections, putting them at a higher risk of heart disease, said Dr. Katherine O'Hanlan, a Bay Area gynecologic cancer surgeon and healthy policy advocate.

"The health profile of lesbians is significantly more unhealthy," she said. "Lesbians have a higher concentration of risk factors for cancer, heart disease and stroke than heterosexual women."

Research has shown that lesbians undergo fewer mammograms than heterosexual women and perhaps as a consequence, may suffer higher rates of breast cancer, she said.

Additionally, they may have a higher risk for ovarian and uterine carcinomas due to "less frequent use of oral contraceptives, combined with higher rates of obesity and endometriosis," O'Hanlan wrote in an article published three years ago in Obstetrics & Gynecology.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/03/06/BAQQ16ARFB.DTL

[TEmperorHasNoClothes]

1. glad this is being studied

I'm a breast cancer survivor. One of the reasons obesity raises the risk of female cancers is that fat cells store estrogen, which fuels these type cancers. Obesity attacks on all health fronts. That doesn't explain why skinny me got breast cancer, but is great info to help women be more proactive about their health.

[bluedawg12]

3. ....

THNC-

Be well. Stay well. :pals:

[bluedawg12]

2. The negative consequences of bigotry on the human psyche.

I think this sounds intuitively correct: "Social stress has an enormous impact on their health,"

and this, "health consequences to lesbian, gay and bisexual adolescents due to family rejection."

Imagine growing up, being out, or outed, in a family where heteronormative "strong traditional values," :puke: are used as an emotional club to beat a child into submission.

Yeah it's a choice alright. :eyes:

Here is the amazing thing:

"One thing we still need to do are more studies on resiliency - to learn why so many lesbians not only function but thrive despite having so many health obstacles."


There is another variable. We touched on this in another thread. I wonder how things shape up when lesbian women are studied in terms of their presentation to society as gender appropriate vs. "butch."

We place such a high value on appearance in our culture, that, while (my hunch) is that many of the women were actually into sports in their teens and their youth, the ever present drumbeat of judgementalism eventually wears people down in terms of self image and self care.

Anyway, this is fascinating and important and about time that someone studied it.

[totodeinhere]

6. I think you are exactly right. n/t

[Name removed]

42. Deleted message

Message removed by moderator. Click here to review the message board rules.

[bluedawg12]

43. You are welcome and welcome to DU!!

:hi:

[JenniferJuniper]

4. Mammograms do not prevent cancer

so the statement that undergoing fewer of them might cause higher rates of cancer is misleading.

[Jamastiene]

5. You are right, but I think they meant to say that

catching it early gives someone a better chance at survival. Or at least, that is how I understood it. I see what you are saying about the wording though.

[bluedawg12]

7. Mammograms are a diagostic tool for early detection of breast cancer

early detection means that when the diagnosis is made it is less likely to be in a later stage with metastasis.

The correct statement should have read:

"Research has shown that lesbians undergo fewer mammograms than heterosexual women and perhaps as a consequence, may suffer higher rates of late stage breast cancer , she said.

[TEmperorHasNoClothes]

12. thinking about the difference between precancerous conditions and cancerous, they do

Early detection is the best protection.

[JenniferJuniper]

13. That's the mantra. They say it over and over again.

But reality may be quite different as statistics seem to indicate otherwise for some types cancers, notably prostate and breast.

It's beginning to look like it isn't the size of the tumor that matters but the nature of the particular cancer cells in the patient's body. So a tiny tumor could be really bad and kill a patient regardless of how quickly it is caught while much larger one could be relatively harmless.

Have breast cancer rates really gone through the roof in the years since mammography became standard practice or are mammograms just detecting many more pre-invasive ductal carcinoma-in-situ that otherwise would never be diagnosed and may not require aggressive treatment? Our current diagnostic tools cannot distinguish.

From a UK study reported in the Sunday Times: "Whilst mammography detects some potentially deadly cancers, it also picks up many times more cancers that might never become symptomatic during the patients’ lifetime, or that could be treated just as easily if detection were left until the woman could feel the lump herself. Thus, for every woman saved by early diagnosis, many others receive painful and potentially dangerous treatments to destroy tumours that pose little or no threat – tumours that they might die with, not of.”

Despite the mantra, mammograms are an old-fashioned tool of somewhat limited value. We should be demanding much more.

[bluedawg12]

14. Mammograms, self breast examinations and MRI of the breast are screening tools.

The nature of the lesion, mass, is determined by histophatology.

The first step is diagnosis.

The second step is treatment.

Since we don't know which mass is a potentially deadly cancer, versus, the "cancers that might never become symptomatic during the patients’ lifetime..." it is prudent to identify the mass and make a diagnosis.

This statement has no bearing on screening, it addresses another issue entirely, namely, once a mass is diagnosed, which ones should be treated? This excerpt conflates and confuses issues of diagnosis versus controversies regarding treatment.

"From a UK study reported in the Sunday Times: "Whilst mammography detects some potentially deadly cancers, it also picks up many times more cancers that might never become symptomatic during the patients’ lifetime, or that could be treated just as easily if detection were left until the woman could feel the lump herself. Thus, for every woman saved by early diagnosis, many others receive painful and potentially dangerous treatments to destroy tumours that pose little or no threat – tumours that they might die with, not of.”

Yup, tell a person to sit tight, you may be the lucky one, your lump may be a cancer and it may be a low grade malignancy, and if we wait till the lump is bigger and it is one of the low grade cancers it, " could be treated just as easily if detection were left until the woman could feel the lump herself." On the other hand, if it is not a low grade malignancy, and we did nothing, be sure to write the Sunday Times editor and tell them you are disappointed in their article, you were not among the lucky ones.

In the universe of breast cancers, some carry a more grave prognosis than others. Medicine is an art and a science. It is not perfect. However, society, the medical community and the payors have to decide what the standard of care should be. Not the Sunday Times.

Would we rather have women undergo screening and potentially catch a lethal breast cancer early, or wait until the lump is large enough to feel on self exam, because some of those lumps won't be the most lethal kind, while some will be?

In every diagnostic tool there are false positives and false negatives. The decision to use a tool is weighted on a risk vs. reward analysis.

Yes, some women will be diagnosed with the less invasive ductual cell carcinoma in situ and some women with the more malignant type will also be picked up early.

What does a woman want to do? The decision to undergo self breast exams and diagnostic tools such as mammography or breast MRI are part of personal decision making process and mitigated by other risk factors, such as obesity, smoking, a positve family history of breast cancer, the use of HRT and oral cotraceptives and history of pregnancy.

The second issue is controversial, that has to do with the idea of a "good cancer of the breast" the kind that you might out live, the kind that might not kill you, the ductal carcinoma in situ. Apparently not all ductal cell carcinomas in situ ( ductal cell cancer localized and not locally invasive or spread to distant sites, such as brain, bone and liver)are harmless and able to be outlived.

Here is some info on ductal cell carcinoma in situ:

http://www.mayoclinic.com/health/dcis/DS00983

In ductal carcinoma in situ (DCIS), abnormal cells multiply and form a growth within a milk duct of your breast. Although DCIS is an early form of breast cancer, it's noninvasive, meaning it hasn't spread out of the milk duct to invade other parts of the breast. Some experts consider DCIS to be a "preinvasive" condition. DCIS is the most common type of noninvasive breast cancer.

DCIS is usually found during mammogram screenings, but it can be difficult to detect. Because of increased screening with mammograms, the rate at which DCIS is diagnosed has increased dramatically in recent years. Fortunately, the condition isn't life-threatening, but it does require treatment. Unlike lobular carcinoma in situ (LCIS) — which really isn't a cancer at all but a marker for increased risk of developing invasive breast cancer — DCIS is more likely to develop into invasive breast cancer if left untreated.

Symptoms

DCIS usually has no outward signs or symptoms. However, some women may have a breast lump or nipple discharge associated with DCIS. Most often, though, DCIS is found on a screening mammogram, in which a radiologist identifies microcalcifications — tiny groups of calcium deposits — that indicate the presence of breast cancer. The microcalcifications appear on a mammogram as irregularly sized and shaped clusters of white spots.

Treatments and drugs
Treatment of DCIS has a high likelihood of success, in most instances removing the tumor and preventing any recurrence, particularly a recurrence that spreads beyond the original site. The challenge is to avoid either overtreating or undertreating the condition.

Treatment options for DCIS include:

Lumpectomy only
Lumpectomy and radiation therapy
Lumpectomy and the drug tamoxifen
Simple mastectomy
Surgery
If you're diagnosed with DCIS, one of the first decisions you'll have to make is whether to treat the condition with breast-conserving surgery (lumpectomy) or breast-removing surgery (mastectomy).

Lumpectomy. Lumpectomy removes only a portion of your breast. The procedure allows you to keep as much of your breast as possible, and depending on the amount of tissue removed, usually eliminates the need for breast reconstruction.

Lumpectomy followed by radiation therapy is the most common treatment for DCIS. Research suggests that lumpectomy combined with radiation produces survival rates similar to those of mastectomy. Recurrence rates, however, are slightly higher for women treated with a lumpectomy than for women who undergo mastectomy.

For older women with multiple medical conditions, lumpectomy plus tamoxifen therapy may be an option.

Mastectomy. For treating DCIS, a simple mastectomy — removing the breast tissue, skin, areola and nipple, and possibly the underarm lymph nodes (sentinel node biopsy) — is one option. Breast reconstruction after mastectomy, if desired, can be performed in most cases. Because less extensive surgery, combined with radiation, may be equally effective, simple mastectomy is less common than it once was for treating DCIS.
Most women with DCIS are candidates for lumpectomy. However, mastectomy may be recommended if:

You have a large area of DCIS. If the area is large compared with the size of your breast, a lumpectomy may not produce acceptable cosmetic results.
There's more than one area of DCIS. It's difficult to remove multiple areas of DCIS with a lumpectomy. This is especially true if DCIS is found in different sections — or quadrants — of the breast.
Tissue samples taken for biopsy show cancer cells at or near the edge (margin) of the tissue specimen. There may be more DCIS than originally thought, meaning that a lumpectomy might not be adequate to remove all areas of DCIS. If the area of DCIS is large, relative to the size of your breast, lumpectomy may produce unacceptable cosmetic results.
You're not a candidate for radiation therapy. Radiation is usually given after a lumpectomy. You may not be a candidate if you're diagnosed in the first trimester of pregnancy, you've received prior radiation to your chest or you have a condition that makes you more sensitive to the side effects of radiation therapy.
You prefer to have a mastectomy rather than a lumpectomy for any reason. For instance, you might not want a lumpectomy if you don't want to have radiation therapy. Or if you're a BRCA gene carrier, you might opt for preventive mastectomy to reduce your risk of breast cancer.
Surgery for DCIS typically doesn't involve removal of lymph nodes from under your arm because it's a noninvasive cancer. The chance of finding cancer in the lymph nodes is extremely small. If tissue obtained during surgery leads your doctor to think cancer may have spread outside the breast duct, he or she may then recommend a sentinel node biopsy or removal of some lymph nodes.

Radiation therapy
Radiation therapy after lumpectomy reduces the chance that DCIS will come back (recur) or that it will progress to invasive cancer. Radiation therapy uses high-energy X-rays to kill cancer cells or damage them to the point where they lose their ability to grow and divide. Because cancer cells multiply rapidly, they're more vulnerable to the effects of radiation than are normal cells. A type of radiation therapy called external beam radiation is most commonly used to treat DCIS.

Radiation might not be needed in selected cases, especially for older women with low-grade DCIS in a very small area of the breast.

Tamoxifen
Tamoxifen (Nolvadex) is a synthetic anti-estrogen hormone shown to be beneficial in the treatment of invasive breast cancer. It's also used as a cancer prevention (chemoprevention) agent for women at high risk of breast cancer. Tamoxifen is only effective against cancers that grow in response to hormones (hormone receptor positive cancers).

Tamoxifen isn't a treatment for DCIS in and of itself, but it can be considered as additional (adjuvant) therapy after surgery or radiation in an attempt to decrease your chance of developing a recurrence of DCIS or invasive breast cancer in either breast in the future. If you choose to have a mastectomy, there's less reason to use tamoxifen. With a mastectomy, the risk of invasive breast cancer or recurrent DCIS in the small amount of remaining breast tissue is very small. Any potential benefit from tamoxifen would apply only to the opposite breast. Discuss the pros and cons of tamoxifen with your doctor.

Factors that influence treatment
Several factors may influence treatment of DCIS. Researchers are attempting to identify which women are at high risk of recurrence and which are at low risk, based on the following factors:

Pathologic margins. If cancer cells extend close to the edge of the tissue samples removed during a biopsy, there's a higher likelihood that some cancer cells have been left behind. In such a situation, wide excision — removing a larger area of breast tissue — or a mastectomy may be necessary.
Tumor size. A small tumor has a better chance of being adequately removed with lumpectomy than does a larger tumor.
Grade. In DCIS, grade refers to the appearance of the control centers (nuclei) of the cells. If, when examined under a microscope, the nuclei appear fairly similar to the nuclei of normal cells and very few cells are dividing, the tumor is low grade. If the nuclei are markedly different from the nuclei of normal cells, or if they're dividing rapidly, or both, the tumor is high grade. High-grade tumors have a higher rate of developing into invasive breast cancer than do low-grade tumors.
Cell structure. Two major subtypes of DCIS are distinguished by the structure of their cells. One type is characterized by large, atypical cells with a central area of dead or degenerating cells (comedo necrosis). The other type is characterized by the lack of these qualities. The presence of comedo necrosis generally signifies a more aggressive lesion. Tumors with comedo necrosis have a higher rate of recurrence than do DCIS tumors without comedo necrosis.
Age. If DCIS is diagnosed when you're younger than age 40, you may be at higher risk of recurrence than a woman age 40 or older.

The concept of which cancers behave differently is long established. The same is true for breast cancer.

When a woman feels a lump, or undergoes a screening mamogram and a lesion is discovered, that is the approproatwe time to discuss differential diagnosis, further testing options, such as to biopsy or not, and to discuss treatments.

There is plenty of information on the inter net from primary sources rather than media synposis of serious diseases.

http://www.webmd.com/breast-cancer/ductal-carcinoma-invasive-in-situ
What is ductal carcinoma in situ?
One out of every five new breast cancer diagnoses each year is ductal carcinoma in situ (DCIS). This is an uncontrolled growth of cells within the breast ducts. The phrase "in situ" means "in its original place." This cancer is noninvasive and has not yet made it to breast tissue outside of the ducts.

Ductal carcinoma in situ is the earliest stage at which breast cancer can be diagnosed. It's known as Stage 0 breast cancer. The prognosis for women diagnosed with this form is excellent. The vast majority of cases of ductal carcinoma in situ are curable.

Even though ductal carcinoma in situ is noninvasive, it is imperative that women with the disease receive medical treatment. Experts believe that one out of every three women with untreated DCIS will later develop invasive breast cancer.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1557717

Breast Cancer Res. 2006; 8(2): 204.
Published online 2006 April 21. doi: 10.1186/bcr1397. PMCID: PMC1557717

Copyright © 2006 BioMed Central Ltd
Overdiagnosis and overtreatment of breast cancer: Progression of ductal carcinoma in situ: the pathological perspective
J Louise Jones1
1Tumour Biology Laboratory, Institute of Cancer, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, UK


Epidemiological, histopathological and genetic studies have provided compelling evidence to support the concept that DCIS represents the precursor of invasive carcinoma in the majority of cases. In recent years, this 'model of progression' of breast cancer has been further refined with the recognition and characterisation of earlier precursor lesions, such as atypical ductal hyperplasia and the columnar cell lesions <3>.
Because the aim of screening is to detect and treat disease in its early stages in order to prevent life-threatening disease, it could be argued that DCIS (and maybe even earlier lesions) represents the ideal target in a strategy to prevent invasive breast cancer.
This makes the assumption that all DCIS will inevitably progress to invasive carcinoma; however, much about the behaviour of DCIS is still poorly understood because opportunities to study its natural history are limited. Over recent years, large clinical trials and follow-up on several important studies in which patients received diagnostic biopsy alone as treatment for their DCIS have provided further insight into the behaviour of this disease. The latter studies, which are biased towards lower-grade lesions, show that, untreated, up to 50% of DCIS lesions progress to invasive disease, and that the time for progression may be up to four decades <4,5>. Conversely, this also indicates that half of these lesions do not progress to invasive disease within a woman's lifetime. The challenge is to define better ways of quantifying the risk of progression for individual lesions in order to better tailor treatment decisions.

<snip>

The studies to date indicate that DCIS of all grades has the potential to progress, though high-grade lesions progress more rapidly than lower grade lesions and are more likely to lead to metastatic disease and death. Long-term follow-up studies have further stratified disease behaviour and led to the identification of lesions that exhibit significantly lower progression potential, such as flat cell atypia, and it is clear that these should be treated differently to DCIS. Given the different behaviour of low and high grade DCIS, both in terms of leading to life-threatening disease and in the time for evolution of the disease, it would appear warranted to tailor treatment more closely to disease type, with less aggressive therapy for low grade lesions. However, the challenge remains to accurately identify the small number of low-grade lesions likely to progress in order to provide the most appropriate treatment without over-treating the vast majority of patients with lesions that will be cured by breast conserving surgery alone

This is complicated and serious material of importance to any woman ( or man, as 10% of breast cancer affects men, if I recall) and the decision to undergo mammography and self screening should be made with the understanding of all of the facts and even a look at the medical literature followed by a forthright discussion with one's health care providor. The decision to undergo treatment is also a very personal one and should be preceded by a detailed discussion of the alternatives, benefits, risks and rewards.

[JenniferJuniper]

18. You have missed my point.

"Yup, tell a person to sit tight, you may be the lucky one, your lump may be a cancer and it may be a low grade malignancy, and if we wait till the lump is bigger and it is one of the low grade cancers it."

No one is saying that. Even if up to 80% (the figures vary) of ductal carcinoma in situ will not be ultimately life-threatening, most women, of course, once diagnosed would not want to wait around and hope for the best. But what harm - both psychological and physical - is being done to the up to 80% that didn't need aggressive treatment?

Point one is that mammograms (and for different reasons, MRIs) are a lousy screening tool for many reasons which I won't further delineate here. But it's a billion dollar industry that is, as all profit-making businesses, looking to keep itself sustained. Hence the non-stop "early detection is the best prevention" propaganda.

Leading into point two - which is where we started - does early detection really as much good as claimed in the case of most breast cancers? Yes, lives are saved. But it's nothing along the lines of what the Cancer and Mammography Industries (and oh, yes, they are industries) would have us believe. And this must be balanced with an understanding of the harm that over-diagnosing and over-treatment can cause.

Just a few weeks ago, a new (and controversial) study found that up to 22% of breast cancers will resolve on their own. You can read about it here: http://www.medpagetoday.com/HematologyOncology/BreastCancer/11898

And finally, I completely agree with your statement "The decision to undergo treatment is also a very personal one and should be preceded by a detailed discussion of the alternatives, benefits, risks and rewards." But I reiterate that we should be demanding more. More focus on TRUE prevention. Better screening tools. And better information and education about the over-diagnosis scenario.

[bluedawg12]

19. I'm not sure.

But, I'll give this another try.

>>No one is saying that. Even if up to 80% (the figures vary) of ductal carcinoma in situ will not be ultimately life-threatening, most women, of course, once diagnosed would not want to wait around and hope for the best. But what harm - both psychological and physical - is being done to the up to 80% that didn't need aggressive treatment? - JenniferJuniper <<

I’m not talking about treatment at all. I am talking about having as many tools as possible to monitor breast health. I am talking about getting to the point of knowing if there is or is not a tumor and then, determining what the tumor is and how it will likely behave.

Whether to treat it or not, or to treat it aggressively is not the discussion we are having.

The discussion was about mammography.
...........
JenniferJuniper (697 posts) Sat Mar-07-09 04:10 PM
4. Mammograms do not prevent cancer so the statement that undergoing fewer of them might cause higher rates of cancer is misleading.


bluedawg12 (1000+ posts) Sat Mar-07-09 11:07 PM
Response to Reply #4
7. Mammograms are a diagostic tool for early detection of breast cancer
early detection means that when the diagnosis is made it is less likely to be in a later stage with metastasis.
The correct statement should have read:"Research has shown that lesbians undergo fewer mammograms than heterosexual women and perhaps as a consequence, may suffer higher rates of late stage breast cancer , she said.
...........

>>Point one is that mammograms (and for different reasons, MRIs) are a lousy screening tool for many reasons which I won't further delineate here. - JenniferJuniper <<

OK, that’s disappointing, because it started to get interesting, because, while most people would know that they are not 100% able to detect all forms and all stages of breast cancer, is the issue then that there is something better, or that, in your opinion they are minimally effective, or not at all effective? That’s disappointing that you would not delineate.

>>Leading into point two - which is where we started - does early detection really as much good as claimed in the case of most breast cancers? Yes, lives are saved. - - JenniferJuniper <<

“ Lives are saved,” that’s pretty much my area of interest in this discussion. Are lives saved? Are lives saved at a rate that makes the screening what? Cost effective? Or is it that the yield of diagnosis is so low that it is medically meaningless? What are you saying?

>>And this must be balanced with an understanding of the harm that over-diagnosing and over-treatment can cause. - JenniferJuniper <<

This is true and this is phase two and as I said earlier, making a diagnosis is the first step. A very personal step and one that is mitigated by unique personal health history and a discussion with your health care provider.

Please note, I have not made any suggestions about who should get mammograms, how often, or why, because that is a personal decision made with your health care provider.

OK, for the sake of discussion, let’s assume there is a diagnosis, then what is to be done?

Well, my first thought is that a mammogram alone is not sufficient to make a diagnosis, so one of several things will happen.

a.) Do nothing, observe and perhaps repeat the mammogram in six months, a year or two. Again many variables.

b.) Recommend an additional test. Perhaps an ultrasound or MRI.

c.) Recommend a biopsy.

My thought, at each step of the way, from a through c, ask for a diagnosis in writing and if necessary a second opinion from either an oncologist or breast surgeon. Or, simply take the piece of paper home with the diagnosis and look up the diagnosis and educate yourself on the term, including the various types of breast cancer, their diagnoses, symptoms, tests and treatments.


The same thing holds true in the event that G-d forbid a histopathologic diagnosis is made and confirms one of the variety of breast cancers. Take the path report home and get a clear diagnosis in writing, and go home and read as much as you can to be self informed before deciding on treatment. A few days of rest away from a clinical setting, a chance to think calmly and a chance to study the options and then, a return appointment to finalize things.


>>Just a few weeks ago, a new (and controversial) study found that up to 22% of breast cancers will resolve on their own. You can read about it here: http://www.medpagetoday.com/HematologyOncology/BreastCa... - JenniferJuniper<<


No this is completely false. The study did not find that up to 22% of breast cancer will resolve on their own. Here is the abstract for that study and what they conclude. Please note, that “appears” and “that some cancers” and the words “raises the possibility” that
“the natural course of some screen-detected invasive breast cancers is to spontaneously regress.”

That is not at all what you assert: “the study found that up to 22% of breast cancers will resolve on their own. - JenniferJuniper”

That’s wrong and misinformation for any woman reader who may see this and be misled.

Here's what they said:

“Because the cumulative incidence among controls never reached that of the screened group, it appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of 6 years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress.” (1)

This is a preliminary study and they didn't even know the type of cancers they were speculating about.

I hope their research is fruitful. I would like to thin that 20% of any and all breast cancer regresses, but, that is not what that paper said.

Also, you never provided any citations for your generous statement that 80% of ductal carcinoma will not be life threatening. Would you kindly provide a reference for myself and other readers?

“Even if up to 80% (the figures vary) of ductal carcinoma in situ will not be ultimately life-threatening, most women, of course, once diagnosed ...But what harm ...is being done to the up to 80% that didn't need aggressive treatment?”

The journal article I cited, showed that about 50% will likely recur.

“This makes the assumption that all DCIS will inevitably progress to invasive carcinoma; however, much about the behaviour of DCIS is still poorly understood because opportunities to study its natural history are limited.

Over recent years, large clinical trials and follow-up on several important studies in which patients received diagnostic biopsy alone as treatment for their DCIS have provided further insight into the behaviour of this disease.

The latter studies, which are biased towards lower-grade lesions, show that, untreated, up to 50% of DCIS lesions progress to invasive disease, and that the time for progression may be up to four decades <4,5>.

Conversely, this also indicates that half of these lesions do not progress to invasive disease within a woman's lifetime. The challenge is to define better ways of quantifying the risk of progression for individual lesions in order to better tailor treatment decisions.”(2)

It’s not starting at four decades, recurrence can occur in under six years:

“Bijker and colleagues <11> followed up 775 cases of DCIS as part of a randomised clinical trial of breast conserving surgery for DCIS with or without radiotherapy. Recurrence was detected in 125 cases at a median follow-up of 5.4 years: 65 developed recurrent DCIS whilst 60 developed invasive breast cancer.” (2)

You raised some interesting points and did not elaborate.

>>“But I reiterate that we should be demanding more. More focus on TRUE prevention. Better screening tools. And better information and education about the over-diagnosis scenario.” - JenniferJuniper<<

I am asking this on the assumption that you do care, that you may some serious information to impart and that being aware that this is a public forum where you and I are not chatting in private, if you do have some good information on prevention and diagnosis I would ask you to share that for myself as well, as for other readers.

What is TRUE prevention?
What are better screening tools.

I agree about the education regarding over-diagnosis scenario.

Finally, here is a 2008 peer reviewed paper from the UK that found: “The results suggest that the National Breast Screening Programme in East Anglia is achieving a reduction in breast cancer deaths, which is at least consistent with the results from the randomised controlled trials of mammographic screening.” (3)

However, as with most things in medicine, I can also find you one from the year before that says it’s unproven. There are no cook book answers.

Here is a site that covers the different diagnostic techniques:

http://www.radiologyinfo.org/en/sitemap/modal-alias.cfm?modal=MAMMO


Citations:

(1) Arch Intern Med. 2008 Nov 24;168(21):2311-6.

The natural history of invasive breast cancers detected by screening mammography.Zahl PH, Maehlen J, Welch HG.
VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.

BACKGROUND: The introduction of screening mammography has been associated with sustained increases in breast cancer incidence. The natural history of these screen-detected cancers is not well understood. METHODS: We compared cumulative breast cancer incidence in age-matched cohorts of women residing in 4 Norwegian counties before and after the initiation of biennial mammography. The screened group included all women who were invited for all 3 rounds of screening during the period 1996 through 2001 (age range in 1996, 50-64 years). The control group included all women who would have been invited for screening had there been a screening program during the period 1992 through 1997 (age range in 1992, 50-64 years). All women in the control group were invited to undergo a 1-time prevalence screen at the end of their observation period. Screening attendance was similar in both groups (screened, 78.3%, and controls, 79.5%). Counts of incident invasive breast cancers were obtained from the Norwegian Cancer Registry (in situ cancers were excluded). RESULTS: As expected, before the age-matched controls were invited to be screened at the end of their observation period, the cumulative incidence of invasive breast cancer was significantly higher in the screened group than in the controls (4-year cumulative incidence: 1268 vs 810 per 100 000 population; relative rate, 1.57; 95% confidence interval, 1.44-1.70). Even after prevalence screening in controls, however, the cumulative incidence of invasive breast cancer remained 22% higher in the screened group (6-year cumulative incidence: 1909 vs 1564 per 100 000 population; relative rate, 1.22; 95% confidence interval, 1.16-1.30). Higher incidence was observed in screened women at each year of age. CONCLUSIONS: Because the cumulative incidence among controls never reached that of the screened group, it appears that some breast cancers detected by repeated mammographic screening would not persist to be detectable by a single mammogram at the end of 6 years. This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress.

(2) http://www.pubmedcentral.nih.gov/articlerender.fcgi?art...

Breast Cancer Res. 2006; 8(2): 204.
Published online 2006 April 21. doi: 10.1186/bcr1397. PMCID: PMC1557717

Copyright © 2006 BioMed Central Ltd
Overdiagnosis and overtreatment of breast cancer: Progression of ductal carcinoma in situ: the pathological perspective
J Louise Jones1
1Tumour Biology Laboratory, Institute of Cancer, Queen Mary's School of Medicine and Dentistry, Charterhouse Square, London, UK

(3) Br J Cancer. 2008 Jan 15;98(1):206-9. Epub 2007 Dec 4.
A case-control study of the impact of the East Anglian breast screening programme on breast cancer mortality.Allgood PC, Warwick J, Warren RM, Day NE, Duffy SW.
Cancer Research UK Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK. [email protected]

Although breast cancer screening has been shown to work in randomised trials, there is a need to evaluate service screening programmes to ensure that they are delivering the benefit indicated by the trials. We carried out a case-control study to investigate the effect of mammography service screening, in the NHS breast screening programme, on breast cancer mortality in the East Anglian region of the UK. Cases were deaths from breast cancer in women diagnosed between the ages of 50 and 70 years, following the instigation of the East Anglia Breast Screening Programme in 1989. The controls were women (two per case) who had not died of breast cancer, from the same area, matched by date of birth to the cases. Each control was known to be alive at the time of death of her matched case. All women were known to the breast screening programme and were invited, at least once, to be screened. There were 284 cases and 568 controls. The odds ratio (OR) for risk of death from breast cancer in women who attended at least one routine screen compared to those who did not attend was 0.35 (CI: 0.24, 0.50). Adjusting for self-selection bias gave an estimate of the breast cancer mortality reduction associated with invitation to screening of 35% (OR=0.65, 95% CI: 0.48, 0.88). The effect of actually being screened was a 48% breast cancer mortality reduction (OR=0.52, 95% CI: 0.32, 0.84). The results suggest that the National Breast Screening Programme in East Anglia is achieving a reduction in breast cancer deaths, which is at least consistent with the results from the randomised controlled trials of mammographic screening.

.............

[JenniferJuniper]

21. Some delineation for you

Mammograms in all age groups are a very poor screening tool. About 5 percent of mammograms are abnormal or suspicious, and of these 80 to 93 percent are false positives that cause unnecessary anxiety and further procedures, including surgery. If that were not enough to question the reliability of mammograms as a diagnostic tool, consider the unfounded
reassurance that results from the false negatives that occur in 10 to 15 percent of women who
already have breast cancer that will manifest clinically within one year.

In the October 2001 issue of The Lancet, the Nordic Cochrane Centre of Denmark published a follow-up report on its groundbreaking 2000 analysis of the efficacy of screening mammograms in reducing breast cancer death. The new report confirmed the earlier findings. After reviewing the seven largest mammography screening trials, no benefit attributable to mammograms was
found for any age group. The new research focused on the ability of mammograms to reduce total mortality because, as stated by the report’s authors, this is the only “reliable” measure of benefit.

The Danish researchers found numerous flaws in the mammography screening trials.They found that the studies under review did not tally fatal cases that were misclassified or that were triggered by cancer treatment such as radiotherapy.For example, none of the leukemia deaths and cardiac deaths occurring as a result of chemotherapy for breast cancer and none of the increased cases of fatal lung cancer caused by radiation to the breast during diagnosis and
treatment were ever considered in prior studies. Lung cancer is a known late-stage side effect to
breast cancer radiation, and congestive heart failure is a known late side effect of the cardiac toxicity of chemotherapy. The Cochrane researchers found that the studies’ claims that mammograms reduce breast cancer deaths by 25 to 30 percent were invalid, since those
investigators did not consider all other deaths related to breast cancer treatments.

The researchers also found that the studies that claimed to show some benefit from mammograms for women in their fifties and sixties were 1) biased in favor of screening
and 2) incorrect because they only looked at breast cancer mortality,not all-cause mortality. Based on this highly respected review, The Lancet editors concluded,“There is no reliable evidence from large randomized trials to support screening mammography at any age.”

The recent reassessment of the 2000 Cochrane analysis also confirmed that breast cancer screening with mammograms creates an overuse of aggressive treatments. The authors reasoned that the mammograms detect lots of slow-growing tumors that will never progress to
cancer within the patient’s lifetime and classify these as cancer. These account for the mammograms’ so called “successes.” There are cellular changes that may be histologically
cancerous but biologically benign. Carcinoma-in-situ may be treated by bilateral mastectomy even though they will not progress to invasive disease. The flawed studies count these as mammogram successes, when they are not.At the same time, the cancers that are truly invasive are not really caught early enough to make a difference. The patient only appears to live longer because the disease is diagnosed earlier. As stated previously, the same percentage of women are dying at the same ages they were before the widespread use of mammograms. The inescapable conclusion drawn from these carefully performed investigations is that
mammograms do not provide a survival benefit in any age group.Those who benefit are balanced out almost equally by those who are hurt.

[bluedawg12]

22. Tell us about the true prevention and better screening tools

I did ask you some questions about your previous statement that were of interest.

What is TRUE prevention?
What are better screening tools.

You never replied.

I consider this a serious matter, if you have those answers, please provide.

>>Mammograms in all age groups are a very poor screening tool. About 5 percent of mammograms are abnormal or suspicious, and of these 80 to 93 percent are false positives that cause unnecessary anxiety and further procedures, including surgery. If that were not enough to question the reliability of mammograms as a diagnostic tool, consider the unfounded reassurance that results from the false negatives that occur in 10 to 15 percent of women whoalready have breast cancer that will manifest clinically within one year.<<

Is this your opinion? Please cite where these statistics come from?

>>In the October 2001 issue of The Lancet, the Nordic Cochrane Centre of Denmark...<<

Your citation about Lancet does not sound like it is from the Lancet article. Is it?
It appears to be from another derivative news source. Again, where is the link? Who are the authors?
This is not from the Cochran report, nor is it even the latest Cochrane report. It’s out of date.

As I mentioned before in my reply:

“However, as with most things in medicine, I can also find you one from the year before that says it’s unproven. There are no cook book answers.- bluedawg12"

...........

http://www.webmd.com/news/20000106/report-calls-mammography-screening-unjustified

Report Calls Mammography Screening 'Unjustified'
By Daniel J. DeNoon
WebMD Health NewsJan. 6, 2000 (Atlanta) -- The scientific evidence that says women should get regular mammograms is flawed, concludes a hotly debated new report appearing in the current issue of The Lancet. Of the eight clinical studies of mammography screening -- in which a half-million women took part -- the report advises doctors to ignore six "biased" studies and to focus on two trials it says show no benefit for screening.

"We feel that the effect of mammography has not been proved," co-author Peter C. Gøtzsche, MD, tells WebMD. "The two well-done trials did not find any effect, even a trend. We do not say mammography is without effect, we say we could not see an effect. If there is an effect of mammography it is likely to be much smaller than we had previously thought."

The American Cancer Society takes strong exception to these conclusions. In an interview to provide objective comment, ACS chief medical officer Harmon Eyre, MD, dismisses the new data analysis in no uncertain terms. "The ACS continues to recommend that women get regular mammograms," Eyre says. "The most important person to get that done is the physician. We believe that by recommending regular mammograms, U.S. physicians have dramatically reduced breast-cancer mortality. We see no reason for them to stop doing so."

But Gøtzsche, director of the Nordic Cochrane Center in Copenhagen, Denmark, stands by the report. "My personal opinion is that if a woman turned to me for advice and asked me if she should join a mammography screening program, with examinations every second year, I would advise her not to do so," he says.

Eyre could not disagree more. "The American Cancer Society very strongly believes that mammography reduces the mortality rate from breast cancer and that the evidence is incredibly strong in the U.S.," he says. "The paper is arguing they haven't seen the same drop in breast-cancer death rates in other countries that is seen in the U.S., but no other country is doing as frequently or as well as we do it in the U.S."

In an editorial also published in TheLancet, Harry J. de Koning, MD, PhD, from Erasmus University in the Netherlands, suggests that the report is too quick to reject the six trials seen as flawed. "In seven of the eight trials there was clearly a benefit for women age 50 and older," de Koning tells WebMD. "I'm still pretty much convinced that most of the trials were run quite adequately."

Gøtzsche and Ole Olsen reanalyzed the mammography studies when they learned that Sweden 's breast-cancer mortality rate did not decrease since mammography screening began in 1985. Six of the trials, they found, did not properly assign women to the study groups that either got or did not get mammograms.

Report Calls Mammography Screening 'Unjustified'
(continued)
continued...
Gøtzsche and Olsen found that two of the trials, one conducted in Canada and one in Malmö, Sweden, had no serious methodological errors. "We rely on the two trials that did produce comparable groups, because that is the point of randomizing hundreds of thousands of women," Gøtzsche says. "We relied on the two best trials, and that showed no effect of mammography on mortality."

The original results from the Malmö study, which Gøtzsche and Olsen endorse, found no mortality benefit from mammography screening. But Koning points out that updated results published in 1995 indeed show a 26% reduction in breast-cancer mortality for women age 55-69 years who were screened.

Koning also criticizes the Gøtzsche and Olsen analysis for failing to take women's ages into account. "We know from breast cancer screening that it is different for premenopausal vs. postmenopausal women," he says. "One major issue is that with breast cancer screening you have to look at mammograms, and with premenopausal women it is more difficult to detect cancers earlier. There is a real biological difference between these women."

Eyre notes that the authors' focus on randomized trials fails to take into account the vast U.S. experience with mammography screening. "In the U.S. in the 1980s, only 13% of women were getting mammograms and average breast tumor size was 3.2 cm in diameter," he says. "In the late 1990s, when about 75% of U.S. women had a mammography, 60% regularly, average tumor size dropped to 2 cm. ... The death rate from breast cancer has dropped 10 consecutive years. All of these things have happened in large part due to American women receiving mammography. The evidence in favor of mammography is very, very strong."

[bluedawg12]

24. False Positive Mammograms.

http://www.radiologyinfo.org/en/news/newdetarget.cfm?id=3
False Positive Mammograms.
Five percent to 15 percent of screening mammograms require more testing such as additional mammograms or ultrasound. Most of these tests turn out to be normal.

If there is an abnormal finding, a follow-up or biopsy may have to be performed.

Most of the biopsies confirm that no cancer was present.

It is estimated that a woman who has yearly mammograms between ages 40 and 49 has about a 30 percent chance of having a false-positive mammogram at some point in that decade and about a 7 percent to 8 percent chance of having a breast biopsy within the 10-year period.

Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.

What are the limitations of Mammography?
Initial mammographic images themselves are not usually enough to determine the existence of a benign or malignant disease with certainty. If a finding or spot seems suspicious, your radiologist may recommend further diagnostic studies.

Interpretations of mammograms can be difficult because a normal breast can appear differently for each woman. Also, the appearance of an image may be compromised if there is powder or salve on the breasts or if you have undergone breast surgery. Because some breast cancers are hard to visualize, a radiologist may want to compare the image to views from previous examinations. Not all cancers of the breast can be seen on mammography.

Breast implants can also impede accurate mammogram readings because both silicone and saline implants are not transparent on x-rays and can block a clear view of the tissues behind them, especially if the implant has been placed in front of, rather than beneath, the chest muscles Experienced technologists and radiologists know how to carefully compress the breasts to improve the view without rupturing the implant.

When making an appointment for a mammogram, women with implants should ask if the facility uses special techniques designed to accommodate them. Before the mammogram is taken, they should make sure the technologist is experienced in performing mammography on patients with breast implants.

While mammography is the best screening tool for breast cancer available today, mammograms do not detect all breast cancers. Also, a small portion of mammograms indicate that a cancer could possibly be present when it is not (called a false-positive result).

Research is being done on a variety of breast imaging techniques that can contribute to the early detection of breast cancer and improve the accuracy in distinguishing non-cancerous breast conditions from breast cancers.
Results of Large Trial Reveal Certain Women Could Benefit from Digital Mammography
Preliminary results of the Digital Mammographic Imaging Screening Trial (DMIST), one of the largest cancer screening trials ever conducted by radiologists, were published September 16, 2005 by the New England Journal of Medicine and at a meeting of the American College of Radiology Imaging Network (ACRIN). This large-scale, multi-center clinical trial was designed to measure differences in diagnostic accuracy between digital mammography and film mammography, an x-ray examination used to screen for breast cancer.

Film vs. Digital Mammography

Both digital and film mammography use x-rays to produce an image of the breast.
In a film mammogram, the image is created directly on the film; once obtained, it cannot be significantly altered.
A digital system converts the x-rays to a digitized signal to create an electronic image that can be modified and enhanced by the radiologist.

DMIST results showed that, for the entire population of women studied, digital and film mammography had very similar screening accuracy. However, the study revealed that digital mammography was significantly better in screening women in three categories, such as those:

under age 50 (no matter what level of breast tissue density they had).
of any age with very dense or extremely dense breasts.
of any age who are pre- or peri-menopausal women (defined as women who had a final menstrual period within 12 months of their mammograms).
The study's results suggest that for women who fall into these three subgroups, digital mammography may be better than conventional film mammography at detecting breast cancer.

Considerations for Women Seeking Mammography
DMIST showed that there is no apparent benefit of digital mammography over film mammography for women who:

are over age 50.
do not have dense or very dense breast tissue.
are no longer menstruating.
Women who fit these categories should continue to undergo screening mammography per the advice of their physician and the guidelines of national health organizations (see below).

According to the DMIST trial results, women under age 50 (regardless of breast tissue density), women of any age with very or extremely dense breasts and pre-and peri-menopausal women of any age are likely to benefit from earlier detection of breast cancer if they undergo digital mammography instead of film mammography.

However, only 8 percent of breast imaging units in the United States currently provide digital mammography. Women who would like to have digital mammograms can ask their doctors or contact local hospitals or imaging centers to determine if digital mammography is available in their area.

It is important that women not defer screening with mammography due to a lack of access to digital mammography. Film mammography has been successfully used for over 35 years and continues to be the best screening tool for breast cancer available.

The National Cancer Institute recommends that:

Women age 40 and over should be screened every one to two years with mammography.
Women who are at a higher than average risk for breast cancer should seek expert medical advice about whether they should begin screening before age 40 and how often they should undergo a screening mammogram.
About the Trial
Begun in October 2001, DMIST enrolled 49,528 women at 33 sites in the United States and Canada who had no signs of breast cancer. Participants had both digital and film mammograms interpreted by two different certified radiologists and were asked to return in one year for their annual mammogram. Breast cancer diagnoses were confirmed by a breast biopsy performed within 15 months after a participant's entry into the study or a follow-up mammogram performed at least 10 months after entry into the study.

The American College of Radiology Imaging Network (ACRIN) coordinated the study. ACRIN, a Cooperative Group sponsored by the Division of Cancer Treatment and Diagnosis at the National Cancer Institute (NCI), is a network of physicians, scientists, and medical institutions that have joined together to conduct clinical trials of new medical imaging technologies. The DMIST was led by Etta D. Pisano, M.D., of the Department of Radiology and Biomedical Engineering, the Biomedical Research Imaging Center and the Lineberger Comprehensive Cancer Center of the University of North Carolina at Chapel Hill.

The Need for DMIST
DMIST is one of several major studies currently underway to determine whether other diagnostic modalities, including digital mammography, can contribute to the early detection of cancer and prevent deaths from the disease. It is estimated that 211,240 women will be diagnosed with breast cancer in the United States this year, and that more than 40,000 will die of the disease.

Death rates from breast cancer have been declining since 1990; a decrease believed to be the result, in part, of earlier detection and improved treatment. However, mammograms do not detect all cancers. Studies have suggested that approximately 10 to 20 percent of breast cancers detected by breast self- or physical examination are not visible on film mammography. The sensitivity of film mammography is somewhat limited in women with dense breasts, which is a population at higher risk for breast cancer. DMIST and other studies are trying to determine what technologies can effectively supplement mammography, especially for high-risk women.

Cancer Detection during DMIST
The Digital Mammography Advantage

http://www.radiologyinfo.org/en/news/newdetarget.cfm?id=3

According to DMIST researchers, the trial's results are understandable in light of the technical advantages of digital mammography over film mammography. In a digital image, the x-ray transmission can be manipulated to visually enhance subtle structural changes in tissue throughout the breast. For mammograms, the most problematic areas are those in which cancers can be hidden by adjacent dense tissue. Digital mammography is able to enhance visibility by increasing the image contrast between lesions or small clusters of calcifications and the surrounding tissue.

During the course of DMIST, including the initial screening and follow-up, 335 women were diagnosed with cancer. In general, cancers detected by either film or digital mammography were similar in microscopic structure and stage (how advanced they were).

However, digital mammography detected more advanced or serious breast cancers in women under age 50, women with dense or extremely dense breasts, and in pre- and peri-menopausal women. Lesions missed by film mammography but detected by digital mammography within these three subgroups included many invasive cancers and medium- and high-grade in situ lesions.

In situ lesions in the breast are those confined to the breast duct without invading the surrounding breast tissue and are known as ductal carcinoma in situ (DCIS). Many of these cancers were confined to the breast at diagnosis and had not yet spread to the lymph nodes under the arm. These are lesions that must be detected early to save more lives through screening.

Additional Results of DMIST
Secondary goals of the DMIST study include measurement of the:

Relative cost-effectiveness of both digital and film technologies; digital systems currently cost approximately 1.5 to 4 times more than film systems.
Effect on participant quality of life due to the expected reduction of false positive test results.
The results of these parts of the study are still under analysis and will be presented at a later date.

For more information on digital mammography, see:
"Full-Field Digital Mammography: A Potential Alternative to the Traditional Film-Screen Technique?"
http://RadiologyInfo.org/en/news/newdetarget.cfm?id=1
National Cancer Institute: Digital vs. Film Mammography Q&A http://www.nci.nih.gov/newscenter/pressreleases/DMISTQandA

[bluedawg12]

8. lesbians and bisexual women: less likely to have health insurance

Am J Public Health. 2001 Apr;91(4):591-7.
Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women.Cochran SD, Mays VM, Bowen D, Gage S, Bybee D, Roberts SJ, Goldstein RS, Robison A, Rankow EJ, White J.
Department of Epidemiology, School of Public Health, Center for Health Sciences, University of California, Los Angeles, Box 951772, Los Angeles, CA 90095-1772, USA.

OBJECTIVES: This study examined whether lesbians are at increased risk for certain cancers as a result of an accumulation of behavioral risk factors and difficulties in accessing health care. METHODS: Prevalence estimates of behavioral risk factors (nulliparity, obesity, smoking, and alcohol use), cancer screening behaviors, and self-reported breast cancer histories derived from 7 independently conducted surveys of lesbians/bisexual women (n = 11,876) were compared with national estimates for women. RESULTS: In comparison with adjusted estimates for the US female population, lesbians/bisexual women exhibited greater prevalence rates of obesity, alcohol use, and tobacco use and lower rates of parity and birth control pill use. These women were also less likely to have health insurance coverage or to have had a recent pelvic examination or mammogram. Self-reported histories of breast cancer, however, did not differ from adjusted US female population estimates. CONCLUSIONS: Lesbians and bisexual women differ from heterosexual women in patterns of health risk. These women would be expected to be at especially greater risk for chronic diseases linked to smoking and obesity.

[readmoreoften]

9. My SO won't take her clothes off at the doctors.

She is masculine identified and can't handle a breast example. I'd say about 50% of the folks I know have serious issues of discomfort at medical facilities and I've seen some maltreatment.

[bluedawg12]

10. That's why I am relieved to hear about work being done in this field

all populations have subsets.
We study men and we study women. We study by ethnic heritage because some diseases are either more prevalent or exclusive to one group or another.

At last, we have a group that studies gay women/lesbians.

The problems are unique on some levels and you just mentioned one.

It can be awkward just to get the message out that for example: "I am not in need of a pregnancy test because I am exclusively a lesbian." The fear is judgementalism from a health care provider.

Or for a woman to be called into an exam room as "Your'e next, Sir." That's another scenario that comes to mind that could bring real apprehension into going to a clinic.

I was reading about elder care for gays (m/f) and many don't get proper care because of fear or prejudice, or actual prejuice and abuse.

How can anyone not imagine that pervasive societal prejudices don't seep into a human being's everyday day life and every aspect of that life, from health care, to marriage rights, to walking down the street?

I am very pleased with this group at UCSF, it's about time. I hope they get some decent funding now that anti-science rwing chimperator is gone.

[bluedawg12]

11. This seems useful for L/Bi women.

Am Fam Physician. 2006 Jul 15;74(2):279-86.Links

Primary care for lesbians and bisexual women.Mravcak SA.
University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Department of Family Medicine, New Brunswick 08903, USA. [email protected]

For the most part, lesbians and bisexual women face the same health issues as heterosexual women, but they often have difficulty accessing appropriate care. Physicians can improve care for lesbians and bisexual women by acknowledging the potential barriers to care (e.g., hesitancy of physicians to inquire about sexual orientation and of patients to disclose their sexual behavior) and working to create a therapeutic physician-patient relationship. Taking an inclusive and nonjudgmental history and being aware of the range of health-related behaviors and medicolegal issues pertinent to these patients enables physicians to perform relevant screening tests and make appropriate referrals. Some recommendations, such as those for screening for cervical cancer and intimate partner violence, should not be altered for lesbians and bisexual women. Considerations unique to lesbians and bisexual women concern fertility and medico-legal issues to protect familial relationships during life changes and illness. The risks of suicidal ideation, self-harm, and depression may be higher in lesbians and bisexual women, especially those who are not open about their sexual orientation, are not in satisfying relationships, or lack social support. Because of increased rates of nulliparity, the risks of conditions such as breast and ovarian cancers also may be higher. The comparative rates of alcohol and drug use are controversial. Smoking and obesity rates are higher in lesbians and bisexual women, but there is no evidence of an increased risk of cardiovascular disease.

[Pacifist Patriot]

15. I once had a lesbian approach me about starting a healthy-lifestyles group at my church...

When she told me lesbians "smoke more, drink more, abuse drugs more often, and have more fat around their midsections," I asked her why she thought that might be. What she told me made perfect sense, particularly in light of the recent theories relative to evolutionary psychology.

What is the best way to spurn advances of potential boyfriends as teenagers? Become unattractive so as not to gain their attention in the first place. I think that might be a bit of a broad brush but she may be on to something. Efforts to fly under the pubescent male radar may create lifelong habits that undermine health.

Of course, coping emotionally with a sense of Self that family, friends, society tells you are fundamentally wrong may have a bit to do with self-destructive behaviors as well. I think in the long run the best course of action to optimize physical health is the core understanding on the part of all humans that lesbianism is perfectly natural and nothing that must be compensated for.

[bluedawg12]

16. Good health habits are of vital importance to gay men and women: smoking.

Your experience was pretty interesting and it does lead to another line of thought, or hypothesis: creating a barrier or shield against unwanted, hostile, or aggressive heterosexual male advances.

I think we could see how this might be the exact opposite situation for gay men in so far as advances from other males would not be off putting ( of course I do not mean hostile advances) and their concerns about the opposite scenario, unwanted sexual advances from females still carries with it less physical threat, maybe annoyance, than for say, a teenage lesbian being sexually harassed by a group of teenage males.

On the other hand, the same may also be asked of anyone who suffers from obesity, namely, is it some form of defense or barrier to intimacy? That's rhetorical and I am aware of diet, genetics, socioeconomic variables, still, it is a question worth merit on a behavioral level.

Of course a lot these studies are preliminary and remind me of the old saying, you can't prove anything in science, you can only disprove it. (Ok, not an old saying, I just made it up, but it does come from something I was reading about recently related to scientific method.)(1)

The point is, try to understand things and do research and when you do get results, question the heck out of them.

So, I start with the premise that lesbians smoke more and drink more than their heterosexual counterparts. From the little I have read from peer reviewed published papers, I accept it, but I reserve the right to revisit and challenge it. Why? Because I suspect and have read, that, "existing research on sexual orientation and alcohol use is characterized by a plethora of methodological problems." (2)

Also, another recent study measured alcohol-related problems. "The hypothesis that a positive relationship exists was partially supported for lesbians, but generally not supported for males." (3) So, the most this study states is that it is only a hypothesis and partially supported by that particular study.

There are other variables, for example gay youth and smoking, as opposed to gay adults: Few meaningful differences in tobacco use were related to sexual identity. The remarkably high levels of cigarette smoking in the sample highlights the need for prevention and cessation resources.(4)

Here’s a study that looks for causes of smoking in GLBT youth:
“In conclusion, smoking is a pervasive problem among LGBT youths. The findings corroborate prior explanations and implicate new ones. Some risks (e.g., limited opportunities to socialize with LGBT peers outside of smoking venues, the desire to appear more masculine, and sexuality-related stress) and resiliency factors (e.g., positive sexual identity) are unique to LGBT populations, reinforcing the need for culturally specific approaches to prevention and cessation. Highlighting the positive attributes of nonsmokers and nonsmoking might prove useful in prevention campaigns.” (5)

Here’s a study that looks at some social and cultural reasons why smoking may be tolerated in the gay community and by the “leaders” in the gay community:
“They saw smoking as a personal choice and individual right rather than as a health crisis fuelled by industry activities. As such, they were reluctant to judge a legal industry, fearing it might lead to having to evaluate other potential funders. They saw tobacco control as divisive, potentially alienating their peers who smoke. “ (6)

How about this for a mind game: If they, the tobacco industry target us, we must be real and legitimate and we are no longer marginalized. “ Focus group participants often responded positively to tobacco company targeting. Targeting connoted community visibility, legitimacy, and economic viability. Participants did not view tobacco as a gay health issue. Targeting is a key aspect of corporate-community interaction. (7)

I think it is prudent to pay attention to this data because it does signal behavioral choices that adversely impact health and quality of life. We cannot chose to be gay or not, but we can chose to abuse tobacco, alcohol or drugs, or not.

At the same time, it is important to note that this data is still to a large extent preliminary and even if true, the underlying causes are not fully known for gay versus straight populations.

It is worth mentioning again, that, these behaviors may be a result of social pressures, the desire for peer acceptance, or a response to heterosexism.

It would be wrong to ignore important data about adverse behaviors that can be modified, especially in GLBTQ youth, as with any youth. On the other hand, this all has to be kept in perspective and not internalized by GLBTQ adults and youth, as further confirmation that GLBTQ self worth is low.

Finally, we have to be prepared for the inevitable misuse of this type of data by politically motivated actors who would cherry pick selective data to make negative generalizations about the gay community, as they already do and have done in other regards.

Self education among ourselves and our allies is the first start, as is sending the right message about healthy life choices to our peeps.

I am going to start another reply about the weight issue in lesbians, this is getting pretty long. :)


Citations:
(1) Karl Popper denied the existence of evidence and of scientific method. Popper holds that there is only one universal method, the negative method of trial and error. It covers not only all products of the human mind, including science, mathematics, philosophy, art and so on, but also the evolution of life. - http://en.wikipedia.org/wiki/Scientific_method

(2) Annu Rev Nurs Res. 2005;23:283-325.
Alcohol use and alcohol-related problems among lesbians and gay men.Hughes TL.
Center of Excellence in Women's Health, Chicago, Illinois, USA.

While a substantial amount is known about some of the risk factors for alcohol-related problems among lesbians and gay men, major gaps in knowledge exist. Epidemiological studies focusing on alcohol use rarely ask about sexual orientation, and broad-based studies of sexual minority population groups have only occasionally assessed alcohol use. Although the AIDS crisis has stimulated substantial research on alcohol and other substance use among gay men, only a handful of studies have systematically explored lesbians' use of alcohol. Further, existing research on sexual orientation and alcohol use is characterized by a plethora of methodological problems. Nevertheless, when viewed as a whole, this research suggests that lesbians and gay men are more likely than their heterosexual counterparts to drink alcohol and to report alcohol-related problems; differences based on sexual orientation are more pronounced for women than for men. Risks related to alcohol use do not stem from sexual orientation per se, but are more likely a consequence of cultural and environmental factors associated with being part of a stigmatized and marginalized population. Much of the research on alcohol use among sexual minorities has focused on White, middle-class, and well-educated lesbians and gay men. There is a clear need for more research with bisexual women and men and with sexual minority members of color. Longitudinal studies, including those that focus on treatment effectiveness, are particularly lacking.

(3)Addict Behav. 2006 Jul;31(7):1153-62. Epub 2005 Sep 22. Links
Internalized heterosexism, alcohol use, and alcohol-related problems among lesbians and gay men.Amadio DM.
Department of Psychology, Siena College, Loudonville, New York, 12211, USA.

Research regarding internalized heterosexism in relation to alcohol use and alcohol-related problems has suffered from methodological problems. Moreover, the results of the research have been mixed. The purpose of the current study was to examine internalized heterosexism in relation to alcohol use and alcohol-related problems among a sample of 335 lesbians and gay men recruited through lesbian and gay events, listserves, and friendship networks. Females completed the Lesbian Internalized Homophobia Scale ; males completed the Internalized Homonegativity Inventory . Items from the National Household Survey on Drug Abuse measured alcohol consumption. The Michigan Alcoholism Screening Test and the Drinker Inventory of Consequences measured alcohol-related problems. The hypothesis that a positive relationship exists was partially supported for lesbians, but generally not supported for males.

(4)Am J Prev Med. 2008 Dec;35(6 Suppl):S463-70. Links
Sexual identity and tobacco use in a venue-based sample of adolescents and young adults.Remafedi G, Jurek AM, Oakes JM.
Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota 55403, USA.

(5) Nicotine Tob Res. 2007 Jan;9 Suppl 1:S65-71.
Lesbian, gay, bisexual, and transgender youths: who smokes, and why?Remafedi G.
Department of Pediatrics, University of Minnesota, Minneapolis, MN 55403

(6) Cult Health Sex. 2008 Feb;10(2):143-57.
Is tobacco a gay issue? Interviews with leaders of the lesbian, gay, bisexual and transgender community.Offen N, Smith EA, Malone RE.
School of Nursing, University of California San Francisco, San Francisco, CA 94143, USA.

This study examined the extent of tobacco industry funding of lesbian, gay, bisexual and transgender (LGBT) organisations and whether leaders of these organisations thought tobacco was a priority health issue for their community. We interviewed leaders of 74 LGBT organisations and publications in the USA, reflecting a wide variety of groups. Twenty-two percent said they had accepted tobacco industry funding and few (24%) identified tobacco as a priority issue. Most leaders did not perceive tobacco as an issue relevant to LGBT identity. They saw smoking as a personal choice and individual right rather than as a health crisis fuelled by industry activities. As such, they were reluctant to judge a legal industry, fearing it might lead to having to evaluate other potential funders. They saw tobacco control as divisive, potentially alienating their peers who smoke. The minority who embraced tobacco control saw the industry as culpable and viewed their own roles as protecting the community from all harms, not just those specific to the gay community. Lesbian, gay, bisexual and transgender tobacco-control advocates should reframe smoking as an unhealthy response to the stresses of homophobia to persuade leaders that tobacco control is central to LGBT health.

(7) Am J Public Health. 2008 Jun;98(6) 996-1003. Epub 2008 Apr 29.
"If you know you exist, it's just marketing poison": meanings of tobacco industry targeting in the lesbian, gay, bisexual, and transgender community.Smith EA, Thomson K, Offen N, Malone RE.
Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA 94118, USA.

In the public health literature, it is generally assumed that the perception of "targeting" as positive or negative by the targeted audience depends on the product or message being promoted. Smoking prevalence rates are high among lesbian, gay, bisexual, and transgender (LGBT) individuals, but little is known about how they perceive tobacco industry targeting. We conducted focus groups with LGBT individuals in 4 US cities to explore their perceptions. Our findings indicated that focus group participants often responded positively to tobacco company targeting. Targeting connoted community visibility, legitimacy, and economic viability. Participants did not view tobacco as a gay health issue. Targeting is a key aspect of corporate-community interaction. A better understanding of targeting may aid public health efforts to counter corporate disease promotion.

[bluedawg12]

37. I once had a lesbian approach me ...

ooops. wrong thread. :evilgrin:

:rofl:

[bluedawg12]

17. Health, exercise and weight in lesbians.

Several studies point to the fact that lesbians are at greater risk for obesity than their heterosexual counterparts. I wonder why. I wonder what research has been done other than pointing this out as a demographic finding.

It maybe a simple fact of not knowing how to eat properly.

“Sexual orientation is an important demographic factor that has been suggested to affect engagement in health-related behaviors, and interventions developed for the general population of women are likely to be less effective in assisting sexual minority women to make healthy choices. We conducted seven focus groups with sexual minority women (i.e., lesbians and bisexual women) to explore issues, including barriers and motivations, regarding healthy eating, physical activity, and weight in this population. The participants reported a wide range of levels of engagement in health-related behaviors. While nearly all of the participants reported some awareness of the importance of good dietary choices, the majority reported some confusion about what constitutes a healthy diet. (1)

Another variable is socioeconomic status. “Body weight is inversely related to socioeconomic status (SES) in women in the United States (U.S.). Reasons for the social differential in weight are poorly understood. (2)”

When reporting on obesity in lesbians, the socioeconomic status of the gay women being studied has to be taken into consideration.

Being a woman is a risk factor for weight gai and obesity, certainly, and even when a higher socioeconomic group with higher levels of education are studied, obesity is a concern for later in life, as shown in a report on healthy, active, college women.

“The years between ages 18 and 24 are a critical time in the lives of young women. During this period, they develop physical activity and nutrition habits that will affect their health across the life span....Health teaching in the areas of physical activity and dietary habits may be useful even in young women who appear to be healthy, are of normal weight, and are physically active. Poor dietary habits, if unattended, may eventually contribute to the development of obesity and related illnesses.(3)”

Another study looked at childhood sexual abuse and obesity in lesbians and found a positive correlation.

“Our goal was to examine the association between childhood sexual abuse (CSA) and obesity in a community-based sample of self-identified lesbians. ...After adjusting for age, race/ethnicity, and education, women who reported CSA were more likely to be obese (odds ratio, 1.9; 95% confidence interval, 1.1-3.4) or severely obese (odds ratio, 2.3; 95% confidence interval, 1.1-5.2).

DISCUSSION: Our findings, in conjunction with the available literature, suggest that CSA may be an important risk factor for obesity. Understanding CSA as a factor that may contribute to weight gain or act as a barrier to weight loss or maintenance in lesbians, a high-risk group for both CSA and obesity, is important for developing successful obesity interventions for this group of women.” (4)

This study did confirm a higher rate of obesity in lesbians and found that it was “more than twice the odds of (being) overweight” but did not study causation.

“Adjusted multinomial logistic regression analyses showed lesbians have more than twice the odds of overweight (odds ratio =2.69; 95% confidence interval =1.40, 5.18) and obesity (OR=2.47; 95% CI=1.19, 5.09) as heterosexual women. Bisexuals and women who reported their sexual orientation as "something else" (besides heterosexual, lesbian, or bisexual) showed no such increase in the odds of overweight and obesity.” (5)

This study looked at correlates of obesity and exercise frequency among lesbians and bisexual women. BMI = body mass index.

“Prevalence of overweight and obesity among lesbians varied by racial/ethnic background. Higher BMI was associated with older age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency. Higher BMI, perceptions of being overweight, and reporting a limiting health condition were identified as independent predictors of infrequent exercise.” (6)

Going back to the issue of sexual abuse, here is a study that shows “disparities in child abuse victimization in lesbian, bisexual, and heterosexual women.”

“A growing body of research documents multiple health disparities by sexual orientation among women, yet little is known about the possible causes of these disparities. One underlying factor may be heightened risk for abuse victimization in childhood in lesbian and bisexual women.”

“Results showed strong evidence of elevated frequency, severity, and persistence of abuse experienced by lesbian and bisexual women. Comparing physical abuse victimization occurring in both childhood and adolescence. This study documents prevalent and persistent abuse disproportionately experienced by lesbian and bisexual women.” (7)

What about the psychological impact of discrimination against sexual minorities?
This study showed that, “lesbians and gay men are at higher risk for stress-sensitive psychiatric disorders than are heterosexual persons.” (8) Whether there is a direct correlation to health risks such as obesity is speculative at this stage of my review, but it does seem intuitively likely.

“Homosexual and bisexual individuals more frequently than heterosexual persons reported both lifetime and day-to-day experiences with discrimination. Approximately 42% attributed this to their sexual orientation, in whole or part. Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity in the total sample. Controlling for differences in discrimination experiences attenuated observed associations between psychiatric morbidity and sexual orientation. CONCLUSIONS: Higher levels of discrimination may underlie recent observations of greater psychiatric morbidity risk among lesbian, gay, and bisexual individuals.” (8)

I seems the obesity in the lesbian population is linked to other variables, thee are probably more, but this is all I could find in the time I had to search:

socioeconomic status
education level
lack of education or information about good dietary habits
a past history of sexual abuse
discrimination


Citations:

(1) Women Health. 2006;44(1)79-93.
Healthy eating, exercise, and weight: impressions of sexual minority women.Bowen DJ, Balsam KF, Diergaarde B, Russo M, Escamilla GM.
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.

Obesity is a risk factor for multiple disease outcomes, including cancer and cardiovascular disease. A healthy diet and physically active lifestyle can prevent obesity. Sexual orientation is an important demographic factor that has been suggested to affect engagement in health-related behaviors, and interventions developed for the general population of women are likely to be less effective in assisting sexual minority women to make healthy choices. We conducted seven focus groups with sexual minority women (i.e., lesbians and bisexual women) to explore issues, including barriers and motivations, regarding healthy eating, physical activity, and weight in this population. The participants reported a wide range of levels of engagement in health-related behaviors. While nearly all of the participants reported some awareness of the importance of good dietary choices, the majority reported some confusion about what constitutes a healthy diet. In contrast, the majority of participants seemed clearly aware that regular exercise was important for good health. These data can guide the design of effective intervention strategies to improve health behaviors in sexual minority women.

(2) Women Health. 2006;44(1):57-78.
Obesity in low-income rural women: qualitative insights about physical activity and eating patterns.Bove CF, Olson CM.
Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA.

Body weight is inversely related to socioeconomic status (SES) in women in the United States (U.S.). Reasons for the social differential in weight are poorly understood. This investigation sought to understand overweight and obesity from the perspective of low-income mothers living in rural New York State, focusing in particular on challenges to maintaining a healthy weight that may be unique to rural poverty. In-depth interviews with 28 women, who were interviewed 3 times over a 3-year period, were audiotaped, transcribed, and analyzed using the constant comparative method. Findings suggest that transportation difficulties confined some women to their homes, which were physical settings offering little opportunity for physical activity. Food insecurity and associated fluctuating household food supplies contributed to disordered eating patterns and to perceptions of dietary deprivation that affected food intake. Rural isolation contributed to negative emotional states that some women alleviated by eating. This research elucidates factors contributing to obesity among rural, economically disadvantaged women, highlighting the interplay between the structural constraints imposed by rural poverty and women's physical activity, eating patterns, body image, and weight. These insights further the understanding of social inequalities in health and could inform the design of future research aimed at improving the health status of low-income women and families.

(3) J Am Acad Nurse Pract. 2004 Jul;16(7):291-9.
Obesity and physical activity in college women: implications for clinical practice.Clement JM, Schmidt CA, Bernaix LW, Covington NK, Carr TR.
School of Nursing, Southern Illinois University, Edwardsville, USA.

PURPOSE: To investigate the relationships between levels of physical activity, health attitudes and behaviors, and specific health indicators in women attending college. DATA SOURCES: A convenience sample of 116 college women, ages 18 to 24 years, participated in this research study at a moderate-sized midwestern university. The data were obtained through a self-administered questionnaire; trained technicians collected physiological measurements. CONCLUSIONS: The young women in this study had, on average, normal body mass indexes (BMIs) and reported activity levels consistent with or greater than the Centers for Disease Control and Prevention/American College of Sports Medicine guidelines. Items used to assign participants into the appropriate stage of the transtheoretical model of change were correlated with participants' perceived personal physical activity levels. Similarly, the participants, whose scores fell in the higher stages of the transtheoretical model, reported greater levels of physical activity; consumption of more fruits, vegetables, and water; and less consumption of high-fat/high-calorie foods. IMPLICATIONS FOR PRACTICE: The years between ages 18 and 24 are a critical time in the lives of young women. During this period, they develop physical activity and nutrition habits that will affect their health across the life span. Because of the sometimes insidious development of major health problems, young women's current health status may not accurately reflect the possible long- term results of negative health habits. Nurse practitioners (NPs) have many opportunities to identify and address major factors that, if unattended, may threaten the life-long health status of women. Health teaching in the areas of physical activity and dietary habits may be useful even in young women who appear to be healthy, are of normal weight, and are physically active. Poor dietary habits, if unattended, may eventually contribute to the development of obesity and related illnesses.

(4) Obesity (Silver Spring). 2007 Apr;15(4):1023-8.
Association of childhood sexual abuse with obesity in a community sample of lesbians.Aaron DJ, Hughes TL.
Department of Health and Physical Activity, 155 Trees Hall, University of Pittsburgh, Pittsburgh, PA 15261, USA.

OBJECTIVE: Our goal was to examine the association between childhood sexual abuse (CSA) and obesity in a community-based sample of self-identified lesbians. RESEARCH METHODS AND PROCEDURES: A diverse sample of women who self-identified as lesbian was recruited from the greater Chicago metropolitan area. Women (n=416) were interviewed about sexual abuse experiences that occurred before the age of 18. Self-reported height and weight were used to calculate BMI and categorize women as normal-weight (<25.0 kg/m2), overweight (25.0 to 29.9 kg/m2), obese (30.0 to 39.9 kg/m2), or severely obese (>or=40 kg/m2). The relationship between CSA and BMI was examined using multinomial logistic regression analysis. RESULTS: Overall, 31% of women in the sample reported CSA, and 57% had BMI>or=25.0 kg/m2. Mean BMI was 27.8 (+/-7.2) kg/m2 and was significantly higher among women who reported CSA than among those who did not report CSA (29.4 vs. 27.1, p<0.01). CSA was significantly related to weight status; 39% of women who reported CSA compared with 25% of women who did not report CSA were obese (p=0.004). After adjusting for age, race/ethnicity, and education, women who reported CSA were more likely to be obese (odds ratio, 1.9; 95% confidence interval, 1.1-3.4) or severely obese (odds ratio, 2.3; 95% confidence interval, 1.1-5.2). DISCUSSION: Our findings, in conjunction with the available literature, suggest that CSA may be an important risk factor for obesity. Understanding CSA as a factor that may contribute to weight gain or act as a barrier to weight loss or maintenance in lesbians, a high-risk group for both CSA and obesity, is important for developing successful obesity interventions for this group of women.

(5) 1: Am J Public Health. 2007 Jun;97(6):1134-40. Epub 2007 Apr 26. Links
Overweight and obesity in sexual-minority women: evidence from population-based data.Boehmer U, Bowen DJ, Bauer GR.
Department of Social and Behavioral Sciences, Boston University, Boston, Mass 02118, USA.

OBJECTIVE: We sought to determine whether lesbians have higher rates of overweight and obesity than women of other sexual orientations. METHODS: We compared population estimates of overweight and obesity across sexual orientation groups, using data from the 2002 National Survey of Family Growth. RESULTS: Adjusted multinomial logistic regression analyses showed lesbians have more than twice the odds of overweight (odds ratio =2.69; 95% confidence interval =1.40, 5.18) and obesity (OR=2.47; 95% CI=1.19, 5.09) as heterosexual women. Bisexuals and women who reported their sexual orientation as "something else" (besides heterosexual, lesbian, or bisexual) showed no such increase in the odds of overweight and obesity. CONCLUSIONS: Lesbian women have a higher prevalence of overweight and obesity than all other female sexual orientation groups. This finding suggests that lesbians are at greater risk for morbidity and mortality linked to overweight and obesity. This finding also highlights the need for interventions within this population

(6)Prev Med. 2003 Jun;36(6):676-83.
Correlates of overweight and obesity among lesbian and bisexual women.Yancey AK, Cochran SD, Corliss HL, Mays VM.
Department of Community Health Sciences, UCLA School of Public Health, Los Angeles, CA 90095, USA.

BACKGROUND: Recent studies find lesbians at greater risk for overweight and obesity than heterosexual women. While this may reflect differences in attitudes concerning weight and body shape, little is actually known about risk factors within this group. This study examines correlates of obesity and exercise frequency among lesbians and bisexual women. METHODS: Data from a snowball sample (n = 1209) of lesbians/bisexual women living in Los Angeles Country were utilized. Overweight was defined as BMI >/= 25 kg/m(2); obesity as BMI >/= 30. Associations between sociodemographic characteristics, exercise frequency, health indicators, and weight-related measures were evaluated to identify independent predictors of BMI and exercise frequency. RESULTS: Prevalence of overweight and obesity among lesbians varied by racial/ethnic background. Higher BMI was associated with older age, poorer health status, lower educational attainment, relationship cohabitation, and lower exercise frequency. Higher BMI, perceptions of being overweight, and reporting a limiting health condition were identified as independent predictors of infrequent exercise. Women were generally quite accurate in self-perceptions of weight status. CONCLUSIONS: Correlates of overweight and obesity among lesbians and bisexual women are generally comparable to those observed in studies of heterosexual women. Evidence that lesbians' higher BMI is associated with higher levels of fitness is not supported.

(7) J Womens Health (Larchmt). 2008 May;17(4):597-606.
Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses' Health Study II.Austin SB, Jun HJ, Jackson B, Spiegelman D, Rich-Edwards J, Corliss HL, Wright RJ.
Division of Adolescent and Young Adult Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.

BACKGROUND: A growing body of research documents multiple health disparities by sexual orientation among women, yet little is known about the possible causes of these disparities. One underlying factor may be heightened risk for abuse victimization in childhood in lesbian and bisexual women. METHODS: Using survey data from 63,028 women participating in the Nurses' Health Study II, we investigated sexual orientation group differences in emotional, physical, and sexual abuse in childhood and adolescence. Multivariable log-binomial and linear regression models were used to examine orientation group differences in prevalence and severity of abuse, with heterosexual as the referent and controlling for sociodemographics. RESULTS: Results showed strong evidence of elevated frequency, severity, and persistence of abuse experienced by lesbian and bisexual women. Comparing physical abuse victimization occurring in both childhood and adolescence, lesbian (30%, prevalence ratio 1.61, 95% confidence interval 1.40, 1.84) and bisexual (24%, PR 1.26, 95% CI 1.00, 1.60) women were more likely to report victimization than were heterosexual women (19%). Similarly, comparing sexual abuse victimization occurring in both age periods, lesbian (19%, PR 2.16, 95% CI 1.80, 2.60) and bisexual (20%, PR 2.29, 95% CI 1.76, 2.98) women were more likely to report victimization than were heterosexual women (9%). CONCLUSIONS: This study documents prevalent and persistent abuse disproportionately experienced by lesbian and bisexual women.


(8)Am J Public Health. 2001 Nov;91(11):1869-76. Links
Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States.Mays VM, Cochran SD.
Department of Psychology, University of California, Los Angeles 90095-1563, USA.

OBJECTIVES: Recent studies suggest that lesbians and gay men are at higher risk for stress-sensitive psychiatric disorders than are heterosexual persons. We examined the possible role of perceived discrimination in generating that risk. METHODS: The National Survey of Midlife Development in the United States, a nationally representative sample of adults aged 25 to 74 years, surveyed individuals self-identifying as homosexual or bisexual (n = 73) or heterosexual (n = 2844) about their lifetime and day-to-day experiences with discrimination. Also assessed were 1-year prevalence of depressive, anxiety, and substance dependence disorders; current psychologic distress; and self-rated mental health. RESULTS: Homosexual and bisexual individuals more frequently than heterosexual persons reported both lifetime and day-to-day experiences with discrimination. Approximately 42% attributed this to their sexual orientation, in whole or part. Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity in the total sample. Controlling for differences in discrimination experiences attenuated observed associations between psychiatric morbidity and sexual orientation. CONCLUSIONS: Higher levels of discrimination may underlie recent observations of greater psychiatric morbidity risk among lesbian, gay, and bisexual individuals.

[XemaSab]

20. My guess?

Heterosexual women are more worried about their weight than lesbians.

[bluedawg12]

23. Why?

I mean why would you think that?

[XemaSab]

28. It would be my guess that lesbians would be more tolerant of a few extra pounds

than most straight women would guess most straight men to be.

Most straight women I know HATE their bodies and think their bodies are horrible. Part of the worry is that men will see those "imperfect" areas and be grossed out. I would guess that lesbians, having more experience with other women's bodies, would have a more positive self-image and would be less likely to starve themselves to achieve some imagined ideal.

Who knows? Maybe lesbians hate their bodies too. :shrug:

[Zuiderelle]

29. Gay women I know who are overweight hate their bodies just as much as straight women do.

I really cannot believe that straight women are less prone to obesity than gay women simply because of their own self-loathing and fear that men will not find them attractive. If anything, I think it would cause MORE self-loathing and more obesity in straight women if that were the case. Starving oneself, especially if it is to attain the approval of someone else, usually leads to more weight issues (and definitely more health issues) in the long run anyway.

[Vanje]

30. So I guess thats why

there are no overweight heterosexual women.

[bluedawg12]

31. I think it will relate to socioeconomic factors.

It wasn't just a few pounds. It was enough, based on BMI, to be a health risk.

I think in someways all women probably share some basic reasons for being overweight, but, there were specific factors relating to lesbians I found in the studies, namely:

socioeconomic status
education level
lack of education or information about good dietary habits
a past history of sexual abuse
discrimination

If you look at socioeconomic factors for example, women from lower socioeconomic levels have a higher obesity rate across the board.

[XemaSab]

32. That makes sense

Thanks. :)

[bluedawg12]

34. Well, Xema, you did get us thinking!

:P

[Zuiderelle]

25. Straight women who are obese probably have about the same reasons for being obese as gay women.

Assuming that you are inferring that straight women care more about their weight because they care more about being attractive to men. I've never understood that argument. Do you think that gay women aren't interested in being attractive to each other?

This subject is an interesting one and definitely warrants discussion, but I really don't think the specific issue of obesity in gay women can be boiled down to them being less worried about their weight than straight women.

As for health coverage, I think the main factor is that straight women are often covered by their spouse's health insurance, whereas gay women usually have no access at all to partner's insurance, and when they do, it's MUCH more expensive, with additional taxes imposed that amount to thousands of dollars a year. Couple that with the fact that women still make less on average than men, then put two of them together... those are likely the main reasons that lesbians have less health insurance, and therefore more health issues, and less likelihood of getting mammograms, etc.

[bluedawg12]

33. Yes, there are overweight straight women too.

"...lesbians, having more experience with other women's bodies, would have a more positive self-image and would be less likely to starve themselves to achieve some imagined ideal."

I'm not sure that having more experience with other similar bodies really influences self -image either way.

I mean str8 women know female bodies well too, they own one and yet they seem to "hate themselves?"

This is pretty confusing. I think I'll just stick with the old socioeconomic theory. :shrug:

[Vanje]

38. I like your socio-economic theory too.

And from what I know about depression, I'll bet that plays a huge role in health status among gays.

I know from personal experience that I wasnt able to quit nicotine, until I dealt with some depression issues.

Fortunately, I remained svelte and hot through out. But I did get older and more wrinkly. Damn it.

[bluedawg12]

41. Exactly, nicotine does act like an anti-depressant

it keeps certain neurotransitor levels high, if I recall, it was dopamine.

Congrats on quitting.

Certainly for some gay women, depression and isolation in addition to societal prejudice is a big burden and may be expressed in weight gain, and even apathy towards wellness measures like exercise.

There is a lot of research yet to be done, by age, by economic status, by whether or not the woman is in a relationship, has friends, family. We are not monolithic either.

Also, this is one place where I could see a faith community do some good---except of course---most (not all) would exclude such a person for being a lesbian, the very one who could benefit from fellowship.

[Vanje]

26. Sure

And we dont brush our teeth either.


Just this morning, I had fried lard for breakfast. I found a loggers shirt crumpled on the floor. No need to shower before putting it on. I'll eat a carton of MoonPies instead.
Wheres my hairbrush?
No matter, I'll just hide my greasy mullet under an old ball cap.
Now WHERE are those sensible shoes?

[bluedawg12]

27. Please

leave sensible shoes alone!




:rofl:

[XemaSab]

35. I'm straight, and I resemble that description more than I would like!

:hide:

[bluedawg12]

36. On a serious note ( very serious)

aren't we all glad that mullets are out?

:evilgrin:

for the record, I never part took of that trend, but I did like Bill Ray Cyrus' one hit wonder Achy Breaky Heart!

[Vanje]

39. Yes.

Sensible shoes : GOOD

Mullets : BAD

[bluedawg12]

40. Lethal

sensible shoes with a mullet.