Differences in Coping with Breast Cancer between Lesbian and Heterosexual Women: A Life Course Perspective

Background: We tested a theoretical framework to explain differences in coping responses to breast cancer between lesbian and heterosexual women. Materials and Methods: Breast cancer survivors were recruited through cancer registries and community-based sampling. Cross-sectional telephone surveys were completed among self-identified lesbian (n = 330) and heterosexual (n = 595) women who were diagnosed with breast cancer. Five subscales from the Mini-Mental Adjustment to Cancer (Mini-MAC) Scale were used to measure coping with breast cancer among women post-treatment. Mediation analysis was used to examine the explanatory power of life course factors (e.g., parenting and education) in explicating the association between sexual identity and coping responses. Results: Lesbian women had lower mean scores on the anxious preoccupation and cognitive avoidance subscales (p < 0.05). These differences were moderated by age at diagnosis, with differences in anxious preoccupation and cognitive avoidance greater among women diagnosed with breast cancer before 45 years of age. Having children mediated the association between lesbian identity and anxious preoccupation, but only among women diagnosed at younger ages. College education mediated the association between lesbian identity and cognitive avoidance among women diagnosed at older ages. Conclusions: Despite previous evidence of suboptimal cancer care and gaps in supportive services, lesbian women with breast cancer demonstrate adaptive coping. This study calls for an increased focus on life course factors, both in the empirical and theoretical literature, which may partially explain some of this resiliency. Identifying mechanisms that lead to active coping can inform supportive care for both lesbian and heterosexual women.