Sexual orientation and gender identity minority respondents were less likely to report being up to date with recommended cervical and breast cancer screening in an analysis of Behavioral Risk Factor Surveillance System data from selected US states and years.
Researchers analyzed data from the 2018 to 2022 Behavioral Risk Factor Surveillance System and included 663,924 unweighted screening-eligible adult respondents with available sexual orientation or gender identity data, representing a weighted US adult population of approximately 63.9 million. Researchers defined eligibility according to US Preventive Services Task Force recommendations for colorectal, cervical, and breast cancer screening.
The study included respondents eligible for colorectal cancer screening based on age and absence of prior colorectal cancer. Cervical cancer screening analyses included respondents assigned female at birth aged 25 to 64 years without prior cervical cancer or hysterectomy, and breast cancer screening analyses included respondents assigned female at birth aged 40 to 74 years without prior breast cancer.
Screening adherence was self-reported. Colorectal cancer screening adherence included colonoscopy within 10 years; sigmoidoscopy or computed tomography colonography within 5 years; fecal immunochemical testing or fecal occult blood testing within 1 year; or stool DNA testing within 1 to 3 years. Cervical cancer screening adherence included Pap testing within 3 years, human papillomavirus testing, or Pap plus human papillomavirus cotesting within 5 years. Breast cancer screening adherence was defined as mammography within the last 2 years.
Using survey-weighted Poisson regression models adjusted for demographic, socioeconomic, and health care access factors, the researchers found that sexual orientation minority women were less likely than heterosexual women to report recommended cervical and breast cancer screening. The adjusted prevalence ratios were 0.92 for cervical cancer screening and 0.84 for breast cancer screening.
Colorectal cancer screening adherence did not differ by sexual orientation among women. Among men, sexual orientation minority respondents had a modestly higher adjusted prevalence of colorectal cancer screening adherence compared with heterosexual respondents.
Researchers reported larger screening gaps among gender identity minority respondents, although estimates were based on small screening-eligible subgroups. Compared with cisgender respondents, gender identity minority respondents were less likely to report recommended cervical cancer screening and breast cancer screening. The adjusted prevalence ratios were 0.58 and 0.24, respectively. Adjusted colorectal cancer screening adherence among gender identity minority women was lower but did not reach statistical significance, and the estimate was based on a small screening-eligible subgroup.
In exploratory subgroup analyses, female-to-male transgender respondents had lower adherence to colorectal and cervical cancer screening compared with cisgender female respondents. The researchers cautioned that transgender and gender-nonconforming subgroup analyses were limited by small sample sizes.
A Blinder-Oaxaca decomposition analysis of cervical cancer screening among sexual orientation minority vs heterosexual women found an 8.3-percentage-point adherence gap. Measured sociodemographic and health care access characteristics explained 5.3 percentage points, or about 64%, of the disparity; the remaining 3.0 percentage points, or 36%, were unexplained, although the unexplained portion did not reach statistical significance.
Adjusted analyses did not show associations between sexual orientation or gender identity status and cervical or breast cancer prevalence. Colorectal cancer prevalence estimates among gender identity minority female respondents were unstable because no colorectal cancer cases were observed in that subgroup.
In their discussion, the study authors noted that most cancer screening guidelines, including USPSTF recommendations, are sex-specific, and that gender identity minority respondents face documented challenges obtaining insurance coverage tied to sex assigned at birth vs current gender, a structural factor they raised as a possible contributor to gaps in screening services tied to sex-specific eligibility and administrative gender records.
The researchers noted several limitations, including the cross-sectional design, self-reported screening and cancer history, potential recall bias, and possible misclassification of sexual orientation and gender identity. The sexual orientation and gender identity module and cancer screening modules were optional in the Behavioral Risk Factor Surveillance System and were administered only in selected states and years, meaning the analytic sample was not nationally representative of all screening-eligible US adults. Notably, only 25.9% of respondents in states administering the sexual orientation question answered it; the remaining 74.1% were excluded due to individual nonresponse, a gap the researchers identified as a meaningful constraint on the sexual-orientation-stratified analyses. The survey also did not use a two-step measure of sex assigned at birth and current gender identity, and it lacked data on medical or surgical transition and hormone therapy use.
The findings suggest persistent disparities in cervical and breast cancer screening adherence among sexual orientation and gender identity minority respondents.
Disclosures: The researchers reported no conflicts of interest.
Source: Cancer