Sexual and sexual minority populations remain less likely to receive recommended breast and cervical cancer screening, highlighting ongoing health care disparities and the need for more comprehensive and equitable preventive care.
Study: Disparities in colorectal, cervical, and breast cancer screening in the United States based on sexual orientation and gender identity. Image credit: New Africa/Shutterstock.com
Recent research published in journals cancer We found persistent disparities in breast and cervical cancer screening rates among sexual orientation and gender identity (SOGI) minority groups.
Structural barriers limit equitable access to cancer screening
Almost 10 million people die from cancer each year worldwide. In the United States alone, 1.8 million new cancer cases were reported in 2022, with approximately 54,000 and 42,000 deaths from colorectal cancer and female breast cancer, respectively, in the following year. Cervical cancer has claimed more than 4,000 lives.
The U.S. Preventive Services Task Force recommends routine screening for cervical, breast, and colorectal cancer because effective and inexpensive screening tests are available. However, structural barriers impede equitable access to testing services, including access issues and the influence of social determinants of health.
Sexual orientation and gender identity (SOGI) characterizes several minorities that make up approximately 5.5% of the adult population in the United States. These groups experience health care disparities due to discrimination, too few professionals trained to adequately address SOGI minorities, and systemic differences in health care delivery.
They are more likely to have only public insurance and are thought to have more difficulty accessing health care than others, according to previous research. Discrimination is reported by up to 16%, and this can reduce access to health care for others, as reported by almost 1 in 6 people in this group.
Several risk factors for cancer are more prevalent among SOGI patients due to multiple factors, including structural discrimination, history of sexual abuse, homophobia, and transphobia. Together, these can increase your risk of cancer. Behaviors such as smoking and drinking alcohol, obesity, and even increased vulnerability to viruses such as human papillomavirus (HPV) and HIV. These factors increase the risk of cancer.
In the current study, we aimed to assess how SOGI status is associated with colorectal, cervical, and breast cancer screening rates.
Researchers analyzed screening patterns in diverse populations
The study included 663,924 respondents, of whom only 25.9% answered the optional sexual orientation question and were included in the sexual orientation analysis. Sexual orientation and gender identity questions were asked separately, so different denominators were used in the corresponding analyses.
Most of the participants who responded were heterosexual (24.7%), but 1.2% belonged to the Sexual Orientation Minority (SOM) group and 0.4% identified as Gender Identity Minority (GIM). Gender assigned at birth was 51% female and 68% Caucasian.
Ethnic minorities face additional challenges in accessing health care
SOMs were younger and more likely to be female than heterosexual participants. They were less likely to have insurance (12% vs. 7%, respectively). Approximately 60% have ever been tested for HIV, compared with 37% of heterosexuals and 42% of GIM.
SOM and GIM individuals were more likely to be from racial/ethnic minorities, have lower annual household income, and less likely to have a primary care physician compared to heterosexual participants. However, insurance coverage was similar for GIM individuals.
Of the population analyzed for cancer incidence, 7% and 0.6% identified as SOM and GIM, respectively, 42% were female at birth, and 64% were Caucasian.
Compliance with cancer screening
After adjusting for demographic and health-related factors, sexual orientation minority (SOM) men were 10% more likely than heterosexual men to have received up-to-date colorectal cancer screening. However, a similar association was not observed among SOM women, and no independent association between gender identity minority (GIM) status and colorectal cancer screening adherence was observed.
The most obvious differences were seen in cervical and breast cancer screening. Compared to heterosexual women, SOM women They are 8% less likely to follow cervical cancer screening recommendations and 16% less likely to receive recommended breast cancer screening.
Screening disparities were even greater among people with GIM, who were 42% less likely to receive cervical cancer screening and 76% less likely to receive breast cancer screening than cisgender people.
cancer incidence
Unadjusted analyzes identified some differences in cancer incidence between groups, but these did not hold consistently after adjusting for potential confounders.
Overall, adjusted analyzes found no statistically significant association between SOM or GIM status and cervical or breast cancer prevalence. Similarly, no differences in cancer incidence were observed between cisgender and GIM respondents within either birth sex cohort.
Improving fair cancer screening
The results of this study suggest that the lower screening rates observed among SOGI minority populations are more likely to reflect barriers to preventive care than differences in cancer incidence. To address these disparities, the authors suggest creating a more gender-affirming healthcare environment through inclusive language, revised intake forms, and additional clinician training.
They also suggest that self-collected HPV testing may improve cervical cancer screening uptake in eligible GIM patients. At a broader level, the authors recommend incorporating SOGI questions into national surveys, cancer registries, public health campaigns, and clinical guidelines, as well as expanding insurance coverage so that screening recommendations are based on an individual’s anatomy rather than just gender identity. The authors also call for further research to better understand the factors contributing to poor screening compliance in these populations.
Self-reported data introduced a potential source of bias
This study is observational and confounding by multiple factors such as self-reported data, recall bias, and misclassification errors cannot be excluded. The poorest populations may be underrepresented due to lack of adequate telephone access. The SOGI population was small because this part of the form was optional and provided to participants in specific states and years. No data were collected on gender transition.
Comprehensive testing policies could improve preventive care
According to the authors, it is as follows.
These results highlight persistent gaps in cancer prevention care for the SOGI minority. Further research is needed to elucidate the causes of these disparities and inform targeted interventions that improve equitable access to cancer prevention services.
This finding suggests that screening recommendations should be based on an individual’s anatomy rather than gender identity alone and should be accompanied by more comprehensive preventive care. this This approach could help reduce disparities and support early detection of cancer among sexual and sexual minority populations.
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