Sexual orientation and gender identity based disparities in colorectal, cervical, and breast cancer screening in the United States.

Abstract

Sexual orientation and gender identity (SOGI) minorities experience disparities in health care access and quality of care, however national evidence regarding adherence to recommended cancer screening remains limited. This study aimed to evaluate associations between SOGI status and adherence to US Preventive Services Task Force-recommended colorectal, cervical, and breast cancer screening. Adults eligible for colorectal (CRC; 45-74 years old), cervical (25-64 years old), or breast cancer (40-74 years old) screening were identified from the 2018-2022 Behavioral Risk Factor Surveillance System according to guideline-concordant criteria. Respondents were categorized as sexual orientation minorities (SOM) versus heterosexual and as gender identity minorities (GIM) versus cisgender. Univariable results were reported as unweighted frequencies with survey-weighted proportions. Survey-weighted Poisson regression models were used to estimate adjusted prevalence ratios (aPRs) for screening adherence. Among 663,924 unweighted screening-eligible respondents, weighted 1.2% (n = 8108) identified as SOM and 0.4% (n = 2315) as GIM; 33.5% (n = 223,065) were assigned male at birth and 67.9% (n = 522,845) identified as White. After adjustment for covariates, SOM was associated with lower adherence to cervical (aPR, 0.92; 95% CI, 0.87-0.97) and breast cancer screening (aPR, 0.84; 95% CI, 0.77-0.92) compared with heterosexual women. CRC screening adherence among SOM men was slightly higher (aPR, 1.10; 95% CI, 1.00-1.21). GIM status was associated with substantially lower adherence to cervical (aPR, 0.58; 95% CI, 0.37-0.90) and breast cancer screening (aPR, 0.24; 95% CI, 0.08-0.74) compared with cisgender respondents, with no difference in CRC screening (p > .05). Disparities in cervical and breast cancer screening persist among SOGI minorities. These findings underscore prevalent structural and systemic barriers in preventive cancer care and highlight the need for inclusive, culturally sensitive interventions to promote equitable screening access.