The association between sexual orientation and screening of prevalent gender-specific cancers.

Abstract

198 Background: Data on heterogeneity in cancer screening and diagnosis rates among sexual minorities (SMs) is lacking. Recent studies have shown SMs are more likely to engage in risky health behavior and have decreased healthcare utilization. However, few studies have examined how sexual orientation impacts cancer screening and prevalence. We therefore investigated whether sexual orientation affects prevalent gender-specific cancer including prostate (PCa), breast (BC), and cervical cancer (CC). Methods: This was a cross-sectional survey-based US study, including men and women aged 18+ from the Health Information National Trends Survey (HINTS) database (part of the National Cancer Institute’s division of cancer control and population sciences) between 2017-2019. The primary endpoint was individual-reported PCa, BC, and CC screening and prevalence rates among heterosexuals and homosexuals/bisexuals. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Results: Overall, 4,441 and 6,333 heterosexual men and women, respectively, were compared to 225 and 213 homosexual/bisexual men and women, respectively. Homosexuals/bisexuals were younger and less likely to be screened for PCa (34.7% vs 41.3%, p=0.013), BC (54.5% vs 80.7%, p=<0.001), and CC (88.3% vs 95.4%, p=<0.001). While rates of PCa and BC diagnosis were similar, more than twice as many homosexual/bisexual women were diagnosed with CC (4.2% vs 1.9%, p=0.023). Multivariable logistic regression models (Table) showed homosexuals/bisexuals were less likely to be screened for cancer with ORs of 0.61 (95% CI 0.39-0.95) for PCa, 0.52 (95% CI 0.30-0.92) for BC, and 0.21 (95% CI 0.09-0.46) for CC. Homosexuals/bisexuals were more likely to be diagnosed with any cancer with ORs of 1.64 (95% CI 1.06-2.54) in women only and 1.50 (95% CI 1.11-2.03) in men and women combined. Conclusions: Homosexuals/bisexuals in the US may be less likely to undergo screening of gender-specific prevalent malignancies, including PCa, BC, and CC. The implementation of cancer screening among SMs should be improved. [Table: see text]

Sexuality After Cancer as an Unmet Need: Addressing Disparities, Achieving Equality

“…54 In 2022, the National Academies of Science, Engineering, and Medicine published a report calling for the routine collection of gender identity across National Institutes of Health activities. 55 For oncologists, this is important because the inability to collect sexual orientation and gen-der identity data makes it nearly impossible to assess treatment and post-treatment outcomes in this population and to explain disparities that SGM people face, including a higher self-reported prevalence of cervical and breast cancer among lesbian women compared with heterosexual women, 56 and reportedly lower odds of treatment of kidney and pancreatic cancer among transgender people compared with cisgender people. 57 The National Academies of Science, Engineering, and Medicine report recommends asking respondents to identify their (1) sex assigned at birth (male, female, don't know/prefer not to answer) and their gender (female, male, transgender, uses a different term, don't know/prefer not to answer).…”