Sexual minority individuals less likely to undergo cervical cancer screening
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Individuals who identified as a sexual minority had lower odds of ever undergoing Pap testing compared with heterosexual individuals, according to a study published in Cancer.
The findings appeared consistent across specific sexual minority groups, according to researchers, who reported the lowest uptake among Hispanic sexual minority individuals.
Rationale and methods
“Our team was made up of individuals dedicated to health disparities, as well as individuals dedicated to gynecologic cancer research. We wanted to expand on what was known in the field to identify how disparities in cervical cancer research may be exacerbated when we look at multiple identities that are oppressed by our society,” Ashley E. Stenzel, PhD, MS, researcher at Allina Health in Minneapolis, told Healio.
Investigators used data from the National Health Interview Survey between 2015 and 2018 to assess disparities in cervical cancer screening among a cohort of 877 natal females aged 21 to 65 years without a history of hysterectomy who reported their sexual orientation and Pap testing history. They compared these sexual minority individuals with a cohort of heterosexual individuals (n = 17,760), adjusting for differences in confounding variables between the groups using propensity score-based inverse probability of treatment weighting.
The researchers estimated odds of ever undergoing a Pap test by sexual orientation alone and with race/ethnicity using inverse probability treatment weighting-adjusted multivariable logistic regression models.
Key findings
Results showed sexual minority individuals had significantly lower odds of ever undergoing Pap testing (OR = 0.54; 95% CI, 0.42-0.7).
Specifically, both white and Hispanic sexual minority individuals had lower odds of ever undergoing Pap testing compared with white heterosexual individuals when researchers considered the intersection of sexual orientation and race/ethnicity.
However, researchers observed no significant differences between white heterosexual individuals and Black or Hispanic heterosexual individuals.
“Our analysis showed that most individuals who self-identify as belonging to a sexual minority group had lower uptake of cervical cancer screening, but that this was more pronounced among those who identified as both Hispanic and belonging to a sexual minority group,” Stenzel said.
Implications
These results are highly concerning, given that cervical cancer screening can reduce the severity of disease, including death, Stenzel said.
“We need to continue to examine disparities at the intersection of multiple societally oppressed identities, how systemic discrimination plays a role in these disparities, and the additional barriers that individuals face with respect to cancer screening access,” she added. “Together, these can guide institutional and policy level changes for better serving these populations.”
Campaigns to address patient knowledge and provider communication may help to improve screening rates, and cultural adaptation of interventions is needed to reduce existing disparities, Ana I. Tergas, MD, MPH, researcher in the department of surgery at City of Hope Comprehensive Cancer Center, wrote in an accompanying editorial.
“When we seek to reduce disparities in cervical cancer screening compliance, it is important to design interventions that are flexible for targeted individuals’ needs, barriers and facilitators,” Tergas wrote. “Although educational and practitioner-focused interventions may improve screening for many individuals, others may not benefit if access barriers are not addressed. Defining how individuals define their sexual identify is, thus, a critical step in providing the right information, education and resources to overcome barriers and address the disparity.”
References:
Stenzel AE, et al. Cancer. 2022;doi:10.1002/cncr.34213.
Tergas AI, et al. Cancer. 2022;doi:10.1002/cncr.34212.
For more information:
Ashley E. Stenzel, PhD, MS, can be reached at Allina Health, 2925 Chicago Ave., Minneapolis, MN 55407; email: ashley.stenzel@allina.com.
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