The association of sexual orientation with cancer screening and diagnosis.

Abstract

6506 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 compared to heterosexual counterparts. However, few studies have examined how sexual orientation (SO) impacts cancer screening and prevalence. We therefore investigated whether SO affects prevalent gender-specific cancer screening and prevalence, 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 heterosexual and SM men and women. Multivariable logistic regression analyses assessed association of various covariates with undergoing screening and diagnosis of these cancers. Results: Overall, 4,441 (95.18%) men and 6,333 (96.75%) women reported a SO of heterosexual whereas 167 (3.6%) and 58 (1.2%) men and 105 (1.6%) and 108 (1.6%) women reported a SO of gay and bisexual, respectively. Mean age was higher in the heterosexual group compared to the gay and bisexual groups in both men (57.7 [±16.0] vs. 52.4 [±14.5] and 51.9 [±18.0] years, p = < 0.001) and women (56.2 [±16.7] vs. 49.0 [±17.1] and 40.0 [±14.8] years, p = < 0.001). Homosexuals and bisexuals were less likely to be screened for PCa (30.53% and 27.58% vs 41.27%, p = < 0.001), BC (63.81% and 45.37% vs 80.74%, p = < 0.001), and CC (90.48% and 86.11% vs 95.36%, p = < 0.001) than their heterosexual counterparts. While rates of PCa and BC diagnoses were similar across SO, more homosexual and bisexual women were diagnosed with CC compared to their heterosexual counterparts (4.76% and 3.70% vs 1.85%, p = 0.039). Multivariable logistic regression models showed that SMs were less likely to be screened for cancer with ORs of 0.61 (95% CI 0.39-0.95, p = 0.030) for PCa, 0.52 (95% CI 0.30-0.92, p = 0.025) for BC, and 0.21 (95% CI 0.09-0.46, p = < 0.001) for CC. Although multivariable models did not show that SMs were more likely to be diagnosed with PC, BC, or CC, SMs were more likely to be diagnosed with any cancer with ORs of 1.64 (95% CI 1.06-2.54, p = 0.026) in women only and 1.50 (95% CI 1.11-2.03, p = 0.009) in men and women combined. Conclusions: These data suggest that in addition to other established and known specific socio-economic risk factors, SMs may be less likely to undergo screening of prevalent malignancies such as PCa, BC, and CC. This provides more evidence of ongoing healthcare inequality, urging our healthcare system to invest more in cancer screening of this vulnerable population.

Gynecological and breast cancer risk factors and screenings in lesbian and bisexual women

“…Herriges et al (1) The Legend: LBW = lesbian women and bisexual women are obesity, nulliparity, medications suppressing the ovaries, and anovulation. Risk factors such as polycystic ovarian syndrome, tamoxifen use, hypertension and diabetes mellitus, and Lynch syndrome are thought to affect the prevalence at the same rate as in heterosexual women.…”

“…(8,19) In addition, the main risk factors for cervical cancer, namely early sexual intercourse before the age of 16, polygamous sexual life, and STIs such as HPV-16 and HPV-18, [especially HPV-11 and HPV-16], are common in LBW and are reported to increase the risk of getting caught. (1,9) It is known that HPV-16 and HPV-18 are responsible for almost 70% of all cervical cancer cases. When the literature is examined, different study results related to the subject were found.…”

“…Clavelle et al (36) (18,21) In some studies, the risk of endometrial cancer in LBW has been reported to be higher than in heterosexual women, (3) while in other studies it has been reported to be lower. (1) It is known that the most important factors that increase the risk of endometrial cancer in LBW C…”

“…The abbreviation "LGBTI +" is used for lesbian, gay, bisexual, transsexual, intersex, and other sexual trends that reflect different dimensions of homosexuality worldwide. (1,2) While men with a sexual orientation towards their sex are defined as gay and women as lesbian, sexual tendency towards both sexes is defined as bisexual. (1,3) When the literature is examined, it will be seen that LGBTI + individuals make up approximately 3-12% of the total population.…”

“…(1,2) While men with a sexual orientation towards their sex are defined as gay and women as lesbian, sexual tendency towards both sexes is defined as bisexual. (1,3) When the literature is examined, it will be seen that LGBTI + individuals make up approximately 3-12% of the total population. (4,5) It is estimated that the proportion of lesbian and female bisexuality in the world varies between 1-20% of all women.…”