Modifiers of Cancer Screening Prevention Among Sexual and Gender Minorities in the Behavioral Risk Factor Surveillance System.

Increasing social acceptance of sexual and gender minorities may not translate to parity in health care access and health outcomes. Sexual orientation and gender identity (SOGI) may continue to contribute to differences in preventive health behavior including cancer screening. Our purpose was to estimate the independent effect of SOGI on breast, cervical, and colorectal cancer screening adherence. We used sampling weighted data from 2016 Behavioral Risk Factor Surveillance System. We defined breast, cervical, and colorectal cancer screening using the US Preventive Services Task Force guidelines. All survey data were self-reported including demographic and medical information. We calculated the prevalence of screening by sexual orientation (straight, lesbian or gay, bisexual) and gender identity (cisgender, transgender). The term "sexual and gender minorities" in our study refers to lesbian or gay, bisexual, and transgender individuals. Logistic regression models assessed independent effect of SOGI on screening adherence. Prevalence of breast, cervical, and colorectal cancer screening varied significantly by SOGI. After adjusting for other variables, bisexual persons had significantly lower odds (odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38-0.93) of breast cancer screening adherence. Lesbian or gay persons had significantly decreased likelihood (OR = 0.53, 95% CI = 0.29-0.95) of cervical cancer screening adherence. Although rate of colorectal cancer screening adherence varied significantly by SOGI, we did not find an independent effect of SOGI and colorectal cancer screening adherence after adjusting for other variables. No independent effect of gender identity categories on breast, cervical, and colorectal cancer screening adherence was detected. Social determinants of health, such as health care access and insurance, that disproportionately disadvantaged bisexual individuals independently influenced screening adherence. SOGI can affect cancer screening adherence. Bisexual individuals had worse health care access and socioeconomic hardships among sexual and gender minorities. Given the independent effects of social determinants of health on cancer screening adherence, more attention needs to be paid to sexual and gender minorities, especially bisexual population.

Charkhchi P ，Schabath MB ，Carlos RC 《-》

Using sexual orientation and gender identity data in electronic health records to assess for disparities in preventive health screening services.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations have an increased risk of multiple adverse health outcomes. Capturing patient data on sexual orientation and gender identity (SOGI) in the electronic health record (EHR) can enable healthcare organizations to identify inequities in the provision of preventive health screenings and other quality of care services to their LGBTQ patients. However, organizations may not be familiar with methods for analyzing and interpreting SOGI data to detect health disparities. To assess an approach for using SOGI EHR data to identify potential screening disparities of LGBTQ patients within distinct healthcare organizations. Five US federally qualified health centers (FQHCs) retrospectively extracted three consecutive months of EHR patient data on SOGI and routine screening for cervical cancer, tobacco use, and clinical depression. The screening data were stratified across SOGI categories. Chi-Square and Fisher's Exact test were used to identify statistically significant differences in screening compliance across SOGI categories within each FQHC. In all FQHCs, cervical cancer screening percentages were lower among lesbian/gay patients than among bisexual and straight/heterosexual patients. In three FQHCs, cervical cancer screening percentages were lower for transgender men than for cisgender (i.e., not transgender) women. Within each FQHC, we observed statistically significant associations (P < 0.05) between SOGI categories and at least one screening measure. The small number of transgender patients, and limitations in EHR functionality, created challenges in interpretation of SOGI data. To our knowledge, this is the first published report of using SOGI data from EHRs to detect potential disparities in healthcare services to LGBTQ patients. Our finding that lesbian/gay and transgender male patients had lower cervical cancer screening rates compared to heterosexual, bisexual, and cisgender women, is consistent with the research literature and suggests that using SOGI EHR data to detect preventive screening disparities has value. EHR functionality should allow for cross-checking gender identity with sex assigned at birth to reduce errors in data interpretation. Additional functionality, like clinical decision support based on anatomical inventories rather than gender identity, is needed to more accurately identify services that transgender patients need.

Grasso C ，Goldhammer H ，Brown RJ ，Furness BW ... -  《-》

Breast, Cervical, and Colorectal Cancer Screening Adherence: Effect of Low Body Mass Index in Women.

Charkhchi P ，Schabath MB ，Carlos RC 《-》

Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming.

Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.

Kratzer TB ，Star J ，Minihan AK ，Bandi P ，Scout NFN ，Gary M ，Riddle-Jones L ，Giaquinto AN ，Islami F ，Jemal A ，Siegel RL ... -  《-》

Will Veterans Answer Sexual Orientation and Gender Identity Questions?

Ruben MA ，Blosnich JR ，Dichter ME ，Luscri L ，Shipherd JC ... -  《-》