An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women.
OBJECTIVE
Underutilization of cancer screening has been found especially to affect socially marginalized groups. We investigated sexual orientation group patterns in breast and colorectal cancer screening adherence.


METHODS
Data on breast and colorectal cancer screening, sexual orientation, and sociodemographics were gathered prospectively from 1989 through 2005 from 85,759 U.S. women in the Nurses' Health Study II. Publicly available data on state-level healthcare quality and sexual-orientation-related legal protections were also gathered. Multivariable models were used to estimate sexual orientation group differences in breast and colorectal cancer screening, controlling for sociodemographics and state-level healthcare quality and legal protections for sexual minorities.


RESULTS
Receipt of a mammogram in the past 2 years was common though not universal and differed only slightly by sexual orientation: heterosexual 84 %, bisexual 79 %, and lesbian 82 %. Fewer than half of eligible women had ever received a colonoscopy or sigmoidoscopy, and rates did not differ by sexual orientation: heterosexual 39 %, bisexual 39 %, and lesbian 42 %. In fully adjusted models, state-level healthcare quality score, though not state-level legal protections for sexual minorities, was positively associated with likelihood of being screened for all women regardless of sexual orientation.


CONCLUSIONS
Concerns have been raised that unequal healthcare access for sexual orientation minorities may adversely affect cancer screening. We found small disparities in mammography and none in colorectal screening, though adherence to colorectal screening recommendations was uniformly very low. Interventions are needed to increase screening in women of all sexual orientation groups, particularly in areas with poor healthcare policies.
Channing Laboratory, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA. bryn.austin@childrens.harvard.edu
S Bryn
SB
Austin
Mathew J
MJ
Pazaris
Lauren P
LP
Nichols
Deborah
D
Bowen
Esther K
EK
Wei
Donna
D
Spiegelman
D000328:Adult; D001727:Bisexuality / Q000208:ethnology / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D020010:Heterosexuality / Q000208:ethnology / Q000706:statistics & numerical data; D018452:Homosexuality, Female / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D008327:Mammography / Q000379:methods / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D011446:Prospective Studies; D012725:Sexual Behavior / Q000208:ethnology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology