An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women

Cancer Causes Control (2013) 24:539547

DOI 10.1007/s10552-012-9991-0

ORIGINAL PAPER

An examination of sexual orientation group patterns in mammographic and colorectal screeningin a cohort of U.S. women

S. Bryn Austin Mathew J. Pazaris

Lauren P. Nichols Deborah Bowen

Esther K. Wei Donna Spiegelman

Received: 10 October 2011 / Accepted: 4 May 2012 / Published online: 22 May 2012 Springer Science+Business Media B.V. 2012

AbstractPurpose 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.

Keywords Breast cancer Colorectal cancer Screening

Sexual orientation Bisexual Lesbian

Introduction

Breast and colorectal cancer are two of the most common cancers affecting U.S. women. In 2007 in the United States, incidence rates of a new diagnosis of breast and colorectal cancer, respectively, were 1,204 and 397 per 1,000,000 women [1]. In addition, 228 and 141 per

S. B. Austin E....