Inequities in colorectal and breast cancer screening: At the intersection of race/ethnicity, sexuality, and gender

Emmeline Lin; Patrycja Sleboda; Bobbie J Rimel; Geetanjali D Datta

doi:10.1016/j.ssmph.2023.101540

Inequities in colorectal and breast cancer screening: At the intersection of race/ethnicity, sexuality, and gender

SSM Popul Health. 2023 Oct 17:24:101540. doi: 10.1016/j.ssmph.2023.101540. eCollection 2023 Dec.

Authors

Emmeline Lin¹, Patrycja Sleboda¹, Bobbie J Rimel^{1

2}, Geetanjali D Datta^{1

3}

Affiliations

¹ Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA.
² Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.
³ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.

Abstract

Objective: To investigate the joint impact of sexual orientation, gender identity, and race/ethnicity on colorectal and breast cancer screening disparities in the United States.

Methods: Utilizing sampling weighted data from the 2016 and 2018 Behavioral Risk Factor Surveillance System, we assessed differences in two metrics via chi-square statistics: 1) lifetime uptake, and 2) up-to-date colorectal and breast cancer screening by sexual orientation and gender identity, within and across racial/ethnic classifications.

Results: Within specific races/ethnicities, lifetime CRC screening was higher among gay/lesbian (within NH-White, Hispanic, and Asian/Pacific Islander) and bisexual individuals (Hispanic) compared to straight individuals, and lowest overall among transgender women and transgender nonconforming populations (p < 0.05). Asian transgender women had the lowest lifetime CRC screening (13.0%; w.n. = 1,428). Lifetime breast cancer screening was lowest among the Hispanic bisexual population (86.6%; w.n. = 26,940) and Hispanic transgender nonconforming population (71.8%; w.n. = 739); within all races, SGM individuals (except NH-White, Hispanic, and Black bisexual populations, and NH-White transgender men) had greater breast cancer screening adherence compared to straight individuals.

Conclusions: Due to small, unweighted sample sizes, results should be interpreted with caution. Heterogeneity in screening participation by SGM status within and across racial/ethnic groups were observed, revealing the need to disaggregate data to account for intersecting identities and for studies with larger sample sizes to increase estimate reliability.

Keywords: Breast cancer screening; Colorectal cancer screening; Gender minority health; Intersectionality; Screening disparities; Sexual minority health.