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

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.

Automated summary

This study investigated the joint impact of sexual orientation, gender identity, and race/ethnicity on colorectal and breast cancer screening disparities. The results revealed that within specific racial/ethnic groups, gay/lesbian and bisexual individuals had higher colorectal cancer screening rates, while transgender women and transgender nonconforming populations had the lowest rates. For breast cancer screening, SGM individuals generally had higher adherence compared to straight individuals. However, caution should be exercised in interpreting the results due to small sample sizes, and larger studies are needed to increase estimate reliability.