Cancer Causes & Control

, Volume 24, Issue 3, pp 539–547 | Cite as

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

  • S. Bryn AustinEmail author
  • Mathew J. Pazaris
  • Lauren P. Nichols
  • Deborah Bowen
  • Esther K. Wei
  • Donna Spiegelman
Original paper



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.


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.


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.


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.


Breast cancer Colorectal cancer Screening Sexual orientation Bisexual Lesbian 



The authors would like to thank the participants and staff of the Nurses’ Health Study II for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, and WY. The work reported in this manuscript was supported by the American Cancer Society grant RSGT-07-172-01-CPPB, NIH grants HL64108 and CA50385. NHSII is supported for other specific projects by the following NIH grants: CA67262, AG/CA14742, CA67883, CA65725, DK52866, HL64108, HL03804, DK59583, and HD40882. In addition, the Channing Laboratory has received modest additional resources at various times and for varying periods since January 1, 1993, from the Alcoholic Beverage Medical Research Foundation, American Cancer Society, Amgen, California Prune Board, Centers for Disease Control and Prevention, Ellison Medical Foundation, Florida Citrus Growers, Glaucoma Medical Research Foundation, Hoffmann-LaRoche, Kellogg’s, Lederle, Massachusetts Department of Public Health, Mission Pharmacal, National Dairy Council, Rhone Poulenc Rorer, Robert Wood Johnson Foundation, Roche, Sandoz, U.S. Department of Defense, U.S. Department of Agriculture, Wallace Genetics Fund, Wyeth-Ayerst, and private contributions. S. Bryn Austin is supported by the Leadership Education in Adolescent Health project, Maternal and Child Health Bureau, HRSA grant T71-MC00009. Deborah J. Bowen is supported by Centers for Disease Control and Prevention grant U48DP001922.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • S. Bryn Austin
    • 1
    • 2
    • 3
    Email author
  • Mathew J. Pazaris
    • 4
  • Lauren P. Nichols
    • 2
  • Deborah Bowen
    • 5
  • Esther K. Wei
    • 1
    • 6
  • Donna Spiegelman
    • 1
    • 4
    • 7
  1. 1.Channing LaboratoryBrigham & Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Division of Adolescent and Young Adult MedicineChildren’s HospitalBostonUSA
  3. 3.Department of Society, Human Development, and HealthHarvard School of Public HealthBostonUSA
  4. 4.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  5. 5.Department of Community Health SciencesBoston University School of Public HealthBostonUSA
  6. 6.California Pacific Medical Center Research InstituteSan FranciscoUSA
  7. 7.Department of BiostatisticsHarvard School of Public HealthBostonUSA

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