An examination of sexual orientation group patterns in mammographic and colorectal screening in a cohort of U.S. women
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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.
KeywordsBreast 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.
- 1.Centers for Disease Control and Prevention USCSWG (2010) United States cancer statistics: 1997–2007 incidence and mortality web-based report. Centers for Disease Control and Prevention. Available from: www.cdc.gov/uscs
- 4.Edwards BK, Ward E, Kohler BA, Eheman C, Zauber AG, Anderson RN et al (2010) Annual report to the nation on the status of cancer, 1975–2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 116(3):544–573PubMedCrossRefGoogle Scholar
- 6.American Cancer Society (2010) American Cancer Society guidelines for the early detection of cancer [database on the Internet]. Available from: http://www.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer. Cited 11 Aug 2010
- 7.U.S. Preventive Services Task Force (2009) Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 151:716–726Google Scholar
- 9.DATA 2010: The Healthy People 2010 Database [database on the Internet]. Centers for Disease Control and Prevention 2010 [cited April 6, 2010]. Available from: http://wonder.cdc.gov/data2010
- 10.Centers for Disease Control and Prevention (2010) Vital signs: breast cancer screening among women aged 50–74 years—United States, 2008. MMWR Morb Mortal Wkly Rep 59(26):813–816Google Scholar
- 17.Kaiser Family Foundation (2008) Percent of women age 50 or older who report ever having had a colorectal screening, 2008 [database on the Internet]. Available from: http://www.statehealthfacts.org/comparemaptable.jsp?ind=484&cat=10&sub=113&sort=a. Cited 11 May 2011
- 18.Kaiser Family Foundation (2008) Percent of women age 40 and older who report having had a mammogram within the last 2 years, 2008 [database on the Internet]. Available from: http://www.statehealthfacts.org/comparemaptable.jsp?cat=10&ind=479. Cited 11 May 2011
- 20.Eskridge WN, Spedale D (2006) Gay marriage: for better or for worse?. Oxford University Press, OxfordGoogle Scholar
- 21.Badgett MVL (2006) Discrimination based on sexual orientation: a review of the literature in economics and beyond. In: Rodgers WMI (ed) Handbook on the economics of discrimination. Edward Elgar Publishers, Inc., Northampton, pp 161–186Google Scholar
- 25.Holmes MD, Stampfer MJ, Wolf AM, Jones CP, Spiegelman D, Manson JE et al (1998) Can behavioral risk factors explain the difference in body mass index between African-American and European-American women? Ethn Dis Autumn 8(3):331–339Google Scholar
- 26.Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (2008) National healthcare quality report [database on the Internet]. Available from: http://statesnapshots.ahrq.gov/snaps09/index.jsp. Cited 13 May 2013