Population Research and Policy Review

, Volume 36, Issue 3, pp 357–377 | Cite as

Cancer Screening Utilization Among U.S. Women: How Mammogram and Pap Test Use Varies Among Heterosexual, Lesbian, and Bisexual Women

  • Alexa L. Solazzo
  • Bridget K. Gorman
  • Justin T. Denney


Existing research on cancer screening utilization among sexual minority women in the U.S. has mostly relied on non-random samples that combine lesbian and bisexual women into a single group. We respond to these limitations by examining the relationship between sexual orientation and cancer screening among a sample of U.S. women from the Behavioral Risk Factor Surveillance System (BRFSS). Our analytic sample includes 2273 lesbian, 1689 bisexual, and 174,839 heterosexual women interviewed in 15 U.S. states between 2000 and 2010. We examine two cancer screening measures: timely mammogram and pap tests, defined as having had a mammogram in the past 2 years for women aged 40 and older, and having had a pap test in the past 3 years for women aged 21–65. For mammogram, results showed that rates of timely use did not significantly differ by sexual orientation. However, lesbian and bisexual women report significantly lower rates of timely pap testing than heterosexual women. Logistic regression results on timely pap testing showed that lower pap test use for bisexual women is primarily driven by their poorer socioeconomic status relative to heterosexual women, while the significantly lower odds of timely pap testing for lesbian women were unaffected by control measures. Better understanding of cancer screening utilization disparities among lesbian and bisexual women is necessary to address morbidity and mortality disparities by sexual orientation.


Cancer screening Sexual minority LGBT Mammogram Pap test Women 


  1. Aaron, D. J., Markovic, N., Danielson, M. E., Honnold, J. A., Janosky, J. E., & Schmidt, N. J. (2001). Behavioral risk factors for disease and preventive health practices among lesbians. American Journal of Public Health, 92(6), 972–975.Google Scholar
  2. Agenor, M., Bailey, Z., Krieger, N., Austin, S. B., & Gottlieb, B. (2015). Exploring the cervical cancer screening experiences in black lesbian, bisexual, and queer women: The role of patient-provider communications. Women and Health, 55(6), 717–736.CrossRefGoogle Scholar
  3. Agenor, M., Krieger, N., Austin, B., Haneuse, S., & Gottlieb, G. (2014). Sexual orientation disparities in papanicolaou test use among US women: The role of sexual and reproductive health services. American Journal of Public Health, 104(2), 68–73.CrossRefGoogle Scholar
  4. Badgett, L., Durso, L.E., Schneebaum, A. (2013). New Patterns of Poverty in the Lesbian, Gay, and Bisexual Community. UCLA School of Law: The Williams InstituteGoogle Scholar
  5. Berkman, L. F., & Glass, T. (2000). Social integration, social networks, social support, and health. In L. F. Berkman & I. Kawachi (Eds.), Social epidemiology. New York: Oxford University Press.Google Scholar
  6. Black, D., Gates, G., Sanders, S., & Taylor, L. (2000). Demographics of the gay and lesbian population in the United States: Evidence from available systematic data sources. Demography, 37, 139–154.CrossRefGoogle Scholar
  7. Buchmueller, T., & Carpenter, C. (2010). Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. American Journal of Public Health, 100(3), 489–495.CrossRefGoogle Scholar
  8. CDC (Centers for Disease Control and Prevention). (2012). Methodologic changes in the behavioral risk factor surveillance system in 2011 and potential effects on prevalence estimates. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6122a3.htm.
  9. CDC (Centers for Disease Control and Prevention). (2014a). What should i know about screening?. http://www.cdc.gov/cancer/cervical/basic_info/screening.htm.
  10. CDC (Centers for Disease Control and Prevention). (2014b). What screening tests are there?. http://www.cdc.gov/cancer/breast/basic_info/screening.htm.
  11. Charlton, B., Corliss, H., Missmer, S., Frazier, A. L., Rosario, M., Kahn, J., et al. (2011). Reproductive health screening disparities and sexual orientation in a cohort study of U.S. adolescent and young adult females. Journal of Adolescent Health, 49, 505–510.CrossRefGoogle Scholar
  12. Charlton, B., Corliss, H., Missmer, S., Frazier, A. L., Rosario, M., Kahn, J., et al. (2014). Influence of hormonal contraceptive use and health beliefs on sexual orientation disparities in Papanicolaou test use. American Journal of Public Health, 104(2), 319–325.CrossRefGoogle Scholar
  13. Cochran, S. D., Mays, V. M., Bowen, D., Gage, S., Bybee, D., Roberts, S. J., et al. (2001). Cancer related risk indicators and preventive screening behaviors among lesbians and bisexual women. American Journal of Public Health, 91(4), 591–597.CrossRefGoogle Scholar
  14. Conron, K. J., Mimiaga, M., & Landers, S. (2010). A population-based study of sexual orientation identity and gender differences in adult health. American Journal of Public Health, 100(10), 1953–1960.CrossRefGoogle Scholar
  15. Corrigan, P., & Matthews, A. (2003). Stigma and disclosure: Implications for coming out of the closet. Journal of Mental Health, 12(3), 235–248.CrossRefGoogle Scholar
  16. Diamante, A. L., Schuster, M. A., & Lever, J. (2000). Receipt of preventive health care services by lesbians. American Journal of Preventive Medicine, 19(3), 141–148.CrossRefGoogle Scholar
  17. Dilley, J. A., Simmons, K., Boysun, M., Pizacani, B., & Stark, M. (2010). Demonstrating the importance and feasibility of including sexual orientation in Public Health Surveys: Health disparities in the Pacific Northwest. American Journal of Public Health, 100(3), 460–467.CrossRefGoogle Scholar
  18. Fredman, L., Sexton, M., Cui, Y., Althuis, M., Wehren, L., Hornbeck, P., et al. (1999). Cigarette smoking, alcohol consumption, and screening mammography among women aged 50 and older. Preventive Medicine, 28(4), 407–417.CrossRefGoogle Scholar
  19. Gates, G., Newport, F. (2012). Special Report: 3.4% of U.S. Adults Identify as LGBT. http://www.gallup.com/poll/158066/special-report-adults-identify-lgbt.aspx.
  20. Gates, G., & Ost, J. (2004). The gay and lesbian atlas. New York: Urban Institute Press.Google Scholar
  21. GLMA (Gay and Lesbian Medical Association and LGBT Health Experts). (2001). Healthy People 2010 companion document for lesbian, gay, bisexual, and transgender (LGBT) health. San Francisco, CA: Gay and Lesbian Medical Association.Google Scholar
  22. Gorman, B., Denney, J., Dowdy, H., & Medeiros, R. A. (2015). A new piece of the puzzle: Sexual orientation, gender, and physical health status. Demography, 52(4), 1357–1382.CrossRefGoogle Scholar
  23. Healthy People 2020. Cancer Objectives U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. http://www.healthypeople.gov/2020/topics-objectives/topic/cancer/objectives.
  24. Henderson, J. T., Sawaya, G. F., Blum, M., Stratton, L., & Harper, C. C. (2010). Pelvic examinations and access to oral hormonal contraception. Obstetrics and Gynecology, 116(6), 1257–1264.CrossRefGoogle Scholar
  25. Hirth, J. M., Tabassum, H. L., Rahman, M., & Berenson, A. B. (2015). Racial/ethnic differences affecting adherence to cancer screening guidelines among women. Journal of Women’s Health, 25(4), 371–380.CrossRefGoogle Scholar
  26. IOM (Institute of Medicine). (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, D.C.: The National Academies Press.Google Scholar
  27. Karlson, K. B., Holm, A., & Breen, R. (2012). Comparing regression coefficients between same-sample nested models using logit and probit: A new method. Sociological Methodology, 42, 286–313.CrossRefGoogle Scholar
  28. Kerker, B. D., Mostashari, F., & Thorpe, L. (2006). Health care access and utilization among women who have sex with women: Sexual behavior and identity. Journal of Urban Health, 83(5), 970–979.CrossRefGoogle Scholar
  29. King, S. (2004). Pink Ribbons Inc: Breast cancer activism and the politics of philanthropy. International Journal of Qualitative Studies in Education, 17(4), 473–492.CrossRefGoogle Scholar
  30. Lick, D. J., Durso, L. E., & Johnson, K. L. (2013). Minority stress and physical health among sexual minorities. Perspectives on Psychological Science, 8(5), 521–548.CrossRefGoogle Scholar
  31. Lin, K., & Gostin, L. (2016). A public health framework for screening mammography: Evidence based vs politically mandated care. Journal of American Medical Association., 315(10), 977–978.CrossRefGoogle Scholar
  32. Link, B. G., & Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, 1, 80–94.CrossRefGoogle Scholar
  33. Mayer-Oakes, S. A., Atchison, K. A., Matthias, R. E., De Jong, F. J., Lubben, J., & Schweitzer, S. O. (1996). Mammography use in older women with regular physicians: What are the predictors? American Journal of Preventive Medicine, 12(1), 44–50.Google Scholar
  34. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697.CrossRefGoogle Scholar
  35. Meyer, I. H., & Northridge, M. (2007). The health of sexual minorities: Public health perspectives on lesbian, gay, bisexual, and transgender populations. New York: Springer.CrossRefGoogle Scholar
  36. Miranda, P., Tarraf, W., & Gonzalez, H. (2011). Breast cancer screening and ethnicity in the United States: implications for health disparities research. Breast Cancer Research and Treatment, 128(2), 535–542.CrossRefGoogle Scholar
  37. Mood, C. (2010). Logistic regression: Why we cannot do what we think we can do, and what we can do about it. European Sociological Review, 26(1), 67–82.CrossRefGoogle Scholar
  38. National Cancer Institute. (2015). Cancer screening overview—for health professionals. http://www.cancer.gov/about-cancer/screening/hp-screening-overview-pdq.
  39. National Center for Health Statistics. (2015a). Mammography and breast cancer. http://www.cdc.gov/nchs/fastats/mammography.htm.
  40. National Center for Health Statistics. (2015b). Pap tests and cervical cancer. http://www.cdc.gov/nchs/fastats/pap-tests.htm.
  41. National Institute of Health. (2013). Cervical cancer. https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=76.
  42. Powell, B., Bolzendahl, C., Geist, C., & Steelman, L. C. (2010). Counted out: Same-sex relations and Americans’ definitions of family. New York: Russell Sage Foundation.Google Scholar
  43. Selvin, E., & Brett, K. M. (2003). Breast and cervical cancer screening: Sociodemographic predictors among white, black, and hispanic women. American Journal of Public Health, 93(4), 618–623.CrossRefGoogle Scholar
  44. Shapiro, J., Seeff, L., & Nadel, M. (2001). Colorectal Cancer-Screening Tests and Associated Health Behaviors. American Journal of Preventive Medicine., 21(2), 132–137.CrossRefGoogle Scholar
  45. Stata Corps. (2013). Mi impute chained—Impute missing values using chained equations. http://www.stata.com/manuals13/mimiimputechained.pdf.
  46. Swan, J., Breen, N., Coates, R., Rimer, B., & Lee, N. (2003). Progress in cancer screening practices in the United States. Cancer, 97(6), 1528–1540.CrossRefGoogle Scholar
  47. U.S. Preventative Services Task Force. (2002). Archived: Breast cancer: Screening, 2002. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening-2002.
  48. U.S. Preventative Services Task Force. (2003). Screening for cervical cancer: Recommendations and rationale. American Family Physician, 67(8), 1759–1766.Google Scholar
  49. U.S. Preventative Services Task Force. (2015). Final update summary: Cervical cancer: Screening. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening.
  50. U.S. Preventative Services Task Force. (2016). Archived: Breast cancer: Screening, 2009. http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening.
  51. USDHHS (US Department of Health and Human Services). (2014). Lesbian, gay, bisexual, and transgender health. https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health.
  52. Valanis, B. G., Bowen, D. J., Bassford, T., Whitlock, E., Charney, P., & Carter, R. A. (2000). Sexual orientation and health: Comparisons in the women’s health initiative sample. Archive of Family Medicine, 9(9), 843–853.CrossRefGoogle Scholar
  53. Von Hippel, P. T. (2007). Regression with missing Ys: An improved strategy for analyzing multiply imputed data. Sociological Methodology, 37(1), 83–117.CrossRefGoogle Scholar
  54. Weedon-Fekjaer, H., Romundstad, P. R., & Vatten, L. J. (2014). Modern mammography screening and breast cancer mortality: Population study. BMJ, 17, 348.Google Scholar
  55. Wiepking, P., & James, R. (2013). Why are the oldest old less generous? Explanations for the unexpected age-related drop in charitable giving. Ageing and Society, 33(3), 486–510.CrossRefGoogle Scholar
  56. Winship, C., & Mare, R. D. (1984). Regression models with ordinal variables. American Sociological Review, 49, 512–525.CrossRefGoogle Scholar
  57. Wood, R. G., Goesling, B., & Avellar, S. (2007). The effect of marriage on health: A synthesis of recent research evidence. Washington, DC: U.S. Department of Health and Human Services.Google Scholar
  58. Zahl, P. H., Gotzche, P. C., & Maehlen, J. (2011). Natural history of breast cancers detected in the Swedish mammography screening programme: a cohort study. Lancet Oncology, 12(12), 1118–1124.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2017

Authors and Affiliations

  1. 1.Department of SociologyRice UniversityHoustonUSA

Personalised recommendations