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

Abstract

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.

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Notes

  1. 1.

    Recent years have seen growing debate on whether or not mammograms help reduce cancer mortality (Weedon-Fekjaer et al. 2014; Zahl et al. 2011).

  2. 2.

    Pap test and mammogram samples overlapped considerably, and few differences were visible that could not be attributed to age. Table comparing descriptive statistics from the two samples are available upon request.

  3. 3.

    Since the KHB procedure cannot be run on multiply imputed data, we selected the first imputed data file and ran the test on just that file (see Wiepking and James (2013) for a similar technique).

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Correspondence to Alexa L. Solazzo.

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Solazzo, A.L., Gorman, B.K. & Denney, J.T. Cancer Screening Utilization Among U.S. Women: How Mammogram and Pap Test Use Varies Among Heterosexual, Lesbian, and Bisexual Women. Popul Res Policy Rev 36, 357–377 (2017). https://doi.org/10.1007/s11113-017-9425-5

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Keywords

  • Cancer screening
  • Sexual minority
  • LGBT
  • Mammogram
  • Pap test
  • Women