Study Identifies Cancer Screening Inequities Among Sexual and Gender Identity Minority Populations

By Teresa Hagan Thomas, PhD, RN - March 16, 2023

People who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) are at higher risk for several cancers, including breast, cervical, and prostate cancer because of low screening rates. Lower screening rates result in more advanced stages during diagnosis and higher mortality rates.

A recent study aimed to compare the individual, environmental, and organizational barriers LGBTQ+ populations experience associated with lower rates of receiving cancer screening. Kelly Haviland, PhD, FNP-BC, an advanced practice provider manager at Memorial Sloan Kettering Cancer Center, led the study, recently published in the Oncology Nursing Forum. Results demonstrate that individuals with marginalized intersectional identities, including sexual orientation and gender identity, are at a higher risk for low participation in cancer screening.

The researchers analyzed data from 403,900 respondents of the 2014 and 2016 Behavioral Risk Factor Surveillance System (BRFSS) national datasets, containing information on respondents’ sexual orientation and gender identity. In the sample, 12,204 respondents identified as LGBTQ+. The researchers analyzed if respondents’ screening status was associated with any individual, socioeconomic, or healthcare characteristics.

Overall, LGBTQ+ respondents who did not have cancer screenings were more likely to be younger compared to those who received cancer screenings. Female LGBTQ+ individuals were 10 times more likely not to have cancer screening than their male counterparts. Moreover, LGBTQ+ individuals who were unmarried, had a high school education, self-reported good or better health, and did not have health care coverage were more likely to receive screening.

Black, female, college-educated LGBTQ+ respondents with health care coverage were less likely to receive screenings than their respective counterparts. Women who did not receive screenings were more likely to be LGBTQ+ if they had at least some college education, were unmarried, aged 18-55, and reported a non-white race.

The researchers concluded that non-white LGBTQ+ populations with lower socioeconomic status were less likely to receive cancer screenings than white non-LGBTQ+ populations. These findings had mixed comparisons with published literature, suggesting that more research is necessary to understand the drivers of cancer screening among LGBTQ+ populations. For example, the role of education and health care coverage should be explored to understand why individuals with higher education and coverage are less likely to receive screening. Some potential reasons for these discrepancies are that these populations are largely underrepresented (or mislabeled) in clinical care and research due to a lack of understanding and appreciation for their specific needs.

Oncology nurses can support such efforts by encouraging the documentation of sexual orientation and gender identity in patient records to expand the scientific knowledge of this underserved group. In addition, tailored interventions to enhance cancer screening among LGBTQ+ populations can address barriers to seeking care and support cancer prevention. Designing educational materials and support services that appreciate the multiple marginalized experiences of these individuals can assist in ensuring care is directed at their specific needs and barriers to care.


Disparities in cancer screening in sexual and gender minority populations: A secondary analysis of Behavioral Risk Factor Surveillance System data.