Screening Gaps Among Sexual and Gender Minorities Shown in New US Data

Sexual orientation and gender identity (SOGI) minority adults in the United States are substantially less likely than their heterosexual and cisgender counterparts to be up to date on cervical and breast cancer screening, according to a national analysis of Behavioral Risk Factor Surveillance System (BRFSS) data published in Cancer.¹ The study, led by researchers at The Ohio State University Wexner Medical Center, found no corresponding increase in self-reported cervical or breast cancer prevalence among these groups, suggesting that observed disparities reflect access and utilization barriers rather than underlying disease burden.

The retrospective analysis drew on 2018 to 2022 BRFSS data from adults eligible for colorectal, cervical, or breast cancer screening under US Preventive Services Task Force criteria.² Among 663,924 unweighted respondents, 1.2% identified as sexual orientation minorities and 0.4% as gender identity minorities. Using survey-weighted Poisson regression adjusted for age, race, income, education, marital status, employment, insurance type, and rurality, the investigators estimated adjusted prevalence ratios (aPRs) for guideline-concordant screening.¹

Screening Disparities Observed Across SOGI Groups

Sexual orientation minority women had lower adjusted screening adherence for both cervical cancer (aPR, 0.92; 95% CI, 0.87-0.97) and breast cancer (aPR, 0.84; 95% CI, 0.77-0.92) compared with heterosexual women. No difference was observed for colorectal cancer screening among women by sexual orientation. Among men, sexual orientation minority status was associated with modestly higher colorectal cancer screening adherence (aPR, 1.10; 95% CI, 1.00-1.21), a pattern the authors attribute in part to more frequent engagement with preventive sexual health services, including HIV testing, that may create opportunities to discuss colonoscopy or sigmoidoscopy with clinicians.

Disparities were more pronounced among gender identity minority respondents. Compared with cisgender women, gender identity minority women had substantially lower adherence to cervical cancer screening (aPR, 0.58; 95% CI, 0.37-0.90) and breast cancer screening (aPR, 0.24; 95% CI, 0.08-0.74). Exploratory subgroup analyses found that female-to-male transgender respondents had roughly half the likelihood of cervical cancer screening compared with cisgender women (aPR, 0.50; 95% CI, 0.30-0.84), and lower colorectal cancer screening adherence as well (aPR, 0.20; 95% CI, 0.04-0.92). No gender identity-based disparity was observed for colorectal cancer screening overall, a pattern the authors note may reflect that colorectal screening is less embedded in gendered clinical contexts than cervical or breast screening, which rely on sex-specific service categorizations that can create administrative and insurance barriers for transgender patients.

Health Care Access Explained Most of the Gap

A Blinder-Oaxaca decomposition applied to the cervical cancer screening disparity between sexual orientation minority and heterosexual women found that observed sociodemographic and health care access variables—led by insurance status, age, and marital status—accounted for approximately 64% of the gap, leaving more than one-third unexplained. The authors suggest the residual disparity may reflect psychosocial factors such as anticipated discrimination, prior adverse experiences, and reluctance to disclose sexual orientation to clinicians.

Despite the screening gaps, multivariable analyses found no statistically significant association between sexual orientation or gender identity status and self-reported prevalence of colorectal, cervical, or breast cancer.

Limitations and Next Steps

The authors note several limitations, including the cross-sectional, self-reported nature of BRFSS data; optional state-level administration of the SOGI module, which reduced sample size and statistical power for subgroup analyses; separate survey items for sexual orientation and gender identity that produced different analytic denominators; and a single transgender-identity question that did not separately capture sex assigned at birth, which may have led to misclassification.

The authors called for mandatory inclusion of 2-step SOGI measures in national surveys and cancer registries, insurance policies based on anatomy rather than administrative gender markers, and further research into culturally affirming screening interventions, including self-collected HPV testing, for transgender populations.

REFERENCES

1. Arena L, Alizai Q, Elemosho A, Chatzipanagiotou OP, Pawlik TM. Sexual orientation and gender identity based disparities in colorectal, cervical, and breast cancer screening in the United States. Cancer. 2026;e70462. doi:10.1002/cncr.70462

2. United States Preventive Services Task Force. Accessed July 14, 2026. https://www.uspreventiveservicestaskforce.org/uspstf/