Sexual Minorities Less Likely to Receive Pap Screening

NEW YORK (Reuters Health) – Sexual minorities who have a cervix are less likely than heterosexual women to be screened for cervical cancer, a new study suggest.

An analysis of data from more than 18,000 people who were assigned female sex at birth and who participated in a national health survey revealed that sexual minorities (SM) were half as likely as heterosexual women to ever undergo Pap screening, researchers report in Cancer.

“Our analysis showed that most individuals in our study population who self-identified as belonging to a sexual-minority group had lower uptake of cervical-cancer screening compared to non-Hispanic white heterosexual counterparts,” said Dr. Ashley Stenzel of Allina Health, in Minneapolis. “This was more pronounced among those identifying as both Hispanic and belonging to a sexual-minority group. This is very concerning as cervical-cancer screening can catch this disease at early stages to prevent poor outcomes.”

“We need to continue to examine disparities at the intersection of multiple societally oppressed identities, how systemic discrimination plays a role in these disparities, and the additional barriers that individuals face with respect to cancer screening access,” she told Reuters Health by email. “Together, these can guide institutional and policy level changes for better serving these populations.”

To take a closer look at the uptake of cervical-cancer screening in SM individuals, Dr. Stenzel and her colleagues turned to data from the 2015 and 2018 editions of the U.S. National Health Interview Survey (NHIS), a nationally representative cross-sectional survey program that collects data on a broad range of health topics through personal household interviews.

The researchers identified more than 20,000 NHIS participants in the years 2015 and 2018 who were assigned female gender at birth, did not have a history of hysterectomy and were between the ages of 21 and 65. Three percent did not report sexual orientation and another 4% did not report their Pap testing history. That left 18,637 participants for the analysis, with 877 identifying as SM.

After adjusting for potentially confounders, the researchers found that the SM participants had significantly reduced odds of ever undergoing Pap testing (odds ratio, 0.54) compared with the 17,760 heterosexual participants.

The researchers also looked at the impact of race/ethnicity and found that non-Hispanic white SM participants and Hispanic SM participants had reduced odds of ever undergoing Pap testing in comparison with non-Hispanic white heterosexual participants. They observed no significant differences between non-Hispanic white heterosexual participants and participants of non-Hispanic Black SM or Hispanic heterosexual identities.

“Having the data that highlights the health disparity amongst sexual minorities could help institutions, providers and regulatory organizations to focus on education and policies to help narrow disparities and improve healthcare outcomes,” said Dr. Zoe Rodriguez, vice chair of the department of obstetrics and gynecology at Mount Sinai West in New York.

For the many heterosexual women who need contraceptives, there’s a regular touchpoint with an ob-gyn, said Dr. Rodriguez, who was not involved in the study. That’s not true for many sexual minorities because they don’t need contraception as they are not having intercourse with a man, she added.

“There’s no question that patients come in with the preconceived notion that if they don’t engage in sexual behavior with people who have penises it’s impossible for them to get HPV (human papillomavirus),” Dr. Rodriguez told Reuters Health by phone.

“HPV can be found on the skin and under the fingernails, so penetrative relations is not the only way to contract HPV and who’s to say who a partner has been with.”

“It’s been well documented that the vast majority of people in their 20s have been exposed to HPV at some point in their lives regardless of the gender of their partners,” Dr. Rodriguez said.

That’s why at any point that providers come in contact with SM patients, they should take the opportunity to educate these patients about screening guidelines and to draw attention to the fact that if you are not having sex with a person with a penis, you could still catch HPV and develop cervical cancer, Dr. Rodriguez said.

SOURCE: and Cancer, online May16, 2022.

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