Disparities in Breast and Cervical Cancer Screening in Lesbian and Bisexual Residents of Michigan

Authors:

Diana Haggerty, Michigan Department of Health and Human Services
Bethany Hollender (Presenter)
Michigan Department of Health and Human Services

Public Health Statement: Michigan women who identify as lesbian or bisexual have lower uptake of age-appropriate breast and cervical cancer screenings as compared to Michigan women who identify as heterosexual. Lesbian and bisexual women reported receiving a Mammogram and Pap-Test, 16.2% and 14.2% less frequently, respectively, than their heterosexual counterparts.

Purpose: Our research question was: Do disparities in breast and cervical cancer screening persist in these two groups after adjusting for demographic factors?

Methods/Approach: We used multiple years of Michigan Behavioral Risk Factor Surveillance System (MiBRFSS) data to model receipt of age-appropriate mammography and age-appropriate Pap test as the outcome. The primary exposure status was sexual orientation. We adjusted for age group, household income, having a healthcare provider, and insurance status using multivariable logistic regression. Analysis was performed using SAS 9.2 survey procedures.

Results: After adjustment for the factors listed above, lesbian and bisexual women still had a two-fold higher odds of lacking age-appropriate mammogram compared to heterosexual women. Adjustment for these factors attenuated the differences for age-appropriate Pap test.

Conclusions/Implications: Factors not accounted for in the MiBRFSS may affect lesbian and bisexual women’s receipt of appropriately timed cancer screenings. Barriers may be related to insurance status and having a healthcare provider or, as documented in the literature, unique to the population including discrimination, mistrust, lower perceived risk, and fewer clinical prompts. Improving access to care for lesbian and bisexual women will require a collaborative approach with community organizations who serve this population.