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Mammography screening and risk factor prevalence by sexual identity: A comparison of two national surveys
Hanwen Zhang1, Brittany M Charlton2,3, Phillip W Schnarrs4,5
1Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, Texas, USA.
Background:
Emerging research suggests that lesbian, gay, bisexual, and queer (LGBQ) women face barriers to breast cancer screening. The authors sought to quantify sexual identity disparities in mammography screening, health care access, and lifestyle-related risk factors using two national surveys.
Methods:
Data from the 2018, 2019, and 2021 National Health Interview Survey (NHIS) and the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. The authors performed meta-analyses to determine the relative risks (RRs) of self-reported, up-to-date mammography for women identifying as LGBQ versus those identifying as straight. Differences in health care access and lifestyle-related breast cancer risk factors were also assessed by sexual identity.
Results:
LGBQ women reported lower up-to-date mammography (pooled RR [pRR], 0.95; 95% confidence interval [CI], 0.92-0.98) versus straight women, driven by differences among bisexual/queer women (pRR, 0.91; 95% CI, 0.87-0.95) and those entering screen-eligibility at ages 40-49 years (pRR, 0.86; 95% CI, 0.80-0.91) and 50-59 years (pRR, 0.93; 95% CI, 0.88-0.98). LGBQ women were more likely than straight women to be uninsured (BRFSS survey [8.6%; 95% CI, 6.5%-11.2%] vs. NHIS [5.1%; 95% CI, 4.8%-5.4%]) and to experience financial barriers to care (BRFSS survey [13.8%; 95% CI, 11.6%-16.3%] vs. NHIS [8.9%; 8.5%-9.2%]). Lifestyle-related breast cancer risk factors were more common among LGBQ women versus straight women, including current smoking (BRFSS survey [19.0%; 17.1%-21.2%] vs. NHIS [13.9%; 13.6%-14.3%]).
Conclusions:
LGBQ women were more likely than straight women to be exposed to breast cancer risk factors, which were compounded by lower screening and facing health care access barriers. It is crucial to identify interventions for screening and risk reduction that are accessible and effective for LGBQ women, particularly bisexual/queer women and those aging into screen-eligibility.
