Cervical cancer screening preferences by sexual orientation among persons assigned female at birth

Disparities in up-to-date cervical cancer screening rates persist among women, including those identifying as lesbian, gay, bisexual or other sexual orientation (LGB+), highlighting the need for more inclusive and targeted screening interventions. With human papillomavirus at-home self-testing recently approved, we studied cervical cancer screening preferences by sexual orientation among persons assigned female at birth.

We examined cervical cancer screening preferences among a nationally representative sample of persons assigned female at birth aged 25-65 years in the 2024 Health Information National Trends Survey who did not self-report a history of cervical cancer. We assessed variation in preference for at-home self-testing or clinician-delivered cervical cancer screening by sexual orientation using weighted Rao-Scott chi-square tests and multivariate multinomial regression. We also examined reasons for preferring at-home self-testing.

The analytical sample included 2,168 respondents. Most self-identified as heterosexual (88.43%) and preferred cervical cancer screening by clinicians (61.45%). Cervical cancer screening preferences differed by sexual orientation (p = 0.02). LGB+ versus heterosexual respondents more frequently preferred at-home self-testing (30.97% versus 19.53%), whereas heterosexual respondents more frequently preferred testing by clinician than their LGB+ counterparts (62.81% versus 50.38%). The odds of preferring at-home self-testing over clinician-delivered screening were higher among LGB+ versus heterosexual respondents (adjusted odds ratio = 2.04, 95% confidence interval = 1.17-3.53), after adjusting for age, household annual income, marital status, health care utilization, race/ethnicity, and health insurance. The most frequently endorsed reason for preferring at-home self-testing was privacy (66.25%). Preferring at-home self-testing due to not taking time off work (35.22%), saving transportation cost (34.24%), and avoiding embarrassment (39.41%) were endorsed less frequently. Reasons for preferring at-home self-testing did not differ by sexual orientation.

LGB+ respondents more frequently preferred at-home self-testing compared to heterosexual respondents. These findings highlight the potential utility of at-home self-testing in addressing screening preferences and barriers among LGB+ persons.