Health Disparities
Mammography Screening and Risk Factor Prevalence by Sexual Identity: A Comparison of Two National Surveys Hanwen Zhang* Hanwen Zhang Brittany M. Charlton Phillip W. Schnarrs Amy Trentham-Dietz Felicitas Kuehne Uwe Siebert Navkiran K. Shokar Michael P. Pignone Jennifer C. Spencer
Background: Emerging research suggests lesbian, gay, bisexual, and queer (LGBQ) women face barriers to breast cancer screening, yet few studies have quantified disparities in mammography screening, healthcare access, and lifestyle-related breast cancer risk factors between LGBQ and straight women across multiple national surveys.
Methods: We analyzed data from the 2018, 2019, and 2021 National Health Interview Survey (NHIS), as well as the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance Survey (BRFSS). We used Poisson regression to estimate relative risks (RR) of biennial mammography for women identifying as lesbian/gay or bisexual/queer versus straight, and we pooled RRs (pRR) with a random effects meta-analysis. We also assessed sexual identity disparities in healthcare access and lifestyle-related breast cancer risk factors with prevalence and 95% CIs. All analyses applied survey weights.
Results: Compared to straight women, LGBQ women reported lower biennial mammography (pRR: 0.95; 95%CI: 0.92-0.98), driven by differences among bisexual/queer women (pRR: 0.91[0.87-0.95]) and those entering screen-eligibility, aged 40–49 (pRR: 0.86[0.80–0.91]) and 50–59 (pRR: 0.93[0.88–0.98]). LGBQ women were more likely than straight women to be uninsured (BRFSS: 8.6% [6.5–11.2] vs. 5.1% [4.8–5.4]) and to experience financial barriers to care (BRFSS: 13.8% [11.6–16.3] vs. 8.9% [8.5–9.2]). Lifestyle-related breast cancer risk factors were more common among LGBQ versus straight women, including current smoking (BRFSS: 19.0% [17.1–21.2] vs. 13.9% [13.6–14.3]).
Conclusions: LGBQ women were more likely than straight peers to be exposed to lifestyle-related breast cancer risk factors, compounded by being screened less often and facing healthcare access barriers. It is crucial to develop and implement targeted interventions for screening and risk reduction that are accessible and effective for LGBQ women, particularly bisexual/queer women and those aging into screen-eligibility.
