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An Examination of Sexual Orientation Group Patterns in Mammographic and Colorectal Screening in a Cohort of U.S. Women
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    Underutilization of cancer screening has been found especially to affect socially marginalized groups. We investigated sexual orientation group patterns in breast and colorectal cancer screening adherence.


    Data on breast and colorectal cancer screening, sexual orientation, and sociodemographics were gathered prospectively from 1989 through 2005 from 85,759 U.S. women in the Nurses' Health Study II. Publicly available data on state-level health care quality and sexual orientation-related legal protections were also gathered. Multivariable models were used to estimate sexual orientation-group differences in breast and colorectal cancer screening, controlling for sociodemographics and state-level health care quality and legal protections for sexual minorities.


    Receipt of a mammogram in the past two years was common though not universal and differed only slightly by sexual orientation: heterosexual 84%; bisexual 79%; lesbian 82%. Fewer than half of eligible women had ever received a colonoscopy or sigmoidoscopy, and rates did not differ by sexual orientation: heterosexual 39%; bisexual 39%; lesbian 42%. In fully adjusted models, state-level health care quality score, though not state-level legal protections for sexual minorities, was positively associated with likelihood of being screened for all women regardless of sexual orientation.


    Concerns have been raised that unequal health care access for sexual orientation minorities may adversely affect cancer screening. We found small disparities in mammography and none in colorectal screening, though adherence to colorectal screening recommendations was uniformly very low. Interventions are needed to increase screening in women of all sexual orientation groups, particularly in areas with poor health care policies.

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  • Funding:
    AG/CA14742/AG/NIA NIH HHS/United States
    CA50385/CA/NCI NIH HHS/United States
    CA65725/CA/NCI NIH HHS/United States
    CA67262/CA/NCI NIH HHS/United States
    CA67883/CA/NCI NIH HHS/United States
    DK52866/DK/NIDDK NIH HHS/United States
    DK59583/DK/NIDDK NIH HHS/United States
    HD40882/HD/NICHD NIH HHS/United States
    HL03804/HL/NHLBI NIH HHS/United States
    HL64108/HL/NHLBI NIH HHS/United States
    R01 CA050385/CA/NCI NIH HHS/United States
    T71-MC00009/PHS HHS/United States
    U48DP001922/DP/NCCDPHP CDC HHS/United States
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