This cross-sectional study used 2018–2022 BRFSS data (n=663,924 screening-eligible adults) to evaluate whether sexual orientation minority (SOM) or gender identity minority (GIM) status was associated with adherence to USPSTF-recommended colorectal (CRC), cervical, and breast cancer screening, compared with heterosexual and cisgender respondents respectively.
After adjustment, SOM women had lower cervical (aPR 0.92; 95% CI 0.87–0.97) and breast cancer screening adherence (aPR 0.84; 95% CI 0.77–0.92) vs. heterosexual women; GIM women had markedly lower cervical (aPR 0.58; 95% CI 0.37–0.90) and breast screening adherence (aPR 0.24; 95% CI 0.08–0.74) vs. cisgender women. SOM men had slightly higher CRC screening adherence (aPR 1.10; 95% CI 1.00–1.21). No CRC screening disparity was seen for GIM. Female-to-male transgender individuals had 50% lower cervical screening adherence vs. cisgender women (aPR 0.50; 95% CI 0.30–0.84). A Blinder–Oaxaca decomposition showed 64% of the cervical screening gap in SOM women was explained by sociodemographic factors (insurance status contributing most), with 36% unexplained.
- SOGI module was optional and administered in select states only, so the analytic sample is not nationally representative and missingness is unlikely random. - Cross-sectional self-report design introduces recall bias and SOGI misclassification; the survey lacks a two-step sex/gender measure, likely underestimating GIM disparities. - Very small GIM subgroup sizes (e.g., n=130 for cervical screening) yield wide confidence intervals and limit precision of transgender subgroup analyses.
Clinicians should proactively offer cervical and breast cancer screening to sexual and gender minority patients, using inclusive, non-heteronormative language and anatomy-based (rather than administrative gender–based) eligibility criteria. Self-collected HPV testing is a practical option to improve cervical screening uptake among female-to-male transgender individuals who may avoid traditional women's health settings.
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