Stenzel Ashley E, Rider G Nic, Wicker Olivia S, Dona Allison C, Teoh Deanna, Rosser B R Simon, Vogel Rachel I
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology & Women's Health, University of Minnesota, 420 Delaware Street SE MMC 395, Minneapolis, MN, 55455, USA.
Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
Cancer Causes Control. 2025 Feb;36(2):147-156. doi: 10.1007/s10552-024-01927-8. Epub 2024 Oct 24.
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ+) individuals experience disparities in cancer screening. We examined whether experience of LGBTQ+ -related discrimination in medical settings was associated with cancer screening disparities.
Participants were recruited via social media for a cross-sectional survey study. Those who self-reported as LGBTQ+ , being 40+ years of age, and residing in the US were eligible. Participants reported their clinical and demographic characteristics, cancer screening history, and experiences of discrimination in a medical setting. We examined the odds (OR) of ever undergoing cancer screening by experienced discrimination, stratified by sex assigned at birth.
Participants (n = 310) were on average 54.4 ± 9.0 years old and primarily White (92.9%). Most identified as lesbian (38.1%) or gay (40.0%) while 17.1% were transgender or gender diverse. Nearly half (45.5%) reported experiencing LGBTQ+ -related discrimination in the medical setting. Participants assigned female at birth with discriminatory experiences had significantly lower odds of ever undergoing colonoscopy/sigmoidoscopy compared to those without discriminatory experiences (OR: 0.37; 95% Confidence Interval (CI) 0.15-0.90). No significant differences in colonoscopy/sigmoidoscopy uptake were observed in those assigned male at birth by discriminatory experiences (OR: 2.02; 95% CI 0.59-6.91). Pap tests, mammogram, and stool colorectal cancer screening did not differ by discriminatory experience.
Discrimination in medical settings was commonly reported by LGBTQ+ individuals in this study. When treating LGBTQ+ patients, clinicians should ask about prior experiences and continue to promote cancer screening. Future studies should examine discrimination as a key driver of LGBTQ+ disparities in cancer screening.
女同性恋、男同性恋、双性恋、跨性别者、酷儿及其他性取向和性别多样化（LGBTQ+）的个体在癌症筛查方面存在差异。我们研究了在医疗环境中经历的与LGBTQ+相关的歧视是否与癌症筛查差异有关。
通过社交媒体招募参与者进行横断面调查研究。那些自我报告为LGBTQ+、年龄在40岁及以上且居住在美国的人符合条件。参与者报告了他们的临床和人口统计学特征、癌症筛查史以及在医疗环境中的歧视经历。我们按出生时指定的性别分层，研究了因经历歧视而进行过癌症筛查的几率（OR）。
参与者（n = 310）平均年龄为54.4±9.0岁，主要为白人（92.9%）。大多数人认定为女同性恋（38.1%）或男同性恋（40.0%），而17.1%为跨性别者或性别多样化者。近一半（45.5%）的人报告在医疗环境中经历过与LGBTQ+相关的歧视。与没有歧视经历的人相比，出生时被指定为女性且有歧视经历的参与者进行结肠镜检查/乙状结肠镜检查的几率显著更低（OR：0.37；95%置信区间（CI）0.15 - 0.90）。在出生时被指定为男性的人中，因歧视经历在结肠镜检查/乙状结肠镜检查接受率上未观察到显著差异（OR：2.02；95% CI 0.59 - 6.91）。巴氏试验、乳房X光检查和粪便结直肠癌筛查在有无歧视经历方面没有差异。
在本研究中，LGBTQ+个体普遍报告在医疗环境中受到歧视。在治疗LGBTQ+患者时，临床医生应询问其既往经历并继续促进癌症筛查。未来的研究应将歧视作为LGBTQ+在癌症筛查方面差异的关键驱动因素进行研究。
