LeBlanc Merrily E, Line Emmett C, Potter Jennifer, Goldman Roberta E, Austin S Bryn, Agénor Madina
Department of Sociology and Anthropology, Northeastern University, Renaissance Park, 360 Huntington Avenue, Boston, MA, 02115, USA.
The Fenway Institute, Fenway Health, Boston, MA, USA.
Reprod Health. 2025 Jul 29;22(1):135. doi: 10.1186/s12978-025-02082-2.
Sexual and gender minoritized (SGM) people, including but not limited to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people assigned female at birth (AFAB), experience a greater burden of cervical cancer relative to their heterosexual and cisgender counterparts. However, they face pronounced systemic barriers to regular cervical cancer screening. Although evidence-based clinical guidelines play an integral role in the implementation of preventive measures, existing United States (U.S.) cervical cancer screening guidelines do not consider the specific experiences, needs, and contexts of SGM AFAB people concerning cervical cancer outcomes nor cervical cancer screening. Thus, it is imperative to determine how cervical cancer screening guidelines can be revised to better address the unique and specific cervical cancer prevention needs of SGM AFAB people in the U.S.
We conducted virtual key informant interviews to elicit recommendations for advancing SGM health equity in developing and implementing cervical cancer screening guidelines from healthcare equity leaders (N = 18), including half with expertise in SGM AFAB people's healthcare. Interviews were analyzed using a template-style thematic analysis approach to develop themes and sub-themes.
Healthcare equity leaders provided three key recommendations for advancing SGM health equity in the development and implementation of U.S. cervical cancer screening guidelines. Healthcare equity leaders recommended prioritizing community and person-centered strategies, including engaging SGM communities in the development of the guidelines and using SGM-affirming approaches in their implementation. Revising language that (re)produces harmful normative and exclusionary assumptions about gender and sexuality in the context of cervical cancer screening guidelines was also recommended. Lastly, leaders recommended a range of strategies to mitigate systemic barriers to cervical cancer screening among SGM AFAB people, including collecting and utilizing representative data on SGM AFAB people's needs, experiences, and contexts to develop the guidelines and ensure cultural responsiveness in the delivery of cervical cancer screening to SGM AFAB people across healthcare systems.
This study's findings can contribute to improving and advancing health equity in cervical cancer screening for SGM AFAB populations through the community-centered development of inclusive, evidence-based guidelines and their person-centered implementation in clinical settings.
性取向和性别少数群体（SGM），包括但不限于出生时被指定为女性的女同性恋、男同性恋、双性恋、跨性别者和酷儿（LGBTQ+），相对于异性恋和顺性别同龄人，患宫颈癌的负担更重。然而，他们在定期进行宫颈癌筛查方面面临明显的系统性障碍。尽管循证临床指南在预防措施的实施中发挥着不可或缺的作用，但美国现有的宫颈癌筛查指南并未考虑SGM出生时被指定为女性者在宫颈癌结局及宫颈癌筛查方面的具体经历、需求和背景。因此，必须确定如何修订宫颈癌筛查指南，以更好地满足美国SGM出生时被指定为女性者独特且具体的宫颈癌预防需求。
我们进行了虚拟关键信息人访谈，以征求医疗保健公平性领导者（N = 18）对在制定和实施宫颈癌筛查指南中推进SGM健康公平性的建议，其中一半领导者在SGM出生时被指定为女性者的医疗保健方面具有专业知识。访谈采用模板式主题分析方法进行分析，以形成主题和子主题。
医疗保健公平性领导者为在美国宫颈癌筛查指南的制定和实施中推进SGM健康公平性提供了三项关键建议。医疗保健公平性领导者建议优先考虑以社区和个人为中心的策略；包括让SGM社区参与指南的制定，并在实施过程中采用肯定SGM的方法。他们还建议修改在宫颈癌筛查指南背景下（重新）产生关于性别和性取向的有害规范性和排他性假设的措辞。最后，领导者们建议采取一系列策略来减轻SGM出生时被指定为女性者在宫颈癌筛查方面的系统性障碍，包括收集和利用关于SGM出生时被指定为女性者的需求、经历和背景的代表性数据来制定指南，并确保在整个医疗系统中为SGM出生时被指定为女性者提供宫颈癌筛查时具有文化敏感性。
本研究的结果有助于通过以社区为中心制定包容性的循证指南，并在临床环境中以个人为中心实施这些指南，来改善和推进SGM出生时被指定为女性人群在宫颈癌筛查方面的健康公平性。
