Disparities in Breast Cancer Screening

Abstract

Background. Despite the death rates of breast cancer declining in the last two decades, new breast cancer cases have disproportionately affected some marginalized populations such as African American women. Since mammography screening disparities by sexual orientation and gender identity are inconsistent, it is important to understand the patterns of mammography screening to inform public health interventions.
 Aims. This secondary data analysis study aimed to examine the disparities in mammography screening by sexual orientation and gender identity among females assigned at birth (FAAB) overall and stratified by race/ethnicity in the U.S.
 Methods. By using 2014, 2016, and 2018 Behavioral Risk Factor Surveillance Survey (BRFSS) data, we conducted adjusted multivariable logistic regression models to estimate the odds of receiving an up-to-date mammography screening in relation to sexual orientation, gender identity, and other correlates among FAAB aged 50-74 years (unweighted N=228,257).
 Results. Overall, the lifetime and up-to-date prevalence of mammography screening were 96.3% and 76.0% in U.S. FAAB, respectively. Non-Hispanic Black (NHB) participants reported a higher rate of up-to-date mammography screening (84.13%) whereas those who had an income less than $15,000 per year had the lowest (71.31%). Being insured, overweight/obese, and not a current smoker were positively associated with receiving an up-to-date mammography screening across racial and ethnic groups. Besides, being physically active was significant for an up-to-date mammography screening in non-Hispanic White (NHW) and Hispanic participants. Also, Hispanic transgender participants were more likely to have an up-to-date mammography screening than their same-ethnic cisgender counterparts.
 Contribution to Evidence-Based Care. The findings reveal that the disparities in receiving an up-to-date mammography screening varied by sexual identity, gender identity, and race/ethnicity in FAAB aged 50-74 years. The lower rate of an up-to-date mammography screening was found particularly in Hispanic, bisexual AFAB. Future tailored mammogram programs should integrate physical activity and cultural components for people with multiple minority identities.