Abstract
BackgroundLesbians have low rates of cervical cancer screening, even though they are at risk of developing the disease. The aim of this study was to examine cervical cancer screening behaviors in a national sample of lesbians.MethodsA standardized internet survey was sent to 3,000 self-identified lesbians to assess cervical cancer screening behaviors and barriers to screening. The sample consisted of 1,006 respondents.ResultsSixty-two percent of the weighted sample of respondents were routine screeners. Lack of a physician referral (17.5%) and lack of a physician (17.3%) were the most commonly-cited top reasons for lack of screening. Adjusting for age, education, relationship status, employments status, and insurance status, women who had disclosed their sexual orientation to their primary care physician (adjusted odds ratio [OR] 2.84 [95% confidence interval 1.82-4.45]) or gynecologist (OR 2.30 [1.33-3.96]) had greater odds of routine screening than those who did not. Those who knew that lack of Pap testing is a risk factor for cervical cancer were also more likely to be routine screeners (OR 1.95 [1.30-2.91]), although no association with screening was apparent for women who had more knowledge of general cervical cancer risk factors. Physician recommendation appeared to be a potent determinant of regular screening behavior. Routine screeners perceived more benefits and fewer barriers to screening, as well as higher susceptibility to cervical cancer.ConclusionsSome women who identify as lesbian are at a potentially elevated risk of cervical cancer because they are not routinely screened. Evidence-based interventions should be developed to address critical health beliefs that undermine participation in screening. Given the value placed on physician recommendation, patient-provider communication may serve as the optimal focus of effective intervention.
Highlights
Lesbians have low rates of cervical cancer screening, even though they are at risk of developing the disease
Participant characteristics Participants were 1,006 women residing in the United States who met inclusion criteria and had sufficiently complete data to be categorized into a screening group
While previous studies have found that lesbians who are non-routine screeners are more likely to report discrimination due to sexual orientation than routine screeners in a variety of health care settings [6,16,17,30,31,32], this study found no compelling association between screening behavior and perceived everyday or lifetime discrimination in all settings
Summary
Lesbians have low rates of cervical cancer screening, even though they are at risk of developing the disease. The aim of this study was to examine cervical cancer screening behaviors in a national sample of lesbians. Cervical cancer incidence and mortality rates overall have decreased significantly during the last 50 years as a result of widespread cervical cancer screening with the Papanicolaou (Pap) test [5]. Lesbians comprise one subgroup of women who have underutilized the Pap test [6,7,8], and they may have unique reasons for not participating in routine cervical cancer screening [8,9]. Cervical cancer screening prevents the occurrence of cervical cancer by allowing detection and treatment of pre-malignant lesions before invasive disease develops. Before an update to screening guidelines in early 2012 [10,11], the American Congress of Obstetricians and Gynecologists [10,11], the American Cancer Society [4], and the US Preventive Services Task Force [12] recommended that cervical cancer screening should: 1) begin no later than age 21 or within 3 years of the onset of sexual activity; 2) continue to at least age 65; and 3) occur at regular intervals— every 1–2 years up to age 30 and at least every 2–3 years thereafter—if the woman had no history of cervical abnormality
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