Abstract C133: Identifying sexual and gender minority colorectal cancer screening disparities via the 2020 Behavioral Risk Factor Surveillance System
Authors: Wolf Frank M. , Alpert Ash , Schwalb Molly , German Danielle 
Published: December 2023

Introduction: Health disparities exist for US sexual and gender minorities (SGM) relative to the general population, including cancer screening disparities with variation across disease sites. Limited data exist to describe the frequency of guideline-concordant colorectal cancer screening (CRC) among SGM people, with few studies using nationally-representative samples. This study aims to assess CRC screening participation among SGM people leveraging nationally-representative US health survey data.  Methods: Data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were used to compare CRC screening participation among screening-eligible SGM to that of the straight, cisgender population. 86,519 individuals aged 50 and older without a lifetime cancer diagnosis and with complete information on demographics, health access, and sexual orientation and gender identity (collected in 33 of 53 participating US states/territories) were included in the analysis. Odds of lifetime CRC screening participation by test type (colonoscopy, sigmoidoscopy, blood stool test, stool DNA test, virtual colonoscopy) for gender minority (GM: transgender man, transgender woman, gender non-conforming) vs. cisgender individuals and sexual minority (SM: gay/lesbian, bisexual, something else) vs. straight individuals were compared via weighted logistic regression models adjusted for age, demographics, and health access.  Results: Of the overall sample, 0.44% and 3.6% identified as GM and SM, respectively.  Prevalence of lifetime CRC screening by any test was 65.4% vs. 78.9% for GM vs. cisgender individuals and 77.1% vs. 78.9% for SM vs. straight individuals. GM reported lower odds of screening participation relative to cisgender individuals in 4 of 5 test types: colonoscopy adjusted odds ratio (AOR) 0.38 (95% CI 0.13, 1.08); sigmoidoscopy 0.58 (0.28, 1.22); blood stool test 0.84 (0.31, 2.28); stool DNA test 0.52 (0.22, 1.20); virtual colonoscopy 1.36 (0.64, 2.90). SM reported lower odds of screening participation relative to straight individuals in 2 of 5 test types: colonoscopy 1.05 (0.83, 1.32); sigmoidoscopy 0.94 (0.74, 1.19); blood stool test 0.95 (0.77, 1.17); stool DNA test 1.11 (0.81, 1.51); virtual colonoscopy 1.12 (0.81, 1.53).  None of the AORs were statistically significant. Conclusions: Disparities in CRC screening participation persist for GM relative to cisgender individuals.  These findings suggest the need for additional subgroup analyses among GM, study replication in other data sources, and interventions to improve access to CRC screening for GM.

Citation Format: Frank M. Wolf, Ash Alpert, Molly Schwalb, Danielle German. Identifying sexual and gender minority colorectal cancer screening disparities via the 2020 Behavioral Risk Factor Surveillance System [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C133.