Abstract A113: National trends in cervical cancer screening by sexual orientation and race/ethnicity in cisgender women
Authors: Baumann Kelley , Peterson Caryn E , Geller Stacie , Awadalla Saria , Holt Hunter K 
Published: September 2024

Abstract
Background: Lesbian, gay, and/or bisexual (LGB) women have decreased rates of cervical cancer screening compared to heterosexual women which may be due to barriers accessing care. This difficulty accessing care is magnified in racial/ethnic minority LGB women. Objective: To estimate changes in guideline-concordant cervical cancer screening (CCS) over time by sexual orientation and race/ethnicity using National Health Interview Survey (NHIS) data from 2013, 2015, 2019 and 2021(full cohort). Methods: This retrospective, population-based, cross-sectional analysis included cisgender (denotes gender identity corresponding with sex assigned at birth) women aged 21-65 without history of hysterectomy. Respondents who self-identified as lesbian, gay, or bisexual or an identity other than straight, lesbian, or bisexual were coded as lesbian, gay, or bisexual (LGB). Respondents who self-identified as straight were coded as heterosexual. Up to date (UTD) CCS was determined based on NHIS questions “When did you have your most recent Pap test?” and “Did you have a human papillomavirus (HPV) test with your most recent Pap test?”. If most recent screening test was within the intervals defined by the US Preventive Services Task Force screening guidelines for respective ages and modalities, they were considered UTD. We performed joinpoint analysis to characterize piecewise log-linear time calendar trends in the proportion of UTD CCS and calculated Annual Percent Change (APC) from 2013 to 2021. Results: Overall, there were 40,818 participants in the full cohort, of which 4.32% identified as LGB. 70.64% of the LGB participants reported UTD CCS in contrast to 78.92% of the heterosexual participants. In 2013, 80.87% of the heterosexual participants were UTD for CCS in comparison to 70.59% of LGB participants. In 2021, UTD screening rates fell to 75.4% for heterosexual participants and 68.86% in LGB participants. In trend analysis only heterosexual participants had a significant APC in screening of -0.97% (p=.002) from 2013- 2021, and there was no significant trend for LGB individuals. When evaluating screening rates by sexual orientation and race, we found that heterosexual Hispanic and non-Hispanic (NH) White women had decreased in UTD CCS (APC of -1.52, p=0.008 and -0.63, p=0.02, respectively). Additionally, LGB NH Black women had a significant decrease in UTD screening over the study period (APC of -2.67, p&lt;0.005) falling from 85.22% in 2013 to 67.91% in 2019. Conclusions: In 2021 there were approximately 19.72 million cisgender women aged 21-65 who were potentially not UTD with CCS. Of these, 1.76 million LGB women were not UTD for CCS, and a greater proportion of these women identified as NH Black. Future efforts need to improve screening in cisgender populations regardless of sexual orientation, and specific attention should be aimed at LGB and Black identifying cisgender women.
Citation Format: Kelley Baumann, Caryn E Peterson, Stacie Geller, Saria Awadalla, Hunter K Holt. National trends in cervical cancer screening by sexual orientation and race/ethnicity in cisgender women [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A113.