Abstract A097: Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors
Authors: Adsul Prajakta , Kanda Deborah , Wu Emily , McClain Molly , Pankratz Vernon Shane , Mishra Shiraz , Tawfik Bernard , Nair Uma , Stimatze Tamara , Madhivanan Purnima , Kano Miria 
Published: January 2023

Abstract
Background Population-based studies to examine cervical cancer screening and prevention among sexual and gender diverse (SGD) individuals have been limited. We conducted a state-wide survey in New Mexico (NM) to examine differences in cervical cancer screening and HPV vaccination uptake based on gender and sexual orientation. Methods The survey was advertised using mailed flyers, social media, and targeted internet ads across the state. We received a total of 2534 responses, of which 797 respondents were cervical cancer screening eligible (i.e., between 21-65 years old, had a cervix, and did not have a prior cervical cancer diagnosis) and provided information about cervical cancer screening and were included in this analysis. Descriptive statistics were conducted using SAS 9.4. Results Of the 797 respondents, 83% were 21 - 40 years old, 44% were white, 34% reported an annual household income below $50,000, 83% were employed, 81% had health insurance, and 73% reported having a primary care provider. Fourteen percent were transgender men or nonbinary, 86% were cisgender women, 34% were bisexual, 48% were lesbian, and 18% were queer. While there were no statistical differences in self-reported cervical cancer screening based on gender identity, 31% of cisgender women and 25% of transgender men and nonbinary individuals reported never receiving a Pap test. The top reason for never receiving a Pap test among cisgender women was that their healthcare provider told them they did not need it (17%) and for transgender men and nonbinary individuals the top reasons were that they had an HPV vaccine (21%) or that it was too painful, unpleasant, or embarrassing (21%). There were significant statistical differences based on sexual orientation for receiving a Pap test (p&lt;0.001) and for being up to date on screening (Pap test in the past 3 years, a co-test, or primary HPV test in the past 5 years) (p=0.03). Among lesbians, 39% reported never having a Pap test, compared with 17% of bisexuals and 30% of queer individuals. For lesbians, the top reason for not receiving a Pap test was not knowing that Pap tests existed (19%), while the top reason for both bisexual and queer individuals was that their healthcare provider told them they did not need it (17% and 19%, respectively). No significant differences were noted in HPV vaccination uptake among respondents. Conclusions In order to address sexual orientation differences noted in our study, future research is needed to explore mechanisms through which these differences operate using community-based approaches. Additionally, educational interventions inclusive of different gender identities and sexual orientations are needed to improve motivations for screening uptake among SGD individuals. Finally, specific considerations for SGD individuals should be incorporated into screening recommendations and guidelines and clearly communicated to providers, further enabling them to make recommendations for these populations.
Citation Format: Prajakta Adsul, Deborah Kanda, Emily Wu, Molly McClain, Vernon Shane Pankratz, Shiraz Mishra, Bernard Tawfik, Uma Nair, Tamara Stimatze, Purnima Madhivanan, Miria Kano. Examining differences based on gender and sexual orientation for cervical cancer screening and prevention behaviors [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A097.