Sarah Peitzmeier, MSPH Clinical data specialist Fenway Institute
LESBIANS AND BISEXUAL WOMEN LAG BEHIND HETEROSEXUAL WOMEN IN RECEIVING ADEQUATE CERVICAL CANCER SCREENING, DESPITE BEING EQUALLY AT RISK FOR CERVICAL CANCER
Lesbians and bisexual women are as likely as heterosexual women to develop cervical cancer, but are up to 10 times less likely to be regularly screened for it, putting them at greater risk of the potentially deadly disease, according to a policy brief released by The Fenway Institute. This disparity is due to a misconception that sexual minority women are not at risk for cervical cancer as well as their broader marginalization in the health care system.
Yearly, over 12,000 American women are diagnosed with cervical cancer and over 4,000 die from the disease. The majority of cervical cancers in the US occur among women who have never been screened or who were not screened within the past five or more years. This is bad news for lesbians and bisexual women, who are less likely to undergo routine screening for cervical cancer. The vast majority of cervical cancers are caused by a human papilloma virus (HPV) infection, and many sexual minority women – and their healthcare providers – are under the misperception that HPV cannot be passed between women during sex. In fact, because HPV passes through skin-to-skin genital, as well as potentially through oral-vaginal and digital-vaginal contact, even women who exclusively have sex with women are at risk for contracting the virus, and by extension, cervical cancer. Multiple studies have shown that lesbians and bisexual women are just as likely as heterosexual women to have HPV and cervical abnormalities that could potentially lead to cancer if unchecked.
Current guidelines recommend that screening start for all women at age 21, regardless of HPV vaccination or age of sexual debut, and continue every three years until age 29; the screening interval may be lengthened to every five years for women ages 30-65 if HPV co-testing is done in addition to the Pap test. Women with a history of a prior abnormal Pap test or who are immune compromised (e.g. by HIV) should be screened yearly.
The brief concludes with a set of policy recommendations, including:
- –Promote routine cervical cancer screening for lesbians and bisexual women through patient in-reach and community outreach with sexual minority-specific messaging, wording, and peer education;
- –Increase training for clinicians in the reproductive health needs of sexual minority populations, including the need for regular cervical cancer screening among women who have sex with women;
- –Promote HPV vaccination as a primary prevention strategy among lesbians and bisexual women;
- –Include transgender men (individuals born with female reproductive organs but who identify as male, many of whom still retain a cervix if a total hysterectomy is not performed) in cervical cancer screening programs;
- –Collect sexual orientation and gender identity data in cancer registries, patient medical records, and health surveys to better understand the burden of cervical cancer and cancer screening practices among this population.
“Lesbian and bisexual women experience a number of health disparities,” said Stephen Boswell, MD, President and CEO of Fenway Health. “The Affordable Care Act’s expansion of health care access and efforts by the federal government to increase clinical competency in LGBT health care offer opportunities to reduce the disparity we see in cervical cancer screening.”
A PDF of the cervical cancer screening policy brief is available online at www.fenwayhealth.org/cervicalcancerfocus.