In October, Michael Bare wrote the post Increasing LGBT HPV vaccines for our blog, and revealed the disturbing statistic that only about 31% of lesbians and bisexual women who were interviewed had completed the 3-shot course of the HPV vaccine, while about 14% had started but not completed the vaccine series. Michael wrote “This is particularly concerning considering lesbians and bisexual women are less likely to get regular PAP tests which can lead to early detection, meaning any cancer diagnosis may come at a later stage in the illness.” In November, the CDC has come out with a series of new infographics illustrating important information about cervical cancer and HPV awareness.
Lesbians and cervical cancer
Compared to heterosexual women, lesbians may be at greater risk for HPV and cervical cancer due to health and lifestyle factors associated with poor overall health. Women who have sex with women can contract the virus from an infected partner in the same ways heterosexual women can, including through genital to genital contact, touching the genitals of a partner and then one’s own, or sharing sex toys without cleaning them properly first. Many lesbians have also experienced heterosexual intercourse, increasing their risk for HPV. However, lesbians are less likely to regularly visit a reproductive health specialist and are therefore less exposed to information about HPV or make use of the preventative steps developed for women. (Source: National LGBT Cancer Network)
Read more about HPV and cancer in LGBT communities HERE
Much of the work now being done in the health arena around HPV is to reframe the discussion from instead of viewing HPV only as an STI, to instead address the instead address it as a cause of cervical cancer, and to the lack of education, knowledge, and vaccination from that perspective.
(Read more about preventing cervical cancer on the CDC website HERE)
Additionally, the widespread misinformation about HPV transmission and lack of access to preventative care in LBT communities must be addressed. Culturally competent clinicians, as well as community outreach campaigns, are two ways to increase testing and awareness in our communities.
Sarah Peitzmeier, MSPH
Clinical data specialist
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.