Having a PCP Important in Cervical Cancer Screening, Especially for LGB Women

Having a primary care practitioner (PCP) improved cervical cancer screening rates among cisgender women, a retrospective cohort study found.

Lesbian, gay, or bisexual (LGB) women were both less likely to be up-to-date with cervical cancer screening and less likely to have a PCP than their straight counterparts (71% vs 77% and 80% vs 86%, respectively), reported Kelley Baumann, a medical student at the University of Illinois Chicago, and colleagues.

However, LGB patients with PCPs were 93% more likely to be up-to-date compared to those without one (prevalence ratio 1.93, 95% CI 1.37-2.72), which was stronger than the association among heterosexual women (PR 1.47, 95% CI 1.31-1.64), the authors wrote in JAMA Network Open.

LGB, transgender, and queer patients face unique barriers to cervical cancer screening, including that both “patients and practitioners often underestimate the risk of contracting high-risk human papillomavirus (HPV) and therefore may not screen as often as recommended,” the authors wrote.

Ultimately, the paper concluded that “although LGB populations are less likely to receive screening than heterosexual populations, this disparity may be reduced with improved health care access and better pathways for LGB patients to establish care with a PCP.”

In an accompanying editorial, Julie Chor, MD, MPH, of the University of Chicago Medical Center, and co-authors noted that this study adds to the body of research detailing LGB health disparities. For cervical cancer screening, they argued that telemedicine and HPV-based vaginal self-sampling — both of which became more common with the COVID-19 pandemic — are useful tools for reaching this group, in part because pelvic exams can be anxiety-provoking for people in this group.

“Although research thus far has demonstrated only a 71.4% concordance between self- and clinician-sampling in this same population, self-sampling may be a reasonable option to extend [screening] to individuals who are unable or reluctant to see a clinician for [screening] compared with receiving no [screening] at all,” Chor and colleagues wrote.

They also recommended that medicine continue initiatives to “(re)build trust so that [sexual and gender minority] individuals feel seen, comfortable, and supported in seeking life-saving care, including [cervical cancer screening].”

The retrospective, cross-sectional, population-based study used data from 2020 to 2022 in the Healthy Chicago Survey, which surveys 4,500 adults randomly selected by address in Chicago. Eligible participants were cisgender women between ages 25 and 64 with no history of hysterectomy. Respondents were either coded as heterosexual or LGB.

To be considered up-to-date with cervical cancer screenings, respondents must have reported having a Papanicolaou test within the past 3 years, though the authors acknowledged that this measure might have led to an under-estimation in women ages 30 to 64 for whom co-testing with an HPV DNA test every 5 years is common practice.

The analysis included 5,167 cisgender women, of whom 447 were LGB and 4,720 were heterosexual. Most respondents were insured, had a PCP, and self-identified as white or Black.

Compared with their straight counterparts, the prevalence of up-to-date screening was 15% lower among Black LGB women, 11% lower for Asian American, Pacific Islander, or Native Hawaiian LGB women, and 5% lower for white LGB women.

“Interestingly, despite Black cisgender women having one of the highest rates of up-to-date [screening] in this study, Black LGB cisgender women showed the greatest disparity in up-to-date [screening] compared with their heterosexual counterparts,” wrote Baumann and team.

The researchers noted limitations related to selection, nonresponse, and recall bias, as well as noting that respondents ages 21 to 24 couldn’t be analyzed, because they were lumped in the 18-to-24 category and cervical cancer screening isn’t recommended for people younger than 21.

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