ANAHEIM, Calif. — Screening for cervical cancer was low among women who self-identified as lesbian — a finding that places them at a potentially elevated risk for the disease, according to data presented at the 11th Annual AACR International Conference on Frontiers in Cancer Prevention Research, held here Oct. 16-19, 2012.
"Despite our knowledge of the value of Pap testing for early detection of treatable cervical abnormalities, lesbians are one subset of women who are not getting screened at recommended rates. In fact, nearly 38 percent of lesbians in our study had not been screened according to recommended guidelines," said J. Kathleen Tracy, Ph.D., associate professor in the department of epidemiology and public health at the University of Maryland School of Medicine in Baltimore.
She and her colleagues conducted a standardized internet survey that examined recent cervical cancer screening behaviors and perceived screening barriers. They sent the survey to 3,000 self-identified lesbians in the United States and received 1,006 responses.
A total of 62 percent of the weighted sample underwent routine screenings. The most common reasons for lack of screening were no physician referral (17.5 percent) and absence of a physician (17.3 percent).
After adjustment for age, education, relationship status, employment status and insurance status, women who disclosed sexual orientation to their primary care physicians were 2.8 times more likely to undergo routine screening compared with women who did not disclose. Similarly, those who disclosed to their gynecologists were 2.3 times more likely to undergo routine screening.
"When this finding is coupled with that of the potency of provider recommendation, it underscores how critical effective communication between patient and provider is for optimal health and disease prevention," Tracy said.
In addition, women who knew that not having a Pap test is a risk factor for cervical cancer were nearly two times more likely to undergo routine screening. No association with screening was found for women who had additional information about general cervical cancer risk factors.
"This study highlights an often overlooked cancer disparity," Tracy said. "We know that human papillomavirus can be transmitted during same-sex sexual activity, so lesbians are at risk for developing cervical cancer. If this group of women doesn't participate in screening, they are at elevated risk for developing cervical cancer via missed opportunities to identify and treat precursor abnormalities."
The study was funded by the National Cancer Institute.
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About the American Association for Cancer Research
Founded in 1907, the American Association for Cancer Research (AACR) is the world's first and largest professional organization dedicated to advancing cancer research and its mission to prevent and cure cancer. AACR membership includes more than 34,000 laboratory, translational and clinical researchers; population scientists; other health care professionals; and cancer advocates residing in more than 90 countries. The AACR marshals the full spectrum of expertise of the cancer community to accelerate progress in the prevention, biology, diagnosis and treatment of cancer by annually convening more than 20 conferences and educational workshops, the largest of which is the AACR Annual Meeting with more than 17,000 attendees. In addition, the AACR publishes seven peer-reviewed scientific journals and a magazine for cancer survivors, patients and their caregivers. The AACR funds meritorious research directly as well as in cooperation with numerous cancer organizations. As the scientific partner of Stand Up To Cancer, the AACR provides expert peer review, grants administration and scientific oversight of team science and individual grants in cancer research that have the potential for near-term patient benefit. The AACR actively communicates with legislators and policymakers about the value of cancer research and related biomedical science in saving lives from cancer.
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A03 Understanding cervical cancer screening among lesbians: a national survey. J Kathleen Tracy. University of Maryland School of Medicine, Baltimore, MD.
Objectives: The aim of this study was to examine cervical cancer screening behaviors among lesbians in the US, a population who has documented low rates of cervical cancer screening, despite their risk of contracting the disease.
Procedures: A standardized internet survey was sent to 3,000 self-identified lesbians across the US. The survey assessed the participants' recent cervical cancer screening behaviors and perceived barriers to screening.
Results: The sample consisted of 1,006 respondents, representing every region of the US. Sixty-two percent of the weighted sample were routine screeners. Lack of a physician referral (17.5%) and lack of a physician (17.3%) were the most commonly-cited top reasons for lack of screening. Adjusting for age, education, relationship status, employments status, and insurance status, women who had disclosed their sexual orientation to their primary care physician (adjusted odds ratio [OR] 2.84 [95% confidence interval 1.82-4.45]) or gynecologist (OR 2.30 [1.33-3.96]) had greater odds of routine screening than those who did not. Those who knew that lack of Pap testing is a risk factor for cervical cancer were also more likely to be routine screeners (OR 1.95 [1.30-2.91]), although no association with screening was apparent for women who had more knowledge of general cervical cancer risk factors. Physician recommendation appeared to be a potent determinant of regular screening behavior. Routine screeners perceived more benefits and fewer barriers to screening, and higher susceptibility to cervical cancer, than did women who did not routinely screen.
Conclusions: Women who identify as lesbian are at potentially elevated risk of cervical cancer because they are not routinely screened. Evidence-based interventions should be developed that address critical health beliefs that undermine participation in screening. Given the value placed on physician recommendation, patient-provider communication may serve as the optimal mode for intervention delivery.
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