Cancer screening gaps persist for sexual and gender minorities

Clinical takeaway: Routinely assess screening eligibility based on anatomy and risk factors rather than gender identity alone, and proactively address barriers to cervical and breast cancer screening among sexual and gender minority patients.

Delayed or missed screening can lead to later-stage cancer diagnosis, making it essential for clinicians to identify and address barriers to preventive care in sexual and gender minority populations.

Analysis of more than 663,000 US adults eligible for colorectal, cervical, or breast cancer screening found persistent disparities in preventive cancer care across sexual orientation and gender identity groups, with the largest gaps seen in cervical and breast cancer screening.

Using 2018–2022 Behavioral Risk Factor Surveillance System data, investigators compared screening adherence among sexual orientation minority (eg, gay, lesbian, bisexual) and gender identity minority (eg, transgender) individuals with heterosexual and cisgender adults. Sexual orientation minority women were 8% less likely to be up to date with cervical cancer screening and 16% less likely to have received recommended breast cancer screening. In contrast, sexual orientation minority men were 10% more likely to undergo colorectal cancer screening than heterosexual men.

Disparities were even greater among gender identity minority individuals. Compared with cisgender adults, transgender and other gender minority participants were 42% less likely to receive cervical cancer screening and 76% less likely to receive breast cancer screening, while colorectal cancer screening rates were generally similar. Among eligible respondents, cervical screening adherence was 42% in gender minority individuals versus 73% in cisgender adults, and breast screening rates were 13% versus 48%, respectively.

Importantly, despite differences in screening uptake, the researchers found no meaningful differences in cancer prevalence by sexual orientation or gender identity.

“The current data highlight how sexual and gender minority populations, particularly transgender individuals, face significant disparities in accessing breast and cervical cancer screenings,” said senior author Timothy M. Pawlik, MD, MPH, PhD. “The study emphasizes the urgent need for targeted interventions, including improved training for providers and policy reform, to bridge these gaps and ensure equitable, inclusive care.”

Source: Arena L, et al. (2026 July 6) Cancer. Sexual orientation and gender identity based disparities in colorectal, cervical, and breast cancer screening in the United States