Having a PCP is important for cervical cancer screening, especially for LGBT women

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

Lesbian, gay, or bisexual (LGB) women were less likely to be up to date with cervical cancer screening and less likely to have a PCP than their heterosexual 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 than those without PCP (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 JAMA network opened.

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

Ultimately, the article concluded that “although LGBT populations are less likely to be screened than heterosexual populations, this disparity can be reduced with better access to health care and better opportunities for LGBT patients to receive 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 describing health disparities among LGB people. For cervical cancer screening, they argued that telemedicine and HPV-based vaginal self-sampling — both of which have become increasingly common with the COVID-19 pandemic — are useful tools for reaching this group, in part because pelvic exams can cause anxiety. provocative for people in this group.

Although research to date has shown only a 71.4% agreement between self-sampling and physician sampling in the same population, self-sampling may be a reasonable option to extend (screening) to individuals who are unable or reluctant to undergo screening. “to visit a doctor for (screening) compared to no screening at all,” Chor and colleagues wrote.

They also recommended that medicine continue initiatives to “(re)build trust so that individuals (sexual and gender minorities) 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 the ages of 25 and 64 years with no history of hysterectomy. Respondents were coded as heterosexual or LGB.

To be considered up-to-date on cervical cancer screening, respondents must have reported having a Papanicolaou test within the past three years, although the authors acknowledge that this measure may have led to an underestimation in women aged 30 to 64 years for whom it is common practice to test simultaneously with an HPV DNA test every five years.

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

Compared to their heterosexual counterparts, the prevalence of current screening was 15% lower among black LGBT women, 11% lower among Asian American, Pacific Islander, or Native Hawaiian LGB women, and 5% lower among white LGBT women.

“Interestingly, despite Black cisgender women having among 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 to their heterosexual counterparts ,” Baumann and team wrote.

The researchers noted limitations related to selection, non-response and recall bias, and also noted that respondents aged 21 to 24 could not be analyzed because they were lumped into the 18 to 24 category and cervical cancer screening is not recommended. for people under 21 years old.