Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: A review of the literature

Mammography screening and risk factor prevalence by sexual identity: A comparison of two national surveys

BACKGROUND

Emerging research suggests that lesbian, gay, bisexual, and queer (LGBQ) women face barriers to breast cancer screening. The authors sought to quantify sexual identity disparities in mammography screening, health care access, and lifestyle-related risk factors using two national surveys.

METHODS

Data from the 2018, 2019, and 2021 National Health Interview Survey (NHIS) and the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed. The authors performed meta-analyses to determine the relative risks (RRs) of self-reported, up-to-date mammography for women identifying as LGBQ versus those identifying as straight. Differences in health care access and lifestyle-related breast cancer risk factors were also assessed by sexual identity.

RESULTS

LGBQ women reported lower up-to-date mammography (pooled RR [pRR], 0.95; 95% confidence interval [CI], 0.92-0.98) versus straight women, driven by differences among bisexual/queer women (pRR, 0.91; 95% CI, 0.87-0.95) and those entering screen-eligibility at ages 40-49 years (pRR, 0.86; 95% CI, 0.80-0.91) and 50-59 years (pRR, 0.93; 95% CI, 0.88-0.98). LGBQ women were more likely than straight women to be uninsured (BRFSS survey [8.6%; 95% CI, 6.5%-11.2%] vs. NHIS [5.1%; 95% CI, 4.8%-5.4%]) and to experience financial barriers to care (BRFSS survey [13.8%; 95% CI, 11.6%-16.3%] vs. NHIS [8.9%; 8.5%-9.2%]). Lifestyle-related breast cancer risk factors were more common among LGBQ women versus straight women, including current smoking (BRFSS survey [19.0%; 17.1%-21.2%] vs. NHIS [13.9%; 13.6%-14.3%]).

CONCLUSIONS

LGBQ women were more likely than straight women to be exposed to breast cancer risk factors, which were compounded by lower screening and facing health care access barriers. It is crucial to identify interventions for screening and risk reduction that are accessible and effective for LGBQ women, particularly bisexual/queer women and those aging into screen-eligibility.

Underinvested, Under-Referred, and Underserved: Applying a Gender Equity Continuum Framework in Cancer Control Continuum Programs and Policies to Expand to Transgender and Nonbinary Populations

Gender-inclusive and gender-specific approaches are critically needed in cancer control continuum services to recognize and meet the needs of transgender and nonbinary (trans) populations. Current research, programs, and policies largely cater to cisgender populations and subscribe to a binary, gendered cisnormative ideology, both within health care systems and insurance policies, leaving trans people's cancer prevention and treatment needs neglected. Such disparities can be attributed to the significant gap in funding and research to address trans cancer prevention and treatment. We discuss the research, program, and policy implications of cisnormative practices and provide recommendations for promoting gender-inclusive and specific services across the cancer control continuum with the goal of eliminating cancer disparities and improving cancer outcomes for people of all gender groups, including trans populations.

Cervical cancer screening and risk factor prevalence by sexual identity: A comparison across three national surveys in the United States

OBJECTIVES

Women identifying as lesbian, gay, bisexual, or queer (LGBQ) have lower cervical cancer screening use and differences in care access. Less known about how differences vary by data sources and within LGBQ subgroups. We evaluated LGBQ disparities in cervical cancer screening use and risk factors across three national surveys in the United States.

METHODS

Data were from the 2019 and 2021 National Health Interview Survey, the 2018 and 2020 Behavioral Risk Factor Surveillance Survey, and the 2017-2019 National Survey of Family Growth. We meta-analyzed self-reported cervical cancer screening to estimate pooled relative risks (pRR), comparing those identifying as LGBQ to those identifying as straight/heterosexual. We also evaluated differences in care access and behavioral risk factors by sexual identity.

RESULTS

Despite demographic differences across surveys, all three surveys demonstrated a small reduction in up-to-date cervical cancer screening for LGBQ vs. straight/heterosexual women (pRR = 0.91 [CI 0.89-0.93]). The screening gap was larger for gay/lesbian (pRR: 0.90 [0.85-0.94]) than bisexual women (pRR: 0.94 [0.92-0.97]) and largest at younger ages (pRR age 21-29: 0.89 [CI 0.85-0.93]). LGBQ women reported consistently lower access to care across multiple measures. Risk factors were mixed, including higher smoking rates and higher HPV vaccination coverage for LGBQ women vs. straight.

DISCUSSION

LGBQ women are less likely to be screened for cervical cancer. Closing disparities in care access and identifying feasible and acceptable screening interventions will help reduce these disparities. We must also ensure high-quality data collection to monitor disparities across and within key subgroups.

Breast cancer screening rates and influencing factors among LGBTQ groups in Japan

BACKGROUND

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals face significant health disparities worldwide, particularly in preventive medicine. In Japan, where breast cancer has the highest incidence rate among women, understanding screening behaviors among LGBTQ individuals is crucial for improving public health outcomes.

OBJECTIVE

This study aimed to elucidate the relationship between LGBTQ status and breast cancer screening behaviors in Japan, identifying factors influencing screening uptake and highlighting challenges in health management for the LGBTQ community.

METHODS

Using data from the Japan COVID-19 and Society Internet Survey (JACSIS), we analyzed breast cancer screening status among 11,056 biological females. Multinomial logistic regression and stratified regression analyzes were employed to examine factors associated with screening behavior, comparing LGBTQ and non-LGBTQ groups.

RESULTS

LGBTQ individuals demonstrated significantly lower odds of undergoing breast cancer screening (OR 0.82, 95% CI 0.73-0.91, p < 0.001) compared to non-LGBTQ individuals. Key factors influencing lower screening rates among individuals in the survey were primarily linked to LGBTQ identity, followed by higher rates of being uninsured, unmarried status, lower income levels, alcohol consumption. Stratified analysis revealed that uninsured LGBTQ individuals had significantly lower odds of screening (OR 0.23, 95% CI 0.08-0.70, p = 0.01) compared to those with national health insurance.

CONCLUSION

This study identifies noteworthy differences in breast cancer screening behaviors between LGBTQ and non-LGBTQ individuals in Japan, as indicated by lower odds of screening participation among LGBTQ individuals, even after adjusting for socioeconomic factors. Findings underscore the need for targeted interventions, including improved healthcare access, LGBTQ-friendly medical environments, and awareness campaigns to address these disparities and promote health equity within the LGBTQ community.

An Education Intervention in Gastrointestinal Healthcare Workers Improves Knowledge of Sexual and Gender Minority Digestive Health

BACKGROUND

Sexual and gender minority (SGM) communities experience barriers in accessing healthcare. While literature exists in remedying SGM-related knowledge deficits in primary care, none exists for gastroenterology specialists.

AIMS

We detail a two-site experience with a focused education intervention for gastrointestinal healthcare workers on SGM digestive health.

METHODS

Gastroenterology and hepatology physicians, nurses, trainees, and staff at two academic medical centers participated. A 10-question pre-test and Likert scale questions on confidence in caring for sexual and gender minority patients were given. Participants then attended a lecture about SGM digestive health. After, they completed a post-test and 6-month follow-up assessment. Pre- and post-test averages of correct answers were compared to assess objective knowledge acquisition and identify gaps in knowledge.

RESULTS

Of 368 eligible participants, 143 (39.0%) completed the pre-test, 79 completed the post-test, and 93 completed 6-month follow-up. Pre-test average correct responses were 61%, while post-test correct responses increased to 70% (p < 0.001). At 6-month follow-up, average percent correct was 66% (p = 0.027 compared to pre-test). Confidence caring for SGM patients improved from 3.62 to 3.99. (1 = strongly disagree, 5 = strongly agree; p = .033). This persisted at 6 months (average 4.07, p = .007).

CONCLUSIONS

A lecture-based intervention results in significant and sustained improvement in confidence and knowledge surrounding digestive healthcare in SGM patients. This can be used as a starting point for curricular development at all medical education levels. Doing so may allow for more culturally inclusive care to be provided to SGM communities and foster cultural humility.

Barriers and facilitators to anal cancer screening among men who have sex with men: a systematic review with narrative synthesis

BACKGROUND

Increasing trends of anal cancer among men who have sex with men (MSM) highlight the importance of anal cancer screening. However, the screening rate of anal cancer among MSM remains relatively low. This systematic review aims to identify and critically evaluate studies examining barriers and facilitators influencing MSM's participation in anal cancer screening.

METHODS

Systematic searches were performed in five databases (Web of Science, Medline, Embase, PsycINFO, and CINAHL). Evidence from qualitative, quantitative, and mixed methods studies was extracted and synthesized. Mixed Methods Appraisal Tool (MMAT) was used for quality assessment. Two researchers underwent selection and appraisal independently. PROSPERO registration number: CRD42024601449.

RESULTS

305 studies were identified with a total of 32 studies included, including 11 qualitative studies, 18 quantitative studies, and 3 mixed methods studies. The barriers and facilitators to anal cancer screening were categorized into four domains: individual factors, healthcare system factors, healthcare provider factors, and screen-related factors. Among the four domains, the most frequently reported barriers and facilitators to anal cancer screening were individual factors. A lack of knowledge about the risks of HPV, anal cancer, and anal screening (n = 16) was the most significant barrier. In contrast, a greater perceived understanding of anal cancer and screening (n = 6) was identified as the primary facilitator.

CONCLUSIONS

This systematic review provided a comprehensive assessment of barriers and facilitators to anal cancer screening among MSM, highlighting the need for targeted comprehensive intervention programs to enhance acceptance of screening. Implementing effective strategies to address potential barriers and promote facilitators across all domains of public health could significantly increase screening uptake.

Barriers and Nursing Strategies in Oncology Care for LGBTQIA+ People: A Scoping Review

LGBTQIA+ individuals with cancer face significant challenges in their interactions with nurses, which can negatively affect the quality of care, treatment adherence, and access to healthcare. Barriers such as implicit biases, discrimination, and inadequate communication skills contribute to these disparities, alongside a lack of nursing education on gender and sexual diversity. Despite the recognized role of nurses in reducing health inequalities, knowledge about effective strategies to overcome these barriers remains fragmented. This scoping review aims to identify and categorize the main barriers affecting the nurse-patient relationship in oncology and to explore evidence-based nursing interventions that promote equitable and inclusive care. A systematic literature search was conducted between January and February 2025 in PUBMED, SCOPUS, and Web of Science, including studies published in the last 10 years. Study management was performed using Zotero (version 6.0.30), and quality assessment was conducted with the JBI Critical Appraisal Tools. Two independent reviewers screened the studies, resolving discrepancies through discussion and consensus. This review follows the PRISMA-ScR checklist and the JBI scoping review methodology. The findings will provide insights into the primary barriers, highlight effective nursing interventions, and identify gaps in education and clinical guidelines, contributing to the development of more inclusive oncology care practices.

Improving cervical screening rates among sexual minorities: Insights from Aotearoa New Zealand

ISSUE ADDRESSED

Sexual minority women (SMW) experience inequities in health outcomes. The extant literature consistently suggests that SMW are much less likely than their heterosexual peers to engage in cervical screening. Using participant's voices, the focus of this study was to explore the ways in which cervical screening rates for SMW might be improved.

METHODS

An online survey was completed by SMW (N = 177) aged 25-69 based in Aotearoa New Zealand and representing a range of sexual identities, ethnicities, and geographical regions. The analysis presented here was derived from open-ended qualitative responses to a single survey item: What do you think could be done to encourage more SMW (lesbians, wahine takatāpui, bisexual women, etc.) to engage in smear testing?

RESULTS

Analysis of the data generated three main themes around how public health services could encourage more SMW to engage in cervical screening: Inclusive health services, clarity of information, and targeted health promotion.

CONCLUSION

The analysis showed that the inherent heteronormativity among health care professionals and the lack of clear and consistent information specific to SMW may be key factors contributing to lower rates of engagement in screening. SO WHAT?: Given that not engaging in screening is the main risk factor for cervical cancer, it is imperative that active consideration is given to these issues with a view to increasing participation rates among SMW.

Considerations for the Treatment of Sexual and Gender Minority Individuals in Colon and Rectal Surgery

Sexual and gender minorities (SGMs) experience critical barriers to health care access and have unique health care needs that are often overlooked. Given the rise in individuals identifying as lesbian, gay, bisexual, transgender, and queer, colorectal surgeons are likely to care for increasing numbers of such individuals. Here, we discuss key barriers to health care access and research among SGM populations and outline approaches to address these barriers in clinical practice. We also highlight two specific topics relevant to SGM populations that colorectal surgeons should be familiar with: current approaches to anal cancer screening among men who have sex with men, and transgender individuals, as well as the management of recto-neovaginal fistula in transfeminine individuals.

Informed choices for some, but not for others: An exploration of Australian midlife women's participation in mammography screening by social class

BACKGROUND

Population-level mammography screening for early detection of breast cancer is a secondary prevention measure well-embedded in developed countries, and the implications for women's health are widely researched. From a public health perspective, efforts have focused on why mammography screening rates remain below the 70% screening rate required for effective population-level screening. From a sociological perspective, debates centre on whether 'informed choice' regarding screening exists for all women and the overemphasis on screening benefits, at the cost of not highlighting the potential harms. We dovetail these disciplinary agendas to contextualise the factors that impact mammography screening choices, interpreting screening status through a social class lens.

OBJECTIVE

To understand how social class impacts informed choice-making among midlife women (45-64 years), regarding (non) participation in mammography screening.

DESIGN

A qualitative study using semi-structured interviews.

METHODS

We interviewed 36 Australian midlife women from differing social class groups who were 'screeners' or 'non-screeners'. We conducted a theory-informed thematic analysis and used Bourdieu's relational social class theory to consider how women's access to social, cultural and economic capital influenced their screening identities. We conducted matrix and crosstab queries across themes to identify patterns by social class. We extend the findings from Friedman's study of women's screening perspectives as 'attentional' types utilising the 'sociology of attention'.

RESULTS

Our results map to Friedman's four 'attentional' types (default or conscious interventionists, conflicted or conscious sceptics), and we show how social class impacts women's attention to screening and participation. We show for middle-class women screening is a 'given', they align closely with normative screening expectations. Working-class women who screen, do so out of a sense of compliance. Affluent non-screeners make informed choices, while working-class women are more passive in their non-screening choices, being a group that sits outside of Friedman's four attentional types.

CONCLUSION

Current approaches to screening communication and programme delivery can be improved by tailoring approaches to reflect the impacts of social class in shaping women's 'choices'. Subsequently, equitable breast cancer prevention may be afforded, which impacts positively on population-level screening rates.

Occupational Therapists in Australia Vary in Their Knowledge, Skills and Clinical Practices to Meet the Health Needs of the LGBTQIA+ Community

This study assessed the knowledge, skills, and practices of occupational therapists in Australia regarding the LGBTQIA+ community's health needs. A cross-sectional online survey gathered qualitative data from 130 occupational therapists practicing in Australia. Most participants were women (85%), with 7% identifying as LGBTQIA+. The survey identified four key themes: Understanding LGBTQIA+ identities; Embedding affirming care in practice; Specific occupational therapy skills and practices, and Individual occupational therapist factors. Results indicated that while occupational therapists showed high attitudinal awareness, many lacked the necessary education and training to deliver inclusive care, highlighting a need for enhanced education in this area.

A Content Analysis of Cancer-Related Changes in Perceptions of Self, Relationships, and Health Among LGBTQI+ Cancer Survivors Across the Life Course: Findings From OUT: The National Cancer Survey

BACKGROUND

The LGBTQI+ population makes up at least 7.6% of the US population. LGBTQI+ populations are at increased risk of experiencing LGBTQI+-related discrimination and cis-heteronormativity in healthcare leading to poorer health outcomes throughout the cancer care continuum. We aimed to explore LGBTQI+ cancer survivors' perspectives of how cancer has changed their perceptions of self and relationships using data from OUT: The National Cancer Survey.

METHODS

We conducted an inductive qualitative content analysis of responses to four open-ended questions from OUT: The National Cancer Survey. Data were collected from September 2020 to April 2021. Eligible participants were 18 years of age or older at time of survey, had been previously diagnosed with cancer, identified as LGBTQI+, and currently lived in the US. Open-ended survey questions asked about the impact of cancer on LGBTQI+ cancer survivors' perceptions of self and relationships. To maximize inter-rater reliability, 20% of the survey responses were double coded. Chi-squared tests assessed differences in changes across the life-course.

RESULTS

Of the participants in the OUT survey (N = 2382), 86.9% (N = 2069) provided responses to at least one of the four open-ended questions. The content analysis sample participants were primarily aged 40-59 (39.3%) and 60-79 (49.4%), gay (54.7%), cisgender men (59.4), White (89.7%), and not on active treatment (77.4%). A total of 5179 codes were applied to the 2069 responses. A total of 5 overarching categories and 18 sub-categories were identified. Themes included: (1) changes in perceptions of self; (2) changes to relationships; (3) changes to health and (4) LGBTQI+ specific unmet needs. The most commonly reported categories were changes in perceptions of self (77%, n = 1593) and changes to health (47%, n = 972). Most cancer-related changes were more frequently reported by young adult survivors.

CONCLUSIONS

This content analysis illuminates the unique challenges that the LGBTQI+ population faces while navigating through the cancer care continuum.

Attitudes and Experiences of Patients Regarding Gender-Specific Aspects of Pain Management

BACKGROUND

Biological, pharmacological, and socio-cultural aspects influence gender-specific effects in pain management.

METHODS

Gender-specific aspects of pain management were assessed in a rural outpatient center via semi-structured patient interview: (i) general gender aspects (total population) from 1 = "fully disagree" to 5 = "fully agree"; and (ii) individual pain (matched pairs) via numeric analog scale (NAS) from 0 = "no pain" to 10 = "maximum pain". Patient charts were assessed for pain management (WHO-ladder).

RESULTS

In total, 113 patients were enrolled (59.18 [SD: 12.76] years, 46% female, 54% male, 0% diverse), and 42 were matched into female-male pairs. (i) Women and men agreed that men and women should be treated equally despite biological differences (median: 5 [women] vs. 5 [men]; p = 0.789). As a reason for gender-specific aspects, "medication concentration" was reported more frequently by women (p = 0.038) and "no answer" by men (p = 0.014). (ii) Mean value (SD) of pain (NAS) was 4.0 (SD 2.3) for women and 3.3 (SD 2.6) for men (p = 0.215) with a positive correlation between pain management escalation (WHO-ladder) and the pain score (NAS) only in men (r = 0.704, p = 0.001). Women rather reported an influence of adverse drug reactions on treatment contentment than men (p = 0.042).

CONCLUSIONS

Although patients pleaded for gender-independent equal treatment, gender-specific differences in pain therapy were found.

Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population

PURPOSE

Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population.

METHODS

A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP).

RESULTS

TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity.

CONCLUSIONS

Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Disparities in Study Inclusion and Breast Cancer Screening Rates Among Transgender People: A Systematic Review

BACKGROUND

Breast cancer screening trends of transgender and gender diverse (TGD) people remain largely unknown. This is concerning, as data are necessary to inform recommendations made by clinicians to their patients and by national guidelines to clinicians. The aim of this review is to explore the state of existing research literature and provide a summary report of current breast cancer screening rates in TGD adults.

METHODS

All articles were identified using Medical Subject Headings terms. Inclusion criteria were all the following: (1) documents inclusion of at least one participant who identifies as a TGD person; (2) at least one TGD participant with top surgery or currently receiving estrogen-based gender-affirming hormone therapy; (3) results that report rates of breast cancer screening or mammogram referral.

RESULTS

Twelve articles met inclusion criteria, six cross-sectional studies and six retrospective chart reviews. Three studies conducted secondary analysis of the Behavioral Risk Factor Surveillance System national dataset, and nine articles recruited their own sample with number of TGD participants ranging from 30 to 1,822 and number of cisgender women ranging from 242 to 18,275. Three studies found lower rates of screening in transfeminine persons receiving gender-affirming care compared with cisgender women; two studies found lower rates among TGD people compared with cisgender women; and three studies found no differences between the breast cancer screening rates of TGD and cisgender participants.

CONCLUSION

Limited studies recruit and report trends in breast cancer screening of TGD people. Those that do include TGD participants have mixed results, but overall TGD people had lower rates of breast cancer screening. More research is needed regarding breast cancer screening of TGD people to inform the development of protocols that ensure equitable access to preventative care.

Applying the Multicultural Orientation in Cancer Care for Sexual and Gender Minority Cancer Survivors: A Cross-Sectional Correlational Study

Purpose: Sexual and gender minority (SGM) cancer survivors report unique needs that are not met by some providers. The multicultural orientation (MCO) holds promise for creating a paradigm shift in providing affirmative cancer care, yet has not been tested empirically. This study examines the predictive strength of MCO's tenets of cultural humility and cultural opportunities for SGM cancer patient-provider relationships. Methods: In this cross-sectional study, 108 SGM cancer survivors completed surveys on perceptions of their oncology providers' cultural humility and actualization of cultural opportunities as predictors of survivors' treatment adherence and the patient-provider alliance. Hierarchical regression analyses were conducted. Results: Average participant age was 50 years (standard deviation = 15 years). Over 10 cancer types were represented and 69% of participants were in active treatment, with the remaining 31% receiving follow-up care. Age at diagnosis and not being in active treatment positively correlated with perceptions of providers' cultural humility, patient-provider alliance, and treatment adherence. Regression models explained 38% and 61%, respectively, of the variance in treatment adherence and patient-provider alliance, with cultural humility remaining a significant predictor in both models after accounting for all other variables. Conclusion: Providers' cultural humility and navigation of cultural opportunities in incorporating their patients' salient cultural identities into cancer care are strongly associated with how supported SGM cancer survivors feel by their oncology providers. The MCO is a useful framework for identifying important dimensions in SGM affirmative cancer care.

Medical Issues Affecting Older Gay and Bisexual Men

Older gay and bisexual men constitute diverse, sizable, and potentially vulnerable populations. They have and continue to face discrimination and stigma in multiple settings, including health care. Older gay and bisexual men report worse health, higher rates of alcohol and tobacco use, and higher HIV rates compared with their heterosexual counterparts. They have unique needs and experiences in multiple realms of health care including mental health, sexual health, and cancer screenings. Geriatric medicine physicians and providers can educate themselves on these unique needs and risks and take steps to provide inclusive, affirming care.

Are women-who-have-sex-with-women an 'at-risk' group for cervical cancer? An exploratory study of women in Aotearoa New Zealand

BACKGROUND

International research consistently indicates that women-who-have-sex-with-women (WSW) are less likely to engage in cervical screening than heterosexual women. In the main, studies have explored rates of engagement and highlighted some reasons for non-engagement. This study extends on this work by exploring perceptions among sexual minority women (WSW) for lower rates of engagement among WSW more generally and is the first study on this topic undertaken in Aotearoa New Zealand.

METHODS

A sample of 177 self-identified WSW domiciled in New Zealand completed an online survey about their engagement in cervical screening, reasons for engaging (or not) in cervical screening, and perceptions of why SMW might be less likely to engage in cervical screening.

RESULTS

Fewer than half of participants had engaged in cervical screening every 3years as recommended, with women who had only ever had sex with other women being significantly less likely to have engaged in screening. A lack of clear information about risk relative to sexual history, heteronormativity, and the invasive nature of screening were the dominant reasons for lower engagement among WSW.

CONCLUSIONS

A legacy of misinformation, and endemic heteronormativity in public health messaging around cervical screening is a significant barrier to engagement in screening for WSW. To increase engagement in screening among WSW, public health information needs to specifically address the needs of WSW.

Evidence-based sexual healthcare for the LGBTQIA2+ patient across the lifespan

ABSTRACT

People who identify as lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, two-spirit, or other minority sexual and gender identities (LGBTQIA2+) often avoid seeking healthcare due to social discrimination and stigma. Clinical education in LGBTQIA2+-affirming care is essential but often lacking across disciplines. Provider acceptance, awareness of personal biases, and understanding of microaggressions affecting LGBTQIA2+ people can improve access, outcomes, and survival for this population. Expertise in caring for LGBTQIA2+ people in rural and suburban communities, for people who are transgender, and for people who have undergone or are in the process of undergoing gender-affirming surgeries is essential to offer best-practice healthcare.