Sexual orientation and assigned sex at birth are significant determinants in the utilization of lung cancer screening, according to an analysis from the Behavioral Risk Factor Surveillance System (BRFSS) 2018, a cross-sectional, nationally representative database, that looked at screening among lesbian, gay, bisexual, transgender (LGBT) populations.
“We have no previous data on lung cancer screening in the LGBT population,” said Hui Xie, PhD, of the Zilber School of Public Health, University of Wisconsin-Milwaukee, at the 2021 International Association for the Study of Lung Cancer meeting. “It is important for healthcare providers and policy makers to be aware of the factors that are associated with lung cancer screening among the LGBT population,” Dr Xie emphasized.
Previous research has shown that LGBT individuals are more likely to start smoking earlier than the general population, and have higher smoking rates. In addition, older (aged 55-79 years) LGBT populations face disproportionate cancer risks as a consequence of lifetime discrimination and long-term tobacco, alcohol, and substance use. In addition, health insurance has been a main barrier to screening and treatment.
The aim of Dr Xie’s study was to identify the main determining factors for lung cancer screening utilization in the LGBT population, and using that information to address health disparities based on sexual orientation.
LGBT and Lung Cancer Screening Disparities
Based on 2018 data from the BRFSS, among 44,348 individuals aged 55 to 79 years who had no personal history of lung cancer and who were eligible for lung cancer screening, 1439 self-identified as LGBT.
Within the past 12 months, 22.85% of those 44,348 individuals had undergone lung cancer screening. Looking at self-reported sex, sexual orientation, and smoking status data, Xie and colleagues found that 1% of those individuals were lesbian or gay, 0.56% were bisexual, and 0.25% identified as other sexual minorities.
In the LGBT population in this study, 7.52% of the people screened were heavy drinkers, and 37.43% were current smokers. The smoking rate among bisexual individuals was the highest of all the subgroups, at 28.9%, which is twice the rate of heterosexual individuals (P <.0001).
Among individuals born as male, the odds of undergoing lung cancer screening were significantly higher in those who were gay (odds ratio [OR], 5.30; 95% confidence interval [CI], 1.32-21.36; P = .019), had fair or poor general health status (OR, 4.16; 95% CI, 1.41-12.26; P = .01), and had no medical cost burden (OR, 9.37; 95% CI, 2.26-38.83; P = .002).
The odds of being screened for lung cancer were significantly lower in individuals who identified as bisexual (OR, 0.13; 95% CI, 0.20-0.96; P = .045) and in heavy drinkers (OR, 0.13; 95% CI, 0.02-0.75; P = .023). The odds of being screened for lung cancer were also significantly higher for those who were born female who had fair or poor general health status (OR, 4.26; 95% CI, 1.15-15.73; P = .030) and had no medical cost burden (OR, 17.00; 95% CI, 2.44-118.23; P = .004).
Among the study population, 11.08% of individuals reported that they could not afford medical costs. Most (98.4%) patients in the study had health insurance.
Dr Xie concluded, “Our findings using BRFSS data from 2018 point to sex-related and sexual-identity disparities regarding use of lung cancer screening among US respondents aged between 55 and 79 years.”
Targeted educational programs are needed, she added, to address economic burdens and to raise lung cancer screening awareness among bisexual populations, especially those assigned male at birth.