# Disparities in Cervical and Breast Cancer Screening Among Sexual Minority Women in Japan: A Comparative Cross-Sectional Study

## TL;DR

Sexual minority women in Japan are less likely to participate in cervical and breast cancer screenings compared to non-sexual minority women, with cervical screening showing a bigger gap.

## Contribution

This study is the first to compare cervical and breast cancer screening disparities among sexual minority women in Japan using a large-scale survey.

## Key findings

- Sexual minority women had lower cervical cancer screening rates (38.7%) compared to non-sexual minority women (45.6%).
- Mental health status and sexual orientation significantly influenced screening participation behaviors.
- Disparities were more pronounced in cervical cancer screening than in breast cancer screening among sexual minority women.

## Abstract

This study addresses the important issue of lower participation in cervical and breast cancer screenings among sexual minority women (such as lesbian, bisexual, queer, and transgender individuals assigned female at birth) in Japan. The research aimed to identify differences in screening rates between sexual minority women and women who are not part of a sexual minority, and to understand the reasons behind these disparities. Using data from an extensive online survey involving over 13,000 participants, the study found that sexual minority women participate less frequently in cervical cancer screenings compared to other women, with significant gaps also observed in breast cancer screenings. Factors like marital status, insurance coverage, income, and mental health influenced these screening behaviors. These findings are valuable as they highlight the need for targeted healthcare strategies to improve cancer screening rates among sexual minority women, ultimately aiming to reduce healthcare inequalities and enhance preventive healthcare in Japan.

Objectives: While health disparities affecting sexual minority women are well-documented globally, little is known about cancer screening behaviors among sexual minority women in Japan. Following our previous study on breast cancer screening, this study examined cervical cancer screening participation patterns and compared screening behaviors between both cancer types among sexual minority women in Japan. Methods: We analyzed data from 13,730 individuals with female sex assigned at birth who participated in a nationwide online survey between September and November 2023. Multinomial logistic regression was used to examine factors associated with screening participation, comparing sexual minority women (n = 2685) and women who are not part of a sexual minority (n = 11,045). Among participants aged 40 and above (n = 8933), we compared participation patterns between cervical and breast cancer screenings. Results: Sexual minority women showed significantly lower cervical cancer screening rates compared to women who are not part of a sexual minority (38.7% vs. 45.6%, p < 0.001), with a wider disparity than observed in breast cancer screening (43.4% vs. 45.9%, p < 0.001). Among those aged 40 and above, sexual minority women were more likely to skip both screenings (35.0% vs. 27.2%) and less likely to participate in both (55.0% vs. 62.6%). Additionally, our analysis revealed that participants with a current mental disorder (i.e., those reporting ongoing mental health issues) were more likely to intend to undergo cervical cancer screening (aOR = 1.39, 95% CI = 1.15–1.67, p = 0.001). In contrast, among bisexual participants and those classified as having “other” mental health conditions—defined as a history of mental health issues without current symptoms—exhibited significantly lower odds of being screened (aOR = 0.31, 95% CI = 0.11–0.82, p = 0.02). Conclusions: Significant disparities exist in cancer screening participation among sexual minority women in Japan, with more pronounced differences in cervical cancer screening compared to breast cancer screening. These findings highlight the need for targeted interventions addressing the unique barriers to gynecological care among sexual minority women.