# Comparing Sexual and Gender Minority and Cisgender Heterosexual Missourians’ Breast and Colorectal Cancer Screening Prevalence: The 2022 Missouri County-Level Study

## TL;DR

This study finds that sexual and gender minority adults in Missouri have similar cancer screening rates as cisgender heterosexual adults when age eligibility is considered.

## Contribution

The study provides county-level insights into cancer screening equity among SGM populations using age-adjusted analyses.

## Key findings

- SGM adults had similar odds of up-to-date breast cancer screening as cisgender heterosexual adults.
- For colorectal cancer, SGM adults had higher odds of ever being screened but similar odds of up-to-date screening.
- Age composition, not access, explains observed differences in screening rates.

## Abstract

This study explores whether adults who identify as sexual and gender minorities (SGM) in Missouri are receiving recommended breast and colorectal cancer screening at similar rates as cisgender heterosexual adults. Regular breast and colorectal cancer screenings can help find cancer early, yet little research has examined how screening rates differ for underrepresented groups at the local level. Using a statewide, county-representative survey, the researchers compared how often SGM adults and cisgender heterosexual adults completed mammograms and colonoscopies. The results showed no significant differences in breast or colorectal cancer screening between SGM adults and cisgender heterosexual adults once analyses were limited to people who were eligible for screening based on age. Although models including all adults suggested lower mammography use among SGM women, this pattern disappeared after adjusting for screening-eligible ages. These findings show that age composition, not reduced access, explains the observed differences and highlight the importance of using guideline-based age groups when assessing cancer screening equity. Understanding true screening patterns can help ensure that prevention efforts remain inclusive and appropriately targeted across Missouri’s diverse communities.

Background: Cancer screening disparities remain understudied, particularly among underrepresented groups at the county level. This study compared the use of preventive breast and colorectal cancer screening services between sexual and gender minority (SGM) adults and cisgender heterosexual adults in Missouri. Methods: The 2022 Missouri County-Level Study, a probabilistic survey of health-related behaviors in each county, was used to estimate breast and colorectal cancer (BC and CRC) screening prevalence. Screening prevalence was calculated using weighted samples, and regression models were used to adjust for demographic composition and age eligibility for both cancer sites. Results: Compared to cisgender heterosexual adults (n = 48,257), SGM adults (n = 2801) were significantly younger and more likely to reside in urban areas and be employed. Statewide, county-representative prevalence of breast cancer screening in the last 2 years was 75.6%, and colorectal cancer screening (i.e., colonoscopy in the last 10 years or sigmoidoscopy in the last 5 years) was 63.1%. In age-adjusted models for BC screening for participants (ages 40–74), age had a curvilinear association, increasing at younger ages but declining in later years. For CR screening (ages 45–75), age showed a strong, stable, positive effect. SGM adults had similar odds of breast cancer screening; however, for CRC, SGM adults had higher odds of ever being screened but similar odds to cisgender heterosexual adults of up-to-date screening. Differences largely reflect eligibility windows and initiation versus maintenance dynamics. Conclusions: In this large sample of Missouri county residents, breast cancer and colorectal cancer screening rates were comparable between SGM adults and cisgender heterosexual adults for up-to-date screening probability. Improving statewide cancer prevention will require addressing the broader structural and regional barriers that suppress screening uptake across Missouri communities. Impact: These findings demonstrate the importance of using age-appropriate, guideline-aligned analyses to accurately assess cancer screening equity and avoid overstating disparities among SGM populations. By identifying where differences do not exist, this work helps focus resources on the structural and regional barriers that continue to limit cancer prevention for all Missourians.