Correlates of underutilization of gynecological cancer screening among lesbian and heterosexual women Alicia K. Matthews, Ph.D., a, * Dana L. Brandenburg, Psy.D., b Timothy P. Johnson, Ph.D., c and Tonda L. Hughes, Ph.D., R.N. d a Department of Psychiatry, University of Chicago, Chicago, IL 60637, USA b McLaren Regional Medical Center, Michigan State University College of Human Medicine, Flint, MI 48824, USA c Survey Research Laboratory, University of Illinois at Chicago, Chicago, IL 60612, USA d Department of Public Health, Mental Health and Administrative Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA Abstract Background. Study aims were to examine cervical cancer risk factors, screening patterns, and predictors of screening adherence in demographically similar samples of lesbian (N = 550) and heterosexual women (N = 279). Methods. Data are from a multisite survey study of women’s health conducted from 1994 to 1996. Results. Differences in sexual behavior risk factors for cervical cancer were observed with lesbians reporting earlier onset of sexual activity ( P < 0.05), more sexual partners ( P < 0.001), and lower use of safer sex activities ( P < 0.01). Lesbian and heterosexual women were equally likely to have ever had a Pap test; however, lesbians were less likely to report annual ( P < 0.001) or routine ( P < 0.001) testing. Multivariate analyses were used to determine the associations between demographics, health care factors, health behaviors, and worry about health and screening behaviors. Individual predictors of never screening included younger age, lower income, and lack of annual medical visits. Independent predictors of both recent and annual screenings included history of an abnormal Pap test, being heterosexual, and annual medical visits. Conclusion. Data indicate that lesbians are at risk for cervical cancer, yet underutilize recommended screening tests. Findings have implications for research, education, and cancer control among lesbians. D 2003 American Health Foundation and Elsevier Inc. All rights reserved. Keywords: Cervical cancer risk; Cervical cancer screening; Sexual orientation Introduction Cervical cancer incidence and mortality rates have de- creased substantially over the past five decades due to widespread screening with the Papanicolaou (Pap) test [1]. Routine screening with Pap tests have increased the likeli- hood of detecting preinvasive lesions or early-stage disease resulting in survival rates of over 90% in women falling into those diagnostic categories [2]. Despite these gains, estimates for 2003 suggest that 12,200 women will be diagnosed with cervical cancer and about 4,100 women will die as a result of the disease [2]. Cervical cancer incidence and mortality rates have been shown to vary based on demographic character- istics such as racial and ethnic minority group membership and lower education and socioeconomic status [3,4]. Identi- fication of additional subpopulations in which cervical can- cer disparities exist and the development of strategies to increase adherence to established guidelines for cervical cancer screening can further reduce the incidence and mor- tality associated with this largely preventable disease [2,5]. A recent report by the Gay and Lesbian Medical Asso- ciation suggests that sexual orientation may be an important contributor to health disparities in the United States [6]. To better understand the role of sexual orientation in cervical cancer risk, the aims of this study were to identify and compare cervical cancer risk factors in a demographically similar sample of lesbian and heterosexual women, measure adherence to established guidelines for cervical cancer screening, and identify variables associated with adherence to screening guidelines. 0091-7435/$ - see front matter D 2003 American Health Foundation and Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2003.09.034 * Corresponding author. University of Illinois at Chicago, College of Nursing, Department of Public Health, Mental Health, and Administrative Nursing, 845 S. Damen Ave. (MC 802), Chicago, IL 60612. Fax: +1-312- 996-9049. E-mail address: AliciaK@uic.edu (A.K. Matthews). www.elsevier.com/locate/ypmed Preventive Medicine 38 (2004) 105– 113