Abstract C146: Cervical cancer screening guideline concordance among sexual minority females in the 2019, 2021, and 2023 National Health Interview Survey (NHIS)

Abstract Background: In 2025, an estimated 13,360 cases of cervical cancer and 4,320 related deaths are expected in the U.S. While incidence and mortality have declined due to HPV vaccination and screening, these trends have plateaued or reversed in certain age and minority groups. Sexual minority females (SMF) are at risk of developing cervical cancer but are less likely to receive screening and face unique barriers to care. Purpose: Existing studies on SMF and screening are often not nationally representative and focus on lifetime screening rather than adherence to guidelines. The impact of the COVID-19 pandemic on screening in this population is also underexplored. This analysis used nationally representative data to examine trends in guideline-concordant cervical cancer screening among SMF and to identify factors associated with screening adherence. Methods: We analyzed 2019, 2021, and 2023 National Health Interview Survey (NHIS) data, including participants aged 21-65 who identified their sex as female, had not had a hysterectomy, and reported sexual orientation and screening history. SMF included those identifying as Gay/Lesbian, Bisexual, or Something Else. Screening was guideline concordant if reported in the last 3 years (ages 21-29) or 5 years (ages 30-65). Age-adjusted prevalence of guideline concordance (GC) was estimated by year and sexual orientation. Logistic regression models were used to identify predictors of GC among SMF and to estimate associations between sexual orientation and GC overall. Results: Across the 2019, 2021, and 2023 NHIS (n=26,797; weighted n=78,128,361), age-adjusted prevalence of GC significantly declined (2019: 81.63%; 2023: 77.49%). GC was consistently lower among SMF versus non-SMF (69.62% vs. 77.96% in 2023), though the decline in GC over time was not statistically significant for SMF. Age, education, and recent live birth predicted GC among SMF. SMF had lower odds of GC (OR 0.75, 95% CI 0.65-0.88), with the lowest odds among those identifying as Gay/Lesbian (OR 0.60, 95% CI 0.47-0.77). Disparities were largest in younger SMF, those with higher education, and those with health insurance. Discussion: While a decline in GC was expected during the COVID-19 pandemic, continued decreases in 2023 suggest ongoing barriers to care. Disparities among SMF, especially those identifying as Gay/Lesbian, are concerning and may reflect differences in care access, clinical experiences, or screening perceptions. Targeted interventions are needed to address these disparities, along with further research into the role of gender identity in screening behaviors. In a political climate increasingly hostile to LGBTQ+ communities, protecting access to inclusive gynecologic care is crucial. Citation Format: Summer V. Harvey, Heather A. Young. Cervical cancer screening guideline concordance among sexual minority females in the 2019, 2021, and 2023 National Health Interview Survey (NHIS) abstract. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C146.