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

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.