Prevention, screening, and early detection play a huge role in cancer care. For LGBTQ people, research shows big gaps in all three parts of this chain. These gaps are not about your body alone. They grow from stigma, misinformed providers, weak systems, and laws that ignore your lives.
What prevention and screening mean for you
Prevention means lowering the chance that cancer starts. That includes stopping smoking, safer sex, HPV vaccination, healthy eating, and staying active.
Screening means checking for cancer or pre-cancer when you feel fine. Examples are mammograms, Pap tests, HPV tests, colonoscopies, stool tests, prostate-specific antigen (PSA) blood tests, and low-dose CT scans for people at high risk for lung cancer.
Early detection means finding cancer at an earlier stage, when treatment works better and survival is higher.
Decades of research show that screening and early detection save lives. Yet many papers focused on LGBTQ communities show that your groups often face higher risk and lower access at the same time. 1312 (ScienceDirect)
What the research shows about LGBTQ screening gaps
One nursing review on cancer screening for lesbian, gay, bisexual, and transgender people explains current guidelines for breast, cervical, colorectal, prostate, and anal screening. It notes that LGBTQ communities often have more risk factors, yet many people are less likely to complete routine screening. 1 (PubMed)
A national study using Behavioral Risk Factor Surveillance System data found that sexual and gender minority adults were less likely to be up to date with some key screenings than non-LGBTQ adults. Bisexual women had especially low cervical screening rates and more problems with health care access, money, and insurance. 2 (PubMed)
A 2023 review of cancer screening among LGBTQ+ populations found the same pattern. LGBTQ+ people face higher risks for several cancers because of smoking, alcohol, HPV, HIV, and chronic stress. At the same time, many are less likely to participate in screening programs or to have regular preventive visits. 3 (PubMed)
A 2025 systematic review looked at how social factors like income, racism, discrimination, and mental health link to screening for sexual minority adults. People with lower income, no primary care clinician, or high levels of stigma were less likely to get screened, even when guidelines said they should. 4 (PubMed)
A 2024 article on cancer screening among sexual minority groups in the United States reported that lesbian, gay, and bisexual adults were more likely to be behind on recommended screening for at least one cancer compared with heterosexual adults. Better access to primary care reduced some of these gaps but did not erase them. 5 (ScienceDirect)
Together, these studies show clear prevention and screening gaps across many LGBTQ communities, even when controlling for age and basic health status.
How social forces drive prevention and screening gaps
Prevention and screening choices do not happen in a vacuum. One core paper describes how social determinants drive LGBT cancer inequities. These include poverty, unstable housing, lack of insurance, discrimination at work and in health care, and laws that treat LGBTQ people as less worthy. 6 (PubMed)
A companion paper on LGBT barriers to cancer care states that progress in cancer prevention in the general population has not been shared equally with LGBTQ people. The authors describe a “clustering” of barriers, including fear of bias, lack of LGBTQ-friendly providers, and poor insurance coverage. 7 (PubMed)
When your daily life includes homophobia, transphobia, racism, or the threat of violence, preventive care often drops on the priority list. If you expect to be judged or harmed in health settings, routine screening visits feel risky instead of safe. These social forces sit under the numbers in cancer screening studies.
Breast and cervical screening gaps
Several studies and reviews focus on breast and cervical screening, especially for sexual minority women and people assigned female at birth.
Data from large US surveys show that sexual minority women are less likely to be up to date with cervical cancer screening than heterosexual women. They are also more likely to skip both cervical and breast screening. 28 (PubMed)
Reasons include
- fewer visits to gynecology services
- providers who assume that women who do not have sex with men do not need Pap tests
- fear of discrimination or rude comments
- painful or triggering past exams, especially for survivors of trauma
A 2025 paper on equity in cervical cancer screening for sexual and gender minoritized people assigned female at birth notes that guidelines were written with straight, cisgender women in mind. It calls for community-centered guidelines, inclusive language, and person-centered decision making so that lesbian, bi, queer, and trans patients receive clear, respectful information about HPV testing and Pap tests. 8 (BioMed Central)
Breast cancer screening shows a mixed picture. Some sexual minority women have similar mammography rates to heterosexual women, while others lag behind. Reviews point to mistrust, cost, lack of primary care, and providers who never bring up screening as important factors. 15 (PubMed)
A 2025 article on breast cancer disparities in the LGBTQ+ community stresses that trans men and nonbinary people with breast tissue often face confusion at imaging centers and feel unwelcome. They might get turned away or misgendered, which lowers the odds of returning for future screening. 9 (ScienceDirect)
Prostate cancer screening and LGBTQ communities
Prostate cancer screening, often using PSA blood tests, raises special questions for gay and bisexual men and for trans women.
A study of prostate cancer screening patterns among sexual and gender minority individuals found that sexual minority men were at least as likely, and sometimes more likely, to have had a PSA test compared with heterosexual men. Yet the study also noted that data on trans women and nonbinary people were extremely limited. 10 (PubMed)
Higher screening in some gay and bisexual men might reflect better engagement with health systems in urban areas, or higher worry due to awareness of prostate cancer in gay communities. At the same time, gay and bi men report that providers rarely discuss how prostate screening and treatment affect anal sex, receptive roles, or erectile function in ways that fit their lives. That silence weakens “early detection” because patients do not receive the detailed, relevant counseling they need to weigh pros and cons. 1 (PubMed)
For trans women, research highlights a different gap. Many providers forget that people on estrogen who still have a prostate remain at risk for prostate cancer, though risk levels may shift. Trans women report difficulty finding providers who understand when PSA tests are needed and how hormone therapy changes the picture. 10 (JAMA Network)
Anal cancer prevention and screening
Anal cancer rates are higher in people living with HIV and in men who have sex with men. HPV drives most anal cancers. Vaccination, safer sex, and screening for anal pre-cancer help lower risk.
Yet anal cancer screening is rarely discussed in primary care or oncology visits. A 2025 scoping review on anal cancer screening among men who have sex with men and other sexual minority populations found four groups of barriers:
- individual factors, such as fear, shame, low knowledge, and discomfort with anal exams
- provider factors, such as low training and reluctance to discuss anal sex
- health system factors, such as lack of guidelines, limited access to high-resolution anoscopy, and cost
- wider social stigma around anal sex and HIV 11 (PubMed Central)
Other studies in gay and bisexual men with HIV show that many have never heard of anal Pap tests or high-resolution anoscopy. The most common barriers are lack of provider recommendation, lack of knowledge about the tests, and lack of clear places to go for anal health concerns. 11 (BioMed Central)
Without clear guidelines and outreach, early detection of anal cancer in LGBTQ communities stays far behind what science suggests is possible.
Colorectal and other screening gaps
Colorectal cancer screening guidelines apply to all adults in certain age ranges, yet sexual and gender minority adults are less likely to be up to date. The large BRFSS study mentioned earlier showed lower colonoscopy or stool test use in some LGBTQ groups, especially those facing more financial hardship. 2 (PubMed)
The 2023 review of LGBTQ+ screening reported that very few studies even reported sexual or gender identity when talking about colorectal screening, so gaps likely remain hidden in national numbers. 3 (PubMed)
Lung cancer screening studies for LGBTQ people remain rare. Yet smoking rates are higher in many LGBTQ subgroups, especially among trans people and sexual minority women, due in part to stress and targeted tobacco marketing. Reviews warn that these patterns will likely raise lung cancer risk, but screening programs seldom collect sexual orientation and gender identity data, so outreach stays weak. 6 (PubMed)
How provider and system behavior widens screening gaps
The integrative review on barriers and facilitators to cancer screening among LGBTQ individuals with cancer organizes obstacles into several levels. 12 (PubMed)
Common patient-level barriers include
- limited knowledge of screening guidelines
- low perceived risk
- fear of pain or embarrassment
- fear of discrimination based on sexual orientation, gender identity, race, or HIV status
Provider-level barriers include
- lack of training on LGBTQ health
- wrong assumptions about who needs which screening based on gender or partner sex
- failure to recommend screening
- discomfort talking about sex, bodies, and gender
System-level barriers include
- forms and electronic records with no place for sexual orientation and gender identity
- policies that ignore chosen names, pronouns, and family structures
- lack of insurance or high out-of-pocket costs
- clinics that do not show visible LGBTQ inclusion
The 2023 LGBTQ+ screening review and the 2025 systematic review on determinants of health both stress that these levels interact. Discrimination in other parts of life, lack of primary care, and poor experiences with health systems all feed into whether you feel safe showing up for screening. 36 (ScienceDirect)
Early detection gaps as a justice issue
A paper on cancer disparities among sexual and gender minority populations notes that screening and early detection are key points in the cancer control “continuum,” yet data on LGBTQ outcomes at these stages remain thin. Where data exist, they often show later stage at diagnosis, higher symptom burden, and more distress. 12 (PubMed Central)
When LGBTQ individuals avoid regular care or face repeated refusals, small problems grow into larger ones. Precancerous lesions do not get treated. Early cancers go unnoticed until they cause pain or bleeding. The result is higher suffering and more complex treatment plans.
From a social justice view, unequal access to prevention and screening is not an individual “choice” problem. It reflects a long history of policies, beliefs, and clinical habits that treat some bodies and identities as standard and others as extra.
What helps close prevention and screening gaps
- LGBTQ-inclusive messaging and environments
Studies and guidelines urge clinics to show visible signs of welcome, such as rainbow or trans flags, gender-neutral restrooms, and intake forms that ask about pronouns, sexual orientation, and gender identity in respectful ways. Patients report more willingness to attend screening when they see clear signals that staff expect LGBTQ people to be present. 17 (PubMed) - Routine collection of sexual orientation and gender identity in records and registries
Cancer registries and electronic medical records that include sexual orientation and gender identity make disparities visible. Leaders then have data to target outreach and to track progress over time. National policy statements now call for this step across cancer systems. 6 (PubMed) - Community-centered guidelines and outreach
The cervical screening equity paper stresses that guidelines need to reflect lives of sexual and gender minoritized people, not push them into boxes built for others. That means asking communities what feels safe and realistic and building programs around those answers. 8 (BioMed Central) - Training for providers in LGBTQ health and cultural humility
Multiple reviews across your spreadsheets highlight training as a key step. When oncology and primary care teams learn about LGBTQ identities, bodies, and experiences, their screening advice becomes more accurate and their visits feel safer. Training in cultural humility adds skills in listening, recognizing bias, and sharing power in decision making. 37 (PubMed) - Better access to primary care and insurance
The systematic review on determinants of health and screening shows that having a regular primary care clinician reduces some gaps, especially for cervical and colorectal screening. Insurance coverage and simple appointment systems matter as well. 48 (PubMed)
What you are able to do for yourself right now
Responsibility for change sits with health systems, not individual patients. Still, research suggests a few steps that help you protect your health while those systems slowly change.
- Learn which screenings match your body parts and risk
– Cervix present: Pap and/or HPV testing on the schedule for your age and history
– Breasts present: mammograms as recommended for your age and risk
– Colon and rectum present: colorectal screening starting at the guideline age
– Prostate present: talks about PSA testing and prostate exams based on age and risk factors
– High risk for anal cancer: ask about anal Pap tests or high-resolution anoscopy - Ask direct questions
– “What screenings do you recommend for someone with my body and identity”
– “How does being lesbian, gay, bi, trans, or nonbinary affect my cancer risk”
– “Where do I go for breast, cervical, prostate, or anal screening that feels safe for LGBTQ people” - Bring support
A trusted friend, partner, or family member helps you feel stronger in visits and helps push for clear answers. - Look for LGBTQ-affirming clinics or community centers
LGBTQ cancer groups, local queer health centers, and online survivor communities often share lists of affirming providers. Studies show that peer support and community referrals help people stay engaged with screening and follow-up. 311 (ScienceDirect)
You deserve prevention, screening, and early detection that match your risks and respect your identity. The studies in your spreadsheets, and newer work that builds on them, send a clear message. LGBTQ people face real gaps at every step of the cancer prevention chain, yet those gaps have causes that systems are able to change.
Your choices to ask questions, seek affirming care, and share your story add to that change.
References
1 Ceres M, Quinn GP, Loscalzo M, Rice D. Cancer screening considerations and cancer screening uptake for lesbian, gay, bisexual, and transgender persons. Semin Oncol Nurs. 2018;34(1):37-51. (PubMed)
2 Charkhchi P, Carlos RC, Chawla N, Schabath MB. Modifiers of cancer screening prevention among sexual and gender minorities in the Behavioral Risk Factor Surveillance System. J Am Coll Radiol. 2019;16(4B):607-620. (PubMed)
3 Heer E, Peters C, Knight R, Yang L, Heitman S. Participation, barriers, and facilitators of cancer screening among LGBTQ+ populations: a review of the literature. Prev Med. 2023;170:107478. (PubMed)
4 Harris CK, Wu H, Lehto R, Wyatt G, Given B. Relationships among determinants of health, cancer screening participation, and sexual minority identity: a systematic review. LGBT Health. 2025;12(1):3-19. (PubMed)
5 Tundealao S, Sajja A, Titiloye T, et al. Cancer screening among sexual minority groups in the United States. J Med Surg Public Health. 2024;4:100159. (ScienceDirect)
6 Matthews AK, Breen E, Kittiteerasack P. Social determinants of LGBT cancer health inequities. Semin Oncol Nurs. 2018;34(1):12-20. (PubMed)
7 Boehmer U. LGBT populations’ barriers to cancer care. Semin Oncol Nurs. 2018;34(1):21-29. (PubMed)
8 LeBlanc ME, Line M, et al. Advancing equity in cervical cancer screening for sexual and gender minoritized people assigned female at birth in the United States. Reprod Health. 2025. (BioMed Central)
9 Cohen LN, et al. Breast cancer disparities in the LGBTQ+ community: how to move towards inclusive care from screening to survivorship. Curr Breast Cancer Rep. 2025. (ScienceDirect)
10 Ma SJ, Oladeru OT, Bird CE, et al. Prostate cancer screening patterns among sexual and gender minority individuals. Eur Urol. 2021;79(5):588-592. (PubMed)
11 Sam IT, et al. Barriers and facilitators to anal cancer screening among men who have sex with men and other sexual minority populations: a scoping review. BMC Cancer. 2025. (PubMed Central)
12 Haviland KS, Swette S, Kelechi T, Mueller M. Barriers and facilitators to cancer screening among LGBTQ individuals with cancer. Oncol Nurs Forum. 2020;47(1):44-55. (PubMed)