ASCO GU 2018: Impact of Sexual Orientation on Contemporary Rates of Prostate Cancer Screening

San Francisco, CA ( Dr. Daniel Pucheril and colleagues presented their findings regarding the impact of sexual orientation on contemporary rates of prostate cancer screening. Although there has been increasing societal acceptance of non-heterosexual individuals, sexual minorities continue to face discrimination. The effect of non-heterosexual orientation on adoption of cancer preventive services, specifically prostate cancer screening, is essentially unknown. The objective of this study was to assess whether male sexual minorities are less likely to receive prostate cancer screening compared to heterosexual males.

For this study, the authors utilized the Behavioral Risk Factor Surveillance System database from 2014-2016 for males 40-69, without a history of prostate cancer, and having answered all sexual orientation questions in the survey. Prostate cancer screening was deemed to have occurred if a respondent had a PSA test within the last two years for reasons other than “a prostate problem” or “for prostate cancer”. The authors used descriptive statistics to assess for demographic covariates stratified by year and sexual orientation [heterosexual vs homosexual vs bisexual vs transgender vs other vs refused]. The Chi-Square test was used to compare the distribution of covariate proportions amongst sexual orientation categories within each year. Multivariable regression was used to determine the independent effect of sexual orientation and other covariates on receipt of prostate cancer screening in this cohort.

There were 49.2 million weighted individuals (n = 86,893) that met inclusion criteria. In 2014 and 2016, 94% and 93% of the cohort identified as heterosexual. Interestingly, in both years, a higher proportion of homosexual (2014: 40.5%, 2016: 47.4) and bisexual (2014: 30.3%, 2016: 31.0%) respondents were college graduates compared to heterosexual males (2014: 28.8%, 2016: 28.9%). In 2014, rates of prostate cancer screening were higher amongst homosexual (34.9%), bisexual (37.1%) and transgender (37.5%) individuals compared to heterosexual males (34.5%). In 2016, rates of prostate cancer screening were clinically similar among heterosexual (30.4%), homosexual (30.2%), bisexual (30.1%), and transgender (27.8%) individuals. In the multivariable analysis, increasing age (65-69 OR 8.93, 95%CI 7.80-10.22) and education level (college graduate OR 2.21, 95%CI 1.93-2.54) along with insurance coverage (OR 2.15, 95%CI 1.85-2.51) and a personal physician (OR 2.88, 95%CI 2.59-3.20) were associated with higher odds of prostate cancer screening. Aside from homosexual orientation (OR 1.30, 95%CI 1.04-1.62), sexual orientation was not an independent predictor of prostate cancer screening.

The authors concluded that based on a nationally representative sample, disparities for prostate cancer screening are not apparent for non-heterosexual males. Despite these encouraging findings, these results should be reassessed and validated in other, non-survey based cohorts.

Speaker: Daniel Pucheril, Brigham and Women's Hospital, Boston, MA

Co-Authors: Matthew D. Ingham, Dimitar V. Zlatev, Sebastian Berg, Matthew Mossanen, Steven Lee Chang, Adam S. Kibel, Quoc-Dien Trinh

Written by: Zachary Klaassen, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@zklaassen_md at the 2018 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, February 8-10, 2018 - San Francisco, CA

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