Addressing barriers and advancing equitable colorectal cancer screening in the lesbian, gay, bisexual, transgender, and queer/questioning population

Abstract

In the United States, colorectal cancer is the third most prevalent non-skin cancer, causing 8% of cancer-related deaths. The most effective way to decrease cancer morbidity and mortality is cancer screening. However, individuals who identify as lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) are less likely to utilize cancer screening services compared to the general population. To understand the barriers to effective colorectal cancer screening in the LGBTQ+ population and recommend solutions, we conducted a critical review of the literature using multiple databases until March 2024 using search strings like "colorectal cancer", "screening", "LGBTQ+", "healthcare equity" and "barriers". We addressed the barriers at various levels, including patient, provider, institution, health insurance, healthcare policies, and data and population surveys. Our analysis indicates that the key contributing factors are social stigma, lack of provider awareness, and insufficient culturally competent care. We also recommend potential solutions such as provider training, increasing awareness and accessibility of screening services, and incorporating patient-centered care models. To achieve equitable access to colorectal cancer screening for the LGBTQ+ population, a holistic strategy involving healthcare professionals, lawmakers, and researchers is required. By identifying the challenges and solutions, this minireview aims to promote healthcare equity and better health outcomes for the LGBTQ+ population. Recommendations for future studies are also given to improve healthcare provision for the LGBTQ+ community.

Keywords: Colorectal cancer; Barriers to care; Healthcare equity; Good health and well-being; Gender equality; Reduced inequalities; Quality education

Core Tip: Colorectal cancer is the third most common non-skin cancer in the United States, yet lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals are less likely to undergo screening, contributing to healthcare disparities. This critical literature minireview, covering studies up to March 2024, examines barriers to colorectal cancer screening in the LGBTQ+ population across patient, provider, institutional, and policy levels. Key challenges include social stigma, lack of provider awareness, and insufficient culturally competent care. Proposed solutions include provider training, enhancing screening access, and adopting patient-centered models. The review emphasizes the need for a holistic, multi-level approach to ensure equitable cancer screening and improved outcomes for LGBTQ+ individuals.