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Are women who identify as LGBTQ less likely to get a Pap test?

Cervical cancer screening saves lives. In the decades since the widespread adoption of the Pap test as a regular screening tool, deaths from cervical cancer have dropped dramatically.

Cancer Care Ontario guidelines recommend a Pap test every three years for women between the ages of 21 and 70 who have ever been sexually active. However, some groups of women may be less likely to get screened regularly. LGBTQ (lesbian, gay, bisexual, transgender and queer) women are one of those groups. Studies have found that women who have sex with women have lower rates of Pap testing.

“They may perceive that their risk is low,” says Dr. Sheila Dunn, research director at the Family Practice Health Centre at Women’s College Hospital. “But HPV – which is the cause of cervical cancer – can be passed from woman to woman as well as heterosexually.”

Dr. Dunn notes that women who have sex with women comprise a very diverse group, with different individual risks for HPV (human papillomavirus). Sexual orientation may have little effect on individual HPV risk.

“It actually has a lot more to do with things like the number of sexual partners you have over your lifetime, and the age that you started having sex,” Dr. Dunn says.

One reason LGBTQ women may have lower screening rates than the general population is that Pap testing has often been linked to doctor visits for contraception, and women who have sex with women are less likely to seek a prescription for birth control.

Dr. Dunn stresses that all women who have ever been sexually active with a partner of any gender need cervical cancer screening. This includes women in long-term monogamous relationships, as well as women who are not currently sexually active. The changes that HPV causes in cervical cells can take years to develop.

“It’s often surprising for women who have been in longstanding monogamous relationships when their Pap test comes back abnormal,” Dr. Dunn says. “And yes, you do need screening even if you haven’t been sexually active in 20 years: if you were sexually active 20 years ago, you still need to be screened.

“We really want to promote life-long screening,” she adds. “It’s often as women get older that we’re identifying these persistent HPV infections that are causing the precancerous changes that are most important to pick up.”

Unlike other types of cancer screening, Pap testing can actually prevent cancer. Other tests, such as mammography, can identify early-stage cancers, but Pap testing can identify potential cancer cases before they develop.

“We pick up changes that may be more likely to progress to cancer, and treat them before they do,” Dr. Dunn says. “So it’s prevention that we’re talking about.”

However, despite screening, the Canadian Cancer Society estimates that 1,450 Canadian women will be diagnosed with cervical cancer this year.

“We know that women who present with cervical cancer are much more likely to be under- or never-screened for cancer. We have to look at who is under- or never-screened because they’re not getting the benefits of the screening that can actually help prevent cancer,” Dr. Dunn says. The goal is get the message out to these groups that screening is a key part of preventive healthcare, and to make sure that there is an appropriate means of access to screening, through either their primary care provider or clinics that provide screening in an acceptable way.

Groups who are less likely to be screened include LGBTQ women, older women, newcomers to Canada, and trans men.

“Trans men are a significant group that there is a real interest in trying to engage in screening,” Dr. Dunn says. “They may not feel that they have a place to go, or care providers who know how to address this.”

It’s also a group that is less likely to be reached by the traditional channels for Pap screening education, which are often women’s publications that trans men may be unlikely to read.

The message for all groups – trans men, women who have sex with women, older women, newcomers, and all women between 21 and 70 – is to try to take an active role in getting preventive care like cervical cancer screening.

“It’s in every individual’s best interest to make sure that they own this,” Dr. Dunn says.

This information is provided by Women’s College Hospital and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: Oct. 28, 2014

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