More than just socioeconomic factors impact overall cancer screening compliance and risk: Growing evidence shows that both sexual and racial minority status are associated with significantly lower rates of diagnostic cancer screening and preventive services, as well as higher distrust of the health care system.

Researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) conducted an extensive review of both peer-reviewed research studies and governmental public health data looking at the so-called “intersectionality” of factors influencing health disparities to determine that this combination of factors influences cancer screening behaviors and cancer risk.  

Intersectionality is the idea that social categorizations and personal identities are interconnected in a way that creates a unique, nuanced, lived experience for individuals rather than an additive experience. For example, the experience of a queer Black woman living in a rural area is not the sum of being queer, Black and in a rural location, as these identities are not mutually exclusive.

Study authors stress that clinicians need to be increasingly aware of intersectionality relative to disparities across the cancer care continuum. Previous intersectionality research has primarily focused on pre-diagnosis topics, such as control and prevention. 
 
This new retrospective analysis included 28 studies and found that the intersection of sexual minority status with race/ethnicity was associated with lower diagnostic screening, lower participation in preventive services and an increase in distrust of the health care system.

“A greater openness and understanding of patient identity—and the intersection of various identities—is needed to effectively address inequities in cancer care and survivorship. We must try to understand patients from a more holistic perspective using an ‘intersectional’ lens that accommodates a multidimensional, complex and nuanced understanding of patients and how they self-identify,” said senior author Dr. Timothy Pawlik, a surgical oncologist and Urban Meyer III and Shelly Meyer Chair of Cancer Research at the OSUCCC – James, where he also serves as a professor at The Ohio State University College of Medicine.

Pawlik and colleagues report their analysis in the Feb. 24 edition of the medical journal Psycho-Oncology. Their results uncover the various ways in which patients with intersectional identities may be at higher risk for negative cancer outcomes.

Study authors note that sexual minority women, particularly individuals of color, were less likely to engage in cancer prevention behaviors prior to diagnosis. Race and socioeconomic status were important factors in patient care/survivorship, with worse outcomes found among non-white women of low socioeconomic status.

“Our study results emphasize the importance of patient intersectional identities, as well as feelings of marginalization, fears of discrimination, and general discomfort with providers as barriers to seeking cancer care. This awareness is critical for building trust and understanding of our patients to ensure they receive both cancer screening and quality follow-up care,” added Pawlik.