Disparities in Cervical Cancer Screening Across Intersections of Disability and Sexual Orientation

Abstract Women with disabilities and sexual minority women face significant disparities in cervical cancer screening and may have higher incidence. Prior studies report that sexual minority women are nearly 50% less likely to receive recommended cervical cancer screening, and screening rates are also lower among women with disabilities. These disparities may compound when identities intersect. This study examines cervical cancer screening using HPV tests by disability status and sexual orientation. We used nationally representative data (2014–2022) from the Behavioral Risk Factor Surveillance System (N = 145,668). Modified Poisson regression estimated adjusted prevalence ratios (aPRs) for cervical cancer screening among women aged 25–64 years, based on 2020 American Cancer Society guidelines, across four sub-groups: heterosexual women without disabilities, heterosexual women with disabilities, sexual minority women without disabilities, and sexual minority women with disabilities. Overall, 49.6% of women reported receiving cervical cancer screening using HPV tests. Compared with heterosexual women without disabilities, both women with disabilities and those identifying as sexual minorities were less likely to receive screening with HPV testing. The lowest screening prevalence was among sexual minorities without disabilities (aPR = 0.71; 95% CI: 0.64, 0.79), followed by sexual minorities with disabilities (aPR = 0.81; 95% CI: 0.71, 0.92) and heterosexual women with disabilities (aPR = 0.95; 95% CI: 0.91, 0.98). Overall screening rates were low, particularly among sexual minority women without disabilities. Women at the intersection of disability and sexual minority status also had significantly reduced screening compared with heterosexual women without disabilities. These findings suggest the need for targeted interventions and an intersectional approach to address overlapping barriers, ultimately improving cervical cancer screening equity for all women.