Colorectal Cancer Screening Compliance Among Sexual Minority Subpopulations After the 2021 Updated U.S. Preventive Services Task Force Guidelines: A Cross-Sectional Analysis

Introduction The U.S. Preventive Services Task Force updated its colorectal cancer (CRC) screening guidelines in 2021; however, little is known about adherence to these updated guidelines among sexual minority populations. Methods Using data from the 2022 Behavioral Risk Factor Surveillance System, this study analyzed the adjusted prevalence ratios (aPR) of up-to-date CRC screening across sexual orientation groups (straight, gay/lesbian, bisexual, and another sexual orientation [defined as "something else"]) using modified Poisson regression with robust variance estimation adjusted for sociodemographic factors. Analyses were further stratified by age group (45–49, 50–64, 65–75 years) and sex. Results The study included 173,381 respondents (weighted N = 93,061,050) aged 45–75 years. Overall, up-to-date CRC screening prevalence ranged from 58.4% (another sexual orientation), 62.7% (bisexual), 68.8% (straight) to 69.0% among gay/lesbian individuals (p < 0.001). Individuals with another sexual orientation had significantly lower prevalence than both straight (aPR=0.90; 95% confidence interval [CI]: 0.84–0.97) and gay/lesbian individuals (aPR=0.90; 95% CI: 0.82–0.98). When stratified by age and sex, individuals of another sexual orientation consistently had lower likelihoods of being up-to-date with CRC screening in the 65–75 age group and among female participants compared with their straight counterparts. Conclusions CRC screening among individuals with another sexual orientation consistently had a lower prevalence of up-to-date CRC screening compared to straight and gay/lesbian individuals and did not differ significantly for gay/lesbian or bisexual individuals. This disparity was primarily driven by females, and those aged 65-75 years, highlighting the need for age- and sex-tailored interventions.