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. 2025 Jul 29;22(1):135.
doi: 10.1186/s12978-025-02082-2.

Advancing equity in cervical cancer screening for sexual and gender minoritized people assigned female at birth (SGM AFAB) in the United States: recommendations from healthcare equity leaders

Merrily E LeBlanc  1   2 , Emmett C Line  3 , Jennifer Potter  4   5   6 , Roberta E Goldman  7   8 , S Bryn Austin  8   9   10 , Madina Agénor  4   11   12   13
Affiliations

Advancing equity in cervical cancer screening for sexual and gender minoritized people assigned female at birth (SGM AFAB) in the United States: recommendations from healthcare equity leaders

Merrily E LeBlanc et al. Reprod Health. .

Abstract

Background: Sexual and gender minoritized (SGM) people, including but not limited to lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people assigned female at birth (AFAB), experience a greater burden of cervical cancer relative to their heterosexual and cisgender counterparts. However, they face pronounced systemic barriers to regular cervical cancer screening. Although evidence-based clinical guidelines play an integral role in the implementation of preventive measures, existing United States (U.S.) cervical cancer screening guidelines do not consider the specific experiences, needs, and contexts of SGM AFAB people concerning cervical cancer outcomes nor cervical cancer screening. Thus, it is imperative to determine how cervical cancer screening guidelines can be revised to better address the unique and specific cervical cancer prevention needs of SGM AFAB people in the U.S.

Methods: We conducted virtual key informant interviews to elicit recommendations for advancing SGM health equity in developing and implementing cervical cancer screening guidelines from healthcare equity leaders (N = 18), including half with expertise in SGM AFAB people's healthcare. Interviews were analyzed using a template-style thematic analysis approach to develop themes and sub-themes.

Results: Healthcare equity leaders provided three key recommendations for advancing SGM health equity in the development and implementation of U.S. cervical cancer screening guidelines. Healthcare equity leaders recommended prioritizing community and person-centered strategies, including engaging SGM communities in the development of the guidelines and using SGM-affirming approaches in their implementation. Revising language that (re)produces harmful normative and exclusionary assumptions about gender and sexuality in the context of cervical cancer screening guidelines was also recommended. Lastly, leaders recommended a range of strategies to mitigate systemic barriers to cervical cancer screening among SGM AFAB people, including collecting and utilizing representative data on SGM AFAB people's needs, experiences, and contexts to develop the guidelines and ensure cultural responsiveness in the delivery of cervical cancer screening to SGM AFAB people across healthcare systems.

Conclusion: This study's findings can contribute to improving and advancing health equity in cervical cancer screening for SGM AFAB populations through the community-centered development of inclusive, evidence-based guidelines and their person-centered implementation in clinical settings.

Keywords: Cervical cancer screening; Gender; Guidelines; Health equity; Reproductive health; Sexuality.

Plain language summary

Sexual and gender minoritized (SGM) people, including but not limited to lesbian, gay, bisexual, transgender and queer (LGBTQ+) people assigned female at birth (AFAB) experience a greater burden of cervical cancer relative to their heterosexual and cisgender counterparts; yet, they face pronounced barriers to regular cervical cancer screening. Although clinical guidelines play an integral role in the implementation of preventive measures, including screening for cervical cancer, existing United States (U.S.) cervical cancer screening guidelines do not take into account the specific experiences, needs, and contexts of SGM AFAB people. Thus, it is imperative to determine how cervical cancer screening guidelines can be improved to better address the unique and specific cervical cancer prevention needs of SGM AFAB people in the U.S. We conducted virtual key informant interviews with healthcare equity leaders (N = 18) in medicine, public health research, and policy to learn more about the ways in which cervical cancer screening guidelines could better meet the needs of SGM AFAB people in the U.S. These healthcare equity leaders recommended (1) including the SGM AFAB community in the development of the guidelines (2), avoiding harmful assumptions about SGM people and cervical cancer risk in the guidelines and (3) implementing the guidelines in ways that reduce barriers and increase cultural responsiveness in cervical cancer screening among SGM AFAB people. These valuable insights from healthcare equity leaders provide actionable insights for improving SGM health equity in the development and implementation of U.S. cervical cancer screening guidelines.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Social, Behavioral and Educational Research Institutional Review Board at Tufts University approved all research activities (Protocol #IRB00009494). All participants gave verbal informed consent to participate in the study at the beginning of their online video interview, as approved by the IRB. Consent for publication: Not Applicable. Competing interests: The authors declare no competing interests.

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