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    2019-08-11

    r> Conflicts of interest
    Acknowledgements
    Introduction Lung cancer is the leading cause of cancer-related deaths among both men and women in the U.S. [1]. A recent study estimated that 8 million Americans are at high risk for lung cancer due to chronic high frequency smoking [2]. The National Lung Screening Trial (NLST) demonstrated that low-dose helical computed tomography (LDCT) lung cancer early detection screening demonstrated a relative Cucurbitacin I in mortality by 20% among high risk smokers [3]. However, efforts to identify and target high-risk populations for outreach and engagement in early detection screening are in their infancy. Sexual minorities (e.g., those who identify as lesbian, gay, bisexual, or ‘not sure’) are at greater risk of cigarette smoking and tobacco use disorders than heterosexuals [[4], [5], [6]]. We found only one published study reporting the prevalence of eligibility for low-dose computed tomography (LDCT) lung cancer screening based on sexual orientation.7 No study, to our knowledge, has examined actual rates of lung cancer screening in this population. Gaining a better understanding of potential sexual-orientation-related differences in LDCT eligibility and engagement in lung cancer screening could guide efforts to reduce the risk of lung cancer among sexual minorities. The purpose of this study was to compare rates of eligibility for LDCT lung cancer screening and receipt of a CT scan for lung cancer in a five-state U.S. sample of sexual minority and heterosexual adults aged 55–77. Given their greater risk for cigarette smoking and tobacco use [[4], [5], [6]], it is expected that sexual minority adults will report proportionately higher rates of eligibility for LDCT lung screening and therefore have higher rates of CT scans to check for lung cancer during the past year than their heterosexual counterparts.
    Methods
    Results Supplemental Table 1 displays the demographic characteristics of the sample. Overall, 10.6% of the sample met eligibility criteria for LDCT early detection screening, and 8.4% indicated receiving a CT scan for lung cancer during the past year. Table 2 shows the unadjusted and adjusted associations of LDCT eligibility and past-year CT scan for lung cancer by sexual identity (see Supplemental Table A and C for dichotomous comparison of heterosexuals versus sexual minorities). The odds of gay men indicating eligibility for LDCT screening were higher than odds for heterosexual men (AOR = 3.58, 95% CI = 1.25, 10.3) and the odds of lesbian women indicating eligibility for LDCT screening were higher than those of heterosexual women (AOR = 4.95, 95% CI = 1.82, 13.4). Bisexual men (AOR = 1.99, 95% CI = .829, 4.78) and women (AOR = 1.39, 95% CI = .286, 6.75) did not differ significantly from their heterosexual counterparts in the adjusted models related to LDCT screening eligibility. Moreover, no significant differences were found between heterosexuals and sexual minorities (i.e., gay/lesbian and bisexual) with respect to receiving a CT scan for lung cancer during the past 12 months. Results of adjusted models indicated that the odds of LDCT screening eligibility but not receiving a CT scan for lung cancer during the past 12 months were higher for gay/lesbian participants than heterosexuals participants (AOR = 3.31, 95% CI = 1.38, 7.94). When stratifying by sex, translation difference remained significant for lesbian women when compared to heterosexual women (AOR = 4.91, 95% CI = 1.60, 15.1); no statistically significant difference was found between gay men and heterosexual men (AOR = 2.30, 95% CI = .670, 7.90).
    Discussion Using a large sample of older sexual minority and heterosexual adults in five U.S. states, we found that eligibility for LDCT lung cancer screening was highest among gay men and lesbian women. Consistent with research using the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) [7] in which sexual minority-identified adults had the highest rates of eligibility for LDCT lung cancer screening, we similarly found notably higher rates of eligibility for LDCT lung cancer screening among sexual minority-identified adults than among heterosexuals.