Disparities in cancer incidence by sexual orientation.

INTRODUCTION: Cancer risk factors are more common among sexual minority populations (e.g., lesbian, bisexual) than their heterosexual peers, yet little is known about cancer incidence across sexual orientation groups. METHODS: The 1989-2017 data from the Nurses' Health Study II, a longitudinal cohort of female nurses across the United States, were analyzed (N = 101,543). Sexual orientation-related cancer disparities were quantified by comparing any cancer incidence among four sexual minority groups based on self-disclosure-(1) heterosexual with past same-sex attractions/partners/identity; (2) mostly heterosexual; (3) bisexual; and (4) lesbian women-to completely heterosexual women using age-adjusted incidence rate ratios (aIRR) calculated by the Mantel-Haenszel method. Additionally, subanalyses at 21 cancer disease sites (e.g., breast, colon/rectum) were conducted. RESULTS: For all-cancer analyses, there were no statistically significant differences in cancer incidence at the 5% type I error cutoff among sexual minority groups when compared to completely heterosexual women; the aIRR was 1.17 (95% CI,0.99-1.38) among lesbian women and 0.80 (0.58-1.10) among bisexual women. For the site-specific analyses, incidences at multiple sites were significantly higher among lesbian women compared to completely heterosexual women: thyroid cancer (aIRR, 1.87 [1.03-3.41]), basal cell carcinoma (aIRR, 1.85 [1.09-3.14]), and non-Hodgkin lymphoma (aIRR, 2.13 [1.10-4.12]). CONCLUSION: Lesbian women may be disproportionately burdened by cancer relative to their heterosexual peers. Sexual minority populations must be explicitly included in cancer prevention efforts. Comprehensive and standardized sexual orientation data must be systematically collected so nuanced sexual orientation-related cancer disparities can be accurately assessed for both common and rare cancers.

Trends in Sexual Orientation and Gender Identity Data Collection.

OBJECTIVE: The aim of this study was to determine response patterns to sexual orientation and gender identity (SOGI) questions in the Behavioral Risk Factor Surveillance System (BRFSS) over time and to assess nonresponse and indeterminate responses by demographic characteristics. METHODS: This is a secondary data analysis of the SOGI module of the BRFSS. We used data from 46 states and Guam that implemented SOGI questions between 2014 and 2022. We used weighted analyses that accounted for the sampling design, determined SOGI response patterns by year, and assessed nonresponse and indeterminate responses by demographic characteristics. RESULTS: Over time, increasing numbers self-reported as sexual and gender minority respondents, while heterosexual identity declined. Sexual orientation nonresponse and indeterminate responses increased with time, while respondents' reports of not knowing gender identity declined. Hispanic, older, respondents, those with lower education, and those who completed the questionnaire in Spanish had higher SOGI nonresponse and indeterminate responses. CONCLUSIONS: The low amount of SOGI nonresponse and indeterminate responses in the BRFSS can be instructive for the implementation of SOGI questions in medical settings. SOGI data collection in all settings requires improving procedures for the groups that have been shown to have elevated nonresponse and indeterminate response.

Scoping review of experiences of sexual minority women treated for breast cancer.

PURPOSE: To summarize and critique research on the experiences and outcomes of sexual minority women (SMW) treated with surgery for breast cancer through systematic literature review. METHODS: A comprehensive literature search identified studies from the last 20 years addressing surgical experiences and outcomes of SMW breast cancer survivors. Authors performed a quality assessment and thematic content analysis to identify emergent themes. RESULTS: The search yielded 121 records; eight qualitative studies were included in the final critical appraisal. Quality scores for included studies ranged 6-8 out of 10. Experiences and outcomes of SMW breast cancer survivors were organized by major themes: 1) Individual, 2) Interpersonal, 3) Healthcare System, and 4) Sociocultural and Discursive. CONCLUSIONS: SMW breast cancer survivors have unique experiences of treatment access, decision-making, and quality of life in survivorship. SMW breast cancer survivors' personal values, preferences, and support network are critical considerations for researchers and clinicians.

Piloting the Sexual and Gender Minority Cancer Curricular Advances for Research and Education (SGM Cancer CARE) Workshop: Research Training in the Service of SGM Cancer Health Equity.

The purpose of this study is to describe the context, curriculum design, and pilot evaluation of the educational program "Sexual and Gender Minority Cancer Curricular Advances for Research and Education" (SGM Cancer CARE), a workshop for early-career researchers and healthcare providers interested in gaining knowledge and skills in sexual and gender minority (SGM) cancer research and healthcare advocacy. A needs assessment of a sample of clinicians and researchers (n = 104) and feedback from an Advisory Board informed the curriculum design of the SGM Cancer CARE workshop. Four SGM-tailored modules, focusing on epidemiology, clinical research, behavioral science and interventions, and community-based participatory approaches, were developed and tested in a 2.5-day virtual format among 19 clinicians and researchers. A fifth module to provide feedback to participants on brief presentations about their SGM cancer research ideas or related efforts was added later. A mixed-methods evaluation comprised of pre- and post-modular online evaluation surveys and virtual focus groups was used to determine the degree to which the workshop curriculum met participant needs. Compared to pre-module evaluations, participants reported a marked increase in SGM cancer research knowledge in post-module scores. Quantitative results were supported by our qualitative findings. In open field response survey questions and post-workshop focus groups, participants reported being extremely pleased with the content and delivery format of the SGM Cancer CARE workshop. Participants did regret not having the opportunity to connect with instructors, mentors, and colleagues in person. The SGM Cancer CARE curriculum was shown to increase the knowledge, skills, and level of preparedness of early-career clinicians and scientists to conduct culturally relevant and appropriate research needed to improve care for SGM persons across the cancer care continuum from prevention to survivorship.

Intersectionality and cancer survivorship: Sexual orientation and racial/ethnic differences in physical and mental health outcomes among female and male cancer survivors.

BACKGROUND: Because of concerns about sexual minorities' poor cancer survivorship, this study compared cancer survivors' health outcomes in relation to multiple intersecting social positions, namely gender, sexual orientation, and race/ethnicity. METHODS: This secondary data analysis used 2014-2019 Behavior Risk Factor Surveillance Survey data. The survey respondents consisted of 40,482 heterosexual and sexual minority men and 69,302 heterosexual and sexual minority women who identified as White, Black, or Hispanic. Logistic regression models compared White, Black, and Hispanic male and female cancer survivors' health status, depression, and health-related quality of life by sexual orientation. Models were adjusted for sociodemographic characteristics and access to care. RESULTS: Mental health findings showed consistency, with sexual minority male and female cancer survivors having 2 to 3 times greater odds of depression and/or poor mental health among White, Black, and Hispanic survivors. Among White women, sexual minorities reported greater odds of fair or poor health, poor physical health, and poor activity days, whereas White sexual minority men showed similar odds in comparison with their heterosexual counterparts. Among Black and Hispanic sexual minority men and women, differences in the odds of fair or poor health, poor physical health, and poor activity days in comparison with their heterosexual counterparts were mostly explained by sociodemographic and access-to-care factors. CONCLUSIONS: Physical and mental health outcomes vary in relation to sexual orientation and race/ethnicity among both female and male cancer survivors. Clinicians, researchers, and health care administrators must better understand and address the unique needs of cancer survivors in relation to multiple axes of social inequality to advance cancer equity.

Anxiety and depression in colorectal cancer survivors: Are there differences by sexual orientation?

OBJECTIVE: To examine sexual minority compared to heterosexual survivors' health-related anxiety, anxiety, and depression. METHODS: Four hundred and eighty eligible survivors participated in a telephone survey, which measured their anxiety and depression. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of three years prior to the survey and were recruited from four cancer registries. As explanatory factors, we considered individual, social and contextual characteristics, prior psychological factors, psychological responses to cancer, and characteristics of cancer and its treatments. Using forward selection with generalized linear models or logistic regression models, we identified significant correlates for each outcome. RESULTS: Prior to adjusting for covariates, depression was similar for all survivors, while sexual minority survivors had worse health-related anxiety and anxiety compared to heterosexual survivors. After adjustment, these differences were no longer statistically significant. Individual, social and contextual characteristics, characteristics of cancer, and psychological responses to cancer explained 44% of the variance in anxiety and 60% of the variance in depression. CONCLUSION: There are modifiable factors associated with health-related and generalized anxiety as well as depression that can be changed to improve cancer survivorship among diverse survivors.

Health-related quality of life among colorectal cancer survivors of diverse sexual orientations.

BACKGROUND: The purpose of this study was to examine the health-related quality of life of sexual minority survivors in comparison with heterosexual survivors. METHODS: Four hundred eighty eligible survivors participated in a telephone survey that measured survivors' outcomes, which consisted of physical and mental quality of life and self-rated fair or poor health. These survivors were diagnosed with stage I, II, or III colorectal cancer an average of 3 years before the survey and were recruited from 4 cancer registries. Using forward selection with generalized linear models or logistic regression models, the authors considered 4 domains-personal factors, environmental factors, health condition characteristics, and body function and structure-as correlates for each survivorship outcome. RESULTS: The authors found that unadjusted physical quality of life and self-rated fair/poor health were similar for all survivors. Sexual minority survivors had poorer unadjusted mental quality of life in comparison with heterosexual survivors. After adjustments for covariates, this difference was no longer statistically significant. Three domains (personal factors, health condition characteristics, and body function and structure) explained colorectal cancer survivors' fair/poor health and 46% of the variance in physical quality of life, whereas 56% of the variance in mental quality of life was explained by personal factors, body function and structure, and environmental factors. CONCLUSIONS: This study has identified modifiable factors that can be used to improve cancer survivors' quality of life and are, therefore, relevant to ongoing efforts to improve the survivorship experience.

Assessing the relationship between symptoms and health care utilization in colorectal cancer survivors of different sexual orientations.

OBJECTIVE: The purpose of this study was to determine the association of physical and psychological symptoms with health care utilization in sexual minority and heterosexual colorectal cancer survivors. METHODS: Four hundred eighteen colorectal cancer survivors who were in remission an average of 3 years after their diagnosis were surveyed about their non-emergency health care visits during the preceding 3 months. Survivors reported whether they had experienced any of 21 symptoms common among colorectal cancer survivors in the past week. The relation between having had two or more health care visits in the preceding 3 months and symptoms experienced was assessed using logistic regression, controlling for cancer registry, sexual orientation, sex, age, race/ethnicity, income, and comorbidities. RESULTS: Of the survivors, 12% reported no symptoms, while 12% reported six or more symptoms. Sexual minority survivors reported significantly more weight concerns and more health-related and general anxiety as well as worse body image than heterosexual survivors. Frequent worrying about weight and experiencing sore skin around the anal area or stoma were the two symptoms that significantly contributed towards explaining survivors' increased health care utilization. CONCLUSION: Weight concerns, which are more common among the heaviest survivors, may prompt survivors to seek help from health care providers, which may lead to more frequent visits. On the other hand, some symptoms, despite their prevalence, had no relationship with the frequency of health care visits, raising questions about whether survivors share these concerns with providers.

Transgender individuals' cancer survivorship: Results of a cross-sectional study.

BACKGROUND: Transgender individuals' cancer prevalence and transgender cancer survivors' health needs have received scarce attention. The current study compared transgender and cisgender individuals' cancer prevalence and described the health needs of transgender cancer survivors. METHODS: The authors used Behavioral Risk Factor Surveillance System data on 95,800 cisgender and transgender individuals who self-reported a cancer diagnosis. Using multiple logistic regression, they estimated cancer prevalence and calculated odds ratios with 95% confidence intervals of physical, psychological, overall health, and health behaviors of transgender survivors compared with cisgender survivors. RESULTS: After adjusting for confounders, transgender men had a significantly higher (>2-fold) number of cancer diagnoses compared with cisgender men, but not cisgender women. Cancer prevalence among gender nonconforming individuals and transgender women was not significantly different from that of cisgender men and cisgender women. Gender nonconforming survivors had significantly greater physical inactivity, heavy episodic alcohol use, and depression compared with cisgender men and cisgender women. Transgender men survivors were significantly more likely to report poor physical health and greater medical comorbidities and were less likely to report smoking compared with cisgender men and cisgender women. Transgender women survivors were significantly more likely to report diabetes compared with cisgender men and cisgender women and were more likely to report cardiovascular disease compared with cisgender women. CONCLUSIONS: Clinicians should be aware of the higher prevalence of cancer among transgender men and a potential survivorship bias among transgender individuals. Transgender survivors have considerable variation in their risk profile. Clinicians and health services can target gender nonconforming survivors' depression and health behaviors to improve survival and should address the complex comorbidities of transgender men and transgender women.

Sexual orientation and benign breast disease in a cohort of U.S. women.

PURPOSE: Several studies indicate that sexual minority (e.g., bisexual, lesbian) women may be at an increased risk for breast cancer. However, we know little about how risk factors, such as benign breast disease (BBD)-which can confer nearly a fourfold breast cancer risk increase-may vary across sexual orientation groups. METHODS: Among Nurses' Health Study II participants followed from 1989 to 2013 (n = 99,656), we investigated whether bisexual and lesbian women were more likely than heterosexual women to have breast cancer risk factors including a BBD diagnosis (self-reported biopsy or aspiration confirmed, n = 11,021). Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS: Compared to heterosexuals, sexual minority participants more commonly reported certain breast cancer risk factors including increased alcohol intake and nulliparity. However, sexual minority participants were more likely than heterosexuals to have certain protective factors including higher body mass index and less oral contraceptive use. When evaluating age- and family history-adjusted rates of BBD diagnoses across sexual orientation groups, bisexual (HR 1.04, 95% CI [0.78, 1.38]) and lesbian (0.99 [0.81, 1.21]) women were just as likely as heterosexuals to have a BBD diagnosis. Results were similar after adjusting for other known breast cancer risk factors. CONCLUSIONS: In this cohort of women across the U.S., sexual minorities were more likely than heterosexuals to have some breast cancer risk factors-including modifiable risk factors such as alcohol intake. Heterosexual, bisexual, and lesbian women were equally as likely to have a BBD diagnosis.

Dyadic quality of life among heterosexual and sexual minority breast cancer survivors and their caregivers.

PURPOSE: The number of informal caregivers to cancer survivors is increasing, and limited information is available about caregivers to sexual minority breast cancer survivors. The purpose of this study was to assess dyadic quality of life among sexual minority cancer survivors and their caregivers compared with heterosexual cancer survivors and their caregivers. METHODS: We recruited 167 survivors of non-metastatic breast cancer of different sexual orientations and their caregivers, who were surveyed via telephone after obtaining consent. We used inverse propensity score weighting to account for differences by sexual orientation in age and length of the survivor-caregiver relationship, and simultaneous equation models consistent with the needs for analyzing dyadic data. RESULTS: About 6-7 years after diagnosis, survivors and caregivers reported quality of life scores consistent with population norms, and there were no differences by survivors' sexual orientation. With few exceptions, caregivers' and survivors' quality of life influenced one another directly, and these effects were stronger among sexual minority dyads than heterosexual dyads. CONCLUSIONS: Because of the strength of sexual minority, survivors' and their caregivers' mutual influence on each other's quality of life, interventions, and clinical care for sexual minority breast cancer survivors should consider their caregivers.

Cancer survivors' access to care and quality of life: Do sexual minorities fare worse than heterosexuals?

BACKGROUND: Adults with poor access to care are known to have worse quality of life (QOL). The purpose of the current study was to determine differences in cancer survivors' access to care by sexual orientation and to examine the association between access to care and QOL. METHODS: The current secondary data analysis used 4 years of Behavioral Risk Factor Surveillance System data regarding adult men and women who self-reported a history of cancer. Among the 70,524 cancer survivors, a total of 1931 self-identified as sexual minorities, defined as lesbian, gay, bisexual, or other nonheterosexual orientation. RESULTS: Sexual minority women had significantly more access deficits compared with heterosexual women (42.7% vs 28.0%; P < .0001), whereas men of different sexual orientations had similar access to care. Among sexual minority women, those with access deficits had higher odds of poor physical QOL compared with heterosexual women (odds ratio [OR], 2.0 [95% CI, 1.2-3.4] vs OR, 1.3 [95% CI, 1.2-1.5]), poor mental QOL (OR, 1.8 [95% CI, 1.1-3.1] vs OR, 1.5 [95% CI, 1.3-1.7]), and difficulties concentrating (OR, 2.0 [95% CI, 1.2-3.5] vs OR, 1.7 [95% CI, 1.4-1.9]). Sexual minority men with access deficits had greater odds of difficulty concentrating compared with heterosexual men (OR, 4.3 [95% CI, 2.0-9.3] vs OR, 1.5 [95% CI, 1.2-1.9]). Among men, sexual minority status increased the odds of poor mental QOL (OR, 1.49 [95% CI, 1.11-2.01]). CONCLUSIONS: Access to care among sexual minority cancer survivors needs improvement. Sexual minority women should be a focus of future research because their poor access to care more strongly relates to worse QOL.

Cancer genetic counselors' experiences with transgender patients: A qualitative study.

It is becoming increasingly common for people to openly identify as transgender, yet there is little research in the field of genetic counseling regarding this community's unique medical needs. Transgender patients are likely to present with issues that cross genetics and gender-related care in a cancer genetic counseling session, and empiric data about these differences is needed to provide adequate care. In order to investigate what specific health topics and concerns are addressed in cancer genetic counseling sessions with transgender patients, 21 cancer genetic counselors who have seen transgender patients were interviewed. Through inductive analysis, six themes emerged: (1) documentation systems are not inclusive or clear; (2) genetic counselors feel unprepared for these sessions; (3) gender affirming hormones impact risk assessment; (4) genetic testing affects gender affirming surgical decisions; (5) transgender patients present at younger ages to clinic; and (6) pathogenic variants allow for insurance coverage for gender affirming surgeries. This study's findings point to opportunities for the field of genetic counseling to enhance services for transgender patients by reporting distinctive situations that may arise in clinic with these patients and providing training recommendations for genetic counselors.

Dyadic stress of breast cancer survivors and their caregivers: Are there differences by sexual orientation?

OBJECTIVE: The objective of the study is to assess dyadic stress among sexual minority cancer survivor and caregivers compared to heterosexual cancer survivors and their caregivers. METHODS: We recruited 167 survivors of nonmetastatic breast cancer of different sexual orientations and their caregivers, who were interviewed via telephone after obtaining consent. We used inverse propensity score weighting to account for differences by sexual orientation in age and length of the survivor-caregiver relationship and simultaneous equation models consistent with the needs for analyzing dyadic data. RESULTS: Survivors and caregivers reported stress levels consistent with population norms, irrespective of survivors' sexual orientation. Accounting for covariates, survivors' and caregivers' stress did not mutually influence one another overall. However, differences by sexual orientation were noted such that caregivers' stress was influential for sexual minority survivors' stress, but not for heterosexual survivors' stress. CONCLUSIONS: Careful consideration should be given to caregivers of sexual minority survivors, an underserved group for whom currently no interventions exist.

Dental Care in an Equal Access System Valuing Equity: Are There Racial Disparities?

BACKGROUND: Racial disparities in dental care have previously been shown in the Veterans Health Administration (VA)-a controlled access setting valuing equitable, high-quality care. OBJECTIVES: The aim of this study is to examine current disparities in dental care by focusing on the receipt of root canal therapy (RCT) versus tooth extraction. RESEARCH DESIGN: This is a retrospective analysis of data contained in the VA's electronic health records. We performed logistic regressions on the independent measures along with a facility-specific random effect, using dependent binary variables that distinguished RCT from tooth extraction procedures. SUBJECTS: VA outpatients who had at least 1 tooth extraction or RCT visit in the VA in fiscal year 2011. MEASURES: A dependent binary measure of tooth extraction or RCT. Other measures are medical record data on medical comorbidities, dental morbidity, prior dental utilization, and demographic characteristics. RESULTS: The overall rate of preferred tooth-preserving RCT was 18.1% during the study period. Black and Asian patients were most dissimilar with respect to dental morbidity, medical and psychological disorders, and black patients had the least amount of eligibility for comprehensive dental care. After adjustment for known confounding factors of RCT, black patients had the lowest RCT rates, whereas Asians had the highest. CONCLUSIONS: Current quality improvement efforts and a value to improve the equity of care are not sufficient to address racial/ethnic disparities in VA dental care; rather more targeted efforts will be needed to achieve equity for all.

Weight status and sexual orientation: differences by age and within racial and ethnic subgroups.

OBJECTIVES: We determined differences in weight at age 18 years and at current age and weight change by sexual orientation within different racial/ethnic populations, stratifying by gender. METHODS: We used 2001-2007 data from the California Health Interview Survey, resulting in an unweighted sample of 120,274 individuals aged 18 to 74 years. Using regression models, we examined overweight status and change in weight by sexual orientation, stratifying by race/ethnicity and gender. RESULTS: Compared with heterosexual women of the same race/ethnicity, White and African American lesbians and bisexuals had increased likelihood of being overweight at age 18 years and maintaining overweight status during adulthood. Sexual minority status was unrelated to weight among Latinas and inconsistently linked to weight among Asian women compared with heterosexual women of the same race/ethnicity. Sexual minority status was protective against unhealthy weight among White, African American, Asian, and Latino men compared with heterosexual counterparts of the same race/ethnicity. This protective effect was seen after age 18 years except among African American bisexual men. CONCLUSIONS: Our findings indicate a need for age- and culture-sensitive interventions that reduce weight or prevent weight gain in sexual minority women and men.

Perceptions of patient-provider communications with healthcare providers among sexual and gender minority individuals in the United States.

OBJECTIVES: To identify perceived differences in the key domains of patient-provider communications between sexual and gender minority (SGM) and non-SGM patients. METHODS: We reviewed data from the Health Information National Trends Survey (HINTS) to assess patient perspectives on different domains of patient-provider communications in the ideological framework by Epstein and Street (2007) [1]. Between SGM-identified (N = 491) and cisgender, heterosexual respondents (N = 7426), we assessed the proportions of responses to survey questions about the six domains of patient-provider communications and calculated odds ratios (OR) with 95 % confidence intervals (CI) (N = 7917). RESULTS: Overall, compared to cisgender, heterosexual individuals, fewer SGM individuals reported always experiencing optimal patient-provider communications across all domains, most notably in areas of emotional support (OR=0.70, 95 % CI: (0.51, 0.97)), patient self-management (OR=0.73, 95 % CI: (0.54, 0.99)), and managing uncertainty (OR=0.68, 95 % CI: (0.49, 0.94)). CONCLUSION: Further research on detailed SGM patient perceptions of their relationships with healthcare providers is needed to understand why such differences in communication exist and provide practical recommendations to improve care delivery. PRACTICE IMPLICATIONS: SGM patients perceive their current provider communications to be suboptimal, so we must improve emotional management training in future provider-based SGM competency trainings and encourage patient self-management during individual provider encounters.

Lesbian and bisexual women's adjustment after a breast cancer diagnosis.

BACKGROUND: Little research has been devoted to lesbian and bisexual survivors' adjustment after breast cancer. OBJECTIVES: To determine differences between lesbian and bisexual survivors and to examine whether sexual minority-specific issues contribute to these survivors' adjustment. DESIGN: We recruited 180 lesbian and bisexual survivors with primary diagnoses of DCIS (ductal carcinoma in situ) or I-III nonrecurrent breast cancer from a cancer registry and the community. RESULTS: The characteristics of lesbian and bisexual survivors of breast cancer were similar, with few exceptions, such as partner status and gender of partner. Sexual minority-specific factors contributed toward explaining lesbian and bisexual survivors' anxiety and depression but did not contribute toward explaining survivors' physical and mental health. CONCLUSIONS: Awareness about vulnerabilities due to partner status and about the sexual minority-specific issues that contribute to adjustment is important for medical and mental health professionals who have lesbian and bisexual breast cancer survivors as patients.

Cancer and men who have sex with men: a systematic review.

Disparities in cancer burden between specific populations are widely acknowledged, including differences associated with sexual orientation. We searched PubMed for articles about cancer in men who have sex with men. Of the 410 publications that we identified, 47 reports were eligible for inclusion and review. Most addressed issues of cancer prevention, followed by diagnosis, survivorship, detection, and cancer treatment. Disparities exist mainly in the prevalence of viruses linked to cancers. Knowledge about sexual orientation and cancer is skewed towards infection-related cancers, so information about the association between sexual orientation and other cancers, and social and cultural causes for disparities in cancer, is less available. Men who have sex with men are still a largely overlooked minority group in this respect. Future research should examine the effects of sexual orientation on cancer, from prevention to survivorship.

Recruitment of sexual minority and heterosexual colorectal cancer survivors through US cancer registries.

PURPOSE: Describe the process, outcomes, and costs of cancer registry recruitment and enrollment of sexual minority and heterosexual non-metastatic colorectal cancer survivors into an observational survivorship study. METHODS: We recruited stage I-III colorectal cancer survivors from four US cancer registries. Potential participants were screened for eligibility, and all eligible sexual minority and every 10th heterosexual survivor was invited to participate in a 45-min telephone interview. RESULTS: We mailed study packets to 17,855 individuals and obtained 6370 screening surveys of presumed eligible individuals. After screening, there were 182 eligible sexual minority and 5568 eligible heterosexual survivors. Of the 719 invited survivors, 127 sexual minority and 353 heterosexual individuals participated in the interview. There were some small differences in personal and neighborhood sociodemographic characteristics for the survivors who screened eligible and completed the interview relative to the registry sample. The per-participant direct costs were about $40, $120, and $1425 in the registry, screened eligible, and interviewed samples, respectively. CONCLUSIONS: Although we did not observe substantial selection biases, the costs of enrolling a representative sample were high. IMPLICATIONS FOR CANCER SURVIVORS: Inclusion of sexual orientation and gender identity as standard demographic questions in cancer registries is needed for reliable and cost-efficient monitoring of population health.