A Literature Review of Cervical Cancer Screening in Transgender Men

Gatos, Kayla C.

doi:10.1016/j.nwh.2017.12.008

Cited by 67 publications

(66 citation statements)

References 28 publications

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“…Although further study of the cervical cancer screening needs and practices of transgender, gender non‐binary, and intersex populations is needed, this is beyond the scope of this review . Two recent reviews summarize the experiences of transgender men seeking cervical cancer screening and the disparities faced by this population …”

Section: Methodsmentioning

confidence: 99%

Health Care‐Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review

Greene¹,

Meghani²,

Sommers³

et al. 2018

J Midwife Womens Health

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Introduction: Sexual minority women (SMW; lesbian, bisexual, nonheterosexual women) may have lower rates of cervical cancer screening than heterosexual women. Health care-related factors may explain some of the variation in cervical cancer screening rates among SMW. We aimed to synthesize published evidence of health care-related correlates of cervical cancer screening among SMW. Methods:We searched PubMed, CINAHL, and PsycINFO databases for English-language studies published between January 2000 and March 2017 that 1) assessed sexual identity or the sexual partners of female participants, 2) included cervical cancer screening as a main outcome of interest, and 3) measured at least one health care-related variable in addition to cervical cancer screening. We excluded articles that 1) reported on non-US samples or 2) did not report original research. We reviewed the sample, methods, and findings of 17 studies. We then summarized current knowledge about health care-related factors across 3 categories and generated recommendations for clinical practice and future research.Results: Several health care-related factors such as previous contraception use, having a primary care provider, knowledge of screening recommendations, and disclosing sexual orientation to providers were consistently positively associated with cervical cancer screening. Three groups of factors-previous health care use, health care provider-related factors, and belief-related factors-account for a substantial part of the variation in cervical cancer screening among SMW.Discussion: Several gaps in knowledge remain that could be addressed by recruiting more diverse samples of SMW with improved generalizability. Clinicians and clinical institutions can address factors associated with low rates of screening among SMW by preventing sexual orientation-based discrimination, inviting sexual orientation disclosure, and offering cervical cancer screening to SMW at a variety of health care encounters. Future research should examine how the location of care and health care provider type affect SMW's cervical cancer screening behaviors and should test the effectiveness of health care interventions designed to address sexual orientation-related disparities.

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Section: Methodsmentioning

confidence: 99%

Health Care‐Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review

Greene¹,

Meghani²,

Sommers³

et al. 2018

J Midwife Womens Health

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“…5 A literature review of cervical cancer screening among people who are FTM transgender also reported that they were less likely to be up to date on Pap test screening; among those who did receive screening, they were more likely to have abnormal or inadequate results compared with women who were cisgender. 8 There are many factors that may precipitate this disparity. Patients who are FTM transgender and health care providers may misperceive sexual history risk.…”

Section: Cervical Cancer Screeningmentioning

confidence: 99%

“…10 This disparity is likely further exacerbated by the fact that patients who are transgender regularly experience stigmatization and discrimination in the health care setting. 5,8 Primary care providers should consider how to improve the experience of and access to screening for malignant disease in patients who are transgender. To this effect, a recent publication reporting on best practices based on qualitative interviews with patients who are transgender and clinicians experienced in caring for this patient population is an excellent resource for health care providers.…”

Section: Cervical Cancer Screeningmentioning

confidence: 99%

Locally advanced cervical cancer in a transgender man

Beswick

Corkum

D’Souza

2019

CMAJ

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A 45-year-old transgender man presented to a gynecologist with a 2-year history of dysfunctional uterine bleeding. Vaginal bleeding had been occurring daily, small to moderate in volume, with periods of heavier irregular bleeding occurring without precipitating or alleviating factors. Additional symptoms included suprapubic discomfort managed with acetaminophen. The patient had attributed the cause of the persistent bleed to previous exogenous testosterone used for his hormonal gender confirmation, which he had stopped 18 months before presentation. Constitutional symptoms included a weight loss of 4.5 kg in the 4 months before initial assessment. The patient had been told that he did not require screening for cervical cancer because he had never had penetrative sexual intercourse with a male. He had never been pregnant.Pertinent medical history included a surgery for a double mastectomy. A hysterectomy had been planned 1 year before presentation because of a uterine fibroid (3 cm in diameter) that was identified on ultrasonography; however, the patient decided not to undergo the procedure.A speculum examination showed an abnormal mass located at the cervix that easily bled. A Papanicolaou smear confirmed a high-grade squamous intraepithelial lesion suspicious for invasion. A mass in the bladder (2.2 × 2.1 × 2.1 cm 3 in size) was identified on ultrasonography. Examination under anesthesia with cystoscopy showed an abnormal mass in the bladder at the trigone that was obstructing the right ureter. Gynecologic examination showed a friable mass (4 cm in diameter) in maximal dimension that had entirely replaced the normal cervical tissue. Biopsies of the bladder mass, endometrium and cervix confirmed squamous cell cervical carcinoma. The patient was referred to a regional cancer centre for further management.Staging investigations included a computed tomography scan of the chest, abdomen and pelvis, which did not identify regional adenopathy or metastatic disease. There was severe right-sided hydronephrosis secondary to ureteric obstruction. Magnetic resonance imaging of the pelvis confirmed a cervical mass (3.4 × 3.3 × 2.4 cm 3 in size) with indistinct margins, parametrial involvement and invasion into the right posterior wall of the bladder (Figures 1 and 2). The mass abutted but did not invade the anterior rectal wall. Final disease staging was International Federation of Gynecology and Obstetrics stage IVA cervical cancer.We started curative intent treatment with external beam radiotherapy and concurrent weekly radiosensitizing cisplatin chemotherapy, followed by high-dose-rate intracavitary brachytherapy. After chemoradiotherapy, there was an excellent local response with no evidence of residual tumour. Our patient remains disease-free 6 months posttreatment with five years of surveillance planned. DiscussionPap smears represent a major public health advancement for the detection of gynecologic neoplasia; increased participation in screening has resulted in a drastic decline in the incidence of and mortality from...

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“…4 3 Transgender men with a cervix are less likely than cisgender women to have up-to-date Papanicolaou screening In a literature review, transgender men with a cervix were 8.3 times more likely to have an inadequate Pap test, related to testosterone-induced physical changes and examination discomfort for provider and patient, and less likely to be screened appropriately (64.3% v. 73.5%) than cisgender women. 5 Individuals should be kept on the recall list for regular cervical screening. Providers should be trained on transgender-inclusive Pap testing, which can include a baseline Pap test before starting testosterone; short-term topical estrogen before the test; topical lidocaine to the vaginal introitus; use of a pediatric or long, narrow speculum; informing individuals that test results may be inadequate; and communication that prioritizes dignity and autonomy.…”

Section: Medical Guidelines On Providing Care For Transgender Individmentioning

confidence: 99%

Transgender-inclusive care

Lam

Abramovich

2019

CMAJ

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1 Population studies estimate that 0.5% of adults (about 25 million people worldwide) identify as transgender 1 Transgender (trans) is a term used to describe individuals whose gender identity does not align with the sex assigned to them at birth. The term gender-expansive refers to gender identities and expressions that are not strictly masculine or feminine, including non binary, genderqueer and gender fluid. 2 Patients should be asked privately what name and pronoun they go by and addressed accordingly. Many pronouns exist, including nonbinary pronouns, such as they and ze. Medical guidelines on providing care for transgender individuals have been publishedA primary care physician can deliver most health care needs for transgender individuals. 4 After further training and with expert support, primary care physicians should be able to prescribe hormones, monitor for potential effects of hormone therapy, assess for gender dysphoria and make referrals for transition-related surgeries for transgender people who choose to transition medically. 3,4 Gender-affirming care leads to improved quality of life and psychological outcomes. 4 3 Transgender men with a cervix are less likely than cisgender women to have up-to-date Papanicolaou screening In a literature review, transgender men with a cervix were 8.3 times more likely to have an inadequate Pap test, related to testosterone-induced physical changes and examination discomfort for provider and patient, and less likely to be screened appropriately (64.3% v. 73.5%) than cisgender women. 5 Individuals should be kept on the recall list for regular cervical screening. Providers should be trained on transgender-inclusive Pap testing, which can include a baseline Pap test before starting testosterone; short-term topical estrogen before the test; topical lidocaine to the vaginal introitus; use of a pediatric or long, narrow speculum; informing individuals that test results may be inadequate; and communication that prioritizes dignity and autonomy. 5 4 Fertility preservation should be discussed with transgender individuals before starting hormone therapy Only 12.4% of transgender adolescents were seen in consultation for fertility preservation before starting hormone therapy in one study. 6 Hormone therapy has gonadal effects that reduce fertility, although the effects are likely partially reversible. 6 Interested individuals should be referred to a fertility preservation program.

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A Literature Review of Cervical Cancer Screening in Transgender Men

Cited by 67 publications

References 28 publications

Health Care‐Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review

Health Care‐Related Correlates of Cervical Cancer Screening among Sexual Minority Women: An Integrative Review

Locally advanced cervical cancer in a transgender man

Transgender-inclusive care

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