Perceptions of and barriers to cancer screening by the sexual and gender minority community: a glimpse into the health care disparity

Lombardo, Joseph; Ko, Kevin; Shimada, Ayako; Nelson, Nicolas G.; Wright, Christopher M.; Chen, Jerry; Maity, A.; Ruggiero, Marissa L.; Richard, Scott D.; Papanagnou, Dimitrios; Mitchell, Edith P.; Leader, Amy; Simone, Nicole L.

doi:10.1007/s10552-021-01549-4

Cited by 24 publications

(28 citation statements)

References 45 publications

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“…Seventy-seven include studies examined education levels (online supplemental table 2). Patients with higher education levels had higher rates of HPV vaccination, vaccination intention, provider recommendation22 95 and HPV-related cancer knowledge 96–100. Patients with lower education levels had increased odds of HPV infections,23 25 101 metastasis of HPV-related squamous cell carcinoma of the head and neck,90 and worse outcomes of HPV-associated oropharyngeal cancer 43.…”

Section: Resultsmentioning

confidence: 99%

“…The increased rates of cancer in this community may be due to lack of detection of lesions prior to malignant transformation as nearly 90% of high-risk gay men have never had an anal pap 124. The lack of screening is twofold: (1) LGBTQ+ patients may avoid healthcare due to financial and emotional distress,98 and (2) patients may not feel comfortable disclosing sexual orientation to their provider, which could result in inappropriate provider recommendations for healthcare 125. As no included studies evaluated cancer screening in gay men, investigation into rates of screening within this population is imperative.…”

Section: Discussionmentioning

confidence: 99%

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Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review

et al. 2022

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BackgroundHuman papillomavirus (HPV) represents the most common STI in the USA. HPV inequities in prevention, diagnostics and clinical care persist. We define inequities as systematic, avoidable and unfair differences in health outcomes.ObjectivesThe objectives of this scoping review are to chart existing data on HPV-related inequities, identify gaps in existing literature and guide future research to reduce these inequities.MethodsWe completed a scoping review following guidelines from the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping reviews extension. We performed a literature search on PubMed and Ovid Embase in July 2022 for articles pertaining to HPV and evaluating populations within the USA. We included English language publications from 2018 to 2022 evaluating at least one health inequity outlined by the National Institutes of Health. General publication characteristics and health inequity data were charted in a masked, duplicate fashion using a pilot-tested Google Form. We analysed frequencies of health inequities and summarised main findings from included studies.ResultsOur final sample included 170 publications. The most common inequities examined were race/ethnicity (140 studies), sex or gender (97 studies), and income (69 studies). Many historically marginalised racial/ethnic groups had lower rates of HPV-related knowledge, vaccination and worse overall outcomes related to HPV. Compared with women, men had lower rates of HPV vaccination and provider recommendation, and higher rates of HPV-infection. Results regarding income were largely conflicting.ConclusionFindings from our review demonstrate clear gaps in HPV-related inequity research. Vaccine completion, provider recommendation and intersectionality should continue to be evaluated to implement targeted interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review

et al. 2022

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“…For example, it has been reported that trans status is associated with a 37% reduction in odds of cervical cancer screening (Peitzmeier et al, 2014), and significantly less likelihood to engage in screening for prostate cancer (odds ratio 1.07) (Ma et al, 2021) and breast cancer (odds ratio 0.47) (Oladeru et al, 2022), in comparison to cisgender people. This is primarily due to previous negative experiences during screening and reluctance to attend gendered health services (Connolly et al, 2020;Lombardo et al, 2022). Trans people may be excluded from screening reminders or invitations to screen for relevant gendered cancers because of the ways their gender is listed in medical records (Connolly et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Reinforcing or Disrupting Gender Affirmation: The Impact of Cancer on Transgender Embodiment and Identity

et al. 2023

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There is a pressing need for greater understanding and focus on cancer survivorship and informal cancer caring of trans people (binary and non-binary), across tumor types, to inform culturally safe trans inclusive cancer information and care. This qualitative study, part of the mixed methods Out with Cancer project, examined experiences of trans embodiment and identity after cancer diagnosis and treatment. We drew on open-ended survey responses from 63 trans cancer survivors and 23 trans cancer carers, as well as interviews and a photo-elicitation activity with a subset of 22 participants (15 cancer survivors, 7 cancer carers). Reflexive thematic analysis identified three themes: Cancer enhances trans embodiment, through experiences of gender euphoria following cancer treatment, and acceleration of decisions about gender affirmation; cancer erases or inhibits gender affirmation; trans embodiment is invisible or pathologized in cancer care. These findings demonstrate that trans embodiment and identity, as well as the process of gender affirmation, may be disrupted by cancer or informal cancer caring. Conversely, cancer and cancer treatment can positively impact the embodied identity and lives of trans people, despite the anxiety and strain of negotiating medical procedures. However, if healthcare professionals operate within a cis-heteronormative framework and do not understand the meaning of embodied change following cancer treatment for trans individuals, these positive benefits may not be realized.

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“…In 2021, an estimated 284,200 people were diagnosed with breast cancer, making it the second most common cancer diagnosis in the United States 1 . Despite this, large disparities remain in the detection, surveillance, and research of breast cancer in all populations, including patients of transgender and gender diverse identities 2 . Breast cancer has long been represented as a disease that affects only cisgender women, but in reality, it can affect anyone.…”

mentioning

confidence: 99%

“…1 Despite this, large disparities remain in the detection, surveillance, and research of breast cancer in all populations, including patients of transgender and gender diverse identities. 2 Breast cancer has long been represented as a disease that affects only cisgender women, but in reality, it can affect anyone. Therefore, reconstructive options after breast cancer must address all needs, for all people.…”

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confidence: 99%

Comprehensive Reconstructive Care for Patients of All Gender Identities After Cancer of the Breast

Bagwell¹,

Peters

2023

Ann Plast Surg

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Breast cancer can affect anyone; therefore, it affects people of all gender identities. Reconstructive options after breast cancer must then address the needs of all people. Our institution is unique in its provision of both high-level comprehensive breast and gender affirmation care. In our practice, patients have expressed gender diverse identities during their breast cancer reconstructive journey. In these cases, goals have deviated from traditional breast restoration, gravitating toward gender-affirming mastectomy, or results often seen with "top surgery." We present a framework for the administration of breast cancer care and discussions of reconstruction from a lens of gender inclusivity. Breast cancer is a diagnosis that has been gendered, resulting in the erasure and exclusion of reconstructive needs for people affected by breast cancer that are not cisgender women. This is illustrated through the case of a nonbinary individual seen in breast cancer clinic for multifocal ductal carcinoma in situ. Our standard review of options of "going flat," implant-based reconstruction, and autologous reconstruction led to initial confusion given their early exploration of gender identity co-occurring with a new diagnosis of breast cancer. These scenarios can be challenging when viewed solely from the perspective of a breast reconstructive surgeon or a gender-affirming surgeon alone. Both perspectives are often needed. Our gender-affirming and breast reconstructive teams have discussed methods to identify patients who require more robust discussion of gender identity and reconstructive options in the setting of breast cancer, such as chest masculinization. By adding gender-affirming surgeons to the list of providers available to counsel breast cancer patients, we may be able to better provide early education on all reconstructive options and appropriately address the needs of transgender and gender diverse people affected by breast cancer.

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Perceptions of and barriers to cancer screening by the sexual and gender minority community: a glimpse into the health care disparity

Cited by 24 publications

References 45 publications

Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review

Health inequities in human papillomavirus prevention, diagnostics and clinical care in the USA: a scoping review

Reinforcing or Disrupting Gender Affirmation: The Impact of Cancer on Transgender Embodiment and Identity

Comprehensive Reconstructive Care for Patients of All Gender Identities After Cancer of the Breast

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