A Single-Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients.


Journal

Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840

Informations de publication

Date de publication:
Mar 2022
Historique:
received: 04 08 2021
accepted: 24 09 2021
pubmed: 28 10 2021
medline: 8 2 2022
entrez: 27 10 2021
Statut: ppublish

Résumé

Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center. Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed. Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2 years (42.3-62.6). Most patients had no family history of breast cancer (n = 163, 64.4%) and were on hormone therapy (n = 191, 75.5%). Most patients where White (n = 164, 64.8%), employed (n = 113, 44.7%), and had public insurance (n = 128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses. Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.

Sections du résumé

BACKGROUND BACKGROUND
Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center.
METHODS METHODS
Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed.
RESULTS RESULTS
Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2 years (42.3-62.6). Most patients had no family history of breast cancer (n = 163, 64.4%) and were on hormone therapy (n = 191, 75.5%). Most patients where White (n = 164, 64.8%), employed (n = 113, 44.7%), and had public insurance (n = 128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses.
CONCLUSION CONCLUSIONS
Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.

Identifiants

pubmed: 34704183
doi: 10.1245/s10434-021-10932-z
pii: 10.1245/s10434-021-10932-z
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1707-1717

Informations de copyright

© 2021. Society of Surgical Oncology.

Références

James SE, Herman JL, Rankin S, Keisling M, Mottet L, Anafi M. The report of the 2015 US Transgender Survey. National Center for Transgender Equality, Washington, DC. 2016. https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
Hatzenbuehler ML, Phelan JC, Link BG. Stigma as a fundamental cause of population health inequalities. Am J Public Health. 2013;103(5):813–21. https://doi.org/10.2105/AJPH.2012.301069 .
doi: 10.2105/AJPH.2012.301069 pubmed: 23488505 pmcid: 3682466
Warren JC, Smalley KB, Barefoot KN. Differences in Psychosocial Predictors of Obesity among LGBT Subgroups. LGBT Health. 2016;3(4):283–91. https://doi.org/10.1089/lgbt.2015.0076 .
doi: 10.1089/lgbt.2015.0076 pubmed: 27228031
Kiran T, Davie S, Singh D, Hranilovic S, Pinto AD, Abramovich A, et al. Cancer screening rates among transgender adults. Can Fam Physician. 2019;65(1):30–7.
Messina MP, D’Angelo A, Giovagnoli R, et al. Cancer screenings among sexual and gender minorities by midwives’ point of view. Minerva Obstet Gynecol. 2021.
Whitlock BL, Duda ES, Elson MJ, et al. Primary care in transgender persons. Endocrinol Metab Clin North Am. 2019;48(2):377–90. https://doi.org/10.1016/j.ecl.2019.02.004 .
doi: 10.1016/j.ecl.2019.02.004 pubmed: 31027546
Tabaac AR, Sutter ME, Wall CSJ, Baker KE. Gender identity disparities in cancer screening behaviors. Am J Prev Med. 2018;54(3):385-393. https://doi.org/10.1016/j.amepre.2017.11.009 .
doi: 10.1016/j.amepre.2017.11.009
Bevers TB, Helvie M, Bonaccio E, et al. Breast cancer screening and diagnosis, version 3.2018 NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2018;16(11):1362–89. https://doi.org/10.6004/jnccn.2018.0083 .
doi: 10.6004/jnccn.2018.0083
Siu AL. Screening for breast cancer: U.S. Preventive services task force recommendation statement. Ann Intern Med. 2016. https://doi.org/10.7326/M15-2886 .
doi: 10.7326/M15-2886 pubmed: 27479225
Deutsch MB, Radix A, Wesp L. Breast cancer screening, management, and a review of case study literature in transgender populations. Semin Reprod Med. 2017;35(5):434–41. https://doi.org/10.1055/s-0037-1606103 .
doi: 10.1055/s-0037-1606103 pubmed: 29073682
Stone JP, Hartley RL, Temple-Oberle C. Breast cancer in transgender patients: a systematic review part 2: female to male. Eur J Surg Oncol. 2018;44(10):1463–8. https://doi.org/10.1016/j.ejso.2018.06.021 .
doi: 10.1016/j.ejso.2018.06.021 pubmed: 30037639
Center of Excellence for Transgender Health. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. 2nd edn, University of California, San Francisco, CA, 2020
Lund EM, Burgess CM. Sexual and Gender Minority Health Care Disparities: Barriers to Care and Strategies to Bridge the Gap. Prim Care. 2021;48(2):179–89. https://doi.org/10.1016/j.pop.2021.02.007 .
doi: 10.1016/j.pop.2021.02.007 pubmed: 33985698
Sukumar S, Mittal R, Kalra S. Transgender medicine in primary care. J Pak Med Assoc. 2020;70(10):1862–3.
pubmed: 33159772
Hartley RL, Stone JP, Temple-Oberle C. Breast cancer in transgender patients: a systematic review. Part 1: male to female. Eur J Surg Oncol. 2018;44(10):1455–62. https://doi.org/10.1016/j.ejso.2018.06.035 .
doi: 10.1016/j.ejso.2018.06.035 pubmed: 30087072
Asscheman H, Giltay EJ, Megens JAJ, De Ronde W, Van Trotsenburg MAA, Gooren LJG. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. 2011;164(4):635–42. https://doi.org/10.1530/EJE-10-1038 .
doi: 10.1530/EJE-10-1038 pubmed: 21266549
Rossouw J, Anderson G, Prentice R, et al. Writing group for the women’s health initiative investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women. JAMA. 2002;288(3):321–33. https://doi.org/10.1001/jama.288.3.321 .
doi: 10.1001/jama.288.3.321 pubmed: 12117397
Chlebowski RT, Anderson GL, Aragaki AK, et al. Association of menopausal hormone therapy with breast cancer incidence and mortality during long-term follow-up of the women’s health initiative randomized clinical trials. JAMA. 2020;324(4):369–80. https://doi.org/10.1001/jama.2020.9482 .
doi: 10.1001/jama.2020.9482 pubmed: 32721007 pmcid: 7388026
Bazzi AR, Whorms DS, King DS, Potter J. Adherence to mammography screening guidelines among transgender persons and sexual minority women. Am J Public Health. 2015;105(11):2356–8. https://doi.org/10.2105/AJPH.2015.302851 .
doi: 10.2105/AJPH.2015.302851 pubmed: 26378843 pmcid: 4605197
Tenny S, Boktor SW. Incidence. [Updated 19 Apr 2021]. StatPearls. Treasure Island, FL: StatPearls Publishing; 2021 Jan. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430746/ .
Deutsch MB. UCSF Transgender Care, Department of Family and Community Medicine, University of California San Francisco, Guidelines for the Primary and Gender-Affiring Care of Transgender and Gender Nonbinary People. 2nd edition. 2016. Available at: https://transcare.ucsf.edu/guidelines . Accessed 26 May 2021.
Mammography. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/nchs/fastats/mammography.htm . Accessed July 1, 2021.
Sauer AG, Liu B, Siegel RL, Jemal A, Fedewa SA. Comparing cancer screening estimates: behavioral risk factor surveillance system and national health interview survey. Prev Med (Baltim). 2018;106:94–100. https://doi.org/10.1016/j.ypmed.2017.10.019 .
doi: 10.1016/j.ypmed.2017.10.019
Accountable Care Organization. Northwestern Medicine. Available at: https://www.nm.org/for-medical-professionals/for-physicians/northwestern-medicine-physiciannetwork/accountable-care-organization . Accessed July 1, 2021.
de Blok CJ, Dijkman BA, Wiepjes CM, et al. Frequency and outcomes of benign breast biopsies in trans women: a nationwide cohort study. Breast. 2021;57:118–22. https://doi.org/10.1016/j.breast.2021.03.007 .
doi: 10.1016/j.breast.2021.03.007 pubmed: 33831630 pmcid: 8056255
Gooren LJ, van Trotsenburg MAA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med. 2013;10(12):3129–34. https://doi.org/10.1111/jsm.12319 .
doi: 10.1111/jsm.12319 pubmed: 24010586
Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in transgender people: evidence and methodological considerations. Epidemiol Rev. 2017;39(1):93–107. https://doi.org/10.1093/epirev/mxw003 .
doi: 10.1093/epirev/mxw003 pubmed: 28486701 pmcid: 5868281
Sterling J, Garcia MM. Cancer screening in the transgender population: A review of current guidelines, best practices, and a proposed care model. Transl Androl Urol. 2020;9(6):2771–85. https://doi.org/10.21037/tau-20-954 .
doi: 10.21037/tau-20-954 pubmed: 33457249 pmcid: 7807311
Kopetti C, Schaffer C, Zaman K, Liapi A, di Summa PG, Bauquis O. Invasive breast cancer in a trans man after bilateral mastectomy: case report and literature review. Clin Breast Cancer. 2021;21(3):e154–7. https://doi.org/10.1016/j.clbc.2020.10.005 .
doi: 10.1016/j.clbc.2020.10.005 pubmed: 33341378
Chotai N, Tang S, Lim H, Lu S. Breast cancer in a female to male transgender patient 20 years post-mastectomy: issues to consider. Breast J. 2019;25(6):1066–70. https://doi.org/10.1111/tbj.13417 .
doi: 10.1111/tbj.13417 pubmed: 31273889
Salibian AA, Axelrod DM, Smith JA, Fischer BA, Agarwal C, Bluebond-Langner R. Oncologic considerations for safe gender-affirming mastectomy: preoperative imaging, pathologic evaluation, counseling, and long-term screening. Plast Reconstr Surg. 2021;147(2):213e–21e. https://doi.org/10.1097/PRS.0000000000007589 .
doi: 10.1097/PRS.0000000000007589 pubmed: 33565823
Monstrey S, Selvaggi G, Ceulemans P, et al. Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg. 2008;121(3):849–59. https://doi.org/10.1097/01.prs.0000299921.15447.b2 .
doi: 10.1097/01.prs.0000299921.15447.b2 pubmed: 18317134
Parikh U, Mausner E, Chhor CM, Gao Y, Karrington I, Heller SL. Breast imaging in transgender patients: What the radiologist should know. Radiographics. 2020;40(1):13–27. https://doi.org/10.1148/rg.2020190044 .
doi: 10.1148/rg.2020190044 pubmed: 31782932
Fledderus AC, Gout HA, Ogilvie AC, van Loenen DKG. Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening. Breast. 2020;53:92–100. https://doi.org/10.1016/j.breast.2020.06.008 .
doi: 10.1016/j.breast.2020.06.008 pubmed: 32679529 pmcid: 7375644
Williamson C. Providing care to transgender persons: a clinical approach to primary care, hormones, and hiv management. J Assoc Nurses AIDS Care. 2010;21(3):221–9. https://doi.org/10.1016/j.jana.2010.02.004 .
doi: 10.1016/j.jana.2010.02.004 pubmed: 20363651
Snelgrove JW, Jasudavisius AM, Roiwe BW, Head EM, Bauer GR. “Completely out-at-sea” with “two-gender medicine”: a qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC Health Serv Res. 2012;12:110.
doi: 10.1186/1472-6963-12-110
Clarke CN, Cortina CS, Fayanju OM, Dossett LA, Johnston FM, Wong SL. Breast cancer risk and screening in transgender persons: a call for inclusive Care. Ann Surg Oncol. 2021. https://doi.org/10.1245/s10434-021-10217-5 .
doi: 10.1245/s10434-021-10217-5 pubmed: 34727315 pmcid: 8591003
Pratt-Chapman ML, Ward AR. Provider recommendations are associated with cancer screening of transgender and gender-nonconforming people: a cross-sectional urban survey. Transgender Health. 2020;5(2):80–5. https://doi.org/10.1089/trgh.2019.0083 .
doi: 10.1089/trgh.2019.0083 pubmed: 32656352 pmcid: 7347019
Sheth HS, Grimes VD, Rudge D, et al. Improving pneumococcal vaccination rates in rheumatology patients by using best practice alerts in the electronic health records. J Rheumatol. 2020;48(9):1472–9. https://doi.org/10.3899/jrheum.200806 .
doi: 10.3899/jrheum.200806 pubmed: 33323531
Burrell CN, Sharon MJ, Davis S, et al. Using the electronic medical record to increase testing for HIV and hepatitis C virus in an appalachian emergency department. BMC Health Serv Res. 2021;21(1):524. https://doi.org/10.1186/s12913-021-06482-5 .
doi: 10.1186/s12913-021-06482-5 pubmed: 34051774 pmcid: 8164230
Ehrenfeld JM, Gottlieb KG, Beach LB, Monahan SE, Fabbri D. Development of a natural language processing algorithm to identify and evaluate transgender patients in electronic health record systems. Ethn Dis. 2019;29:441–50. https://doi.org/10.18865/ed.29.S2.441 .
doi: 10.18865/ed.29.S2.441 pubmed: 31308617 pmcid: 6604788

Auteurs

Natalie Luehmann (N)

Division of Breast Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Mona Ascha (M)

Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Emily Chwa (E)

Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Paige Hackenberger (P)

Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Kareem Termanini (K)

Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Christopher Benning (C)

Information Services, Northwestern Memorial HealthCare, Chicago, IL, USA.

Danny Sama (D)

Information Services, Northwestern Memorial HealthCare, Chicago, IL, USA.

Dylan Felt (D)

Feinberg School of Medicine Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA.

Lauren B Beach (LB)

Feinberg School of Medicine Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
Northwestern Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA.

Dipti Gupta (D)

Division of Breast Imaging, Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Swati A Kulkarni (SA)

Division of Breast Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Sumanas W Jordan (SW)

Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Sumanas.jordan@nm.org.

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