"Population studies show that an increasing number of people are identifying as transgender and gender-diverse, and their needs cannot be ignored," Dr. Oluwadamilola Oladeru of the University of Florida College of Medicine in Gainesville told Reuters Health by email. "Thus, it is imperative that clinicians are aware and open to education about the needs of transgender and gender-diverse people, including those identifying as non-binary."
"This includes understanding of natal anatomy when assessing cancer risk," she noted. "This also requires introspection of an individual clinician's implicit and explicit biases, and active effort to address discomforts that contribute to disparities in seeking and undergoing cancer screening."
As reported in the American Journal of Clinical Oncology, Dr. Oladeru and colleagues compared self-reported breast and cervical cancer screening rates in TG and CG people using cross-sectional data from the 2014 to 2016 and 2018 Behavioral Risk Factor Surveillance System.
Compared with CG participants, odds ratios for adhering to or having undergone breast cancer screening, respectively, were 0.47 and 0.32 for TG men and 0.04 and 0.02, respectively, for TG women.
Odds ratios for having adhering to or having undergone cervical cancer screening were 0.42 and 0.26, respectively, for TG men compared to CG women.
The likelihood of having a primary care physician was lower for transmen (OR, 0.79) and transwomen (OR, 0.58) than for CG people, while the likelihood of avoiding medical care in the past year due to costs was higher (TG men, OR, 1.44; TG women, OR, 1.36).
The authors write, "Interventions are urgently needed to mitigate delays to cancer screening, close gaps in provider and patient knowledge about cancer screening, and improve health care experiences of gender minorities in the United States."
Dr. Oladeru said, "The next research step is to further explore barriers to access to care on a policy level...and propose implementation strategies to remove them. For example, the insurance barrier to cancer screening is a critical policy issue for TG individuals residing in states without Medicaid expansion."
"Further," she said, "evidence-based national cancer screening guidelines should be inclusive of the TG population. This can ensure that our hospital systems are compliant with data capturing of those who are often overlooked and neglected in the community."
Dr. Zoe Rodriguez of the Mount Sinai Center for Transgender Medicine and Surgery in New York City commented in an email to Reuters Health. "The study confirms and underscores what we already know about the healthcare disparity that exists among our TG/non-binary community due to lack of provider cultural competence, fear of medical costs, and patient's own anxiety and unwillingness to undergo dysphoric screening tests."
"It's quite clear that access to primary care physicians and improving physician knowledge and updated screening guidelines are paramount," she said. "It's curious that even though we do not know the length of time on exogenous estrogen, that transwomen were less likely to undergo breast cancer screening despite recommendations to do so. I find it curious because what is more affirming than undergoing cancer screening that is specific to your gender identity? Those rates should be higher."
"So bottom line," she said, "more access and more provider education."
SOURCE: https://bit.ly/3MEb8Pz American Journal of Clinical Oncology, online February 1, 2022.
By Marilynn Larkin
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