Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening
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Little is known about whether and how screening for cancers of natal reproductive structures, including cervical cancer, in female-to-male (FTM) transgender individuals differs from cancer screening among non-transgender females.
To investigate anecdotal reports from clinicians of high rates of inadequate Papanicolaou (Pap) tests among transgender men.
Results of Pap tests performed on 233 FTM and 3,625 female patients at an urban community health center between 2006 and 2012 were extracted from an electronic medical record.
Compared to female patients, FTM patients were more likely to have an inadequate Pap, with prevalence of inadequate samples 8.3 times higher among tests of FTM patients (10.8 % vs. 1.3 % of tests). FTM patients had over ten times higher odds of having an inadequate Pap after adjusting for age, race, and body mass index (AOR = 10.77, 95 % CI = 6.83, 16.83). When years on testosterone therapy was added to the model, the relationship between transgender identity and Pap inadequacy was attenuated, but remained strongly associated (AOR = 6.01, 95 % CI = 3.00, 11.50), and time on testosterone was also associated (AOR = 1.19, 95 % CI 1.04, 1.36). FTM patients were more likely than females to have had multiple inadequate tests, and had longer latency to follow-up testing.
The high unsatisfactory sample prevalence among FTM patients is likely due to a combination of physical changes induced by testosterone therapy and provider/patient discomfort with the exam. Clinicians should receive training in increasing comfort for FTM patients during the exam. FTM patients should be alerted that high rates of inadequate screening may require follow-up testing. Alternatives to repeated Pap testing, such as cytologic reprocessing of inadequate samples or primary human papillomavirus (HPV) DNA screening, should be studied for efficacy and acceptability among FTM patients.
- Bauer GR, Travers R, Scanlon K, Coleman TA. High heterogeneity of HIV-related sexual risk among transgender people in Ontario, Canada: a province-wide respondent-driven sampling survey. BMC Public Health. 2012;12(1):292. CrossRef
- Driák D, Samudovsky M. Could a man be affected with carcinoma of cervix?- The first case of cervical carcinoma in trans-sexual person (FtM)-case report. Acta Medica (Hradec Kralove). 2005;48(1):53–55.
- American College of Obstetricians and Gynecologists. Committee Opinion: Healthcare for Transgender Individuals. 2011: Report Number 512.
- Kaufman R. Introduction to transgender identity and health. In: Makadon H, Mayer K, Potter J, Goldhammer H, eds. Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia: American College of Physicians; 2008:331–363.
- van Trotsenburg MA. Gynecological aspects of transgender healthcare. Int J Transgenderism. 2009;11(4):238–246. CrossRef
- Feldman J. Medical and surgical management of the transgender patient: what the primary care clinician needs to know. In: Makadon H, Mayer K, Potter J, Goldhammer H, eds. Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia: American College of Physicians; 2008:365–392.
- O’Hanlan KA, Dibble SL, Young-Spint M. Total laparoscopic hysterectomy for female-to-male transsexuals. Obstet Gynecol. 2007;110(5):1096–1101. CrossRef
- Kenagy GP. Transgender health: findings from two needs assessment studies in Philadelphia. Health Soc Work. 2005;30(1):19–26. CrossRef
- Miller N, Bedard YC, Cooter NB, Shaul D. Histological changes in the genital tract in transsexual women following androgen therapy. Histopathology. 1986;10(7):661–669. CrossRef
- Dutton L, Koenig K, Fennie K. Gynecologic care of the female‐to‐male transgender man. J Midwifery Womens Health. 2008;53(4):331–337. CrossRef
- Mayer KH, Mimiaga MJ, VanDerwarker R, Goldhammer H, Bradford JB. Fenway Community Health’s model of integrated community based LGBT care, education and research. In: Meyer IH, Northridge ME, editors. The Health of Sexual Minorities. Springer US; 2007:693-715.
- Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, Solomon D, Wentzensen N, Lawson HW. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol. 2013;121(4):829–846. CrossRef
- French DP, Maissi E, Marteau T. Psychological costs of inadequate cervical smear test results. Br J Cancer. 2004;91(11):1887–1892. CrossRef
- Bofin AM, Nygård JF, Skare GB, Dybdahl BM, Westerhagen U, Sauer T. Papanicolaou smear history in women with low‐grade cytology before cervical cancer diagnosis. Cancer. 2007;111(4):210–216. CrossRef
- Hock YL, Ramaiah S, Wall ES, Harris AM, Marston L, Marshall J, Kendall K, Teale A. Outcome of women with inadequate cervical smears followed up for five years. J Clin Pathol. 2003;56(8):592–595. CrossRef
- NHS Cervical Cancer Screening Programme Annual Review 2012. http://www.cancerscreening.nhs.uk/cervical/publications/cervical-annual-review-2012.pdf. Accessed November 19, 2013.
- Paulin H, Geldenhuys L, Naugler C. Predictors of an unsatisfactory conventional cervical cytology smear. J Obstet Gynaecol Can. 2011;33(7):725–728.
- Castle PE, Bulten J, Confortini M, Klinkhamer P, Pellegrini A, Siebers AG, Ronco G, Arbyn M. Age-specific patterns of unsatisfactory results for conventional pap smears and liquid‐based cytology: Data from two randomised clinical trials. BJOG. 2010;117(9):1067–1073. CrossRef
- Bates CK, Carroll N, Potter J. The challenging pelvic examination. J Gen Intern Med. 2011;26(6):651–657. CrossRef
- Van Caenegem E, Wierckx K, Taes Y, Dedecker D, Van de Peer F, Toye K, Kaufman JM, T’Sjoen G. Bone mass, bone geometry, and body composition in female-to-male transsexual persons after long-term cross-sex hormonal therapy. J Clin Endocrinol Metab. 2012;97(7):2503–2511. CrossRef
- Mueller A, Haeberle L, Zollver H, Claassen T, Kronawitter D, Oppelt PG, Cupisti S, Beckmann MW, Dittrich R. Effects of intramuscular testosterone undecanoate on body composition and bone mineral density in female‐to‐male transsexuals. J Sex Med. 2010;7(9):3190–3198. CrossRef
- Camhi SM, Bray GA, Bouchard C, Greenway FL, Johnson WD, Newton RL, Ravussin E, Ryan DH, Smith SR, Katzmarzyk PT. The relationship of waist circumference and BMI to visceral, subcutaneous, and total body fat: Sex and race differences. Obesity. 2010;19(2):402–408. CrossRef
- Noel J, Bucella D, Fayt I, Simonart T, Buxant F, Anaf V, Simon P. Androgen receptor expression in cervical intraepithelial neoplasia and invasive squamous cell carcinoma of the cervix. Int J Gynecol Pathol. 2008;27(3):437–441. CrossRef
- Suh-Burgmann E, Sivret J, Duska LR, Del Carmen M, Seiden MV. Long-term administration of intravaginal dehydroepiandrosterone on regression of low-grade cervical dysplasia—Aa pilot study. Gynecol Obstet Invest. 2003;55(1):25–31. CrossRef
- van der Kwast TH, Dommerholt HB, van Vroonhoven CC, Chadha S. Androgen receptor expression in the cervix of androgen-treated female-to-male transsexuals: association with morphology and chain-specific keratin expression. Int J Gynecol Pathol. 1994;13(2):133–138. CrossRef
- Bateson DJ, Weisberg E. An open-label randomized trial to determine the most effective regimen of vaginal estrogen to reduce the prevalence of atrophic changes reported in postmenopausal cervical smears. Menopause. 2009;16(4):765–769. CrossRef
- Evantash E. Re: lubricant use during Pap sample collection. http://www.thinprep.com/pdfs/ThinPrep_Customer_Lubricant_Letter.pdf. Accessed November 19, 2013.
- Hill DA, Lamvu G. Effect of lubricating gel on patient comfort during vaginal speculum examination: a randomized controlled trial. Obstet Gynecol. 2012;119(2, Part 1):227-–31. CrossRef
- Rosa M, Pragasam P, Saremian J, Aoalin A, Graf W, Mohammadi A. The unsatisfactory ThinPrep® Pap test™: analysis of technical aspects, most common causes, and recommendations for improvement. Diagn Cytopathol. 2013;41(7):588–594. CrossRef
- Giorgi Rossi P, Carozzi F, Collina G, Confortini M, Dalla Palma P, De Lillo M, Del Mistro A, Ghiringhello B, Gillio-Tos A, Maioli P. HPV testing is an efficient management choice for women with inadequate liquid-based cytology in cervical cancer screening. Am J Clin Pathol. 2012;138(1):65–71. CrossRef
- Mayrand MH, Duarte-Franco E, Rodrigues I, Walter SD, Hanley J, Ferenczy A, Ratnam S, Coutlée F, Franco EL. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med. 2007;357(16):1579–1588. CrossRef
- Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening
Journal of General Internal Medicine
Volume 29, Issue 5 , pp 778-784
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Papanicolaou test
- cancer screening
- Industry Sectors
- Author Affiliations
- 1. Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 2. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- 3. Fenway Health, 1340 Boylston Street, Boston, MA, 02215-4302, USA
- 4. Harvard Medical School, Boston, MA, USA
- 5. Beth Israel Deaconess Medical Center, Boston, MA, USA