Female-to-Male Patients Have High Prevalence of Unsatisfactory Paps Compared to Non-Transgender Females: Implications for Cervical Cancer Screening
- 886 Downloads
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.
KEY WORDSfemale-to-male transgender Papanicolaou test cancer screening
SMP had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. We would like to thank Timothy Cavanaugh, MD and Ruben Hopwood, PhD, MDiv for their suggestions on this manuscript.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.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.Google Scholar
- 3.American College of Obstetricians and Gynecologists. Committee Opinion: Healthcare for Transgender Individuals. 2011: Report Number 512.Google Scholar
- 4.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.Google Scholar
- 6.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.Google Scholar
- 11.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.Google Scholar
- 16.NHS Cervical Cancer Screening Programme Annual Review 2012. http://www.cancerscreening.nhs.uk/cervical/publications/cervical-annual-review-2012.pdf. Accessed November 19, 2013.
- 18.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.PubMedCentralPubMedCrossRefGoogle Scholar
- 22.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.PubMedCentralPubMedCrossRefGoogle Scholar
- 27.Evantash E. Re: lubricant use during Pap sample collection. http://www.thinprep.com/pdfs/ThinPrep_Customer_Lubricant_Letter.pdf. Accessed November 19, 2013.
- 30.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.PubMedCrossRefGoogle Scholar