Skip to main content

Advertisement

Log in

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

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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

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

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

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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

  2. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Google Scholar 

  5. 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.

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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

  13. 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.

    Article  PubMed  Google Scholar 

  14. Sukumar S, Mittal R, Kalra S. Transgender medicine in primary care. J Pak Med Assoc. 2020;70(10):1862–3.

    PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  CAS  PubMed  Google Scholar 

  17. 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.

    Article  CAS  PubMed  Google Scholar 

  18. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 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/.

  21. 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.

  22. Mammography. Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/nchs/fastats/mammography.htm. Accessed July 1, 2021.

  23. 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.

    Article  Google Scholar 

  24. 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.

  25. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  26. 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.

    Article  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  CAS  PubMed  Google Scholar 

  32. 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.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. 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.

    Article  Google Scholar 

  37. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 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.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. There are no funding sources to disclose.

Author information

Authors and Affiliations

Authors

Contributions

Natalie Luehmann: Participated in study conception, study design, data acquisition and collection, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Mona Ascha: Participated in data collection, analysis of the data, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Emily Chwa: Participated in data acquisition and collection, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Paige Hackenberger: Participated in data acquisition and collection, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Kareem Termanini: Participated in data acquisition and collection, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Christopher Benning: Participated in data acquisition and collection, analysis of the data, and final approval of the manuscript submitted. Danny Sama: Participated in data acquisition and collection, analysis of the data, and final approval of the manuscript submitted. Dylan Felt: Participated in writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Lauren Beach: Participated in study conception, study design, data acquisition and collection, analysis of the data, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Dipti Gupta: Participated in writing and critical revision of the manuscript for important intellectual content and final approval of the manuscript submitted. Swati Kulkarni: Participated in study conception, study design, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted. Sumanas Jordan: Participated in study conception, study design, data acquisition and collection, analysis of the data, writing and critical revision of the manuscript for important intellectual content, and final approval of the manuscript submitted.

Corresponding author

Correspondence to Sumanas W. Jordan MD PhD.

Ethics declarations

Disclosure

Natalie Luehmann, Mona Ascha, Emily Chwa, Paige Hackenberger, Kareem Termanini, Christopher Benning, Danny Sama, Dylan Felt, Lauren Beach, Dipti Gupta, Swati Kulkarni, and Sumanas Jordan have no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 30 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luehmann, N., Ascha, M., Chwa, E. et al. A Single-Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients. Ann Surg Oncol 29, 1707–1717 (2022). https://doi.org/10.1245/s10434-021-10932-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-10932-z

Navigation