Hippoed Blog

Chapter Summary: Cancer Screening Considerations for Transgender Patients

Written by Hippo Education | Apr 10, 2023 7:06:24 PM

Pearls:

  • Cancer screenings for transgender patients should take into account an organ inventory that can be obtained from history-taking, personal/family risk factors and trauma-informed approaches to sensitive exams like the pelvic exam.
    • Cancer screening considerations for transgender patients:
      • Cancer screening is a cornerstone of primary care yet can be more nuanced among transgender individuals based on their sex organs
      • Pearl: An organ inventory is important to remember as well to ensure you know what the person has that may need cancer screening
  • Breast cancer screening:
    • Transgender men:
      • Testosterone increases risk of breast cancer so should be factored into the conversation
      • If they have NOT had a mastectomy, continue screening every 1-2 years based on general guidelines for cis women with breasts

If they have had a mastectomy, you can reassure they do not need screening and any lumps/bumps can be evaluated with MRI or ultrasound of that area

  • Transgender women:
    • Estrogen increases the risk of breast cancer so if they have breasts than consider starting screening at 50 every 1-2 years
      • You can also take into account estrogen exposure vs. a cisgender woman who may have started menses at age 11-12 years of age vs. starting estrogen in 20’s or 30’s
  • Cervical:
      • Consider that pelvic exams can be associated with organs that are associated with psychological dysphoria as well as atrophy (and therefore physical discomfort)
      • Inquire if they have a cervix and if they have ever had a pelvic exam
      • Offer the exam on a separate day and allow enough time for it
      • Tips for the exam:
        • Talking through the process
        • “Exam table” not “exam bed”
        • “Leg holders” not “stirrups”
        • Trying to keep the speculum quiet instead of ratcheting up to keep in place
  • Endometrial / ovarian:
      • Just as with cisgender individuals there is no recommended screening
  • Testicular:
      • No recommendation for routine screening just as cisgender men
      • Transgender undergoing feminizing therapy may have reduction in the volume/size of the testes as an expected side effect. Important to counsel that is no a sign of cancer
  • Prostate:
      • Prostate cancer is based on risk factors and shared decision making
      • PSA may not be a great test because transgender women may be on five alpha reductase inhibitors that reduce their baseline PSA level
      • For those who have had vaginoplasty, the prostate can actually be felt at the neo vaginal anterior wall instead of via a rectal exam
  • Anal cancer:
    • Risk-factor-driven screening, no universal screening guidelines
      • For example: person with HIV who is having anal insertive penile sex and MSM

References:

  1. Compton ML, et al. Cytology and LGBT+ health: establishing inclusive cancer screening programs. J Am Soc Cytopathol. 2022;11(5):241-252. PMID: 35840516
  2. Wierckx K, et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case-control study. Eur J Endocrinol. 2013;169(4):471-478. Published 2013 Sep 13. PMID: 23904280
  3. Wierckx K, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012;9(10):2641-2651. PMID: 22906135
  4. Grynberg M, et al. Histology of genital tract and breast tissue after long-term testosterone administration in a female-to-male transsexual population. Reprod Biomed Online. 2010;20(4):553-558. PMID: 20122869
  5. Gooren LJG, et al. Review of studies of androgen treatment of female-to-male transsexuals: effects and risks of administration of androgens to females. J Sex Med. 2008;5(4):765-776. PMID: 17971101
  6. Miksad RA, et al. Prostate cancer in a transgender woman 41 years after initiation of feminization. JAMA. 2006;296(19):2316-2317. PMID: 17105793
  7. Turo R, et al. Metastatic prostate cancer in transsexual diagnosed after three decades of estrogen therapy. Can Urol Assoc J. 2013;7(7-8):E544-E546. PMID: 24032068
  8. Camille K, et al. Invasive Breast Cancer in a Female-to-Male Transgender after Bilateral Mastectomy: case-report and Literature Review. Clinical Breast Cancer. Published online November 10, 2020. doi:https://doi.org/10.1016/j.clbc.2020.10.005. https://www.clinical-breast-cancer.com/article/S1526-8209(20)30264-0/fulltext
  9. Maza M, et al. Cervical Cancer Screening with Human Papillomavirus Self-Sampling Among Transgender Men in El Salvador. LGBT Health. 2020;7(4):174-181. PMID: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301324/
  10. Deutsch, MB. General approach to cancer screening in transgender people | Gender Affirming Health Program. transcare.ucsf.edu. Published June 17, 2016. Accessed February 6, 2023. https://transcare.ucsf.edu/guidelines/cancer-screening
  11. Coleman E. Standards of Care for the Health of Transsexual, Transgender, and Gender- Nonconforming People the World Professional Association for Transgender Health. World Professional Association for Transgender Health (WPATH); 2012. Accessed February 6, 2023. https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English2012.pdf?_t=1613669341

 

Want to hear more from our experts? Listen to the full podcast episode here.

Explore more from Primary Care RAP or check out all of what Hippo has to offer.