Advertisement

Gender Identity Disparities in Cancer Screening Behaviors

Published:January 12, 2018DOI:https://doi.org/10.1016/j.amepre.2017.11.009

      Introduction

      Transgender (trans) and gender-nonconforming adults have reported reduced access to health care because of discrimination and lack of knowledgeable care. This study aimed to contribute to the nascent cancer prevention literature among trans and gender-nonconforming individuals by ascertaining rates of breast, cervical, prostate, and colorectal cancer screening behaviors by gender identity.

      Methods

      Publicly available de-identified data from the 2014–2016 Behavioral Risk Factor Surveillance System surveys were utilized to evaluate rates of cancer screenings by gender identity, while controlling for healthcare access, sociodemographics, and survey year. Analyses were conducted in 2018.

      Results

      Weighted chi-square tests identified significant differences in the proportion of cancer screening behaviors by gender identity among lifetime colorectal cancer screenings, mammography tests, Pap tests, prostate-specific antigen tests, discussing prostate-specific antigen test advantages/disadvantages with their healthcare provider, and up-to-date colorectal cancer screenings and Pap tests (all p<0.048). Weighted logistic regressions found that although some differences based on gender identity were fully explained by covariates, gender-nonconforming individuals had reduced odds of ever having a sigmoidoscopy/colonoscopy compared to cisgender (cis) men (AOR=0.46) and cis women (AOR=0.43), whereas trans men were more likely to have an up-to-date colorectal cancer screening as compared to cis men (AOR=2.29) and cis women (AOR=1.97). Trans women were less likely than cis women to have ever had a mammography screening (AOR=0.33) and trans men were more likely than cis women to have an up-to-date mammography test (AOR=2.03). Finally, trans men and gender-nonconforming individuals had reduced odds of lifetime Pap tests versus cis women (AOR=0.50 and 0.20, respectively), and gender-nonconforming individuals had lower odds of being up-to-date for Pap tests (AOR=0.33; all p<0.05).

      Conclusions

      The findings indicate that gender identity disparities in cancer screenings persist beyond known sociodemographic and healthcare factors. It is critical that gender identity questions are included in cancer and other health-related surveillance systems to create knowledge to better inform healthcare practitioners and policymakers of appropriate screenings for trans and gender-nonconforming individuals.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Burkhalter J.E.
        • Margolies L.
        • Sigurdsson H.O.
        • et al.
        The national LGBT cancer action plan: a white paper of the 2014 National Summit on Cancer in the LGBT Communities.
        LGBT Health. 2016; 3: 19-31
        • Poteat T.
        • German D.
        • Kerrigan D.
        Managing uncertainty: a grounded theory of stigma in transgender health care encounters.
        Soc Sci Med. 2013; 84: 22-29https://doi.org/10.1016/j.socscimed.2013.02.019
        • Grant J.M.
        • Mottet L.A.
        • Tanis J.
        • et al.
        National Transgender Discrimination Survey Report on Health and Health Care.
        National Center for Transgender Equality and National Gay and Lesbian Task Force, Washington, DC2010
        • Coleman E.
        • Bockting W.
        • Botzer M.
        • et al.
        Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7.
        Int J Transgend. 2012; 13: 165-232https://doi.org/10.1080/15532739.2011.700873
        • Johnson M.J.
        • Nemeth L.S.
        • Mueller M.
        • Eliason M.J.
        • Stuart G.W.
        Qualitative study of cervical cancer screening among lesbian and bisexual women and transgender men.
        Cancer Nurs. 2016; 39: 455-463https://doi.org/10.1097/NCC.0000000000000338
        • Peitzmeier S.M.
        • Agénor M.
        • Bernstein I.M.
        • et al.
        “It can promote an existential crisis”: factors influencing Pap test acceptability and utilization among transmasculine individuals.
        Qual Health Res. 2017; 27: 2138-2149https://doi.org/10.1177/1049732317725513
        • Potter J.
        • Peitzmeier S.M.
        • Bernstein I.
        • et al.
        Cervical cancer screening for patients on the female-to-male spectrum: a narrative review and guide for clinicians.
        J Gen Intern Med. 2015; 30: 1857-1864https://doi.org/10.1007/s11606-015-3462-8
        • Peitzmeier S.M.
        • Khullar K.
        • Reisner S.L.
        • Potter J.
        Pap test use is lower among female-to-male patients than non-transgender women.
        Am J Prev Med. 2014; 47: 808-812https://doi.org/10.1016/j.amepre.2014.07.031
        • Johnson M.J.
        • Mueller M.
        • Eliason M.J.
        • Stuart G.
        • Nemeth L.S.
        Quantitative and mixed analyses to identify factors that affect cervical cancer screening uptake among lesbian and bisexual women and transgender men.
        J Clin Nurs. 2016; 25: 3628-3642https://doi.org/10.1111/jocn.13414
        • Peitzmeier S.M.
        • Reisner S.L.
        • Harigopal P.
        • Potter J.
        Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening.
        J Gen Intern Med. 2014; 29: 778-784https://doi.org/10.1007/s11606-013-2753-1
        • Bofin A.M.
        • Nygård J.F.
        • Skare G.B.
        • Dybdahl B.M.
        • Westerhagen U.
        • Sauer T.
        Papanicolaou smear history in women with low-grade cytology before cervical cancer diagnosis.
        Cancer. 2007; 111: 210-216https://doi.org/10.1002/cncr.22865
        • Hock Y.L.
        • Ramaiah S.
        • Wall E.S.
        • et al.
        Outcome of women with inadequate cervical smears followed up for five years.
        J Clin Pathol. 2003; 56: 592-595https://doi.org/10.1136/jcp.56.8.592
        • Bazzi A.R.
        • Whorms D.S.
        • King D.S.
        • Potter J.
        Adherence to mammography screening guidelines among transgender persons and sexual minority women.
        Am J Public Health. 2015; 105: 2356-2358https://doi.org/10.2105/AJPH.2015.302851
        • Narayan A.
        • Lebron-Zapata L.
        • Morris E.
        Breast cancer screening in transgender patients: findings from the 2014 BRFSS survey.
        Breast Cancer Res Treat. 2017; 166: 875-879https://doi.org/10.1007/s10549-017-4461-8
      1. CDC. Behavioral Risk Factor Surveillance System. www.cdc.gov/brfss/about/about_brfss.htm. Accessed September 6, 2017.

      2. American Cancer Society. History of ACS recommendations for the early detection of cancer in people without symptoms. www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/chronological-history-of-acs-recommendations.html. Accessed September 1, 2017.

      3. U.S. Preventive Service Task Force. Draft recommendation statement prostate cancer: screening. www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/prostate-cancer-screening1. Accessed October 13, 2017.

        • Finney Rutten L.J.
        • Nelson D.E.
        • Meissner H.I.
        Examination of population-wide trends in barriers to cancer screening from a diffusion of innovation perspective (1987–2000).
        Prev Med. 2004; 38: 258-268https://doi.org/10.1016/j.ypmed.2003.10.011
        • Meissner H.I.
        • Breen N.
        • Klabunde C.N.
        • Vernon S.W.
        Patterns of colorectal cancer screening uptake among men and women in the United States.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 389-394https://doi.org/10.1158/1055-9965.EPI-05-0678
        • Quinn G.P.
        • Sanchez J.A.
        • Sutton S.K.
        • et al.
        Cancer and lesbian, gay, bisexual, transgender/transsexual, and queer/questioning (LGBTQ) populations.
        CA Cancer J Clin. 2015; 65: 384-400https://doi.org/10.3322/caac.21288
        • Griggs J.
        • Maingi S.
        • Blinder V.
        • et al.
        American Society of Clinical Oncology Position Statement: strategies for reducing cancer health disparities among sexual and gender minority populations.
        J Clin Oncol. 2017; 35: 2203-2208https://doi.org/10.1200/JCO.2016.72.0441
        • Reisner S.L.
        • Perkovich B.
        • Mimiaga M.J.
        A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men.
        AIDS Patient Care STDS. 2010; 24: 501-513https://doi.org/10.1089/apc.2010.0059
        • Tracy J.K.
        • Schluterman N.H.
        • Greenberg D.R.
        Understanding cervical cancer screening among lesbians: a national survey.
        BMC Public Health. 2013; 13: 442https://doi.org/10.1186/1471-2458-13-442
        • Finney Rutten L.J.
        • Meissner H.I.
        • Breen N.
        • Vernon S.W.
        • Rimer B.K.
        Factors associated with men’s use of prostate-specific antigen screening: evidence from Health Information National Trends Survey.
        Prev Med. 2005; 40: 461-468https://doi.org/10.1016/j.ypmed.2004.07.011
        • Taylor E.T.
        • Bryson M.K.
        Cancer’s margins: trans* and gender-nonconforming people’s access to knowledge, experiences of cancer health, and decision-making.
        LGBT Health. 2015; 3: 79-89
      4. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. http://transhealth.ucsf.edu/trans?page=guidelines-cancer. Accessed September 5, 2017.

        • Cahill S.
        • Makadon H.
        Sexual orientation and gender identity data collection in clinical settings and in electronic health records: a key to ending LGBT health disparities.
        LGBT Health. 2013; 1: 34-41https://doi.org/10.1089/lgbt.2013.0001
        • Weyers S.
        • De Sutter P.
        • Hoebeke S.
        • et al.
        Gynaecological aspects of the treatment and follow-up of transsexual men and women.
        Facts Views Vis Obgyn. 2010; 2: 35-54
        • Rauscher G.H.
        • Johnson T.P.
        • Cho Y.I.
        • Walk J.A.
        Accuracy of self-reported cancer-screening histories: a meta-analysis.
        Cancer Epidemiol Biomarkers Prev. 2008; 17: 748-757https://doi.org/10.1158/1055-9965.EPI-07-2629

      Linked Article