Systematic Reviews
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jul 24, 2023; 14(7): 265-284
Published online Jul 24, 2023. doi: 10.5306/wjco.v14.i7.265
Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery
Juliet C Panichella, Sthefano Araya, Siddhartha Nannapaneni, Samuel G Robinson, Susan You, Sarah M Gubara, Maria T Gebreyesus, Theresa Webster, Sameer A Patel, Alireza Hamidian Jahromi
Juliet C Panichella, Samuel G Robinson, Susan You, Sarah M Gubara, Maria T Gebreyesus, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, United States
Sthefano Araya, Siddhartha Nannapaneni, Sameer A Patel, Division of Plastic and Reconstructive Surgery, Fox Chase Cancer Center, Philadelphia, PA 19111, United States
Theresa Webster, Department of Plastic Surgery, Temple University, Philadelphia, PA 18045, United States
Alireza Hamidian Jahromi, Division of Plastic and Reconstructive Surgery, Temple University Hospitals, Philadelphia, PA 19140, United States
Author contributions: All authors contributed in a significant and meaningful way to the development of this article.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. Accepted as poster presentation at Plastic Surgery the Meeting October 27th-30th 2022, Boston, Massachusetts.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alireza Hamidian Jahromi, MD, MRCS, Division of Plastic and Reconstructive Surgery, Temple University Hospitals, 3401 Broad Street, Philadelphia, PA 19140, United States. alirezahamidian@yahoo.com
Received: December 28, 2022
Peer-review started: December 28, 2022
First decision: April 13, 2023
Revised: May 15, 2023
Accepted: June 27, 2023
Article in press: June 27, 2023
Published online: July 24, 2023
Abstract
BACKGROUND

Literature focused on cancer screening and management is lacking in the transgender population.

AIM

To action to increase contributions to the scientific literature that drives the creation of cancer screening and management protocols for transgender and gender nonconforming (TGNC) patients.

METHODS

We performed a systematic search of PubMed on January 5th, 2022, with the following terms: “TGNC”, OR “transgender”, OR “gender non-conforming”, OR “gender nonbinary” AND “cancer screening”, AND “breast cancer”, AND “cervical cancer”, AND “uterine cancer”, AND “ovarian cancer”, AND “prostate cancer”, AND “testicular cancer”, AND “surveillance”, AND “follow-up”, AND “management”. 70 unique publications were used. The findings are discussed under “Screening” and “Management” categories.

RESULTS

Screening: Current cancer screening recommendations default to cis-gender protocols. However, long-term gender-affirming hormone therapy and loss to follow-up from the gender-specific specialties contribute to a higher risk for cancer development and possible delayed detection. The only known screening guidelines made specifically for this population are from the American College of Radiology for breast cancer. Management: Prior to undergoing Gender Affirmation Surgery (GAS), discussion should address cancer screening and management in the organs remaining in situ. Cancer treatment in this population requires consideration for chemotherapy, radiation, surgery and/or reconstruction. Modification of hormone therapy is decided on a case-by-case basis. The use of prophylactic vs aesthetic techniques in surgery is still debated.

CONCLUSION

When assessing transgender individuals for GAS, a discussion on the future oncologic risk of the sex-specific organs remaining in situ is essential. Cancer management in this population requires a multidisciplinary approach while the care should be highly individualized with considerations to social, medical, surgical and gender affirming surgery related specifications. Special considerations have to be made during planning for GAS as surgery will alter the anatomy and may render the organ difficult to sample for screening purposes. A discussion with the patient regarding the oncologic risk of remaining organs is imperative prior to GAS. Other special considerations to screening such as the conscious or unconscious will to unassociated with their remaining organs is also a key point to address. We currently lack high quality studies pertinent to the cancer topic in the gender affirmation literature. Further research is required to ensure more comprehensive and individualized care for this population.

Keywords: Gender affirmation surgery, Gender affirming surgery, Screening, Management, Transgender, Gender diverse

Core Tip: Currently, a comprehensive guideline for cancer screening in the transgender and gender diverse (TGGD) population is lacking. Caring for the TGGD population undergoing Gender Affirmation Surgery is highly individualized and requires consideration of factors such as age at which individuals commenced hormonal therapy and the stage of transition. Once diagnosed with cancer, TGGD patients should receive care at institutions capable of providing a multi-disciplinary approach. This collective approach will ensure record upkeep and help delay any unnecessary delays in care.