Cancer screening and management in the transgender population: Review of literature and special considerations for gender affirmation surgery

ARTICLE HIGHLIGHTS

Research background

Lack of screening and management guidelines in the transgender and gender diverse (TGGD) and non binary population.

Research motivation

A comprehensive guideline for cancer screening in the TGGD population is lacking. Caring for the TGGD population undergoing Gender Affirmation Surgery is highly individualized and requires consideration for the whole, integral patient including the physical and psychological realm. Communication and access to care should strive for inclusion and avoid potential discrimination from misgendering. 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. Resolving the lack of guidelines, improving inclusion, and diminishing the barriers of care will ultimately lead to more timely and efficient care for the TGGD population.

Research objectives

Literature is lacking regarding screening and management guidelines in the TGGD and non binary population. Barriers of care are present and need to be addressed to improve access and quality of care for this population.

Research methods

A systematic review utilizing the preferred reporting items for systematic reviews and meta-analyses guidelines was used. Rayyan software was used to organize and collaborate on articles for reviewers. A systematic search of PubMed on January 5^th, 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”. After eliminating review articles, duplicates, abstracts, articles not relevant to the section topic or opinion pieces a total of 70 studies with original data were obtained. Articles relevant to the section topic, including the search terms were included in this systematic review. Search parameters were performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Two independent reviewers Araya S and Nannapaneni S carried out independent abstract revisions on January 11^th, 2022, using systematic review software “Rayyan” registered in Cambridge Massachusetts.

Research results

Literature is lacking regarding screening and management guidelines in the TGGD and non binary population. Barriers of care are present and need to be addressed to improve access and quality of care for this population.

Research conclusions

Caring for the TGGD and nonbinary patients is a complex process and requires understanding of three key points – care is highly individual, it depends on stage of gender affirming surgery, and it is centered on proper provider education and training. An understanding of the biopsychosocial model of health, where illness must be considered from not only the physical body, but also from the psychological and social aspects is required. Prior to breast cancer screening guidelines for the TGGD patient from the American College of Radiology in November 2021, no formal cancer screening guidelines were made for the TGGD population. In most instances, screening guidelines for the TGGD population default to cis gender screening recommendations and management. Further, guidelines are needed to address non binary patients as existing literature in this select population is also lacking. Although screening suggestions based on this systematic review are alluded to in each organ section, the discussion of organ specific screening centers on a call to action for better research. Discussion on cancer management is provided in each organ section in more detail. However, some overarching themes hold true for all cancer management. Provider education in the communication skills with the TGGD population in the form of gender friendly language is paramount to improve the existing barriers of care, improve healthcare accessibility and increase provider options for these patients. Addressing the limitations of care and actively participating in scientific research for this population will allow for earlier detection of cancer, improved treatment adherence, improved patient care accessibility and ultimately improved patient follow up and satisfaction.

Research perspectives

Creating specific cancer screening and management guidelines for the TGGD and non binary population while improving barriers to care.