Transgender Individuals Less Likely to Undergo Prostate Cancer Screening

By Marilynn Larkin

December 10, 2020

NEW YORK (Reuters Health) - Transgender individuals are less likely than lesbian, gay or bisexual people to undergo prostate cancer screening and participate in informed decision making, researchers say.

"Addressing the health needs of sexual and gender minority (SGM) populations remains an area in medicine, across all specialties, that calls for greater attention," Dr. Paula Neira of Johns Hopkins Center for Transgender Health in Baltimore told Reuters Health by email. "SGM communities, and non-binary people specifically, have been either under-represented or non-represented in medical research. The lack of SGM demographic data hinders our ability to effectively address many health disparities these communities face."

As reported in European Urology, Dr. Neira and colleagues searched the Behavioral Risk Factor Surveillance System database for lesbian, gay, bisexual, and transgender (LGBT) adults for 2014-2016 and 2018, when prostate-specific antigen (PSA) questions were asked in the annual survey.

More than 164,000 participants were eligible for PSA screening, representing a weighted estimate of 1.2 million LGBT individuals.

Multivariable logistic regression revealed that, compared to cisgender (CG; gender identity matches the sex assigned at birth) cohorts, CG gay and bisexual cohorts were more likely to have had PSA screening (CG gay: odds ratio, 1.07; CG bisexual: OR, 1.06); to have ever undergone PSA screening (CG gay: OR, 1.29; CG bisexual: OR, 1.13); and to have been recommended for PSA screening by their physician (CG gay: OR, 1.15; CG bisexual: OR, 1.16).

The other groups were less likely to undergo PSA screening and be recommended for PSA screening.

Further, CG gay participants were more likely to make an informed decision (OR, 1.10), whereas other groups were less likely to do so. CG gay participants were also more likely to engage in shared decision-making (OR 2.55), while there was no association for the other groups.

Dr. Neira said, "Addressing these health disparities is multifaceted, and must involve inclusion of SGM communities in research, capturing SGM demographics and clinical care-related data in medical records, and education."

"For patients, education on the importance of screening that is based on their anatomy and medical history must continue," she noted. "For practitioners, the burden is on us to counter the well-founded mistrust of the healthcare system found within SGM communities due to historical and ongoing discrimination - the fear of which often leads people to forego routine screenings."

"Education for all healthcare disciplines should reflect that we are inclusive, cognizant of SGM health concerns, and committed to creating an environment of support grounded in cultural and clinical competence," She said. "This includes a shift in mindset away from linking screening algorithms and processes with gender markers and to one grounded in an organ inventory...i.e., prostate screening being needed for any person who has a prostate."

"The take-away message for clinicians is that if we want to deliver high quality, patient-centered care for our LGBTQ+ patients, we have work to do," she concluded.

Dr. Joshua Safer, Executive Director, Center for Transgender Medicine and Surgery at Mount Sinai Health System and Professor of Medicine, Icahn School of Medicine at Mount Sinai in New York City, commented in an email to Reuters Health. "Many providers may not appreciate that transgender women are at risk for prostate cancer. The prostate is retained even in transgender women who have had genital reconstruction surgery."

"The analogy holds for transgender men, most of whom retain their ovaries and uterus but are often not subject to screening, even straightforward screening like for cervical cancer," he said.

"It may be that health risks do decrease for transgender people with certain treatments," he noted. "For example, there are data for lower breast cancer incidence among transgender women relative to cisgender women in the Netherlands. However, we do know that there is some risk for prostate cancer among transgender women and for breast cancer among transgender men and transgender women."

"The take-home messages," he said, are to "create a welcoming environment in order to encourage transgender people to feel safe accessing health care, and be aware that even if detailed protocols do not yet exist, there should be a plan for surveillance of existing body parts for cancers independent of a person's gender identity."

SOURCE: European Urology, online November 26, 2020.