Cancer Screening in the Transgender Population

A Review of Current Guidelines, Best Practices, and a Proposed Care Model

Joshua Sterling; Maurice M. Garcia

Disclosures

Transl Androl Urol. 2020;9(6):2771-2785. 

In This Article

Malignancies of the Neovagina

There are several techniques and approaches used to create a neovagina all of which have the potential to develop malignancy; the use of genital skin flaps is the gold standard for genital affirmation surgery and intestinal transplant vaginoplasty is more commonly used in patients with congenital or traumatic absence of the vagina. Skin transplants developed squamous cell carcinoma (SCC) of the neovagina while intestinal neovaginas developed adenocarcinoma. There are 4 reported cases of neovaginal SCC in transfeminine patients and 3 of the 4 reported cases also had HPV.[68] The median age of vaginoplasty was 27 and the latency period prior to diagnosis ranged from 18 to 45 years with a median latency period of 26 years.[68–71] There have been 7 reported cases of neovagina adenocarcinoma following colon transplantation and 1 case with a small intestine transplant; none of these cases were in transgender individuals.[72,73] Secondary malignancy at the ureteroenteric anastomosis is a well-documented long-term complication of ureterosigmoidostomy and it has been proposed that chemical stimulants and irritants in semen contribute to malignancies of the neovagina. Any association between HPV and adenocarcinoma occurring in an intestinal transposed neovagina is still unknown. Grosse et al. looked at cytology from neovagina washing from 20 patients, three colon transplants and 17 skin grafts, and found 30% had abnormal cytology. The authors concluded that patients with neovaginas, regardless of graph tissue, were prone to precancerous lesions, and advised patients engage in cancer screening programs.[74] Although the optimal follow up protocol has yet to be defined.

This is a rare complication following vaginoplasty, but physicians must be aware of the persistent risk of malignant transformation. There are no established guidelines the Endocrinology society suggest routine cancer screening for transfeminine patients. Screening should include annual postoperative physical exam including speculum and digital neovaginal examination and cytologic testing every 3 years starting at 21 until 70.[56] HPV vaccination is recommended for all transgender patients under age 26.

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