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

Youth Cancer Risk

Gender dysphoria does not affect a patient's cancer risk, but it does decrease a patient's chance of undergoing screening for their birth sex organs owing to provider factors (lack of education and comfort) and patient factors (aggravation of gender dysphoria with physical examination of sex organs).[19] Children as young as 2 years old may show signs of gender dysphoria; for most children gender dysphoria will disappear before the onset of puberty.[20] Internal survey of our patients found 71% experienced their first experiences of gender dysphoria in early childhood, between the ages of 3–6. A patient's baseline dysphoria is often exacerbated by interactions with the medical community which often result in patients being forced to acknowledge and undergo examinations of birth sex organs. According to transgender patients when they do have doctor visits the focus is on GAHT or mental health concerns, with physical ailments being the least important concern.[21] A review of the literature regarding primary care in transgender patients reinforces these priorities; general health, including cancer, is the least researched aspect of the transgender global burden of disease initiative.[22] The lack of focus on primary health concerns, both by transgender patients and physicians, decreases the likelihood that they will have any sort of cancer screening. The discrimination transgender patients experience when interfacing with the health care system does not easily foster the kind of open conversations needed to discuss a topic like cancer screening, given the lack of clear evidence and professional guidelines.

GAHT has been shown to be safe and have predictable effects on hormone levels in transgender youths.[23] While an increased cancer risk with the use of hormone therapy is theoretically possible and plausible, there have been no well-designed studies published showing that long term use of GAHT or suppression of a patient's natal puberty increases cancer risk.[24] However, the uncertainty and possible risk is frequently emphasized in discussion between patients and transgender patients without placing an equal consideration on the benefits of GAHT.[25]

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