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Cancer Screening for Transgender and Gender Diverse Patients

  • Care for the Transgender Patients (C Ferrando, Section Editor)
  • Published:
Current Obstetrics and Gynecology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The purpose of this review is to summarize the current knowledge base for sex-trait related cancer risks and screening guidelines as applied in transgender and gender diverse (TGD) populations with an emphasis on the potential impact of gender-affirming hormonal and surgical therapies. Additionally, this review will address access to screening services and patient-friendly adaptations to screening approaches for this population.

Recent Findings

While breast cancer incidence is higher among transfeminine persons relative to genotypic males, it still remains significantly lower than that of genotypic females. As chest masculinization surgery performed in transmasculine persons may leave behind breast tissue, there is still a cancer risk. Mammography may not be feasible in a contoured chest and alternative approaches should be considered. Endometrial and ovarian cancers do not appear to have increased incidence in transmasculine persons who receive testosterone. Gender-affirming hormone therapy may be protective in prostate cancer risk in transfeminine persons. Lastly, prevalent societal constraints and outright discrimination of TGD persons in health care settings may limit patients from seeking necessary screening examinations. Some may opt out of screening because of emotional or physical discomfort associated with incongruence between screened anatomy and gender identity.

Summary

Overall, the incidence of sex steroid–influenced cancers among TGD persons appears to be low, but gender-affirming therapies may influence cancer risk. Additionally, the patient experience and potential barriers in access should also be considered in the development of TGD-specific screening guidelines.

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Authors and Affiliations

  1. Division of Gynecology, Department of Surgery, Boston Children’s Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA

    Frances Grimstad

  2. Harvard University, Boston, MA, USA

    Samuel Tulimat

  3. Department of Radiology, Division of Cardiothoracic Imaging, Mayo Clinic, Jacksonville, FL, USA

    Justin Stowell

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  1. Frances Grimstad
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Correspondence to Frances Grimstad.

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Grimstad, F., Tulimat, S. & Stowell, J. Cancer Screening for Transgender and Gender Diverse Patients. Curr Obstet Gynecol Rep 9, 146–152 (2020). https://doi.org/10.1007/s13669-020-00296-8

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