Mammography screening rates low among transgender and nonbinary patients. 2 possible fixes
Mammography screening rates are lower among transgender and nonbinary patients when compared to the cisgender population, but there are a few ways imaging providers can close this gap.
That’s according to a new single-center analysis from Northwestern University, published Oct. 26 in the Annals of Surgical Oncology. Trans individuals have historically seen low breast screening rates due to social stigma and healthcare avoidance, experts noted. Wanting to explore this challenge at the Chicago-based institution, researchers analyzed electronic medical records, among other sources.
They found screening rates ranging from 7% to 48% among trans and nonbinary individuals designated male at birth and 2% to 50% for those designated as female. Meanwhile, nationally reported cancer screening rates range from nearly 67% to more than 78%.
“Guidelines for breast cancer screening among [transgender and nonbinary] patients should be updated, including the development of consensus guidelines for screening following gender-affirming mastectomy,” Sumanas Jordan, MD, PhD, with the Feinberg School of Medicine’s Department of Surgery, and colleagues concluded.
Along with the EMR, Northwestern researchers also used International Classification of Disease gender dysphoria diagnosis codes, sexual orientation and gender identity data, and natural language processing to construct their study cohort. Altogether, 253 patients matched the criteria and were over age 40. Those included 193 trans women and nonbinary individuals designated male at birth and 60 men or nonbinary subjects originally designated female. The two groups saw average mammogram-person years of 0.171 and 0.134, respectively, versus the recommendation of 0.5.
Median age was about 53 years, and most patients had no family history of breast cancer (64%), were on hormone therapy (75.5%), were white (65%), employed (45%) and had public insurance (51%). Jordan et al. found no notable mammography predictors among the female-at-birth population while not being on hormones lowered odds of undergoing breast imaging in the designated-as-male group.
Jordan identified the gendering of anatomy as one potential barrier to screening. They also underlined the need to collect more sexual orientation and gender identity data to facilitate further research.
“Terms such as ‘breasts’ may be discomforting for some patients,” the authors advised. “We provide two recommendations: (1) Providers should mirror the language their patients use to provide culturally competent care, and (2) providers, researchers, patients and society should strive to uncouple organs from gender, to reduce patient distress and promote preventative healthcare.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.