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Kratzer TB, Star J, Minihan AK, Bandi P, Scout NFN, Gary M, Riddle-Jones L, Giaquinto AN, Islami F, Jemal A, Siegel RL. Cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming. Cancer 2024; 130:2948-2967. [PMID: 38818898 DOI: 10.1002/cncr.35355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/04/2024] [Accepted: 04/17/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Individuals who identify as lesbian, gay, bisexual, transgender, queer, intersex, or gender-nonconforming (LGBTQ+) experience discrimination and minority stress that may lead to elevated cancer risk. METHODS In the absence of population-based cancer occurrence information for this population, this article comprehensively examines contemporary, age-adjusted cancer risk factor and screening prevalence using data from the National Health Interview Survey, Behavioral Risk Factor Surveillance System, and National Youth Tobacco Survey, and provides a literature review of cancer incidence and barriers to care. RESULTS Lesbian, gay, and bisexual adults are more likely to smoke cigarettes than heterosexual adults (16% compared to 12% in 2021-2022), with the largest disparity among bisexual women. For example, 34% of bisexual women aged 40-49 years and 24% of those 50 and older smoke compared to 12% and 11%, respectively, of heterosexual women. Smoking is also elevated among youth who identify as lesbian, gay, or bisexual (4%) or transgender (5%) compared to heterosexual or cisgender (1%). Excess body weight is elevated among lesbian and bisexual women (68% vs. 61% among heterosexual women), largely due to higher obesity prevalence among bisexual women (43% vs. 38% among lesbian women and 33% among heterosexual women). Bisexual women also have a higher prevalence of no leisure-time physical activity (35% vs. 28% among heterosexual women), as do transgender individuals (30%-31% vs. 21%-25% among cisgender individuals). Heavier alcohol intake among lesbian, gay, and bisexual individuals is confined to bisexual women, with 14% consuming more than 7 drinks/week versus 6% of heterosexual women. In contrast, prevalence of cancer screening and risk reducing vaccinations in LGBTQ+ individuals is similar to or higher than their heterosexual/cisgender counterparts except for lower cervical and colorectal cancer screening among transgender men. CONCLUSIONS People within the LGBTQ+ population have a higher prevalence of smoking, obesity, and alcohol consumption compared to heterosexual and cisgender people, suggesting a higher cancer burden. Health systems have an opportunity to help inform these disparities through the routine collection of information on sexual orientation and gender identity to facilitate cancer surveillance and to mitigate them through education to increase awareness of LGBTQ+ health needs.
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Affiliation(s)
- Tyler B Kratzer
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Jessica Star
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Adair K Minihan
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Priti Bandi
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - N F N Scout
- National LGBT Cancer Network, Providence, Rhode Island, USA
| | - Monique Gary
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Angela N Giaquinto
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Farhad Islami
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | - Rebecca L Siegel
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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Blasdel G, Borah L, Navarrete R, Howland R, Kuzon WM, Montgomery JS. "Prostatectomy after gender-affirming vaginoplasty for a transgender woman with prostate cancer". Urol Case Rep 2024; 56:102819. [PMID: 39220296 PMCID: PMC11363725 DOI: 10.1016/j.eucr.2024.102819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/04/2024] [Indexed: 09/04/2024] Open
Abstract
We present the case of a 75 year old transgender woman 18 months post gender-affirming vaginoplasty found to have unfavorable, intermediate risk prostate cancer. She elected a robotic radical prostatectomy with bilateral pelvic lymph node dissection. Postoperatively, the patient resumed neovaginal dilation without difficulty, and had improvements on International Prostate Symptom Score when compared to post-vaginoplasty, pre-prostatectomy. Incontinence measured by Revised Urinary Incontinence Scale remained mild. Robotic prostatectomy can, under appropriate circumstances, allow preservation of the neovaginal vault, but requires considerable experience and multidisciplinary intraoperative collaboration.
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Affiliation(s)
- Gaines Blasdel
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Luca Borah
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Rebecca Howland
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - William M. Kuzon
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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3
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Pace R, Goldstein KM, Williams AR, Clayton-Stiglbauer K, Meernik C, Shepherd-Banigan M, Chawla N, Moss H, Skalla LA, Colonna S, Kelley MJ, Zullig LL. The Landscape of Care for Women Veterans with Cancer: An Evidence Map. J Gen Intern Med 2024; 39:2300-2316. [PMID: 38965201 PMCID: PMC11347519 DOI: 10.1007/s11606-024-08903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Women are the fastest growing veteran group in the US and the number of women veterans (WVs) with cancer is rising; however, little is known about this population. Cancer care for WVs is complex and it is essential to understand their unique needs and care coordination challenges to provide evidence-based care. The purpose of this review is to map the quantity, distribution, and characteristics of literature describing cancer and its treatment among WVs. METHODS We searched MEDLINE (via PubMed), Embase (Elsevier), and Web of Science Core Collection (Clarivate) from inception through January, 2024. Publications were eligible that reported gender-specific data on any aspect of cancer care among WVs. Data was abstracted by a single investigator with over-reading. RESULTS Forty-six reports were included; 44 were observational and 19 had a women-only sample. There were no interventional reports and no qualitative reports had a patient sample. Breast cancer was the most commonly addressed (n = 19). There were six additional reports on sex-specific cancers. Many reports used large VA databases or previous trial data, creating the potential for patient overlap between reports. Among VA-specific areas of interest, only three reports evaluated the potential implications of racial differences and only two included a transgender population. No reports examined the effects of toxic exposures on cancer. Within the NCI Cancer Control Continuum, crosscutting areas were more commonly represented; over half (25) of the reports addressed epidemiology. There were few reports on focus areas and little overlap between focus and crosscutting areas. DISCUSSION Existing literature provides an inadequate understanding of the population of WVs with cancer. There is scant information regarding the population of WVs with cancer, their care preferences or experiences, or how to best identify and address unmet healthcare needs. It is imperative to expand research to provide evidence-based care for this population.
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Affiliation(s)
- Rachel Pace
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA.
| | - Karen M Goldstein
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - April R Williams
- Division of Hematology and Oncology, Durham VA Healthcare System, Durham, NC, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Healthcare System, Durham, NC, USA
- Million Veteran Program, Boston Coordinating Center, Boston, MA, USA
| | | | | | - Megan Shepherd-Banigan
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Duke-Margolis Institute for Health Policy, Duke University, Durham, NC, USA
- Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Durham VA Healthcare System, Durham, NC, USA
| | - Neetu Chawla
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Haley Moss
- Division of Hematology and Oncology, Durham VA Healthcare System, Durham, NC, USA
- Department of Obstetrics and Gynecology, Duke University Healthcare System, Durham, NC, USA
| | - Lesley A Skalla
- Duke University Medical Center Library and Archives, Duke University School of Medicine, Durham, NC, USA
| | | | - Michael J Kelley
- Division of Hematology and Oncology, Durham VA Healthcare System, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- National Oncology Program, Department of Veterans Affairs, Washington, DC, USA
| | - Leah L Zullig
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Istl AC, Lawton S, Kamaraju S, Stolley M, Petroll AE, Cortina CS. Tumors, Treatments, and Trust: Cancer Characteristics, Outcomes, and Screening Uptake in Transgender and Gender-Diverse Patients. Ann Surg Oncol 2024; 31:5560-5569. [PMID: 38861206 PMCID: PMC11309885 DOI: 10.1245/s10434-024-15319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/04/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND More than 2.5 million adults in the United States identify as transgender or gender-diverse (TGD), but little data exist on cancer screening and care for this population. We examined cancer characteristics, screening adherence, genetic testing, and provider inclusive language for TGD patients with cancer. METHODS This single institution retrospective cohort study identified TGD patients with cancer between 2000 and 2022. Demographic, clinicopathological, treatment, and screening data were collected, as well as data on gender-affirming care (GAC) and use of patients' personal pronouns in medical records. Descriptive statistics and regression analyses were used to report outcomes. RESULTS Sixty unique patients with 69 cancer diagnoses were included: 63.3% were transgender women, 21.7% transgender men, 6.7% nonbinary, and 8.3% were genderqueer. Sixty-five percent had a family history of cancer. Only 46.2% of those who met genetic testing criteria were referred. On review of recommended cancer screening, colorectal screening had the greatest uptake (62%), followed by breast (48.3%), lung (35.7%), cervical (33.3%), and prostate (32%); 8.5% of cancers were diagnosed on screening. Individuals with Medicare had reduced odds of screening uptake (OR 0.07, 95% CI 0.01-0.58) versus private insurance. With respect to GAC, 73.3% used gender-affirming hormone therapy and 41% had gender-affirming surgery. After initiating GAC and asserting personal pronouns, 75% were referred to by incorrect name/pronouns in provider documentation. CONCLUSIONS Our TGD cancer patient cohort had low rates of disease-specific cancer screening and inadequate genetic referrals. Many providers did not use appropriate patient names/pronouns. Provider and patient interventions are needed to ensure inclusive preventative and oncologic care for this marginalized population.
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Affiliation(s)
- Alexandra C Istl
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Samuel Lawton
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sailaja Kamaraju
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Melinda Stolley
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
| | - Andrew E Petroll
- Division of Infectious Disease, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Froedtert and the Medical College of Wisconsin Inclusion Health Clinic, Milwaukee, WI, USA
| | - Chandler S Cortina
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical College of Wisconsin Cancer Center, Milwaukee, WI, USA
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Nik-Ahd F, De Hoedt AM, Butler C, Anger JT, Carroll PR, Cooperberg MR, Freedland SJ. Prostate-Specific Antigen Values in Transgender Women Receiving Estrogen. JAMA 2024; 332:335-337. [PMID: 38922607 PMCID: PMC11209176 DOI: 10.1001/jama.2024.9997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/09/2024] [Indexed: 06/27/2024]
Abstract
This study examines prostate-specific antigen values among transgender women in the Veterans Health Administration receiving estrogen.
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Affiliation(s)
| | - Amanda M. De Hoedt
- Section of Urology, Veterans Affairs Health Care System, Durham, North Carolina
| | - Christi Butler
- Department of Urology, University of California San Francisco
| | | | | | | | - Stephen J. Freedland
- Section of Urology, Veterans Affairs Health Care System, Durham, North Carolina
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California
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6
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Meagher M, Morgan K, Deshler L, Riviere P, Dolendo I, Rose B, Jamieson C, Morris S, Nik-Ahd F, Freedland S, Anger J, Salmasi A. Prostate cancer in transgender women: A propensity score-matched analysis of disease severity and survival. Cancer 2024. [PMID: 39033478 DOI: 10.1002/cncr.35469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/20/2024] [Accepted: 06/06/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Despite the rise in gender-affirming care, our understanding of prostate cancer (PCa) in transgender women (TGW) remains in its infancy. Health disparities and lack of PCa awareness and screening are possible barriers to providing quality care for this population. In addition, the implication of hormonal manipulation for the aggressiveness of PCa in TGW is yet to be determined. Here, this study sought to compare oncological characteristics and survival outcomes between transgender and cisgender (CG) patients with PCa via two national data sets. METHODS The Veterans Affairs Informatics and Computing Infrastructure database (1999-2020) and the Surveillance, Epidemiology, and End Results-Medicare database (2010-2017) were reviewed. Demographic and clinical details were analyzed. Logistic regression analysis was performed on propensity score-matched groups to identify predictors of high-risk disease and metastasis in patients with PCa. Groups were matched 5:1 (CG:TGW) on the basis of age, race, year of diagnosis, and Charlson Comorbidity Index score. Primary outcomes included metastatic presentation, high-risk localized disease, overall survival (OS), and prostate cancer-specific mortality (PCSM). RESULTS A total of 1194 patients were included (199 TGW; 995 CG). Associations between transgender identity and metastatic presentation (odds ratio [OR], 0.38; p = .2), high-risk localized disease (OR, 1.19; p = .50), or PCSM (hazard ratio [HR], 0.65; p = .3) were not detected. Transgender identity was associated with improved OS (HR, 0.67; p = .014). CONCLUSIONS PCa-specific outcomes seem comparable between TGW and CG men, although the study was underpowered to detect modest differences. Further investigation into the incidence and outcomes of PCa in TGW is warranted.
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Affiliation(s)
- Margaret Meagher
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Kylie Morgan
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
- Veterans Affairs Hospital San Diego, San Diego, California, USA
- Center of Health Equity Education and Research, University of San Diego, La Jolla, California, USA
| | - Leah Deshler
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
- Veterans Affairs Hospital San Diego, San Diego, California, USA
- Center of Health Equity Education and Research, University of San Diego, La Jolla, California, USA
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
- Veterans Affairs Hospital San Diego, San Diego, California, USA
- Center of Health Equity Education and Research, University of San Diego, La Jolla, California, USA
| | - Isabella Dolendo
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Brent Rose
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
- Veterans Affairs Hospital San Diego, San Diego, California, USA
- Center of Health Equity Education and Research, University of San Diego, La Jolla, California, USA
| | - Christina Jamieson
- Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
- Veterans Affairs Hospital San Diego, San Diego, California, USA
| | - Sheldon Morris
- Departments of Medicine and Family Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Farnoosh Nik-Ahd
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Stephen Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Section of Urology, Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
| | - Jennifer Anger
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Amirali Salmasi
- Department of Urology, University of California San Diego School of Medicine, La Jolla, California, USA
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7
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Dickstein DR, Amarasekera C, Chen RC, Nguyen PL, Hoffman KE. Clinical considerations for sexual and gender minorities with prostate cancer. Urol Oncol 2024:S1078-1439(24)00507-6. [PMID: 38987120 DOI: 10.1016/j.urolonc.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 07/12/2024]
Abstract
At every stage of the cancer continuum, the management of sexual and gender minorities with prostate cancer requires a thoughtful and multidisciplinary approach. For example, it is important to recognize that receptive anal intercourse, common among sexual minority men-i.e. gay and bisexual men-can potentially elevate prostate-specific antigen (PSA) leading to overdiagnosis and overtreatment. Additionally, it is important to understand that sexual minority men with prostate cancer might engage in insertive and/or receptive anal intercourse, as opposed to insertive vaginal intercourse, requiring a treatment conversation that expands beyond the usual discussion of sexual health in prostate cancer patients. For gender minorities-i.e. transgender women or trans feminine individuals (those recorded male at birth with feminine gender identities)-it is important to consider gender affirming hormones and pelvic surgeries as they can cause diagnostic and treatment challenges, including PSA suppression, more aggressive disease, and anatomical changes. Furthermore, it is essential to recognize that gender minorities are a diverse cohort and may or may not be on gender affirming hormone therapy and may or may not have received or intend to receive pelvic affirming surgery. In this seminar article, we highlight considerations for personalized management of prostate cancer in sexual and gender minorities to improve care for this understudied cohort and enhance health equity.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York City, NY.
| | - Channa Amarasekera
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ronald C Chen
- Department of Radiation Oncology, The University of Kansas Medical Center, Kansas City, KS
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Brigham Cancer Center, Boston, MA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Sánchez-Varela N, Ferreiro-Abuin L, Durán-González A, Mosteiro-Miguéns DG, Portela-Romero M. [Recommendations for Primary Health Care for transgender people]. Semergen 2024; 50:102222. [PMID: 38569226 DOI: 10.1016/j.semerg.2024.102222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 04/05/2024]
Abstract
The WHO defines Primary Health Care as essential health care, based on practical, scientifically founded and socially acceptable methods and technologies, made available to all individuals and families in the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of their development, in a spirit of self-responsibility and self-determination. With the intention of fulfilling the basic objective of caring for and promoting health in all the groups that make up our current society, the need arises to focus on certain groups in which the actions of Primary Care are currently consensual or poorly protocolised, as is the case with the health care of transgender people.
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Affiliation(s)
- N Sánchez-Varela
- Centro de Saúde Concepción Arenal, Área Sanitaria Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - L Ferreiro-Abuin
- Centro de Saúde Concepción Arenal, Área Sanitaria Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - A Durán-González
- Centro de Saúde Concepción Arenal, Área Sanitaria Santiago de Compostela, Santiago de Compostela, A Coruña, España
| | - D G Mosteiro-Miguéns
- Centro de Saúde Concepción Arenal, Área Sanitaria Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - M Portela-Romero
- Centro de Saúde Concepción Arenal, Área Sanitaria Santiago de Compostela, Santiago de Compostela, A Coruña, España; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, España
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9
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Loria M, Gilbert D, Tabernacki T, Maravillas MA, McNamara M, Gupta S, Mishra K. Incidence of prostate cancer in transgender women in the US: a large database analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00804-4. [PMID: 38326392 DOI: 10.1038/s41391-024-00804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
The risk of prostate cancer among transgender women undergoing medical and surgical gender-affirming interventions remains unclear, though up to a fivefold decreased risk has been reported in comparison to cisgender men. In this study, we conducted a comparative analysis of the risk of prostate cancer among transgender women (TW) using data from TriNetX, a large database, versus SEER. Our findings indicate that, overall, transgender women exhibited a 2.56-fold lower risk of prostate cancer compared to cisgender men. Specifically, among TW on hormone therapy between ages 50-64, we observed a 2.06-fold decrease in risk. Contrary to the previous perception of prostate cancer being rare in transgender women, our study suggests that it may not be as uncommon as previously believed.
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Affiliation(s)
- Matthew Loria
- University Hospitals, Urology Institute, Cleveland, OH, USA.
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - David Gilbert
- University Hospitals, Urology Institute, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Tomasz Tabernacki
- University Hospitals, Urology Institute, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Megan McNamara
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Louis Stokes Veterans Association Cleveland, Cleveland, OH, USA
| | - Shubham Gupta
- University Hospitals, Urology Institute, Cleveland, OH, USA
| | - Kirtishri Mishra
- University Hospitals, Urology Institute, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Metro Health Hospitals, Cleveland, OH, USA
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10
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Kalavacherla S, Riviere P, Kalavacherla S, Anger JT, Murphy JD, Rose BS. Prostate Cancer Screening Uptake in Transgender Women. JAMA Netw Open 2024; 7:e2356088. [PMID: 38353948 PMCID: PMC10867675 DOI: 10.1001/jamanetworkopen.2023.56088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/17/2023] [Indexed: 02/16/2024] Open
Abstract
Importance There is no consensus in prostate-specific antigen (PSA) screening guidelines regarding transgender women despite their known prostate cancer risk. Objective To identify factors associated with recent (within the last 2 years) PSA screening in transgender women compared with cisgender men. Design, Setting, and Participants This case-control study used data from the 2018 and 2020 Behavioral Risk Factor Surveillance System (BRFSS) surveys to characterize rates of PSA screening for prostate cancer within the past 2 years and multivariable logistic regressions to characterize factors associated with recent screening among transgender women. The BRFSS program of the Centers for Disease Control and Prevention annually surveys over 400 000 US adults on behavioral risk factors, chronic illnesses, and use of preventive services. Respondents to the BRFSS who were cisgender men or transgender women 40 years or older and who had complete PSA testing responses and no prostate cancer history were included; 313 transgender women and 138 937 cisgender men met inclusion criteria. Matching was performed by age, race and ethnicity, educational level, employment, annual income, survey year, and cost barriers to care. Data were collected on November 2, 2022, and analyzed from November 2, 2022, to December 3, 2023. Main Outcomes and Measures Rates of and factors associated with recent PSA screening in transgender women. Results Among the 1275 participants included in the matched cohort (255 transgender women and 1020 cisgender men; 570 [44.7%] aged 55-69 years), recent PSA screening rates among transgender women and cisgender men aged 55 to 69 were 22.2% (n = 26) and 36.3% (n = 165), respectively; among those 70 years and older, these rates were 41.8% (n = 26) and 40.2% (n = 98), respectively. In the matched cohort, transgender women had lower univariable odds of recent screening than cisgender men (odds ratio [OR], 0.65 [95% CI, 0.46-0.92]; P = .02). In a hierarchical regression analysis adding time since the last primary care visit, effect size and significance were unchanged (OR, 0.61 [95% CI, 0.42-0.87]; P = .007). After adding whether a clinician recommended a PSA test, there was no statistically significant difference in odds of screening between transgender women and cisgender men (OR, 0.83 [95% CI, 0.45-1.27]; P = .21). The results were further attenuated when clinician-led discussions of PSA screening advantages and disadvantages were added (OR, 0.87 [95% CI, 0.47-1.31]; P = .32). In a multivariable logistic regression among transgender women, having a recommendation for PSA testing was the factor with the strongest association with recent screening (OR, 12.40 [95% CI, 4.47-37.80]; P < .001). Conclusions and Relevance In this case-control study of one of the largest cohorts of transgender women studied regarding PSA screening, the findings suggest that access to care or sociodemographic factors were not principal drivers of the screening differences between transgender women and cisgender men; rather, these data underscore the clinician's role in influencing PSA screening among transgender women.
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Affiliation(s)
- Sandhya Kalavacherla
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
| | - Paul Riviere
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
| | - Sruthi Kalavacherla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
- Department of Biology, Massachusetts Institute of Technology, Cambridge
| | - Jennifer T. Anger
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Department of Urology, University of California, San Diego, La Jolla
| | - James D. Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
| | - Brent S. Rose
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla
- Center for Health Equity, Education, and Research, University of California, San Diego, La Jolla
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11
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Javaroni V. Do we urologists know enough about gender minorities with prostate cancer? Int Braz J Urol 2024; 50:87-94. [PMID: 38166225 PMCID: PMC10947644 DOI: 10.1590/s1677-5538.ibju.2023.9914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 11/20/2023] [Indexed: 01/04/2024] Open
Affiliation(s)
- Valter Javaroni
- Hospital Federal do Andaraí Rio de JaneiroDepartamento de AndrologiaRio de JaneiroRJBrasilDepartamento de Andrologia, Hospital Federal do Andaraí Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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12
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Manfredi C, Ditonno F, Franco A, Bologna E, Licari LC, Arcaniolo D, Tubaro A, De Nunzio C, Antonelli A, De Sio M, Cherullo EE, Autorino R. Prostate Cancer in Transgender Women: Epidemiology, Clinical Characteristics, and Management Challenges. Curr Oncol Rep 2023; 25:1431-1443. [PMID: 37910274 DOI: 10.1007/s11912-023-01470-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW To systematically review the evidence on prostate cancer (PCa) in transgender women (TGW). RECENT FINDINGS A total of 25 studies were included. Fourteen articles were case reports or case series describing 21 TGW with PCa; 11 papers focused primarily on assessing the incidence or screening of PCa in TGW. The median (range) age of patients with PCa was 63 (45-78) years. Median (range) PSA at diagnosis was 7.5 (0.4-1710) ng/mL. Prostate biopsy detected ISUP 3-5 in 10 (67%) cases. T3-4 stages were described in 7 (64%) patients. Three (14.3%) cases of nodal involvement and 2 (9.5%) of metastases were reported at diagnosis. First-line therapy included radical prostatectomy or radiotherapy ± androgen deprivation therapy in 14 (74 %) subjects. Median (range) follow-up was 24 (2-120) months. A good response to first-line therapy was recorded in 8 (47.1%) cases. Median (range) incidence of PCa in TGW was 44.1 (4.34-140) cases per 100,000 person-years. PCa was significantly less frequent in TGW than in cisgender males (HR 0.4, 95% CI 0.2-0.9). Risk of death after PCa diagnosis was significantly higher in TGW compared to cisgender males (HR 1.91, 95% CI 1.06-3.45). TGW had lower lifetime PSA rates (48% vs. 64.6%, p = 0.048) than cisgender males. Few cases of PCa in TGW are currently reported. PCa seems significantly less frequent in TGW than in cisgender males; however, some data suggest a possible higher mortality in this cohort. TGW appear to have less access to PSA testing than cisgender men.
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Affiliation(s)
- Celeste Manfredi
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Davide Arcaniolo
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco De Sio
- Unit of Urology, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Edward E Cherullo
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, 1725 W Harrison St, Professional Building - Suite 970, Chicago, IL, 60612, USA.
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13
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Leone AG, Casolino R, Trapani D, Miceli R, Massagrande M, Morano F, La Verde N, Dalu D, Berardi R, Marsoni S, Lambertini M, Iula B, Carieri E, Converti M, Di Maio M, Beretta GD, Perrone F, Pietrantonio F, Cinieri S. Position paper of the Italian association of medical oncology on health disparities among transgender and gender-diverse people: the Assisi recommendations. EClinicalMedicine 2023; 65:102277. [PMID: 37877000 PMCID: PMC10590834 DOI: 10.1016/j.eclinm.2023.102277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023] Open
Abstract
Transgender and gender-diverse individuals experience substantial health disparities across the cancer care continuum. Despite well recognized unique healthcare needs, there are barriers in accessing cancer prevention and treatment services, influenced by disadvantages in key social-economic determinants of health which result in worse clinical outcomes, as compared to the general population. The Italian Association of Medical Oncology (AIOM) acknowledges the critical relevance of this issue. The "Assisi Recommendations" here summarize the outcomes of the "AIOM Oncology Ethics Day" dedicated to gender differences in oncology and cancer care of transgender and gender-diverse people. The recommendations generated during a 2-day multidisciplinary discussion address the various aspects of cancer care experience of transgender and gender-diverse people. The promotion of research in this field, through the generation of new evidence and the collection of prospective data, has been identified as a priority action to mitigate these disparities. By acknowledging the challenges of cancer care in transgender and gender-diverse people and recognizing the need for dedicated policy and clinical recommendations, AIOM demonstrates its commitment to improving the health and well-being of all patients with cancer, regardless of their gender identity or any other personal or social circumstances, as part of health-for-all societal vision.
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Affiliation(s)
- Alberto Giovanni Leone
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Raffaella Casolino
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - Dario Trapani
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
| | - Rosalba Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | | | - Federica Morano
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Nicla La Verde
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Davide Dalu
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Rossana Berardi
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
| | - Silvia Marsoni
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Bianca Iula
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
| | | | - Manlio Converti
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
| | - Massimo Di Maio
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
| | - Giordano Domenico Beretta
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
| | - Francesco Perrone
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
| | - Filippo Pietrantonio
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
| | - the Italian Foundation of Medical Oncology (Fondazione AIOM)
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- ELMA Research, Milan, Italy
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
- Independent Researcher, Italy Degree: N/A
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
| | - Italian Association of Medical Oncology (AIOM)
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
- Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Via G. Venezian 1, Milan 21033, Italy
- ELMA Research, Milan, Italy
- Department of Oncology, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
- Oncology Clinic, Università Politecnica delle Marche, AOU delle Marche, Ancona, Italy
- IFOM - the FIRC Institute of Molecular Oncology, Milan, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- ACET - Associazione per la Cultura e l’etica Transgenere (Association for Transgender Culture and Ethics), Milan, Italy Degree: N/A
- Independent Researcher, Italy Degree: N/A
- AMIGAY Aps - Associazione Italiana Medici e Personale Sanitario, LGBTQIA+ e Friendly (Italian Association of LGBTQIA+ Medical care Providers), Italy
- Department of Oncology, University of Turin, A.O. Ordine Mauriziano, Turin, Italy
- National Secretary of the Italian Association of Medical Oncology (AIOM), Italy
- UOC Oncologia Medica, ASL Pescara P.O., Pescara, Italy
- National President of the Italian Foundation of Medical Oncology (Fondazione AIOM), Italy
- Clinical Trial Unit, Istituto Nazionale Tumori, IRCCS, Fondazione G. Pascale, Napoli, Italy
- President-elect of the Italian Association of Medical Oncology (AIOM), Italy
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
- National President of the Italian Association of Medical Oncology (AIOM), Italy
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14
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Nik-Ahd F, Anger JT, Cooperberg MR, Freedland SJ. Prostate cancer is not just a man's concern - the use of PSA screening in transgender women. Nat Rev Urol 2023:10.1038/s41585-023-00780-9. [PMID: 37217694 DOI: 10.1038/s41585-023-00780-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Farnoosh Nik-Ahd
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennifer T Anger
- Department of Urology, University of California, San Diego, San Diego, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephen J Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
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