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Berner AM, Buchanan D, Seal L, O'Callaghan S. Methodological considerations in the use of a large database to estimate incidence of prostate cancer in transgender women in the US. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00839-7. [PMID: 38658735 DOI: 10.1038/s41391-024-00839-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Alison M Berner
- Barts Cancer Institute, Queen Mary University of London, London, UK.
- Tavistock and Portman NHS Foundation Trust, London, UK.
| | | | - Leighton Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University of London, London, UK
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Berner AM, O'Callaghan S, Shrewsbury D. No, we mean sex AND gender. Br J Gen Pract 2023; 73:491. [PMID: 37884383 PMCID: PMC10617958 DOI: 10.3399/bjgp23x735309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Affiliation(s)
- Alison M Berner
- Barts Cancer Institute, Queen Mary University of London, London; Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London.
| | | | - Duncan Shrewsbury
- Department of Medical Education, Brighton & Sussex Medical School, Brighton
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Brown J, Pfeiffer RM, Shrewsbury D, O'Callaghan S, Berner AM, Gadalla SM, Shiels MS, Jackson SS. Prevalence of cancer risk factors among transgender and gender diverse individuals: a cross-sectional analysis using UK primary care data. Br J Gen Pract 2023; 73:e486-e492. [PMID: 37365010 PMCID: PMC10325612 DOI: 10.3399/bjgp.2023.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/07/2023] [Accepted: 03/23/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals experience an incongruence between their assigned birth sex and gender identity. They may have a higher prevalence of health conditions associated with cancer risk than cisgender people. AIM To examine the prevalence of several cancer risk factors among TGD individuals compared with cisgender individuals. DESIGN AND SETTING A cross-sectional analysis was conducted using data from the UK's Clinical Practice Research Datalink to identify TGD individuals between 1988-2020, matched to 20 cisgender men and 20 cisgender women on index date (date of diagnosis with gender incongruence), practice, and index age (age at index date). Assigned birth sex was determined from gender-affirming hormone use and procedures, and sex-specific diagnoses documented in the medical record. METHOD The prevalence of each cancer risk factor was calculated and the prevalence ratio by gender identity was estimated using log binomial or Poisson regression models adjusted for age and year at study entry, and obesity where appropriate. RESULTS There were 3474 transfeminine (assigned male at birth) individuals, 3591 transmasculine (assigned female at birth) individuals, 131 747 cisgender men, and 131 827 cisgender women. Transmasculine people had the highest prevalence of obesity (27.5%) and 'ever smoking' (60.2%). Transfeminine people had the highest prevalence of dyslipidaemia (15.1%), diabetes (5.4%), hepatitis C infection (0.7%), hepatitis B infection (0.4%), and HIV infection (0.8%). These prevalence estimates remained elevated in the TGD populations compared with cisgender persons in the multivariable models. CONCLUSION Multiple cancer risk factors are more prevalent among TGD individuals compared with cisgender individuals. Future research should examine how minority stress contributes to the increased prevalence of cancer risk factors in this population.
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Affiliation(s)
- Jalen Brown
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Ruth M Pfeiffer
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Duncan Shrewsbury
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
| | | | - Alison M Berner
- Barts Cancer Institute, Queen Mary University of London, London, UK; Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Shahinaz M Gadalla
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Meredith S Shiels
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
| | - Sarah S Jackson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, US
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Jackson SS, Brown J, Pfeiffer RM, Shrewsbury D, O’Callaghan S, Berner AM, Gadalla SM, Shiels MS. Analysis of Mortality Among Transgender and Gender Diverse Adults in England. JAMA Netw Open 2023; 6:e2253687. [PMID: 36716027 PMCID: PMC9887492 DOI: 10.1001/jamanetworkopen.2022.53687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
IMPORTANCE Limited prior research suggests that transgender and gender diverse (TGD) people may have higher mortality rates than cisgender people. OBJECTIVE To estimate overall and cause-specific mortality among TGD persons compared with cisgender persons. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used data from general practices in England contributing to the UK's Clinical Practice Research Datalink GOLD and Aurum databases. Transfeminine (assigned male at birth) and transmasculine (assigned female at birth) individuals were identified using diagnosis codes for gender incongruence, between 1988 and 2019, and were matched to cisgender men and women according to birth year, practice, and practice registration date and linked to the Office of National Statistics death registration. Data analysis was performed from February to June 2022. MAIN OUTCOMES AND MEASURES Cause-specific mortality counts were calculated for categories of disease as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision chapters. Overall and cause-specific mortality rate ratios (MRRs) were estimated using Poisson models, adjusted for index age, index year, race and ethnicity, Index of Multiple Deprivation, smoking status, alcohol use, and body mass index. RESULTS A total of 1951 transfeminine (mean [SE] age, 36.90 [0.34] years; 1801 White [92.3%]) and 1364 transmasculine (mean [SE] age, 29.20 [0.36] years; 1235 White [90.4%]) individuals were matched with 68 165 cisgender men (mean [SE] age, 33.60 [0.05] years; 59 136 White [86.8%]) and 68 004 cisgender women (mean [SE] age, 33.50 [0.05] years; 57 762 White [84.9%]). The mortality rate was 528.11 deaths per 100 000 person-years (102 deaths) for transfeminine persons, 325.86 deaths per 100 000 person-years (34 deaths) for transmasculine persons, 315.32 deaths per 100 000 person-years (1951 deaths) for cisgender men, and 260.61 deaths per 100 000 person-years (1608 deaths) for cisgender women. Transfeminine persons had a higher overall mortality risk compared with cisgender men (MRR, 1.34; 95% CI, 1.06-1.68) and cisgender women (MRR, 1.60; 95% CI, 1.27-2.01). For transmasculine persons, the overall MMR was 1.43 (95% CI, 0.87-2.33) compared with cisgender men and was 1.75 (95% CI, 1.08-2.83) compared with cisgender women. Transfeminine individuals had lower cancer mortality than cisgender women (MRR, 0.52; 95% CI, 0.32-0.83) but an increased risk of external causes of death (MRR, 1.92; 95% CI, 1.05-3.50). Transmasculine persons had higher mortality from external causes of death than cisgender women (MRR, 2.77; 95% CI, 1.15-6.65). Compared with cisgender men, neither transfeminine nor transmasculine adults had a significantly increased risk of deaths due to external causes. CONCLUSIONS AND RELEVANCE In this cohort study of primary care data, TGD persons had elevated mortality rates compared with cisgender persons, particularly for deaths due to external causes. Further research is needed to examine how minority stress may be contributing to deaths among TGD individuals to reduce mortality.
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Affiliation(s)
- Sarah S. Jackson
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jalen Brown
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Ruth M. Pfeiffer
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Duncan Shrewsbury
- Department of Medical Education, Brighton & Sussex Medical School, Brighton, United Kingdom
| | | | - Alison M. Berner
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
- Gender Identity Clinic, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Shahinaz M. Gadalla
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Meredith S. Shiels
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Berner AM, Suchak T, Wolton A, Bayliss J, Craven K, Pinnell I, Ostrov R, Burchill J. Abstract PO-248: A UK-based pilot cervical screening clinic tailored to trans men and non-binary people. Cancer Epidemiol Biomarkers Prev 2022. [DOI: 10.1158/1538-7755.disp21-po-248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Trans men and non-binary people experience numerous barriers to accessing cervical screening, including dysphoria related to the procedure, anticipated or experienced stigma and discrimination, lack of provider knowledge and exclusion from routine recall systems. As a result, this population are less likely to attend regularly and a recent UK study showed that the majority prefer to access screening via a trans-specific sexual health service. This pilot sought to trial a weekly dedicated cervical screening clinic for trans men and non-binary people to gauge acceptability and to explore how best to promote the service. Organisations with the expertise of working with this population in the UK collaborated on the project. A communications plan was developed which included promotion of the project to local area stakeholders. A promotional video was produced as well as three patient testimonials from trans people who had attended for screening. The social media campaign comprised initial promotional material on six platforms with post-hoc analysis and a second stage using the two most popular platforms. The clinic commenced in October 2019 within an existing trans-specific sexual health service in London, UK. It was staffed by healthcare professionals with training and experience in performing cervical screening for trans people, including sensitive communication and techniques to facilitate a more comfortable procedure. Appointments could be accessed via a dedicated booking email and telephone number. Patients were asked to complete an evaluation after the procedure. From October 2019, nine people were screened prior to the outbreak of Covid-19 in March 2020. The project was suspended immediately after the first social media campaign launched, having had over 40,000 views over 10 days. In July 2020 the project recommenced, and the second social media campaign ran on Facebook and Twitter for 14 days, with over 50,000 views. A targeted email advertising the service was sent to eligible patients currently under the Gender Identity Clinic London in August 2020 and the service advertised via their website. Between July and February 2021, 35 trans men were screened in the clinic, despite another lockdown. Participant surveys from 20 attendees showed 100% positive feedback. The majority of respondents stated that if the service was unavailable, they would not have attended cervical screening (12/20 respondents). However, when asked if their GP could provide a similar service, nine respondents stated that they would attend (9/20 respondents). This pilot suggests that bespoke cervical screening clinics for trans men and non-binary people are highly acceptable, and support patients to engage with screening who otherwise would not have done so. Patients may benefit from such clinics embedded within services across several healthcare settings, in order to maximise access. Targeted promotion via social media is effective and may encourage screening beyond the service being advertised but should be concentrated on platforms most accessed by the community.
Citation Format: Alison M. Berner, Tara Suchak, Aedan Wolton, Jacob Bayliss, Katue Craven, Imogen Pinnell, Ricki Ostrov, John Burchill. A UK-based pilot cervical screening clinic tailored to trans men and non-binary people [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-248.
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Affiliation(s)
- Alison M. Berner
- 1Tavistock and Portman NHS Foundation Trust, London, United Kingdom,
| | - Tara Suchak
- 2Chelsea & Westminster Hospitals NHS Trust, London, United Kingdom,
| | - Aedan Wolton
- 3Chelsea and Westminster Hospitals NHS Trust, London, United Kingdom,
| | | | | | | | - Ricki Ostrov
- 7RM Partners West London Cancer Alliance, London, United Kingdom
| | - John Burchill
- 7RM Partners West London Cancer Alliance, London, United Kingdom
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Affiliation(s)
- Alison M Berner
- Barts Cancer Institute, Queen Mary University of London, London, UK.
- Gender Identity Clinic, Tavistock & Portman NHS Foundation Trust, London, UK.
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Pipinikas CP, Berner AM, Sposito T, Thirlwell C. The evolving (epi)genetic landscape of pancreatic neuroendocrine tumours. Endocr Relat Cancer 2019; 26:R519-R544. [PMID: 31252410 DOI: 10.1530/erc-19-0175] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/26/2019] [Indexed: 11/08/2022]
Abstract
Neuroendocrine neoplasms (NENs) are a relatively rare group of heterogeneous tumours originating from neuroendocrine cells found throughout the body. Pancreatic NENs (PanNENs) are the second most common pancreatic malignancy accounting for 1-3% of all neoplasms developing in the pancreas. Despite having a low background mutation rate, driver mutations in MEN1, DAXX/ATRX and mTOR pathway genes (PTEN, TSC1/2) are implicated in disease development and progression. Their increased incidence coupled with advances in sequencing technologies has reignited the interest in PanNEN research and has accelerated the acquisition of molecular data. Studies utilising such technological advances have further enriched our knowledge of PanNENs' biology through novel findings, including higher-than-expected presence of germline mutations in 17% of sporadic tumours of no familial background, identification of novel mutational signatures and complex chromosomal rearrangements and a dysregulated epigenetic machinery. Integrated genomic studies have progressed the field by identifying the synergistic action between different molecular mechanisms, while holding the promise for deciphering disease heterogeneity. Although our understanding is far from being complete, these novel findings have provided the optimism of shaping the future of PanNEN research, ultimately leading to an era of precision medicine for NETs. Here, we recapitulate the existing knowledge on pancreatic neuroendocrine tumours (PanNETs) and discuss how recent, novel findings have furthered our understanding of these complex tumours.
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Affiliation(s)
| | - Alison M Berner
- Medical Genomics Laboratory, University College London Cancer Institute, London, UK
| | - Teresa Sposito
- Medical Genomics Laboratory, University College London Cancer Institute, London, UK
| | - Christina Thirlwell
- Medical Genomics Laboratory, University College London Cancer Institute, London, UK
- Neuroendocrine Tumour Unit and Department of Oncology, Royal Free Hospital, London, UK
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Beck S, Berner AM, Bignell G, Bond M, Callanan MJ, Chervova O, Conde L, Corpas M, Ecker S, Elliott HR, Fioramonti SA, Flanagan AM, Gaentzsch R, Graham D, Gribbin D, Guerra-Assunção JA, Hamoudi R, Harding V, Harrison PL, Herrero J, Hofmann J, Jones E, Khan S, Kaye J, Kerr P, Libertini E, Marks L, McCormack L, Moghul I, Pontikos N, Rajanayagam S, Rana K, Semega-Janneh M, Smith CP, Strom L, Umur S, Webster AP, Williams EH, Wint K, Wood JN. Personal Genome Project UK (PGP-UK): a research and citizen science hybrid project in support of personalized medicine. BMC Med Genomics 2018; 11:108. [PMID: 30482208 PMCID: PMC6257975 DOI: 10.1186/s12920-018-0423-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Molecular analyses such as whole-genome sequencing have become routine and are expected to be transformational for future healthcare and lifestyle decisions. Population-wide implementation of such analyses is, however, not without challenges, and multiple studies are ongoing to identify what these are and explore how they can be addressed. METHODS Defined as a research project, the Personal Genome Project UK (PGP-UK) is part of the global PGP network and focuses on open data sharing and citizen science to advance and accelerate personalized genomics and medicine. RESULTS Here we report our findings on using an open consent recruitment protocol, active participant involvement, open access release of personal genome, methylome and transcriptome data and associated analyses, including 47 new variants predicted to affect gene function and innovative reports based on the analysis of genetic and epigenetic variants. For this pilot study, we recruited 10 participants willing to actively engage as citizen scientists with the project. In addition, we introduce Genome Donation as a novel mechanism for openly sharing previously restricted data and discuss the first three donations received. Lastly, we present GenoME, a free, open-source educational app suitable for the lay public to allow exploration of personal genomes. CONCLUSIONS Our findings demonstrate that citizen science-based approaches like PGP-UK have an important role to play in the public awareness, acceptance and implementation of genomics and personalized medicine.
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Berner AM, Sharma A, Agarwal S, Al-Sam S, Nathan P. Fatal autoimmune myocarditis with anti-PD-L1 and tyrosine kinase inhibitor therapy for renal cell cancer. Eur J Cancer 2018; 101:287-290. [PMID: 30017380 DOI: 10.1016/j.ejca.2018.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/13/2018] [Accepted: 06/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- A M Berner
- Department of Oncology, Mount Vernon Cancer Centre, Northwood HA6 2RN, UK.
| | - A Sharma
- Department of Oncology, Mount Vernon Cancer Centre, Northwood HA6 2RN, UK
| | - S Agarwal
- Department of Histopathology, East and North Hertfordshire NHS Trust, Coreys Mill Lane, Stevenage, Hertfordshire SG1 4AB, UK
| | - S Al-Sam
- Princess Alexandra Hospital, Hamstel Road, Harlow, Essex CM20 1QX, UK
| | - P Nathan
- Department of Oncology, Mount Vernon Cancer Centre, Northwood HA6 2RN, UK
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