Staff physician and clinician investigator in the Department of Family and Community Medicine at St Michael's Hospital and the University of Toronto in Ontario, Fidani Chair in Improvement and Innovation and Vice-Chair of Quality and Innovation in the Department of Family and Community Medicine at the University of Toronto, and Associate Scientist in the Centre for Urban Health Solutions.
Quality Improvement and Decision Support Specialist in the Department of Family and Community Medicine at St Michael's Hospital at the time of writing.
Can Fam Physician. 2019 Jan;65(1):e30-e37.
To compare rates of cervical, breast, and colorectal cancer screening between patients who are transgender and those who are cisgender (ie, nontransgender).
Cross-sectional study.
A multisite academic family health team in Toronto, Ont, serving more than 45 000 enrolled patients.
All patients enrolled in the family health team who were eligible for cervical, breast, or colorectal cancer screening. Patients were identified as transgender using an automated search of the practice electronic medical record followed by manual audit.
Screening rates for cervical, breast, and colorectal cancer calculated using data from the electronic medical record and provincial cancer screening registry. Screening rates among the transgender and cisgender populations were compared using tests, and logistic regression modeling was used to understand differences in screening after adjustment for age, neighbourhood income quintile, and number of primary care visits.
A total of 120 transgender patients were identified as eligible for cancer screening. More than 85% of transgender patients eligible for breast cancer screening were assigned male at birth. Transgender patients were less likely than cisgender patients (n = 20 514) were to be screened for cervical (56% vs 72%, = .001; adjusted odds ratio [OR] of 0.39; 95% CI 0.25 to 0.62), breast (33% vs 65%, < .001; adjusted OR = 0.27; 95% CI 0.12 to 0.59), and colorectal cancer (55% vs 70%, = .046; adjusted OR = 0.50; 95% CI 0.26 to 0.99).
In this setting, transgender patients were less likely to receive recommended cancer screening compared with the cisgender population. Future research and quality improvement activities should aim to understand and address potential patient, provider, and system factors.
比较跨性别患者和顺性别（即非跨性别）患者的宫颈癌、乳腺癌和结直肠癌筛查率。
横断面研究。
安大略省多伦多市一个多地点学术家庭健康团队，为超过 45000 名登记患者提供服务。
所有符合宫颈癌、乳腺癌或结直肠癌筛查条件并在家庭健康团队登记的患者。使用实践电子病历的自动搜索识别跨性别患者，然后进行手动审核。
使用电子病历和省级癌症筛查登记处的数据计算宫颈癌、乳腺癌和结直肠癌的筛查率。使用卡方检验比较跨性别和顺性别人群的筛查率，并使用逻辑回归模型在调整年龄、社区收入五分位数和初级保健就诊次数后，了解筛查差异。
共确定了 120 名符合癌症筛查条件的跨性别患者。超过 85%的有资格接受乳腺癌筛查的跨性别患者出生时被指定为男性。与顺性别患者（n=20514）相比，跨性别患者接受宫颈癌筛查的可能性较小（56% vs 72%，P<0.001；调整后的优势比[OR]为 0.39；95%CI 0.25 至 0.62）、乳腺癌筛查（33% vs 65%，P<0.001；调整后的 OR=0.27；95%CI 0.12 至 0.59）和结直肠癌筛查（55% vs 70%，P=0.046；调整后的 OR=0.50；95%CI 0.26 至 0.99）。
在本研究中，与顺性别人群相比，跨性别患者接受推荐癌症筛查的可能性较低。未来的研究和质量改进活动应旨在了解和解决潜在的患者、提供者和系统因素。
