Luehmann Natalie, Ascha Mona, Chwa Emily, Hackenberger Paige, Termanini Kareem, Benning Christopher, Sama Danny, Felt Dylan, Beach Lauren B, Gupta Dipti, Kulkarni Swati A, Jordan Sumanas W
Division of Breast Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Ann Surg Oncol. 2022 Mar;29(3):1707-1717. doi: 10.1245/s10434-021-10932-z. Epub 2021 Oct 26.
Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center.
Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed.
Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2 years (42.3-62.6). Most patients had no family history of breast cancer (n = 163, 64.4%) and were on hormone therapy (n = 191, 75.5%). Most patients where White (n = 164, 64.8%), employed (n = 113, 44.7%), and had public insurance (n = 128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses.
Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.
跨性别者和非二元性别者（TGNB）群体对筛查指南的依从性尚未得到充分研究。本研究调查了一家城市学术医疗中心中TGNB患者的乳腺癌筛查模式。
收集人口统计学信息、风险因素和乳腺钼靶检查数据。根据国家指南计算目标人群的钼靶检查率，并计算钼靶检查人年数。进行单因素和多因素逻辑回归分析。
总共分析了253例患者：193例跨性别女性和出生时被指定为男性的非二元性别者（TGNB DMAB），以及60例跨性别男性和出生时被指定为女性的非二元性别者（TGNB DFAB）。年龄中位数（四分位间距）为53.2岁（42.3 - 62.6岁）。大多数患者没有乳腺癌家族史（n = 163，64.4%）且正在接受激素治疗（n = 191，75.5%）。大多数患者为白人（n = 164，64.8%），有工作（n = 113，44.7%），并拥有公共保险（n = 128，50.6%）。TGNB DFAB的乳腺筛查率较低，为2.0%至50.0%，TGNB DMAB的筛查率也较低，为7.1%至47.6%。TGNB DFAB组和TGNB DMAB组的筛查率之间没有显著差异。在TGNB DFAB患者中，单因素分析未显示钼靶检查的显著预测因素。在TGNB DMAB患者中，未接受激素治疗导致接受钼靶检查的几率较低。多因素分析没有显著结果。
TGNB人群的钼靶检查率低于顺性别患者的机构检查率和国家检查率，顺性别患者的机构检查率和国家检查率分别为77.3%和66.7% - 78.4%。应考虑过渡阶段、现有器官、激素治疗和风险因素来指导筛查。
