Hull York Medical School Centre for Biomedical Research, Hull, UK.
CEO, OUTpatients, London, UK.
BMJ Evid Based Med. 2024 Nov 22;29(6):385-393. doi: 10.1136/bmjebm-2023-112719.
To examine disparities in attendance rates at cancer screening services between transgender and gender-diverse (TGD) people in comparison with their cisgender (CG) counterparts, and to determine whether these differences were based on the anatomical organ screened.
Systematic review and meta-analysis.
PubMed, EMBASE (via Ovid), CINAHL Complete (via EBSCO) and Cochrane Library from inception to 30 September 2023.
Studies for inclusion were case-control or cross-sectional studies with quantitative data that investigated TGD adults attending any cancer screening service. Exclusion criteria were studies with participants who were ineligible for cancer screening or without samples from TGD individuals, qualitative data and a cancer diagnosis from symptomatic presentation or incidental findings. A modified Newcastle-Ottawa Scale was used to assess risk of bias, during which seven reports were found incompatible with the inclusion criteria and excluded. Results were synthesised through random-effects meta-analysis and narrative synthesis.
We identified 25 eligible records, of which 18 were included in the analysis. These were cross-sectional studies, including retrospective chart reviews and survey analyses, and encompassed over 14.8 million participants. The main outcomes measured were up-to-date (UTD) and lifetime (LT) attendance. Meta-analysis found differences for UTD cervical (OR 0.37, 95% CI 0.23 to 0.60, p<0.0001) and mammography (OR 0.41, 95% CI 0.20 to 0.87, p=0.02) but not for prostate or colorectal screening. There were no meaningful differences seen in LT attendance based on quantitative synthesis. Narrative synthesis of the seven remaining articles mostly supported the meta-analysis. Reduced rates of screening engagement in TGD participants were found for UTD cervical and mammography screening, alongside LT mammography screening.
Compared with their CG counterparts, TGD individuals had lower rates of using cervical and mammography screening at the recommended frequencies but displayed similar prevalences of LT attendance. The greatest disparity was seen in UTD cervical screening. Limitations of this review included high risk of bias within studies, high heterogeneity and a lack of resources for further statistical testing. Bridging gaps in healthcare to improve cancer screening experiences and outcomes will require consolidated efforts including working with the TGD community.
CRD42022368911.
研究跨性别和性别多样化（TGD）人群与顺性别（CG）人群相比，在参加癌症筛查服务方面的差异，并确定这些差异是否基于筛查的解剖器官。
系统评价和荟萃分析。
从建库至 2023 年 9 月 30 日，PubMed、EMBASE（通过 Ovid）、CINAHL Complete（通过 EBSCO）和 Cochrane Library。
纳入的研究为定量数据的病例对照或横断面研究，调查了参加任何癌症筛查服务的 TGD 成年人。排除标准为不适合癌症筛查的参与者或没有 TGD 个体样本的研究、定性数据以及因症状出现或偶然发现而诊断出癌症的研究。使用改良的 Newcastle-Ottawa 量表评估偏倚风险，其中有 7 份报告与纳入标准不兼容，被排除在外。结果通过随机效应荟萃分析和叙述性综合进行综合。
我们确定了 25 份符合条件的记录，其中 18 份被纳入分析。这些研究是横断面研究，包括回顾性图表审查和调查分析，涵盖了超过 1480 万名参与者。主要测量的结果是最新（UTD）和终身（LT）就诊率。荟萃分析发现，UTD 宫颈癌（OR 0.37，95%CI 0.23 至 0.60，p<0.0001）和乳房 X 光检查（OR 0.41，95%CI 0.20 至 0.87，p=0.02）的差异有统计学意义，但前列腺或结直肠癌筛查的差异无统计学意义。基于定量综合分析，LT 就诊率没有明显差异。对其余 7 篇文章的叙述性综合分析大多支持荟萃分析。在 TGD 参与者中，发现 UTD 宫颈癌和乳房 X 光检查以及 LT 乳房 X 光检查的参与率较低。差异最大的是 UTD 宫颈癌筛查。本综述的局限性包括研究中存在高偏倚风险、高度异质性以及缺乏进一步统计测试的资源。为了改善癌症筛查体验和结果，弥合医疗保健方面的差距将需要包括与 TGD 社区合作在内的综合努力。
PROSPERO 注册号：CRD42022368911。
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