Photo Credit: Lerbank
The disparity in prostate cancer screening between cisgender men and transgender women diminished when physicians recommended screening.
Most prostate cancer screening guidelines exclude transgender women. Despite transitioning, transgender women remain at risk of developing prostate cancer because prostatectomies are not performed during the surgical transition due to a high risk of complications. As a result, clinicians treating transgender women have an opportunity to educate their patients by explaining the benefits of prostate-specific antigen (PSA) screening.
Limited Data on Transgender Women
Because there are limited data regarding the factors that prevent transgender women from undergoing PSA screening, Sandhya Kalavacherla, BS, and colleagues developed a case-control study to identify the issues that prevent transgender women from receiving PSA screenings.
“In addition to a lack of clinician awareness on transgender-specific issues, transgender populations face heightened barriers to health care stemming from discrimination and socioeconomic disparities,” Kalavacherla and colleagues wrote in JAMA Network Open. “These barriers widen gaps in outcomes between transgender women and cisgender men and may have fatal consequences, as evidenced by the significantly lower uptake of many cancer screenings and treatment for transgender people.”
The study drew data from the Behavioral Risk Factor Surveillance System surveys to identify PSA screening rates between 2018 and 2020. The researchers identified 1,275 participants who met the criteria of being cisgender men or transgender women aged 40 or older who had completed PSA screening and had no history of prostate cancer. Of these, 255 were transgender women, and 1,020 were cisgender men. Kalavacherla and coinvestigators matched participants according to age, race, ethnicity, level of education, employment status, annual income, survey year, and identifiable cost barriers to receiving care.
In the selected group of participants, recent PSA screening (ie, screenings that took place within the past 2 years) occurred in 26 transgender women (22%) aged 55 to 69 years compared with 165 cisgender men (36.3%) in the same age group. In those aged 70 years and older, recent screening occurred in 26 transgender women (41.8%) and 98 cisgender men (40.2%).
More Than a Doctor’s Visit
Primary care visits alone did not significantly affect screening rates. Of the participants who had primary care visits within the past year, 26.6% of transgender women received PSA screening compared with 33.2% of cisgender men. Cisgender men also were more likely to report a physician-prompted recommendation for a PSA screening (41.8% [n=421] vs 32.9% [n=84]; P<0.001).
Rates of recent screening following a physician’s recommendation were similar between cisgender men and transgender women (64.2% [n=257] vs 63.4% [n=54]).
Researchers applied a univariable logistic regression model to evaluate the odds of recent screening in the participant group matched for sociodemographic and healthcare access variables. They found cisgender men had a higher likelihood of recent screening than transgender women (OR, 0.65; 95% CI, 0.46-0.92; P=0.02). The likelihood of recent screening was also significantly higher among cisgender men in a hierarchical regression analysis that included time since the last primary care visit (OR, 0.61; 95% CI, 0.42-0.87; P=0.007).
However, when researchers included physician recommendations for PSA testing, the difference in screening between cisgender men and transgender women was no longer statistically significant (OR, 0.83; 95% CI, 0.45-1.27; P=0.21). The screening gap between cisgender men and transgender women further diminished when physicians discussed the advantages and/or disadvantages of PSA screening (OR, 0.87; 95% CI, 0.47-1.31; P=0.32).
“Regular follow-up with a primary care clinician alone was not sufficient to observe equivalent screening uptake between cisgender men and transgender women. Rather, the occurrence of clinician-led recommendations for and discussions of the PSA screening test attenuated differences in PSA screening even when controlling for survey year, age, race and ethnicity, educational level, employment, annual income, and cost barriers to care,” the researchers wrote.
“These data underscore the clinician’s role in influencing use of prostate cancer screening among transgender women and highlight the importance of quantifying the long-term benefits of PSA screening in transgender women,” Kalavacherla and colleagues concluded.
