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Research ArticleResearch

Cancer screening rates among transgender adults

Cross-sectional analysis of primary care data

Tara Kiran, Sam Davie, Dhanveer Singh, Sue Hranilovic, Andrew D. Pinto, Alex Abramovich and Aisha Lofters
Canadian Family Physician January 2019, 65 (1) e30-e37;
Tara Kiran
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.
MD MSc CCFP FCFP
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  • For correspondence: tara.kiran@utoronto.ca
Sam Davie
Quality Improvement and Decision Support Specialist in the Department of Family and Community Medicine at St Michael’s Hospital at the time of writing.
MSc
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Dhanveer Singh
Medical student in the School of Medicine at the Royal College of Surgeons in Ireland in Dublin.
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Sue Hranilovic
Primary health care nurse practitioner in the Department of Family and Community Medicine at St Michael’s Hospital.
NP-PHC MN
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Andrew D. Pinto
Founder and director of the Upstream Lab at the Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute at St Michael’s Hospital, a family physician and public health and preventive medicine specialist in the Department of Family and Community Medicine at St Michael’s Hospital, and Assistant Professor in the Department of Family and Community Medicine and Assistant Professor (status only) in the Dalla Lana School of Public Health at the University of Toronto.
MD CCFP FRCPC MSc
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Alex Abramovich
Independent scientist at the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health and Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto.
PhD MA
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Aisha Lofters
Scientist at the Centre for Urban Health Solutions in the Li Ka Shing Knowledge Institute at St Michael’s Hospital, a staff physician in the Department of Family and Community Medicine at St Michael’s Hospital, Assistant Professor and Clinician Scientist in the Department of Family and Community Medicine at the University of Toronto, Adjunct Scientist at ICES, and Assistant Professor in the Dalla Lana School of Public Health.
MD PhD CCFP
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    Figure 1.

    Process for identifying trans patients eligible for cervical, breast, or colorectal cancer screening

    EMR—electronic medical record, MRP—most responsible provider (physician or nurse practitioner).

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    Table 1.

    Definitions for identifying patients eligible and up-to-date for cancer screening based on trans care guidelines11 and provincial cancer screening guidelines12

    TYPE OF CANCER SCREENINGELIGIBLE PATIENTSDEFINITION OF UP-TO-DATE FOR SCREENINGEXCLUSIONS
    CervicalAssigned female at birth, aged 21 to 69 yReceived a Papanicolaou test in the previous 36 moPrevious total hysterectomy or cervical cancer
    BreastAssigned female at birth, aged 50 to 74 y
    Assigned male at birth, aged 50 to 74 y taking estrogen for > 5 y
    Received a mammogram in the previous 24 moPrevious mastectomy or breast cancer
    ColorectalAdults aged 50 to 74 yReceived either FOBT in the previous 24 mo or flexible sigmoidoscopy in the previous 5 y or a colonoscopy in the previous 10 yPrevious colon cancer or colectomy
    • FOBT—fecal occult blood testing.

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    Table 2.

    Demographic characteristics for rostered patients eligible for cancer screening

    CHARACTERISTICSTRANS PATIENTS (N = 120), N (%)CIS PATIENTS (N = 20 514), N (%)P VALUE*
    Age, y< .001
      • 21–2938 (32)1931 (9)
      • 30–3933 (28)4083 (20)
      • 40–4911 (9)3215 (16)
      • 50–5923 (19)5892 (29)
      • 60–7415 (13)5393 (26)
    Assigned sex at birth.361
      • Female91 (76)14 787 (72)
      • Male29 (24)5727 (28)
    Neighbourhood income quintile†.009
      • 1 (lowest)41 (36)5213 (27)
      • 225 (22)3146 (16)
      • 316 (14)3254 (17)
      • 417 (15)3253 (17)
      • 5 (highest)14 (12)4706 (24)
    No. of primary care visits in the previous 1 y< .001
      • 023 (19)4741 (23)
      • 114 (12)3888 (19)
      • 2–323 (19)5948 (29)
      • 4–1049 (41)5217 (25)
      • ≥ 1111 (9)720 (4)
    • ↵* Calculated using Embedded Image2 tests.

    • ↵† Data were missing for 7 trans patients and 942 cis patients.

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    Table 3.

    Trans and cis patients eligible for and receiving cancer screening

    TYPE OF CANCER SCREENINGTRANS PATIENTS (N = 120)CIS PATIENTS (N = 20 514)P VALUE*
    NO. ELIGIBLE FOR SCREENING TESTSCREENED, %NO. ELIGIBLE FOR SCREENING TESTSCREENED, %
    Cervical865613 68372.001
    Breast3033526565< .001
    Colorectal385511 24770.046
    • ↵* Embedded Image2 statistic comparing percentage screened among cisgender versus transgender patients.

    • View popup
    Table 4.

    Unadjusted and adjusted ORs comparing likelihood of trans individuals being screened for cancer compared with cis individuals

    TYPE OF CANCER SCREENINGUNADJUSTED OR (95% CI)ADJUSTED OR* (95% CI)
    Cervical0.46 (0.30 to 0.72)0.39 (0.25 to 0.62)
    Breast0.28 (0.13 to 0.60)0.27 (0.12 to 0.59)
    Colorectal0.51 (0.27 to 0.99)0.50 (0.26 to 0.99)
    • OR—odds ratio.

    • ↵* Adjusted for age, neighbourhood income quintile, and number of visits.

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Canadian Family Physician: 65 (1)
Canadian Family Physician
Vol. 65, Issue 1
1 Jan 2019
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Cancer screening rates among transgender adults
Tara Kiran, Sam Davie, Dhanveer Singh, Sue Hranilovic, Andrew D. Pinto, Alex Abramovich, Aisha Lofters
Canadian Family Physician Jan 2019, 65 (1) e30-e37;

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Cancer screening rates among transgender adults
Tara Kiran, Sam Davie, Dhanveer Singh, Sue Hranilovic, Andrew D. Pinto, Alex Abramovich, Aisha Lofters
Canadian Family Physician Jan 2019, 65 (1) e30-e37;
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