Assessing Compliance with Cervical Cancer Screening in Transgender Adults

Transgender individuals maintain lower rates of cervical cancer screening (CCS) compared to cisgender individuals. We evaluated adherence to 2018 United States Preventive Services Task Force (USPSTF) guidelines in transgender men, and associated social determinants of health and prevalence of risk factors.

This was a retrospective, single-center study. CCS is recommended for all persons with an intact cervix including transgender men without a hysterectomy. Compliance with CCS was determined appropriate if patients aged 21 to 29 underwent pap testing alone within the past 3 years or patients aged 30-65 had Pap testing with high-risk HPV co-testing or high-risk HPV testing alone in the last 5 years. Comparisons of compliance vs. non-compliance used chi-square and Fisher's exact test analyses with statistical significance declared at p<0.05.

This study included 105 transgender men of which 74/105 (70.4%) were eligible for CCS. 52.1% (aged 21-29) and 39.4% (aged 30-65) were not current with CCS based on recommended guidelines respectively. Statistically significant differences in completion rate were noted based on insurance status (18.5% public vs. 81.5% private insurance) and education level (46.2% for college graduates vs. 3.8% for GED/high school graduates). There were no significant differences in compliance by race/ethnicity (60.8% non-Hispanic White; 21.6% Hispanic/Latino; 9.8% African American), employment, or marital status. Additionally, neither tobacco nor alcohol use was associated with lower compliance rates, and there was no association with a family history of cancer or abnormal HPV testing.

We continued to demonstrate disparities in CCS in transgender men. This study identifies particularly vulnerable sub-populations of transgender men -- those with public insurance and lower education – as more likely to lack CCS. Although limited by its retrospective nature, this study justifies further research to identify barriers to CCS and support the lack of association between lower screening rates and race, ethnicity, employment, or marital status in this population. This study emphasizes the need for continuous patient, community, and provider education on applicable guideline-approved screening to reduce health disparities.