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Can Fam Physician. 2019 Jan;65(1):e30-e37.

Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data.

Author information

1
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. tara.kiran@utoronto.ca.
2
Quality Improvement and Decision Support Specialist in the Department of Family and Community Medicine at St Michael's Hospital at the time of writing.
3
Medical student in the School of Medicine at the Royal College of Surgeons in Ireland in Dublin.
4
Primary health care nurse practitioner in the Department of Family and Community Medicine at St Michael's Hospital.
5
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.
6
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.
7
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.

Abstract

OBJECTIVE:

To compare rates of cervical, breast, and colorectal cancer screening between patients who are transgender and those who are cisgender (ie, nontransgender).

DESIGN:

Cross-sectional study.

SETTING:

A multisite academic family health team in Toronto, Ont, serving more than 45 000 enrolled patients.

PARTICIPANTS:

All patients enrolled in the family health team who were eligible for cervical, breast, or colorectal cancer screening. Patients were identified as transgender using an automated search of the practice electronic medical record followed by manual audit.

MAIN OUTCOME MEASURES:

Screening rates for cervical, breast, and colorectal cancer calculated using data from the electronic medical record and provincial cancer screening registry. Screening rates among the transgender and cisgender populations were compared using 2 tests, and logistic regression modeling was used to understand differences in screening after adjustment for age, neighbourhood income quintile, and number of primary care visits.

RESULTS:

A total of 120 transgender patients were identified as eligible for cancer screening. More than 85% of transgender patients eligible for breast cancer screening were assigned male at birth. Transgender patients were less likely than cisgender patients (n = 20 514) were to be screened for cervical (56% vs 72%, P = .001; adjusted odds ratio [OR] of 0.39; 95% CI 0.25 to 0.62), breast (33% vs 65%, P < .001; adjusted OR = 0.27; 95% CI 0.12 to 0.59), and colorectal cancer (55% vs 70%, P = .046; adjusted OR = 0.50; 95% CI 0.26 to 0.99).

CONCLUSION:

In this setting, transgender patients were less likely to receive recommended cancer screening compared with the cisgender population. Future research and quality improvement activities should aim to understand and address potential patient, provider, and system factors.

PMID:
30674526
PMCID:
PMC6347308

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