Transgender women less likely to get screened for prostate cancer, physicians play a role

Key takeaways:

• Transgender women were significantly less likely to receive a PSA screening vs. cisgender men.
• A clinician’s recommendation was the biggest motivator for screening, highlighting their role in uptake.

Transgender women are significantly less likely than cisgender men to undergo prostate cancer screening, findings suggest, and the principal driver of the disparity appears to be whether physicians recommended testing — not access to care.

The U.S. Preventive Services Task Force currently recommends that men aged 55 to 69 years discuss the benefits of prostate-specific antigen (PSA) screenings with clinicians, whereas men aged 70 years and older should avoid PSA screenings.

“There is no consensus, however, among cancer screening guidelines on PSA screening in transgender women, and most guidelines exclude transgender women entirely,” Sandhya Kalavacherla, BS, a medical student at the University of California, San Diego, and colleagues wrote in JAMA Network Open.

According to the researchers, the lack of guidelines “may in part contribute to the lack of screening for prostate cancer in transgender women, who remain at risk for prostate cancer after transitioning.”

In a case-control study, Kalavacherla and colleagues analyzed surveys from the Behavioral Risk Factor Surveillance System administered between 2018 and 2020. The cohort included 255 transgender women and 1,020 cisgender men who were matched by sociodemographic variables.

They found that recent PSA screening rates among cisgender men and transgender women aged 55 to 69 years were 36.3% and 22.2%, respectively.

The researchers found that transgender women had lower odds of recent screening than cisgender men (OR = 0.65; 95% CI, 0.46-0.92) in an univariable logistic regression model. The association remained significant, even after the researchers adjusted their analysis for the time since the last primary care visit (OR =0.61; 95% CI, 0.42-0.87).

However, after the researchers adjusted for whether a clinician recommended a PSA test, there was no statistically significant difference in the odds of screening between transgender women and cisgender men. The finding was further weakened when researchers accounted for clinician-led discussions of PSA screening advantages and disadvantages.

In a multivariable logistic regression model, among transgender women, a clinician recommendation for PSA testing was the factor most strongly associated with a recent screening (OR = 12.4; 95% CI, 4.47-37.8), followed by a clinician-led discussion on PSA advantages (OR = 7.51; 95% CI, 2.49-24.9).

“It is well established that a significant barrier in transgender health care is lack of clinician competency, as most clinicians have little to no formal training in transgender care,” Kalavacherla and colleagues wrote. “As a result, despite having access to care, transgender individuals may still be less likely to seek non-gender-affirming care, such as PSA screening, with the added fear of being misgendered or misunderstood by inexperienced clinicians.”

They concluded clinicians should make the effort to initiate counseling “in a way that is also gender affirming.”

References:

• Kalavacherla S, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2023.56088.
• Prostate cancer: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening. Accessed Feb. 14, 2024.