Study highlights PSA screening gaps for transgender people
medwireNews: US researchers report a lower uptake of prostate-specific antigen (PSA) screening by transgender individuals than cisgender straight men.
However, cisgender gay and bisexual people were more than likely than their straight counterparts to participate in screening and “select gay individuals were more likely to make informed and shared decisions,” note Paula Neira (Johns Hopkins Center for Transgender Health, Baltimore, Maryland) and team.
They used data on 164,370 participants of the US Behavioral Risk Factor Surveillance System database for the years 2014–2016 and 2018, when questions about PSA screening were included in the annual survey. The majority (95.2%) were cisgender straight men, while 2.0% identified as cisgender gay, 1.0% as cisgender bisexual, 1.5% as cisgender other sexual orientation, and 0.2% identified as male-to-female transgender.
Compared with cisgender straight individuals, cisgender gay and bisexual people were significantly more likely to have undergone PSA screening within the past 2 years (odds ratios [ORs]=1.07 and 1.06, respectively), to have ever undergone screening (ORs=1.29 and 1.13, respectively), or to have been recommended screening by their physician (ORs=1.15 and 1.16, respectively) after accounting for a raft of demographic variables.
By contrast, each of these outcomes was significantly less likely for the cisgender other group, at ORs of 0.82, 0.80, and 0.80, respectively, and the transgender group, with corresponding ORs of 0.23, 0.17, and 0.19.
As reported in European Urology, only cisgender gay people were significantly more likely than their straight counterparts to make an informed decision (OR=1.10) and to be involved in shared decision-making (OR=2.55).
Cisgender bisexual, cisgender other, and transgender individuals were significantly less likely to make informed decisions, “while there was no association” for these groups in terms of shared decision-making, say the study authors.
These findings are “consistent with a prior report suggesting that nonheterosexual men may experience more intensive screening” comment Neira and colleagues.
They continue: “However, the reasons for greater participation in informed and shared decision-making by select gay populations are unclear.
“A diagnosis of prostate cancer may affect same-sex partners differently, and these couples could be concerned about prostate cancer in the context of human immunodeficiency virus or other sexually transmitted infections.”
The researchers express concern at the reduced uptake of PSA screening by the transgender participants, noting that “[t]ransgender women have a risk of prostate cancer irrespective of gonadectomy, genital reconstruction, or feminizing hormone therapy that may shrink the prostate gland.”
And the team concludes: “Thus, greater awareness of preventive cancer care that is organ-oriented in this population and research on social determinants of health that might hinder its utilization are urgently needed.”
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