BOSTON, Mass.—Fenway Health’s Jennifer Potter, MD, and colleagues at Fenway, Harvard Medical School and the Johns Hopkins School of Public Health have published study results in the Journal of General Internal Medicine finding that female to male (FTM) transgender patients had over 10 times higher odds of having an inadequate Papanicolaou (Pap) test compared to female patients.
The researchers found that FTM patients were more likely to have an inadequate Pap, with prevalence of inadequate samples 8.3 times higher among tests of FTM patients (10.8% vs. 1.3% of tests); were more likely to have had multiple inadequate Pap tests; and had longer latency to follow-up testing. Time on testosterone therapy was also independently associated with, but did not fully account for, Pap inadequacy. [pullquote]Cervical cancer can still occur in FTM transgender men, the majority of whom do not undergo complete sex reassignment surgery or undergo total hysterectomy later in life. Because of this, national guidelines recommend that transgender men with a cervix follow the same screening protocol as non-transgender females.[/pullquote]
Cervical cancer can still occur in FTM transgender men, the majority of whom do not undergo complete sex reassignment surgery or undergo total hysterectomy later in life. Because of this, national guidelines recommend that transgender men with a cervix follow the same screening protocol as non-transgender females.
This study points to the need to better understand and address possible reasons for Pap inadequacy among FTM patients, including cytological changes induced by testosterone and patient/provider discomfort with the pelvic exam. In addition, alternatives to repeated Pap testing, such as cytologic reprocessing of inadequate samples or primary HPV DNA screening should be studied for efficacy and acceptability among FTM patients.
“Pap tests are important for FTM patients but it can be challenging to obtain interpretable results,” said Dr. Potter, Director of Women’s Health at Fenway Health. “More information is needed on the effects of testosterone on the cervix and effective cervical screening strategies that do not rely on a Pap test. While we wait for results of studies that address these questions clinicians should do everything possible to increase patient comfort during the exam and alert FTM patients that repeat Pap testing may be necessary after an initial, inadequate result.”
This retrospective electronic medical record review study analyzed results of Pap tests performed on 233 FTM and 3625 female patients at an urban community health center between 2006 and 2012.
The Journal of General Internal Medicine (JGIM) is the official journal of the Society of General Internal Medicine. It promotes improved patient care, research, and education in primary care, general internal medicine, and hospital medicine. Its articles focus on clinical medicine, epidemiology, prevention, health care delivery, curriculum development, and some non-traditional themes. JGIM offers early publication on www.link.springer.com to reach a broad audience, with online access to abstracts and full articles rapidly growing each year. Learn more about JGIM at www.sgim.org/jgim.
For more than forty years, Fenway Health has been working to make life healthier for the people in our neighborhood, the LGBT community, people living with HIV/AIDS and the broader population. The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues. Fenway’s Sidney Borum Jr. Health Center cares for youth and young adults ages 12 to 29 who may not feel comfortable going anywhere else, including those who are LGBT or just figuring things out; homeless; struggling with substance use; or living with HIV/AIDS. In 2013, AIDS Action Committee of Massachusetts joined the Fenway Health family, allowing both organizations to improve delivery of care and services across the state and beyond.
[From a News Release]