BRIEF REPORT
Derek Chen, MS; Jeremy Erroba, BS; Shuling Liu, PhD; Tahlia Hodes, MPH; Heather Holderness, MPH; Nathalie Huguet, PhD; Christina Milano, MD
Corresponding Author: Derek Chen, MS; Oregon Health & Science University, Department of Family Medicine
Email: derek.chen@icahn.mssm.edu
DOI: 10.3122/jabfm.2023.230468R1
Keywords: Cancer Screening, Cervical Cancer, Gender Identity, Hormone Replacement Therapy, Papanicolaou Test, Primary Health Care, Retrospective Studies, Testosterone
Dates: Submitted: 12-13-2023; Revised: 05-02-2024; Accepted: 05-13-2024
FINAL PUBLICATION: |HTML| |PDF|
BACKGROUND: The Papanicolaou (Pap) test is an effective and widely used cervical cancer screening procedure. Recommendations for cervical cancer screening do not incorporate patients’ gender identities nor gender-affirming hormone statuses in determining screening surveillance intervals and interpreting test results. This study assessed the association between testosterone and rates of abnormal pap specimens and specimen adequacy by comparing testosterone-associated Pap specimens and non-testosterone Pap specimens among transgender and gender-diverse (TGD) patients.
METHODS: Retrospective electronic health record chart review of 211 TGD patients with cervixes, contributing 298 unique Pap tests, with a visit to a primary care clinic between 2012 and 2019. Primary outcomes included specimen quality (transformation zone [TZ] present, TZ absent, atrophic specimen, scant cellularity), presence of inflammation (yes/no), and cytology results (normal, abnormal, inadequate specimen). Chi-square and t-tests were used to compare results between testosterone-associated Pap specimens (TAPS) and non-testosterone specimens (NTS)
RESULTS: A higher proportion of TAPS had missing TZ, showed atrophy, or had scant cellularity than NTPS (58.8% vs 33.5%; p<0.001). Additionally, a higher proportion of TAPS showed inflammation (16.0% vs 3.4%; p<0.001). There was no significant difference in the proportion of abnormal results (i.e., cytologic features concerning for dysplasia) between the TAPS and NTPS groups.
CONCLUSIONS: Findings confirmed an association between testosterone usage and cytology specimen adequacy and quality. No association was found between testosterone usage and rates of abnormal results within our TGD population. More research is needed to disentangle the effect of missing TZ on risk of future cervical dysplasia among this younger population.