A Review on Cervical Cancer Screening in Transgender Men: What Are the Particularities of This Approach?

Abstract

Purpose:

Cervical cancer is the fourth most common cancer in the population with a uterus and vagina worldwide. Transgender men (TM) undergo less screening for cervical cancer than the population of cisgender women (CW). This project aims to summarize the evidence on screening methods for cervical cancer in TM.

Methods:

This is an integrative review structured along three axes: barriers of screening, colpocytology and human papillomavirus (HPV) screening. The keywords, “transgender,” “colpocytology,” “pap smear,” and “pap test,” were used to search articles in Embase and PubMed databases.

Results:

Three hundred and fifty-two articles were found, 12 of which were used to prepare this review. Disaffirmation of the patient’s gender and unequal power dynamics between patient and provider during screening contribute to patient unwillingness to be screened. TM are significantly less likely to receive Papanicolaou (Pap) tests. Unsatisfactory Pap tests are more frequent in TM due to vaginal atrophy caused by testosterone use. Even when compared with atrophic CW, the rate of unsatisfactory tests is lower in TM. Metaplasia and cellular changes such as “small cells” and dysplastic changes in TM may have their assessment impaired due to testosterone. HPV molecular detection can be a screening alternative for this group, and self-collection can be an alternative to increase screening rates in this population.

Conclusion:

TM have lower screening rates for cervical cancer than CW. Pap smear presents higher rates of unsatisfactory results in the TM population. The assessment of dysplasias may be hampered by the action of testosterone. Strategies that aim to evaluate HPV molecular biology detection and self-collection can improve this population’s adherence to screening programs.