Transgender Patients, Bisexual Women Less Likely to Have Mammograms.

Transgender patients are less likely than cisgender (or non-transgender) women to adhere to mammography screening guidelines, and bisexual women are less likely than heterosexuals or lesbians to utilize mammography, a study led by a School of Public Health researcher shows.

In the study, published online in the American Journal of Public Health, Angela Robertson Bazzi, assistant professor of community health sciences, and co-authors found that among 1,263 patients at an urban community health center in Boston, male-to-female trans women and preoperative trans men (those who had not undergone gender affirmation surgery) were about half as likely as cisgender women to adhere to mammography guidelines. The finding “is of particular concern for trans men without bilateral mastectomy who remain at risk for breast cancer,” the authors said.

Recommendations for trans women are less clear, but some experts recommend that this group follow the same mammography guidelines as cisgender women, particularly if they are older than 50 and have used estrogen for five years or more.

The finding that bisexual women were less likely than heterosexual women or lesbians to get mammograms points to a need to better understand cancer disparities relating to sexual orientation, the researchers said. Elevated rates of breast cancer among sexual minority women have been reported and are not fully explained by differences in insurance coverage, they noted.

“The specifics of breast cancer screening continue to be clarified, as evidenced by recent changes in the American Cancer Society’s mammography screening recommendations,” Bazzi said. “Regardless of the exact guidelines followed, it is important to understand mammography utilization among sexual and gender minority populations. Additional investigation is needed to elucidate why mammography services are underutilized in these populations.”

Overall, 72 percent of the study population, ages 40 to 67, adhered to mammography screening guidelines. Data were collected from 2012 through 2013—before the release of the new American Cancer Society recommendations.

Besides Bazzi, authors on the study were Debra Whorms, Dana King, and Jennifer Potter, all of Fenway Health.

—Lisa Chedekel