More info needed on transgender patients getting breast imaging

2020 01 28 00 09 7646 Transgender Pride Symbol 400

More background information is needed on patients who identify as nonbinary for better assessment and treatment of breast cancer, according to a study published December 10 in the Journal of the American College of Radiology.

A team led by Dr. Emily Sonnenblick from Mount Sinai Hospital also found that while radiologists may differ in their practice and knowledge of screening transgender patients for breast cancer, many are interested in contributing data to inform guidelines.

"The most important takeaway is that providers need to be educated about gender diversity and how gender-affirming treatment affects specific cancer risk," Sonnenblick told "Complete medical history related to sex and gender identity for each individual should be present in the medical record."

Approximately 0.6% of the U.S. population identifies as transgender: more than 1 million adults. While radiologists play a part in diagnostic and screening services for these individuals, data are scarce when it comes to the effects of estrogen and testosterone treatments on breast cancer risk and development.

Researchers point to "inadequate" recording in the EMR for precise sex and gender, including medical and surgical history related to transition, as an obstacle for patient-centered healthcare.

"Sexual orientation and gender identity have been shown to affect disease prevention by influencing participation in cancer screening," the authors wrote.

Sonnenblick et al wanted to investigate radiological practices related to recording sex and gender in the EMR. Their aim was to extend the existing literature by surveying North American breast radiologists about gender classification, transgender breast cancer screening protocols, and interest in national transgender screening databases.

The team sent out a 19-question survey to active physician members of the Society of Breast Imaging; 401 radiologists in the U.S. and Canada responded.

Out of a subset of 352 respondents, 44 said they recorded birth-assigned sex distinct from gender identity.

Geographic region played a part in how often radiologists followed guidelines and provided recommendations, with 38% to 62% of breast radiologists saying they follow screening guidelines for transgender women. Respondents from the northeastern part of the U.S. had the highest affiliation rates with clinics dedicated to LGBTQ individuals, as well as the highest rate of competency training for physicians and staff members.

Meanwhile, 65% of respondents said they did not provide screening recommendations for transgender men. The researchers noted that these individuals should have at least the same screening recommendations as cisgender women.

Of 400 respondents, 324 said they believed the evidence base for screening transgender individuals is incomplete, and 247 of 352 said they were either unsure of or had no LGBTQ competency training. However, 62% of respondents indicated they would enroll transgender patients in existing or novel national databases.

Limited knowledge among radiologists about special considerations for transgender individuals is a barrier to achieving a gender-inclusive environment for radiologic services, the authors wrote. Regional differences in care access and insufficient evidence to better inform guidelines were also identified as barriers.

"Breast radiologists are aware of limited data upon which to base breast cancer screening recommendations for transgender patients treated with gender-affirming hormones," Sonnenblick told "But the good news is that a substantial number of these doctors would be willing to provide anonymized data to a U.S. registry focused on the trans population."

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