Regina Barragán-Carrillo, MD, on Educating Physicians About Breast Cancer Screening in the Transgender Population

Physicians that most often encounter transgender health as part of their current practice must be, on the firsthand, primary care physicians, as every adult patient needs their usual care. Nonetheless, talking about specialties, I would like to also add endocrinologists as part of the current standards of hormone replacement therapy requires a specialty, also adding surgical specialties, for example, plastic surgery, as well as OBGYN and urologists probably are the one that most typically encounter this type of patient. Nonetheless, I would not like to limit the transgender health to only them, as the current standard is a multidisciplinary care team.

At the end of the day, probably each and every one of us is going to have the chance to encounter these type of patients, which also justifies the need to be sensitized to the topic. Our study was centered on the general knowledge and attitudes of physicians. We developed a 15 item survey, which consisted of two parts. The first part, which was made of six questions, evaluating for current attitudes toward breast cancer screening in the transgender population, and nine questions regarding current knowledge. Talking about current knowledge, we wanted to know whether they were aware that transgender could, transgender patients could have less access also that are risk of a later breast cancer diagnosis, and also we ask specific recommendation for breast cancer screening to evaluate whether or not they were aware of the current recommendations.

So we learned three key points I would like to highlight. First is that current knowledge is very limited. When accounting for number of correct answers in the knowledge part, we could see that overall the scoring for all physician once 40%, which meant only 3.7 answers were selected correctly. Number two is that attitudes overall seem to be positive as most physicians did mention that this is a topic that they would like to be addressed in the curricula either during medical school or fellowship.

And point number three that I would like to highlight is that education is not needed only for physicians, but also to at risk communities, to empower them to know whether they need this type of screening strategies and also to look for them also actively. To educate physicians properly is quite a complex answer as we have been aware of. Educational interventions are not always the strategy that deal the better results. So on one part we can always seek peer to peer education, try to make our colleagues aware of the current recommendations, and also to add specific healthcare transgender health as part of the medical school and residency curricula must be an important intervention.

Finally, I would like also to address the topic about empowering our at risk communities to seek for this type of care and actually look for them actively and not only to wait for the physician to be the one that's aware of them.

Currently, there are a couple of guidelines that physicians might look after to wait for their current decision making and recommendations for their transgender patients. For transgender male patients without a gender affirming surgery, current guidelines state that they should undergo their usual breast cancer screening as for cis female patients. As for the trans male patients with gender affirmance surgery, there isn't currently a specific guideline to be followed, so this might be an area to be addressed in the future. And finally, for the trans female patients, we recommend to start screening after five years of hormone replacement therapy. The age is currently a topic to be discussed as there are guidelines that state to start at 40 years old, but there are also guidelines to that state that they should start at 50 years old. At the end of the day, it's important to adhere to one guideline and to follow it with our patients. Probably our key finding is that we as physicians of the group are not aware or are not fully aware of the screening strategies in the transgender patients, and at the end of the day, in this type of at risk populations, we need to actively seek for the better care in this type of patients. I would actively like to invite both physicians and patients to seek for better care and to understand that even though they represent minorities, that doesn't mean they shouldn't be getting the best standard of care available.