Understanding Breast Cancer Risk and Screening in Transgender Persons through a Pilot Breast Cancer Screening Program

通过乳腺癌筛查试点计划了解跨性别者的乳腺癌风险和筛查

• 批准号: 10738974
• 负责人: Chandler Scott Cortina
• 金额: $ 21.03万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-20 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738974
• 关键词: Address; Adult; Age; American; Anxiety; Appearance; Award; Biopsy; Birth; Breast; Breast Cancer Detection; Breast Cancer Risk Factor; Callback; Caring; Chest Mass; Clinic; Cohort Studies; Collaborations; Communities; Complement; Consensus; Coupled; Data; Databases; Decision Making; Dedications; Detection; Development; Electronics; Equity; Estrogens; Exposure to; Face; Faculty; Focus Groups; Foundations; Funding; Future; Gender; Gender Identity; Goals; Health; Health Personnel; Healthcare Systems; Hormonal; Image; Incidence; Individual; Inferior; Institution; Interview; Knowledge; Lesbian Gay Bisexual Transgender Queer; Lesion; Literature; Malignant Neoplasms; Mammary Gland Parenchyma; Mammary Ultrasonography; Mammographic screening; Mammography; Mass in breast; Mediating; Medical; Mental Health; Mentors; Mentorship; Methods; Minority Groups; Modeling; Operative Surgical Procedures; Participant; Pathology; Perception; Persons; Population; Practice Guidelines; Process; Prospective cohort; Provider; Qualitative Methods; Radiology Specialty; Registries; Reporting; Research; Research Design; Research Proposals; Risk; Risk Factors; Role; Scientist; Screening for cancer; Sensitivity and Specificity; Stage at Diagnosis; Stigmatization; Suggestion; Surgeon; Surveys; Testosterone; Time; Tissues; Training; Training and Education; United States National Institutes of Health; Woman; Work; assigned female at birth; assigned male at birth; breast imaging; cancer care; cancer health disparity; career; cis-female; cis-male; cisgender; cohort; design; evidence base; experience; gender affirming hormone therapy; health belief; improved; innovation; insight; lifetime risk; malignant breast neoplasm; men; novel; participant interview; prevent; process improvement; programs; prospective; psychologic; psychosocial; recruit; routine screening; screening; screening guidelines; screening program; sex; sex assigned at birth; skills; social; system-level barriers; transgender; transgender men; transgender women

PROJECT SUMMARY/ABSTRACT In the U.S., an estimated 1.4 million people identify as transgender (TG), defined as a person whose gender is different than their sex assigned at birth, and are a designated minority population by the NIH (NOT-MD-19-001). Many TG persons take gender-affirming hormone therapy, usually estrogen or testosterone based, to alter their physical appearance and improve their psychological health. Lifetime exposure to estrogen is a well-established risk factor for breast cancer (BC). Despite a growing TG population, the risk of developing BC in TG persons is unclear and there is no consensus on how to ideally screen this undeserved population for BC. These knowledge gaps prevent informed decision-making among healthcare providers and TG persons, likely contributing to the cancer disparities observed in the TG community. The overarching goal of my research agenda is to develop evidence-based TG BC screening guidelines. The proposed K08 will begin to fill critical knowledge gaps. In collaboration with our LGBTQ+ Inclusion Health Clinic, we will establish a pilot BC screening program and utilize a mixed methods approach to explore BC risk and screening in this population. These data will provide the necessary foundation to develop a multi-institutional longitudinal TG BC screening cohort study which will inform the development of BC screening guidelines and best practices for BC screening within the TG community. The foundational K08 work will be accomplished through three specific aims: 1) determine the callback and biopsy rates of TG persons after screening mammography and automated breast ultrasonography, 2) assess perceptions towards BC risk, screening, and the screening experience of TG individuals through surveys and interviews, and 3) identify individual and systems-level barriers to BC screening for TG persons and methods to optimize the screening process through interviews and focus groups. These findings will provide the first-ever prospective scientific data on screening mammography and automated breast ultrasonography lesion detection in TG persons. The qualitative data from Aims 2 and 3 will identify individual and systems-level barriers to screening and opportunities to improve the screening process and experience. The research proposal is complemented by a comprehensive and distinctive training plan focused on mixed methods and survey research, gender studies, database development, and cohort recruitment and retention. In combination with my diverse and collaborative mentorship team, this study and training plan is designed to optimize my seamless transition to becoming an independently funded surgeon–scientist and my efforts to mitigate BC disparities in TG persons through a 3-step process. The novel pilot BC screening study (Step 1) will provide the necessary preliminary data and experience to submit an R01 application to develop a multi-institutional longitudinal TG BC screening program (Step 2) which will definitively establish the lifetime risk and incidence of BC to inform the development of evidence-based BC screening guidelines for TG persons and best practice guidelines (Step 3).

项目总结/文摘