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

项目概要/摘要 在美国，估计有140万人被认定为跨性别者（TG），定义为性别为 与出生时指定的性别不同，是NIH指定的少数群体（NOT-MD-19-001）。 许多TG人采取性别肯定激素疗法，通常是雌激素或睾酮为基础的，以改变他们的性别。 改善他们的身体外观和心理健康。终生暴露于雌激素是一个公认的 乳腺癌的危险因素（BC）。尽管TG人群不断增长，但TG人群中发生BC的风险仍然很高。 目前还不清楚，关于如何理想地筛选这种不应得的BC人群也没有达成共识。这些知识 差距阻碍了医疗保健提供者和TG人员之间的知情决策，可能导致 在TG社区中观察到的癌症差异。我的研究议程的首要目标是发展 基于证据的TG BC筛查指南。拟议的K 08将开始填补关键的知识空白。在 与我们的LGBTQ+包容性健康诊所合作，我们将建立一个试点BC筛查计划，并利用 混合方法的方法，以探讨BC的风险和筛查在这一人群中。这些数据将提供 开发多机构纵向TG BC筛查队列研究的必要基础， 在TG社区内制定BC筛查指南和BC筛查的最佳实践。的 基础K 08工作将通过三个具体目标完成：1）确定回调和活检 筛查乳腺X线摄影和自动乳腺超声检查后TG患者的发病率，2）评估 对BC风险的看法，筛查，以及通过调查TG个体的筛查经验， 访谈，以及3）确定对TG人员进行BC筛查的个人和系统级障碍，以及 通过访谈和焦点小组优化筛选过程。这些发现将首次提供 关于筛查性乳腺X线摄影和自动乳腺超声检查病变检测的前瞻性科学数据 在TG人群中。目标2和目标3的定性数据将确定个人和系统一级的障碍， 筛选和机会，以改善筛选过程和经验。研究建议是 辅之以侧重于混合方法和调查研究的全面而独特的培训计划， 性别研究、数据库开发以及队列招募和保留。结合我多样化的 和协作导师团队，这个学习和培训计划旨在优化我的无缝过渡 成为一名独立资助的外科医生-科学家，以及我努力减轻TG人群中的BC差异 通过三个步骤。新的试点BC筛选研究（第1步）将提供必要的初步 提交R 01申请以开发多机构纵向TG BC筛查的数据和经验 计划（步骤2），将明确确定BC的终身风险和发生率，以告知发展 基于证据的结核病筛查指南和最佳实践指南（步骤3）。

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).