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

项目摘要/摘要 在美国，估计有140万人认为自己是变性人(TG)，定义为性别为 他们与出生时指定的性别不同，是美国国立卫生研究院(NIH)指定的少数民族人口(非MD-19-001)。 许多TG患者接受性别肯定的激素治疗，通常是基于雌激素或睾酮，以改变他们的 身体外貌和改善心理健康。终生暴露于雌激素是一种公认的 乳腺癌的危险因素(BC)。尽管TG人群不断增长，但在TG人群中发展为BC的风险是 对于如何为不列颠哥伦比亚省理想地筛查这些不应得的人群，目前还不清楚，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人员做出明智的决策，可能会导致 在TG社区中观察到癌症差异。我的研究议程的首要目标是开发 循证TG BC筛查指南。拟议的K08将开始填补关键的知识空白。在……里面 与我们的LGBTQ包容健康诊所合作，我们将建立一个试点BC筛查计划，并利用 在这一人群中探索BC风险和筛查的混合方法。这些数据将提供 发展多机构纵向TG BC筛查队列研究的必要基础 为TG社区内的BC筛查制定指南和最佳实践。这个 K08的基础性工作将通过三个具体目标来完成：1)确定回调和活检 筛查乳房X线片和全自动乳腺超声检查后TG的发生率，2)评估 通过调查和调查了解TG患者对BC风险、筛查和筛查经验的看法 面谈，以及3)确定对TG人员进行BC筛查的个人和系统层面的障碍，以及 通过面谈和焦点小组优化筛选流程。这些发现将提供有史以来第一次 乳腺钼靶X线筛查和全自动乳腺超声病变检测的前瞻性科学数据 在TG人群中。来自目标2和目标3的定性数据将确定个人和系统层面的障碍 筛选和机会，以改进筛选流程和体验。研究建议是 辅以以混合方法和调查研究为重点的全面和独特的培训计划， 性别研究、数据库开发以及队列招聘和保留。结合我的多样化 和协作式指导团队，此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和科学家，以及我为减少TG人群BC差异所做的努力 通过3个步骤的过程。新的试点BC筛查研究(步骤1)将提供必要的初步 提交R01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)，它将最终确定BC的终身风险和发病率，以告知开发情况 为TG患者制定基于证据的BC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).