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).

项目概要/摘要 在美国，估计有 140 万人被认定为跨性别者 (TG)，跨性别者的定义是性别为 与出生时指定的性别不同，并且是 NIH 指定的少数群体 (NOT-MD-19-001)。 许多 TG 患者接受性别肯定激素治疗，通常是基于雌激素或睾酮的治疗，以改变他们的性别 外表并改善他们的心理健康。终生接触雌激素是公认的 乳腺癌（BC）的危险因素。尽管 TG 人群不断增长，但 TG 人群患 BC 的风险仍然较高 目前尚不清楚，并且对于如何理想地筛查这些不合格人群的 BC 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，这可能会导致 TG 群体中观察到的癌症差异。我的研究议程的总体目标是开发 基于证据的 TG BC 筛查指南。拟议的 K08 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，我们将建立试点 BC 筛查计划并利用 探索该人群的 BC 风险和筛查的混合方法。这些数据将提供 开展多机构纵向 TG BC 筛查队列研究的必要基础，该研究将提供信息 制定 TG 社区内 BC 筛查指南和 BC 筛查最佳实践。这 K08 的基础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 光检查和自动乳腺超声检查后 TG 人群的比率，2）评估 通过调查和 TG 个人对 BC 风险、筛查和筛查经验的看法 访谈，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方法 通过访谈和焦点小组优化筛选过程。这些发现将首次提供 关于筛查乳房X光检查和自动乳房超声检查病变检测的前瞻性科学数据 在TG人中。目标 2 和 3 的定性数据将确定个人和系统层面的障碍 筛选以及改进筛选过程和体验的机会。研究计划是 辅以全面且独特的培训计划，重点关注混合方法和调查研究， 性别研究、数据库开发以及队列招募和保留。结合我的多元化 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兼科学家以及我为减少 TG 人群的 BC 差异所做的努力 通过 3 步过程。新颖的 BC 试点研究（步骤 1）将提供必要的初步信息 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）将明确确定 BC 的终生风险和发病率，为发展提供信息 针对 TG 人员的基于证据的 BC 筛查指南和最佳实践指南（步骤 3）。