Cytology and High-Risk Human Papillomavirus Testing Performance for Cervical Cancer Screening in Transmasculine...

Area of Science:

• Gynecology
• Oncology
• Transgender Health

Background:

• Cervical cancer screening is crucial for early detection of precancerous lesions.
• Transmasculine individuals may have unique considerations for cervical cancer screening due to hormone use and differing healthcare experiences.
• Assessing the effectiveness of current screening methods in diverse populations is essential for equitable healthcare.

Purpose of the Study:

• To estimate the specificity of cytology and high-risk human papillomavirus (hrHPV) testing in predicting cervical intraepithelial neoplasia 2 (CIN2+) among transmasculine patients.
• To compare the specificity of cytology and hrHPV tests between transmasculine patients using testosterone, and premenopausal and postmenopausal cisgender patients.

Main Methods:

• A multicenter retrospective cohort study included 149 individuals aged 18-65 undergoing cervical cancer screening.
• Transmasculine patients were included if using testosterone for at least 6 months without estrogen supplementation.
• Specificity was analyzed for co-tests followed by colposcopy or hysterectomy using McNemar's test.

Main Results:

• In transmasculine patients, the specificity of cytology (68.9%) and hrHPV tests (63.9%) for predicting CIN2+ was comparable (p=0.26).
• Sensitivity was also equivalent between the two methods in the transmasculine cohort.
• In postmenopausal cisgender patients, hrHPV screening showed significantly lower specificity (24.1%) compared to cytology (69.0%).

Conclusions:

• Cytology and hrHPV screening demonstrate similar predictive ability for CIN2+ in transmasculine individuals.
• Given high rates of insufficient cytology, primary hrHPV screening could be a viable option for transmasculine patients.
• This approach may help reduce unnecessary pelvic examinations and diagnostic procedures in this population.