Answer Key: How Should Clinicians Approach Screening for Gynecologic Cancer in Sexual Minority and Transgender Patients?
Answer Key:
1. Which factor most contributes to lower cervical cancer screening rates among sexual minority women (SMW)?
Correct Answer: Belief that they are at lower risk of cervical cancer
SMW often perceive themselves to be at lower risk of cervical cancer, partly due to misconceptions that HPV transmission only occurs with male partners. This belief, combined with heteronormative public health messaging and provider bias, reduces screening uptake. However, SMW are at comparable or even elevated risk of cervical dysplasia and HPV infection.
2. Which strategy has been shown to improve acceptability and uptake of cervical cancer screening in both SMW and transgender men/nonbinary (TMNB) individuals?
Correct Answer: HPV self-sampling
HPV self-sampling has been found to increase comfort, autonomy, and willingness to undergo screening among SGM populations. It addresses barriers such as dysphoria, stigma, and discomfort with speculum examinations, making it a valuable harm-reductive option.
3. For TMNB individuals on long-term testosterone therapy, which factor can complicate cervical cancer screening results?
Correct Answer: Vaginal atrophy leading to unsatisfactory cytology
Testosterone therapy commonly causes vaginal atrophy, which can lead to poor sample quality during Pap smears, increasing the risk of unsatisfactory cytology results. HPV testing may be preferable in this population to improve diagnostic accuracy.
Reference:
Mayer G, Leone AG, Korostoff-Larsson O, et al. Breast and gynecologic cancer care for sexual minority women and transgender people. Am Soc Clin Oncol Educ Book. 2025;45(3):e473608. doi:10.1200/EDBK-25-473608.
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