Prevalence of Cervical Cancer Precursor Lesions in Transgender Men: a Systematic Review

Abstract

Abstract Purpose To assess the prevalence of cervical cancer precursor lesions in transgender men who have undergone screening by Pap smear, with the intent of contributing with data for the formulation of public policies to widen access to this population. Methods observational studies were selected, with no language or year restrictions, which presented Pap smear results in transgender men. Reviews, case reports and qualitative studies were excluded. The PRISMA guidelines were followed. The risk of bias was assessed using the “NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies”. Results Eleven studies met the inclusion criteria. The prevalence of precursor lesions in transgender men was 0.8%, which is in line with the rates expected by the BETHESDA system for women. However, there was a very high rate of unsatisfactory results in this population (10%), compared to what was expected by the BETHESDA system (1%). Conclusion There is no difference between the prevalence of cervical cancer precursor lesions among transgender men and the expected population prevalence. The number of unsatisfactory tests is high, probably due to the use of testosterone by this population, which makes difficult to collect the material. Studies on transgender men are limited and heterogeneous, and mostly American, limiting the quality of evidence. We suggest that cervical cancer screening policies include, in the exams, information about transgender status and the use of testosterone so that we can reflect on the real health situation of trans men in the context of prevention.