Anal Cancer Risk Factors and Utilization of Anal Pap Smear Screening Among Transgender Persons

Abstract

Objective: To identify risk factors for and understanding of anal cancer and associated screening tests among transgender persons. Methods: An anonymous survey was designed and distributed with SurveyMonkey.com to transgender persons recruited at health fairs, surgical clinics, and self-referral by word of mouth. Descriptive statistical analysis was performed. Results: 24 transgender women (TGW), age 23–67 years old (mean=42) and 13 transgender men (TGM), age 18–59 years old (mean=29) participated. The majority were Caucasian [TGW, 15 (63%); TGM, 12 (92%)], and insured [17(71%) TGW; 10 (77%) TGM]. Reported risk factors for anal cancer included smoking history [(14 (58%) TGW; 7(54%) TGM], past STI diagnosis [9(38%) TGW; 1(8%) TGM], HIV positivity (1(4%) TGW), receptive anal intercourse [17(71%) TGW, 7(54%) TGM], and inconsistent condom use [10(42%) TGW; 7(54%) TGM]. Only 4(17%) TGW perceived themselves to be at risk for anal cancer. Most TGW reported little to no knowledge of anal cancer (16, 67%) or anal pap smears (18, 75%). While five (21%) reported past screening, most expressed willingness to undergo future testing (n=19, 79%). Among TGM, only two (15%) perceived themselves to be at risk for anal cancer; five (38%)were familiar with anal pap smears; and only one (8%) person reported past testing. Eight (62%) reported willingness for future screening. Conclusion: Transgender persons have multiple risk factors for anal cancer, yet self-perceived risk is low. Most are unfamiliar with anal cancer screening and have not been tested. This suggests transgender persons would benefit from increased awareness of anal cancer risk and screening methods.