Physician knowledge and attitudes toward breast cancer screening strategies in transgender population.

Abstract

71 Background: Transgender people experience intersecting forms of marginalization and suffer significant healthcare disparities. There is evidence that healthcare providers are insufficiently equipped to provide adequate healthcare to this population. Hormone-replacement therapy for trans-women requires blockade of androgen production and estrogen supplementation, which increases the risk of breast cancer (BC) compared to cis-males. Also, trans-women without gender-affirming mastectomy should undergo BC screening (BCS). We seek to explore the knowledge and attitudes among physicians regarding current strategies for breast cancer screening in trans-women and men. Methods: We adapted an online 15-item survey exploring knowledge and attitudes among physicians on strategies for BCS in trans people. The first 6-items evaluated attitudes, and the last 9-items knowledge. We conducted a pilot phase to assess physicians' understanding before the final data collection and adjusted it after corrections. Participants were invited through social media and directly peer-to-peer in June 2022. Descriptive statistics and Chi-square test were used for statistical analysis using SPSS ver. 26. Results: A total of 165 participants completed the survey, 96 (58.2%) self-identified as male, 66 (40%) female, and 2 (1.2%) non-binary gender with a mean age of 30 years (23 – 60 years). Most participants were residents and fellows (70.3%), and 29.7% were attendings. Overall, only 7.3% of participants felt confident in their knowledge of BCS in trans-people, 55.2% felt that had an inadequate preparation regarding transgender health during medical school and 86.1 and 83% agreed that it should be thoroughly addressed during medical school and residency, respectively. Regarding knowledge, 10.9% recognized that BC risk is different between trans- and cis-women, 9.7% identified that trans-women had a lower BC risk, and 77% answered that transgender people have insufficient access to health services. Finally, as for specific BC screening strategies, only 49.1% correctly identified BCS strategies for trans-women, 61.2% correctly answered the recommended age to start BCS in trans-women, 40.6% the periodicity for BCS, and 63% identified the correct recommendation for BCS trans-men without a gender-affirming mastectomy. Conclusions: Current physician knowledge regarding BCS strategies in the transgender population is limited. Nonetheless, respondents identified transgender health as an area of opportunity that might be addressed with widespread information. These findings reinforce that education of healthcare providers is required to end health inequalities faced by this diverse group of patients.