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1. The accuracy of anal self- and companion exams among sexual minority men and transgender women: a prospective analysisResearch in context

Author

Alan G. Nyitray, Timothy L. McAuliffe, Cameron Liebert, Michael D. Swartz, Ashish A. Deshmukh, Elizabeth Y. Chiao, Lou Weaver, Ellen Almirol, Jared Kerman, John A. Schneider, J. Michael Wilkerson, Lu-Yu Hwang, Derek Smith, and Aniruddha Hazra

Subjects
Anus neoplasms, Early detection of cancer, Digital anal rectal examination, HIV, Anal canal, Homosexuality, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Squamous cell carcinoma of the anus (SCCA) annual incidence among sexual minority men with and without HIV is 85/100,000 and 19/100,000 persons, respectively, which is significantly higher than the overall incidence (2/100,000). Incidence may also be higher in transgender women. Since SCCA tumours average ≥30 mm at diagnosis, we assessed the accuracy of individuals to self-detect smaller anal abnormalities. Methods: Using convenience sampling, the study enrolled sexual minority men and transgender women, aged 25–81 years, in Chicago, Illinois and Houston, Texas, USA, during 2020–2022. Individuals were taught the anal self-examination and anal companion examination (ASE/ACE). Then, a clinician performed a digital anal rectal examination (DARE) before participants conducted the ASE or ACE. The sensitivity, specificity and concordance of the ASE/ACE to detect an abnormality were measured along with factors associated with ASE/ACE and DARE concordance. Findings: Among 714 enrolled individuals, the median age was 40 years (interquartile range, 32–54), 36.8% (259/703) were living with HIV, and 47.0% (334/710), 23.4% (166/710), and 23.0% (163/710) were non-Hispanic white, non-Hispanic Black, and Hispanic, respectively. A total of 94.1% (671/713) identified as cisgendered men, and 5.9% (42/713) as gender minorities. A total of 658 participants completed an ASE and 28 couples (56 partners) completed an ACE. Clinicians detected abnormalities in 34.3% (245/714) of individuals. The abnormalities were a median of 3 mm in diameter. Sensitivity and specificity of the ASE/ACE was 59.6% (95% CI 53.5–65.7%) and 80.2% (95% CI 76.6–83.8%), respectively. Overall concordance was 0.73 (95% CI 0.70–0.76) between ASE/ACE and DARE and increased with increasing anal canal lesion size (p = 0.02). Concordance was lower when participants were older and received ASE/ACE training from a lay person rather than a clinician. Interpretation: Sexual minority men/transgender women may self-detect SCCA when malignant lesions are much smaller than the current mean dimension at presentation of ≥30 mm. Funding: National Cancer Institute.

Published
2024
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2. Comparing smoking behavior between female-to-male and male-to-female transgender adults

Author

Minxing Chen, Lou Weaver, Anushree Sharma, Irene Tamí-Maury, Janice A. Blalock, Juan Ortiz, and Sanjay Shete

Subjects
Pride, Health (social science), Epidemiology, media_common.quotation_subject, Population, Psychological intervention, Logistic regression, Health Professions (miscellaneous), Smoking behavior, 03 medical and health sciences, 0302 clinical medicine, Transgender, Medicine, 030212 general & internal medicine, gender identity, education, smoking behaviour, media_common, education.field_of_study, 030505 public health, Gender identity, business.industry, lcsh:Public aspects of medicine, Public Health, Environmental and Occupational Health, lcsh:RA1-1270, transgender, Erratum, 0305 other medical science, business, Male to female, Research Paper, Demography
Abstract

Introduction This study aimed to assess the association between current smoking and gender identity among transgender individuals. Methods Data were collected using a cross-sectional survey distributed among transgender individuals attending the Houston Pride Festival and those seeking care at a local transgender health clinic. Relevant variables were compared between female-to-male (FTM) and male-to-female (MTF) transgender individuals using χ2, Fisher's exact, and two-sample t-tests, when appropriate. Gender identity was used to predict current smoking status using logistic regression, adjusting for other sociodemographic determinants. Results The study sample (N=132) comprised 72 MTF (54.5%) and 60 FTM (45.5%) transgender individuals. Mean age of participants was 31.8 years. The sample was racially and ethnically diverse: 45.8% Caucasian, 25.2% Hispanic/Latino, 16.8% African American, and 12.2% other. Current smoking prevalence was 26.7% and 13.9% among FTM and MTF individuals, respectively. Transgender individuals were more likely to self-report current smoking if they were FTM (OR=3.76; 95% CI: 1.17-12.06; p=0.026) or were insured (OR=4.49; 95% CI: 1.53-13.18; p=0.006). Conclusions This study reports on important findings by examining intragroup differences in smoking behavior among the transgender population. However, further research is needed for tailoring smoking prevention and cessation interventions for transgender subgroups.

Published
2019

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