Date of Graduation

Summer 8-10-2019

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: The vast majority of cervical cancers are caused by high-risk strains of human papillomavirus (HPV). Conventional screening by Papanicolaou (Pap) smear can effectively prevent the development of cervical cancer, but transmasculine (TM) individuals (those assigned female at birth, but who do not identify as female) utilize screening less frequently than their cisgender counterparts. Self-collected HPV samples may be viewed as more acceptable by TM patients and may be an equally effective screening method, which could ultimately increase cervical cancer screening uptake in this underserved population.

Methods: An exhaustive search of the literature using MEDLINE-PubMed, CINAHL, and Web of Science with the terms transmasculine, screening, self, and HPV. The resulting studies were appraised and assessed for quality using GRADE.

Results: Three studies met eligibility criteria and were included in this review. One observational study surveyed 91 transmasculine subjects and found that over 50% preferred self-collection methods for cervical cancer screening. An additional observational study collected information from 62 TM participants and found that a clear majority preferred self-collected frontal swabs, or at least provider-collected frontal swabs, over traditional Pap testing. The final article described a mixed methods study, including both an observational and RCT portion. The authors found that most of the participants expressed similar preferences to those in the previous two studies. They also found substantial concordance between self-collected vaginal swabs and provider-collected cervical swabs, which is the current gold standard.

Conclusion: Self-collected vaginal HPV samples are seen as highly acceptable among TM patients, show substantial concordance with Pap testing, and appear to be an efficacious alternative. This is especially true in patients who refuse conventional screening or are not utilizing preventative care. Offering self-collection as a primary HPV screening method would likely increase cervical cancer screening uptake among the TM population.

Keywords: Transmasculine, screening, self-collected, HPV, cervical cancer, perceptions, acceptability, efficacy, concordance

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