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Zorluk: OrtaPreventive Care and Screening

During a routine health maintenance visit, a 51-year-old transgender man discusses his preventive care needs. He has been receiving continuous gender-affirming testosterone therapy for the past six years. His surgical history includes a bilateral mastectomy with chest reconstruction performed five years ago; he has not undergone a hysterectomy or oophorectomy. He is a lifelong non-smoker and consumes one alcoholic beverage per week. His last preventive screening was a normal Papanicolaou (Pap) test with negative high-risk human papillomavirus (HPV) co-testing seven years ago. He has no significant family history of malignancy. His body mass index is 26 kg/m². Vital signs are within normal limits. Which of the following is the most appropriate next step in preventive care for this patient?

  1. A
    Routine screening mammography of the reconstructed chest wall
  2. B
    Reassurance that cervical cancer screening is no longer indicated
  3. Cervical cancer screening with high-risk human papillomavirus testing and/or cytologyCevap
  4. D
    Transvaginal ultrasound to screen for endometrial cancer
  5. E
    Administration of the 9-valent human papillomavirus vaccine

Cevap

Cervical cancer screening with high-risk human papillomavirus testing and/or cytology
The most appropriate next step is performing cervical cancer screening. The core principle of preventive care in transgender patients is to screen the anatomical structures that are present, based on standard age-appropriate guidelines, regardless of gender identity or hormonal therapy. This patient retains a cervix and is therefore at risk for cervical dysplasia and cancer. According to current guidelines, average-risk individuals between the ages of 30 and 65 should undergo screening every 3 years with cytology alone, every 5 years with high-risk HPV testing alone, or every 5 years with co-testing. Because this patient's last screening was 7 years ago, he is overdue and requires screening now.

Adım Adım Çözüm

1
Evaluate the patient's current anatomy based on surgical history.
The patient has had a bilateral mastectomy but retains a cervix, uterus, and ovaries.
Cancer screening guidelines are driven by the presence of specific anatomical structures, not by gender identity.
2
Determine the appropriate screening guidelines for the retained organs.
Patients with a cervix require cervical cancer screening every 3 to 5 years between ages 30 and 65.
Guidelines for cervical cancer screening apply equally to transgender men who have not undergone total hysterectomy.
3
Assess the patient's screening history against the recommended timeline.
The patient's last screening was 7 years ago, which exceeds the maximum recommended interval of 5 years for co-testing.
To maintain standard preventive care, a new screening test is indicated at this visit.

Anahtar Kavram

Preventive care and screening in transgender patients is based on the anatomical structures present, regardless of gender identity or hormonal therapy. Transgender men who retain a cervix require standard cervical cancer screening.
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Preventive Care and Screening

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