Understanding Breast Cancer Risk and Screening in Transgender Persons through a Pilot Breast Cancer Screening Program

通过乳腺癌筛查试点计划了解跨性别者的乳腺癌风险和筛查

基本信息

批准号：
10738974
负责人：
Chandler Scott Cortina
金额：
$ 21.03万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-20 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10738974
关键词：
Address Adult Age American Anxiety Appearance Award Biopsy Birth Breast Breast Cancer Detection Breast Cancer Risk Factor Callback Caring Chest Mass Clinic Cohort Studies Collaborations Communities Complement Consensus Coupled Data Databases Decision Making Dedications Detection Development Electronics Equity Estrogens Exposure to Face Faculty Focus Groups Foundations Funding Future Gender Gender Identity Goals Health Health Personnel Healthcare Systems Hormonal Image Incidence Individual Inferior Institution Interview Knowledge Lesbian Gay Bisexual Transgender Queer Lesion Literature Malignant Neoplasms Mammary Gland Parenchyma Mammary Ultrasonography Mammographic screening Mammography Mass in breast Mediating Medical Mental Health Mentors Mentorship Methods Minority Groups Modeling Operative Surgical Procedures Participant Pathology Perception Persons Population Practice Guidelines Process Prospective cohort Provider Qualitative Methods Radiology Specialty Registries Reporting Research Research Design Research Proposals Risk Risk Factors Role Scientist Screening for cancer Sensitivity and Specificity Stage at Diagnosis Stigmatization Suggestion Surgeon Surveys Testosterone Time Tissues Training Training and Education United States National Institutes of Health Woman Work assigned female at birth assigned male at birth breast imaging cancer care cancer health disparity career cis-female cis-male cisgender cohort design evidence base experience gender affirming hormone therapy health belief improved innovation insight lifetime risk malignant breast neoplasm men novel participant interview prevent process improvement programs prospective psychologic psychosocial recruit routine screening screening screening guidelines screening program sex sex assigned at birth skills social system-level barriers transgender transgender men transgender women

项目摘要

PROJECT SUMMARY/ABSTRACT In the U.S., an estimated 1.4 million people identify as transgender (TG), defined as a person whose gender is different than their sex assigned at birth, and are a designated minority population by the NIH (NOT-MD-19-001). Many TG persons take gender-affirming hormone therapy, usually estrogen or testosterone based, to alter their physical appearance and improve their psychological health. Lifetime exposure to estrogen is a well-established risk factor for breast cancer (BC). Despite a growing TG population, the risk of developing BC in TG persons is unclear and there is no consensus on how to ideally screen this undeserved population for BC. These knowledge gaps prevent informed decision-making among healthcare providers and TG persons, likely contributing to the cancer disparities observed in the TG community. The overarching goal of my research agenda is to develop evidence-based TG BC screening guidelines. The proposed K08 will begin to fill critical knowledge gaps. In collaboration with our LGBTQ+ Inclusion Health Clinic, we will establish a pilot BC screening program and utilize a mixed methods approach to explore BC risk and screening in this population. These data will provide the necessary foundation to develop a multi-institutional longitudinal TG BC screening cohort study which will inform the development of BC screening guidelines and best practices for BC screening within the TG community. The foundational K08 work will be accomplished through three specific aims: 1) determine the callback and biopsy rates of TG persons after screening mammography and automated breast ultrasonography, 2) assess perceptions towards BC risk, screening, and the screening experience of TG individuals through surveys and interviews, and 3) identify individual and systems-level barriers to BC screening for TG persons and methods to optimize the screening process through interviews and focus groups. These findings will provide the first-ever prospective scientific data on screening mammography and automated breast ultrasonography lesion detection in TG persons. The qualitative data from Aims 2 and 3 will identify individual and systems-level barriers to screening and opportunities to improve the screening process and experience. The research proposal is complemented by a comprehensive and distinctive training plan focused on mixed methods and survey research, gender studies, database development, and cohort recruitment and retention. In combination with my diverse and collaborative mentorship team, this study and training plan is designed to optimize my seamless transition to becoming an independently funded surgeon–scientist and my efforts to mitigate BC disparities in TG persons through a 3-step process. The novel pilot BC screening study (Step 1) will provide the necessary preliminary data and experience to submit an R01 application to develop a multi-institutional longitudinal TG BC screening program (Step 2) which will definitively establish the lifetime risk and incidence of BC to inform the development of evidence-based BC screening guidelines for TG persons and best practice guidelines (Step 3).

项目概要/摘要在美国，估计有 140 万人被认定为跨性别者 (TG)，跨性别者的定义是性别为与出生时指定的性别不同，并且是 NIH 指定的少数群体 (NOT-MD-19-001)。许多 TG 患者接受性别肯定激素治疗，通常是基于雌激素或睾酮的治疗，以改变他们的性别终生接触雌激素已是公认的。乳腺癌 (BC) 的危险因素尽管 TG 人群不断增长，但 TG 人群患 BC 的风险仍然很高。对于如何理想地筛查这些不合格人群的 BC，目前尚不清楚，也没有达成共识。防止医疗保健提供者和 TG 人员之间的知情决策差距，这可能有助于我的研究议程的首要目标是发展 TG 群体中观察到的癌症差异。拟议的 K08 将开始填补关键的知识空白。与我们的 LGBTQ+ 包容性健康诊所合作，我们将建立试点 BC 筛查计划并利用这些数据将提供探索 BC 风险和筛查的混合方法。开展多机构纵向 TG BC 筛查队列研究的必要基础，该研究将提供信息制定 TG 社区内 BC 筛查指南和 BC 筛查最佳实践。 K08 的基础工作将通过三个具体目标来完成：1）确定回调和活检筛查乳房 X 光检查和自动乳腺超声后 TG 人群的比率，2）评估通过调查和 TG 个人的看法 BC 风险、筛查和筛查经验访谈，以及 3) 确定对 TG 人员进行 BC 筛查的个人和系统层面的障碍以及方法通过访谈和焦点小组优化筛选过程这些发现将提供有史以来的第一次。关于筛查乳房X光检查和自动乳房超声检查病变检测的前瞻性科学数据目标 2 和 3 的定性数据将确定个人和系统层面的障碍。筛选以及改进筛选过程和体验的机会。辅以全面且独特的培训计划，重点关注混合方法和调查研究，性别研究、数据库开发以及队列招募和保留与我的多元化相结合。和协作导师团队，这个学习和培训计划旨在优化我的无缝过渡成为一名独立资助的外科医生兼科学家以及我为减少 TG 人群的 BC 差异所做的努力通过三步流程，新颖的 BC 筛选研究（步骤 1）将提供必要的初步结果。提交 R01 申请以开发多机构纵向 TG BC 筛查的数据和经验计划（步骤 2）将明确确定 BC 的终生风险和发病率，为发展提供信息针对 TG 人员的基于证据的 BC 筛查指南和最佳实践指南（步骤 3）。