It has been projected that during 2018, 1.7 million new cases of cancer will be diagnosed in the US and its territories; 37% associated to breast and uterine cervix (B/UC) cancer among cisgender females (persons that are not transgender). Cancer is the leading cause of death among Latinos. In Puerto Rico (PR) and Florida (FL), cancer is a leading cause of morbidity and mortality accounting for 17.7% and 21.6% of all deaths respectively. The highest incidence rates included B/UC cancer (34%). These data echo those of the American Cancer Society (ACS), which has indicated that B/UC cancer incidence in Latinos is among the highest when compared to other ethnic groups in the US. This is unfortunate as there is strong evidence that an individual's risk for developing B/UC cancer can be substantially reduced by engaging in healthy behaviors, including cancer screening. Transgender women (TW) and transgender men (TM) have been under-studied with regard to reproductive cancer risk and there is scarce information on how the disease affects their lives. WHO highlights that there is a measurably higher risk of breast and uterine cervix cancer faced by TM who retain their genitalia of birth. For TW, the development of breast tissue due to hormonal treatment may increase breast cancer risk. The scientific literature calls for understanding these risk factors in order to develop innovative approaches to support TW and TM with culturally sensitive, tailored interventions using accessible technology to assist them in overcoming barriers to cancer prevention and screening. The proposed project draws upon Transgender Theory, focusing on the important role that subjective experience the gendered body may have in B/UC cancer screening. Our adaptation of this theory posits that the embodied experiences of TW and TM may have a role in cancer risk because individuals may avoid or neglect body parts that are associated with their at-birth gender, which may be experienced as shameful or disliked. The proposed study aims to document barriers to B/UC cancer screening among TW and TM in PR and FL.
The specific aims are to: (1) Explore the role of transgender embodiment (i.e., internalized stigma related to body image; attitudes toward at-birth genitalia; gendered meanings of cancer screening) on the engagement in B/UC cancer screening among TW and TM, (2) Document the role of individual- level factors (i.e., lack of knowledge; attitudes towards cancer; self-efficacy for cancer screening) and social/structural-level factors (e.g., stigma; institutional and cultural barriers) on the engagement in B/UC cancer screening among TW and TM; and (3) Identify potential intervention content, format and delivery strategies (i.e., mobile technology) for the future development of an intervention to promote B/UC cancer screening among TW and TM. We will implement a sequential mixed methods design using qualitative interviews (20TW and 20TM), quantitative questionnaires (100 TW and 100 TM) and focus groups (10 TW and 10 TM). The gathered data will contribute to the understanding of multilevel barriers for B/UC cancer screening among TW and TM and the future development of an intervention to address them.
This study will produce knowledge addressing how transgender embodiment among Latino TW and TM influences their vulnerability to breast and uterine cervix cancer (B/UC) screening and decision-making about B/UC cancer screening. This is the only study of which we are aware to contribute to this area focusing on this population in Puerto Rico and Florida, which may lead to the development of innovative approaches to support TW and TM with culturally sensitive, tailored interventions using accessible technology (e.g. smartphones) to assist them in overcoming barriers to cancer prevention and screening.
