Before the introduction of cervical cancer screenings, the disease used to be the leading cause of cancer death for women in the US. Though it is now the 14th cause of death, new research suggests that compared with female patients, female-to-male transgender patients are much more likely to have inadequate cell samples taken during screening.

The research team, led by Dr. Jennifer Potter, director of women’s health at Fenway Health in Boston, MA, published their findings in the Journal of General Internal Medicine.

The investigators note that cervical cancer can still occur in female-to-male (FTM) transgender men, particularly as most of these individuals do not undergo a complete sex reassignment or have a full hysterectomy later in life.

National screening guidelines state that FTM transgender men with a cervix should follow the same cervical cancer screening protocol as females. They should undergo a Papanicolaou (Pap) test every 3 years between the ages of 21 and 65.

But the researchers note that there is very little information on whether there are any differences in cervical cancer screening accuracy between FTM transgender individuals and non-transgender females.

To investigate, the research team analyzed the results of Pap tests from 3,625 female patients and 233 FTM transgender patients that were performed between 2006 and 2012.

A Pap test involves a doctor or nurse scraping the outer opening of a patient’s cervix in order to collect a sample of cells. These cells are then analyzed under a microscope for any abnormalities.

From the analysis, the investigators found that FTM transgender patients were 8.3 times more likely to have inadequate samples taken, compared with female patients. This increased to 10 times more after the researchers adjusted for age, race and body mass index (BMI).

Furthermore, the researchers found that FTM transgender patients were more likely to have multiple inadequate Pap tests compared with female patients, and they also had longer time periods between follow-up testing.

The investigators note that inadequate Pap testing for FTM transgender patients was independently linked to testosterone therapy, but this did not fully account for the poor samples in these individuals.

The research team says their study calls for further research to be carried out to determine why there is such a high rate of Pap inadequacy in FTM transgender patients, suggesting that cell changes as a result of testosterone and patient/doctor discomfort during the examination should be assessed as potential reasons.

“Pap tests are important for FTM patients but it can be challenging to obtain interpretable results,” say Dr. Potter, adding:

More information is needed on the effects of testosterone on the cervix and effective cervical screening strategies that do not rely on a Pap test.

While we wait for results of studies that address these questions clinicians should do everything possible to increase patient comfort during the exam and alert FTM patients that repeat Pap testing may be necessary after an initial, inadequate result.”

In line with Cervical Health Awareness Month, Medical News today recently detailed the signs and symptoms of cervical cancer to look out for, as well as the importance of regular screening for the disease.