Alejandro Aranda-Gutierrez

Cancer screening guidelines for transgender individuals: a narrative review of current recommendations and practice gaps

This narrative review aimed to synthesize current cancer screening recommendations for transgender individuals, critically assess their content, identify inconsistencies, and highlight key evidence gaps to inform future clinical practice and policy. We searched MEDLINE, CENTRAL and Web of Science through 9 May 2025 for screening guidelines relevant to transgender individuals. We included documents from national or international bodies, academic institutions or recognized expert panels. Guidelines focused on breast, cervical, prostate, endometrial, ovarian and anal cancer. Data were extracted into a structured matrix by cancer type, screening approach and relevance to transgender populations. Of 79 sources screened, 14 met inclusion criteria. Most were transgender-specific. Recommendations varied substantially across cancer types. Breast cancer screening showed the widest divergence, with differing thresholds based on age, gender-affirming hormone therapy duration and risk stratification. For prostate, endometrial, ovarian and anal cancers, dedicated guidance was sparse or absent, often relying on extrapolation from cisgender populations. Key gaps included inconsistent terminology, lack of integration of gender-affirming hormone therapy and surgical history, and limited rationale for screening intervals and age cutoffs. Future efforts should prioritize inclusive data collection, integration of gender identity into cancer surveillance systems and development of evidence-informed, population-specific screening protocols to advance equitable care.

Uptake of Risk-Reducing Measures, Cascade Testing, and Related Challenges Among Carriers of Breast Cancer–Associated Germline Pathogenic Variants in Mexico

PURPOSE Genetic cancer risk assessment (GCRA) provides pathogenic variant (PV) carriers with the invaluable opportunity to undertake timely cancer risk-reducing (RR) measures and initiate cascade testing (CT). This study describes the uptake of these strategies and the related barriers among breast cancer–associated germline PV carriers in Mexico. METHODS Carriers who were at least 6 months after disclosure of genetic test results at two GCRA referral centers were invited to answer a survey assessing sociodemographic characteristics, awareness of their carrier status and its implications, uptake of RR measures according to international guidelines by PV, CT initiation, and associated challenges. RESULTS Of the eligible carriers, 246/384 (64%) answered the survey (median age: 44 years). Most were female (88%), married/in domestic partnership (66%), and had personal breast/ovarian cancer history (61%). PVs included BRCA1/ 2 (75%), CHEK2 (10%), PALB2 (5%), ATM (5%), NF1 (2%), RAD51C (2%), PTEN (1%), and TP53 (1%). Most (87%) participants were aware of their carrier status. When recommended, 37% underwent RR bilateral mastectomy, 48% RR oophorectomy, 70% annual mammogram, and 20% breast magnetic resonance imaging. Challenges hindering the uptake of RR measures included financial limitations (67%), lack of recommendation by their physician (35%), and fear (24%). Nearly all (98%) claimed sharing their results with their relatives. CT was initiated in 63% of families and was associated with carriers being married/in domestic partnership ( P = .04) and believing GCRA was useful ( P < .001). CONCLUSION Despite the resource-constrained setting, relevant rates of RR measures and CT were observed. Targeted interventions to reduce out-of-pocket expenses and improve patient-physician communication and patients' understanding on carrier status are warranted to enhance the overall benefit of GCRA and ultimately improve the provision of patient-centered care to both carriers and their at-risk relatives.