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Principal Investigator: Chandler Scott Cortina
Organization: MEDICAL COLLEGE OF WISCONSIN
Fiscal Year: 2024
Award: $210,062
Funding agency: National Cancer Institute
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).
Terms: <21+ years old><Address><Adult><Adult Human><Age><American><Anxiety><Appearance><Award><Biopsy><Birth><Body Tissues><Breast><Breast Cancer><Breast Cancer Detection><Breast Cancer Risk Factor><Breast Lump><Breast Nodule><Breast Tissue><Breast Ultrasonography><Breast cancer screening><Breast screening><Callback><Cancers><Caring><Chest Mass><Clinic><Cohort Studies><Collaborations><Communities><Concurrent Studies><Consensus><Coupled><Data><Data Bases><Databases><Decision Making><Dedications><Detection><Development><Education and Training><Electronics><Equity><Estrogens><Exposure to><Face><Faculty><Focus Groups><Foundations><Funding><Future><Gender><Gender Identity><General Radiology><Goals><Health><Health Care Providers><Health Care Systems><Health Personnel><Healthcare Providers><Healthcare Systems><Healthcare worker><Hormonal><Image><Incidence><Individual><Individuals from minority><Individuals of minority><Inferior><Institution><Interview><Knowledge><LGBTQ><Lesbian Gay Bi-sexual Transgender Queer><Lesbian Gay Bisexual Transgender Queer><Lesion><Literature><Malignant Breast Neoplasm><Malignant Neoplasms><Malignant Tumor><Mammary Gland Parenchyma><Mammary Gland Tissue><Mammary Ultrasonography><Mammogram><Mammographic screening><Mammography><Mass in breast><Mediating><Medical><Mental Health><Mental Hygiene><Mentors><Mentorship><Methods><Minority Groups><Minority People><Minority Population><Minority individual><Modeling><NIH><National Institutes of Health><Operative Procedures><Operative Surgical Procedures><Participant><Parturition><Pathology><Perception><Persons><Population><Practice Guidelines><Process><Prospective cohort><Provider><Psychological Health><Qualitative Methods><Radiology><Radiology Specialty><Registries><Reporting><Research><Research Design><Research Proposals><Risk><Risk Factors><Role><Scientist><Screening for cancer><Sensitivity and Specificity><Stage at Diagnosis><Stigmatization><Study Type><Suggestion><Surgeon><Surgical><Surgical Interventions><Surgical Procedure><Survey Instrument><Surveys><Testosterone><Therapeutic Estrogen><Therapeutic Testosterone><Time><Tissues><Training><Training and Education><Trans-Testosterone><Ultrasonic Mammography><Ultrasound Mammography><United States National Institutes of Health><Woman><Work><adulthood><ages><annual screening><assigned female at birth><assigned female gender at birth><assigned female sex at birth><assigned male at birth><assigned male gender at birth><assigned male sex at birth><breast cancer risk><breast imaging><breast mass><breast ultrasound><cancer care><cancer disparity><cancer health disparity><cancer-related health disparity><career><cis-female><cis-gender><cis-gender man><cis-gender woman><cis-male><cis-man><cis-woman><cisgender><cisgender man><cisgender woman><cohort><data base><design><designing><developmental><disparity in cancer><early cancer detection><electronic><electronic device><evidence base><experience><faces><facial><gender affirmation hormone therapy><gender affirmation hormone treatment><gender affirming hormone therapy><gender affirming hormone treatment><gender assigned><health belief><health care personnel><health care worker><health provider><health workforce><health-related belief><healthcare personnel><imaging><improved><innovate><innovation><innovative><insight><life-time risk><lifetime risk><malignancy><malignant breast tumor><mammary cancer detection><mammary imaging><mammary screening><mammographic Imaging><mammographic examinations><mammographic exams><mammography screening><medical personnel><men><neoplasm/cancer><novel><participant interview><prevent><preventing><process improvement><programs><prospective><psychologic><psychological><psychosocial><qualitative reasoning><recommended screening><recruit><routine screening><screening><screening cancer patients><screening guidelines><screening program><screening recommendations><screenings><sex><sex assigned><skills><social><social role><study design><surgery><system-level barriers><trans*><trans-men><trans-women><transgender><transgender men><transgender women><transman><transmen><transwoman><transwomen><treatment provider>