title: Pap test use is lower among female-to-male patients than non-transgender women.
abstract: BACKGROUND
  A paucity of empirical research to date has examined cervical cancer screening in female-to-male (FTM) transgender men who retain their natal reproductive structures compared to non-transgender women.
  
  
  OBJECTIVE
  To examine patient and provider characteristics associated with being up-to-date on Pap tests, with a focus on gender identity and sexual orientation.
  
  
  METHODS
  Retrospective chart review of 5,232 patients (4,882 women, 350 FTM transgender men) at an urban community health center. All HIV-negative primary care patients aged 21-64 years (inclusive) with at least one medical visit during the 2012 calendar year and who had a cervix as of December 31, 2012, were included. Data were analyzed in 2013 using a multilevel logistic regression model nesting patients within providers.
  
  
  RESULTS
  FTM patients were significantly less likely to be up-to-date on Pap tests (AOR=0.63, 95% CI=0.47, 0.85) compared to non-transgender women, after adjusting for individual- and provider-level factors. Behaviorally bisexual patients, compared to patients who had sex with men exclusively, were more likely to be up-to-date (AOR=1.73, 95% CI=1.32, 2.26); patients reporting only sex with women were not significantly more or less likely to be up-to-date (AOR=1.01, 95% CI=0.83, 1.23).
  
  
  CONCLUSIONS
  Transgender patients are not accessing the same level of preventive cervical screening care as non-transgender female patients. There is a need to better understand barriers to care in this population. Contrary to findings in other settings, history of sex with women was not negatively associated with Pap utilization.
authors.affiliation: Fenway Institute, Harvard University, Boston, Massachusetts; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Peitzmeier
authors.affiliation: Fenway Health, Harvard University, Boston, Massachusetts; University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors.forename: Karishma
authors.initials: K
authors.lastname: Khullar
authors.affiliation: Fenway Institute, Harvard University, Boston, Massachusetts; Harvard School of Public Health, Harvard University, Boston, Massachusetts.
authors.forename: Sari L
authors.initials: SL
authors.lastname: Reisner
authors.affiliation: Fenway Health, Harvard University, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts. Electronic address: jpotter@bidmc.harvard.edu.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Potter
mesh_terms: D000328:Adult; D055088:Early Detection of Cancer / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005783:Gender Identity; D062985:Health Services for Transgender Persons / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065006:Papanicolaou Test / Q000379:methods*; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000502:physiology; D063106:Transgender Persons / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology