Authors
Amelia Srajer, John M Hutchinson, Amy Metcalfe, Darren R Brenner, Kristin A Black, Fiona Mattatall, Ioana Nicolau, Paul E Ronksley
Published in
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society. Volume 36. Issue 9. Pages 104850. Jul 24, 2026. Epub Jul 24, 2026.
Abstract
To conduct a systematic review and meta-analysis of observational studies comparing cervical cancer screening participation and Pap cytology results between transgender/gender diverse individuals and cisgender female individuals.
MEDLINE, EMBASE, and CINAHL were searched from database inception to January 7, 2026, by 2 independent reviewers. Primary observational studies reporting up-to-date cervical cancer screening and/or Pap test results in transgender/gender diverse individuals with a cervix compared with cisgender female individuals were included. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, data were independently extracted and critically appraised in duplicate.
Twenty-one studies were included, with sample sizes ranging from 116 to 238,036 participants or Pap tests. Twelve studies (57.1%) assessed up-to-date screening, and 9 (42.9%) reported un-satisfactory and abnormal Pap cytology. Compared with cisgender female individuals, transgender/gender diverse individuals had significantly lower odds of being up to date on cervical cancer screening (odds ratio 0.53, 95% confidence interval 0.35 to 0.79). Estimates were similar when stratified by self-report versus medical record data. Transgender/gender diverse individuals had more than 9-fold higher odds of un-satisfactory cytology (odds ratio 9.92, 95% confidence interval 7.42 to 13.26). Overall, abnormal cytology did not differ between groups (odds ratio 0.75, 95% confidence interval 0.37 to 1.49). In stratified analyses, lower odds of abnormal cytology for transgender/gender diverse individuals were observed among studies with mixed or unspecified testosterone use (odds ratio 0.44, 95% confidence interval 0.32 to 0.60) and in studies using all-comer versus atrophic cisgender comparators (odds ratio 0.44, 95% confidence interval 0.33 to 0.59). Findings for un-satisfactory cytology did not differ significantly across these strata. There was no evidence of small-study effects.
Transgender/gender diverse individuals with a cervix are less likely to be up to date on cervical cancer screening and more likely to have un-satisfactory Pap cytology. Abnormal cytology appears similar overall but varies across testosterone use and comparator strata. These findings underscore the need for anatomically inclusive, evidence-based screening guidelines and evaluation of alternative approaches, such as primary human papillomavirus testing, to improve cervical cancer screening equity and effectiveness.
PMID:
42497580
Bibliographic data and abstract were imported from PubMed on 25 Jul 2026.
Read full publication at:
Please sign in
to see all details.
Advertisement
Stats
- Recommendations n/a n/a positive of 0 vote(s)
- Views 4
- Comments 0