Cytology and High-Risk Human Papillomavirus Testing Performance for Cervical Cancer Screening in Transmasculine Patients.

OBJECTIVE

The primary objective of this study was to estimate the specificity of cytology and high-risk human papillomavirus (hrHPV) testing to predict the presence of cervical intraepithelial neoplasia 2 (CIN2+) among transmasculine patients. The exploratory objective compared the specificity of cytology and hrHPV tests among three populations: transmasculine patients using testosterone, premenopausal cisgender, and postmenopausal cisgender patients.

DESIGN

This multicenter retrospective cohort study included individuals aged 18-65 undergoing cervical cancer screening from 2015 to 2024. Transmasculine patients were included if using ≥30 mg daily transdermal or ≥30 mg weekly subcutaneous testosterone for at least 6 months with no estrogen supplementation. Patients with co-tests followed by colposcopy or hysterectomy were included in the sensitivity and specificity analysis. McNemar's test was used to examine differences in specificity between cytology and hrHPV tests within each cohort.

RESULTS

Of 2,437 records screened, 149 (70 transmasculine, 30 postmenopausal, and 49 premenopausal) met the inclusion criteria with co-tests followed by histologic confirmation via colposcopy or hysterectomy. In the transmasculine cohort, the specificity of screening to predict CIN2+ was comparable between cytology (68.9% [95% CI: 55.7 - 80.1%]) and hrHPV tests (63.9% [95% CI: 50.6 - 75.8%]) with a p-value of 0.26. Sensitivity was equivalent in the transmasculine cohort. In the postmenopausal cohort, specificity was significantly lower for hrHPV screening compared to cytology (24.1% vs. 69.0%).

CONCLUSIONS

The ability of cytology and hrHPV screening to predict the presence of CIN2 + was not different in the transmasculine population. With high insufficient cytology rates, transitioning to primary hrHPV screening can limit unwanted pelvic exams and unnecessary diagnostic testing in transmasculine patients.