Women’s health issues in solid organ transplantation: Breast and gynecologic cancers in the post-transplant population

Table 1 Breast and gynecologic cancer screening recommendations and incidence rates as compared to the general population

Cancer type	Current standard guidelines	SOTR specific recommendations	Rates of malignancy in SOTR: Increased (+), Same (=), or Less (-) than general population
Breast cancer	Mammography every 1-2 yr in women > 50 years old (for average risk). Discussion for screening beginning at age 40 yr	Mammography prior to transplantation if > 50 yr; otherwise, same screening interval as the general population	-
Cervical cancer	Women 21 to 29 years old should have a Pap test alone every 3 yr. HPV testing alone can be considered for women who are 25 to 29 years old, but Pap tests are preferred	Pap if younger than 30 years old at transplant, co-testing with Pap and HPV is preferred beginning at age 30 yr but annual Pap is considered adequate	+
	Women who are 30 to 65 years old have three options for testing: Pap and HPV (co-testing) every 5 yr. Pap alone every 3 yr. Or they can have HPV testing alone every 5 yr	If performing co-testing with HPV and Pap: If results of baseline Pap and HPV testing are normal, co-testing can be performed every 3 yr. If the patient is transplanted prior to age 21, it is recommended screening begin within 1 yr of initial engagement of sexual activity
Vulvar and vaginal cancer	No current screening strategy for the general population, however recommended annual pelvic exam in patients with HIV	AST recommends annual pelvic exam for kidney transplant patients; otherwise, no consistent guidance across societies	+
Endometrial cancer	No current screening strategy	No current screening strategy	=/-
Ovarian cancer	No current screening strategy	No current screening strategy	=/-

SOTR: Solid organ transplant recipient; Pap: Papanicolaou smear; HIV: Human immunodeficiency virus; AST: American Society of Transplantation.