A lack of screening in healthcare puts gender-diverse people at greater risk of cancer, researchers say

The lack of culturally safe health screening for people who are transgender and gender diverse (TGD) puts them at greater risk of cancer going undetected, but nurses could be trained to help close the gap.

That is the view of Canadian and Australian researchers who are calling for better access to prevention and screening services for the vulnerable TGD population.

A new paper published in Seminars in oncology nursing outlines the barriers TGD individuals face when trying to access gender-affirming health care, especially in low-income countries and where gender and sexual diversity is illegal.

Although the proportion of TGD people in the overall community is small – conservatively estimated at between 0.3% and 4.5% of adults – they experience the same health problems and, in some cases, a greater risk of cancer as a result of higher prevalence of alcohol and alcohol. tobacco use and sexually transmitted diseases.

Co-author of the study, nurse Toni Slotnes-O’Brien from the University of South Australia, says TGD people deserve the same care as cis-gendered people, but nurses, doctors and paramedics currently have no experience with providing inclusive and respectful care for this population.

“There is a lack of knowledge about alternative tests – for example self-examination for cervical cancer screening – and the importance of recommending mammograms to transgender women aged 50 and over if they have developed breast tissue,” says Slotnes-O’Brien. “Trans men also need cervical screening, even if they are taking testosterone.”

Despite greater awareness around gender diversity, TGD individuals continue to experience discrimination, threats and violence due to widespread prejudice, the researchers say, and this leads to poorer physical, emotional and mental health compared to cis-gendered individuals.

“A big problem I often see is personal opinions influencing a doctor’s decision to provide gender-affirming care.”

Due to actual discrimination or fear of discrimination, many TGD individuals are reluctant to undergo medical checkups, including cancer screening, which can delay cancer diagnosis and treatment, leading to poorer outcomes and even death.

The World Professional Association of Transgender Health recommends several guidelines for practitioners to follow when considering the estrogen therapy needs of TGD individuals. This takes into account, among other things, the duration of estrogen treatment, the dose, the age of the patient and the age at which gender confirming hormones were started.

Independent studies have shown that breast cancer occurs at a younger average age in transmasculine individuals undergoing mastectomy, highlighting the importance of regular screening.

The risks could be reduced if nurses were trained to work with doctors to improve access to health care for this vulnerable group, researchers say.

“At UniSA’s City West Health Clinic we run a transgender and gender diversity clinic and provide gender-neutral toilets. Little things like that make a big difference to someone who is transgender,” says Slotnes-O’Brien.