Transgender individuals are facing significant obstacles in accessing cancer prevention and screening services, leading to under-screening and heightened vulnerability to certain cancers. A recent review published in Seminars in Oncology Nursing highlights the urgent need for more research and tailored healthcare practices to address these disparities.
“Transgender individuals face multiple barriers to healthcare, including a lack of welcoming environments, discomfort with gender-labeled oncology services, and experiences of discrimination,” said Tyler Kratzer, MPH, a cancer surveillance researcher at the American Cancer Society. These challenges contribute to confusion between patients and providers and can result in delays or gaps in insurance coverage for essential screenings.
Kelly Haviland, NP, a nurse practitioner and LGBTQI+ clinical consultant at Memorial Sloan Kettering Cancer Center, emphasized the gravity of the situation: “We need to address these significant disparities in our healthcare system. We don’t have data on these patients, and we don’t have screening guidelines. We don’t know what we don’t know.”
How Current Screening Methods Exclude Transgender Individuals
The review examined existing research and screening recommendations for various cancers to illustrate how current protocols often leave transgender people behind. For instance, both transgender men and women are at an increased risk of developing breast cancer compared to cisgender men. Transgender men who have undergone mastectomies may still retain some breast tissue, which poses a risk. Similarly, transgender women who develop breast tissue through hormone replacement therapy should be educated about their breast cancer risk.
Despite these risks, screening guidelines are not adequately inclusive. The U.S. Preventive Services Task Force (USPSTF) recommends that all people assigned female at birth start breast cancer screening at age 40, including transgender men and nonbinary persons. However, transgender women are not explicitly included in these recommendations.
The exclusion extends to other types of cancer as well. Transgender individuals may have higher rates of risk factors such as smoking and alcohol use, increasing their susceptibility to cancers like cervical and anal cancer. Yet, prevention interventions and screenings often do not account for transgender populations.
Transgender men who have a cervix remain at risk for cervical cancer but are significantly less likely to get screened compared to cisgender women. Self-swab kits have been suggested as a more appealing option, but current USPSTF recommendations for cervical cancer screening do not include transgender men.
The Impact of Data Gaps and Lack of Research
A significant hurdle in addressing these disparities is the lack of data on transgender individuals within healthcare research. “We don’t have data on these patients, and we don’t have screening guidelines,” Haviland reiterated. Surveys and data collections often do not allow participants to identify outside the binary gender categories of “male” or “female.” Major data sources like the U.S. Census, the Surveillance, Epidemiology, and End Results (SEER) Program, and the National Program of Cancer Registries do not differentiate transgender individuals, making it challenging to develop targeted screening protocols.
Shine Chang, PhD, a professor of epidemiology at the University of Texas MD Anderson Cancer Center, pointed out that this lack of information leads to a general unawareness among both doctors and researchers. “Clinicians, by and large, almost always universally say they definitely want more training [around working with LGBTQ patients] because they recognize there may be deficits to the care these patients receive,” she said.
Personal Experiences Highlight Systemic Failures
A study published in JAMA Network Open utilized artificial intelligence and social media to identify barriers to cancer care for transgender patients. The researchers analyzed over 30 million posts from Reddit, X (formerly Twitter), and YouTube between January 2012 and December 2022.
They identified three main themes:
- Lack of Awareness: Issues like pronoun misuse, conversion therapy, and healthcare avoidance were prevalent. Misgendering was identified as a systemic issue in 16.5% of posts, and healthcare avoidance was common in personal narratives.
- Accessing Care: Financial concerns, such as limited insurance coverage, and nonfinancial barriers, like finding trans-competent clinicians, were significant obstacles.
- Clinical Challenges: Physical and mental health problems were frequently reported, with disease burden being the most common clinical issue.
“The prevalence of issues like misgendering and healthcare avoidance underscores systemic failures and personal challenges,” the researchers wrote. “Access issues during treatment highlight the need for improved clinician education and insurance reforms.”
Emotional and Psychological Barriers
Beyond systemic issues, emotional and psychological factors also deter transgender individuals from seeking necessary screenings. Gender dysphoria can be exacerbated by medical procedures that are incongruent with a person’s gender identity. These experiences can lead to avoidance of preventative care altogether, increasing the risk of late-stage cancer diagnoses and reduced survival rates.
Steps Toward Inclusive and Equitable Care
To bridge these gaps, a multifaceted approach is necessary:
- Education and Training: Enhancing provider education on transgender health needs is crucial. “Research has shown only 75% of medical students and less than 40% of oncologists at NCI-designated cancer centers are confident in the health needs of transgender patients,” Kratzer noted.
- Inclusive Data Collection: Incorporating gender identity options beyond the binary in surveys and health records can provide more accurate data, aiding in the development of targeted screening guidelines.
- Creating Safe Spaces: Healthcare facilities should strive to foster welcoming environments that can dispel fears of discrimination. This includes using inclusive language, respecting pronouns, and ensuring that all staff are trained in cultural competency.
- Policy Changes: Updating screening guidelines to explicitly include transgender individuals and advocating for insurance reforms can reduce financial and systemic barriers.
- Community Outreach: Engaging with transgender communities to raise awareness about cancer risks and the importance of screenings can empower individuals to take proactive steps in their healthcare.
A Collective Responsibility
While the review in Seminars in Oncology Nursing highlights strategies that advanced practice nurses can employ, the responsibility extends to all healthcare providers. “This message could easily be conveyed by a variety of clinical providers—physicians, pharmacists, all sorts of people who have patient interactions,” Chang emphasized.
By working collaboratively, healthcare professionals can begin to dismantle the barriers that prevent transgender individuals from accessing essential cancer prevention and screening services.
The Bottom Line
The disparities in cancer screening and prevention for transgender individuals are a pressing public health concern. Addressing these issues requires concerted efforts from healthcare providers, researchers, policymakers, and the communities themselves.
For transgender individuals, understanding these challenges is a step toward advocating for better care. Families and allies play a crucial role in supporting loved ones to navigate the healthcare system and in advocating for systemic changes.
“We need to address these significant disparities in our healthcare system,” Haviland urged. Recognizing and confronting these issues is essential for ensuring that all individuals, regardless of gender identity, have equitable access to life-saving cancer prevention and screening services.
If you are a transgender individual seeking more information about cancer screening, consider reaching out to LGBTQ-friendly healthcare providers or local support organizations for guidance.
