A new report found transgender and gender diverse people are being under-screened for cancer

Transgender People May Be at a Higher Risk for Certain Cancers, But Aren’t Getting Screened To bridge these gaps, more education and data is needed, experts say

A new report found transgender and gender diverse people are being under-screened for cancer

• Transgender and gender-diverse people (TGD) may not get the cancer screenings they need due to a lack of robust screening protocols, a new review has found.
• To fix the disparity, doctors need more data on cancer risks specific to TGD people, experts said.
• It’s also important that TGD people have access to safe healthcare environments in which they can discuss their health needs.

Transgender and gender diverse (TGD) people are being under-screened for some cancers, largely because of barriers to prevention and screening in those communities, according to a new report.

The review, published in Seminars in Oncology Nursing in June, emphasizes the need for more research into how people who are transgender, genderqueer, nonbinary, or otherwise gender diverse are particularly vulnerable to cancer, experts said.

“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.

“Additionally, transgender individuals are not included in most screening guidelines, which can lead to patient-provider confusion and cause delays or gaps in insurance coverage for screening,” he told Health.

These pitfalls ultimately affect the health and well-being of TGD people.

“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,” Kelly Haviland, NP, a nurse practitioner and LGBTQI+ clinical consultant at Memorial Sloan Kettering Cancer Center, told Health. “We don’t know what we don’t know.”

Here’s what experts had to say about why cancers often go undetected in TGD people, and what needs to be done to remedy the disparities they face.

Typical Screening Methods Can Leave Transgender People Behind

To paint a better picture of how current cancer screening protocols affect TGD people, the authors looked at existing research, as well as screening recommendations for a variety of cancers.

For one, the review noted that both transgender men and women are at an increased risk of developing breast cancer as compared to cisgender men.

Transgender men who have undergone a mastectomy may be more likely to experience breast cancer than cisgender men because these procedures don’t remove all breast tissue, Haviland explained. Additionally, transgender women who developed breast tissue after taking hormone replacement therapy should also be educated on the risks of breast cancer.

Because of this, transgender people may benefit from breast cancer screenings, the review argued.

The U.S. Preventive Services Task Force (USPSTF) currently recommends that all people assigned female at birth start breast cancer screening at age 40. While this includes “transgender men and nonbinary persons,” transgender women are not included.

Not only can cancer screening protocols exclude TGD people, but the researchers also noted that these communities often face higher cancer risks to begin with.

Specific cancer risks—such as smoking and alcohol use—may be more common among TGD people, though institutions usually don’t have prevention interventions specifically for these groups.

Transgender people may also be at a greater risk of getting a human papillomavirus (HPV) infection, which can, in turn, make them more susceptible to cervical cancer and anal cancer. As such, preventive care for some transgender people may include HPV vaccination to reduce rates of HPV-related cancers.

But again, cancer screenings can present issues for TGD people. Transgender men who previously had or have a cervix are still at risk for cervical cancer—but research has shown that, in comparison to cisgender women, TGD people are much less likely to get screened for cervical cancer. Self-swab kits may be a more appealing option, the researchers said. The current USPSTF recommendations for cervical cancer screening don’t include transgender men.

The authors concluded that this combination of potentially greater cancer risks, lack of specific cancer prevention programs, and gaps in traditional screening protocols leave transgender people under-screened and at a high risk of health issues.

Why Do These Cancer Disparities Exist, and How Can We Remedy Them?

Stigma, discrimination, and biases exist in the healthcare system, but cancer disparities among TGD people could stem from a general lack of knowledge among both doctors and researchers, Shine Chang, PhD, professor of epidemiology in the division of cancer prevention and population sciences at the University of Texas MD Anderson Cancer Center, told Health.

Healthcare professionals don’t have a lot of information about which cancers TGD people are particularly susceptible to, Haviland said. In large part, this is because some surveys and other data collections on cancer prevalence don’t allow participants to claim a gender outside of “male or female.” For example, TGD people aren’t differentiated in U.S. Census data, the Surveillance, Epidemiology, and End Results (SEER) Program, or the National Program of Cancer Registries, said Haviland.

Because researchers and policymakers rely on much of this data to develop preventative screening protocols, this lack of data means TGD people can slip through the cracks.

But even if TGD people were better included in this data, individual experiences with providers could be yet another barrier to cancer screening. TGD people may avoid getting screened for certain cancers because it could provoke feelings of gender dysphoria. For example, a transgender man might feel distressed at having to undergo a mammogram, particularly if their physician uses gendered language such as “breast exam” instead of “chest exam.”

Many physicians feel like they don’t provide high-quality cancer care to TGD people because they don’t know how to, Chang said.

“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 explained. However, at most institutions, these trainings are “not really at the level that we would like it to be,” she said.

“Research has shown only 75% of medical students and [less than] 40% of oncologists at [National Cancer Institute]-designated cancer centers are confident in the health needs of transgender patients,” added Kratzer.

Beyond educating providers, cancer care can also be made more equitable by providing TGD people with access to safe spaces in which they can discuss their health concerns openly with providers.

“Healthcare facilities should strive to foster welcoming environments that can dispel fears of discrimination,” Kratzer said.

The new review highlights strategies that advanced practice nurses (APNs) could use to make cancer care more equitable for TGD people, but everyone within the healthcare system should be helping strive toward this goal, said Chang.

“This message could easily be conveyed by a variety of clinical providers—physicians, pharmacists, all sorts of people who have patient interactions,” she said.

This story originally appeared on: Health News - Author:Maggie O'Neill