Cancer screening rates for transgender and non-binary people remain too low, and we GPs hold a responsibility in changing this.
To provide some context, everyone has a gender identity, and trans people have one that isn’t congruent with the sex they were assigned at birth. ‘Trans’ is an umbrella term, while gender identity is increasingly described as being on a spectrum.
Currently, there’s no automated call-recall system, because the system is still defined by the binary genders – male or female. And there also isn’t a national gender identity data collection, which makes an automated call-recall system for trans people almost impossible. Until this is corrected, cancer screening for trans people remains underreported and underdiagnosed, and the risk of cancer is high.
Overall care for trans people is very much neglected and misunderstood. But cancer remains one of the biggest causes of death, and GPs have a duty to prevent and detect these diseases.
A healthcare provider, and in this instance general practice organisations, are required to effectively promote awareness of screening and encourage uptake of cancer screening among trans people. Additionally, GP practices are encouraged to maintain a list of eligible trans patients who wish to participate but won’t be routinely invited for screening.
We shouldn’t – and don’t – have to wait for a large event to change our attitudes to cancer screenings
The three cancer screening programmes (bowel, breast and cervical) are delivered by the NHS through screening centres (bowel and breast) or in primary care (cervical). Furthermore, bowel screening is offered to all genders, men and women aged 60-74, and a self-testing kit is sent to their home every two years. People aged 75+ can self-refer and request a testing kit from the bowel screening helpline.
Trans men with a cervix still carry a risk of cervical cancer, and should be invited for cervical screening. They’re now registered as male in patients’ registration data, and won’t be automatically invited for cervical screening. GPs are required to inform and invite these patients for such screening and directly contact the screening laboratory. It’s worth reiterating that all gendered information is strictly confidential and explicit consent must be sought from patients. I suggest to include ‘patients with a cervix’ on the request forms.
And trans men might still have breast tissue following a mastectomy, so the risk of breast cancer remains. Trans men who haven’t had a mastectomy should be referred to the breast screening service for a mammography.
Furthermore, trans women who are registered as female will automatically get invitations to cancer screening programmes. They will get an invitation for cervical screening and considering they don’t have cervix, they’re not suitable, so can call their surgery to opt out of cervical screening.
Those who have breast augmentation and are on estrogen therapy are encouraged to attend breast screening programmes. All women aged 50-70 are invited for a breast screening mammography every three years, while women aged 71+ can self-refer.
Similarly, Abdominal Aortic Aneurysm (AAA) screening, where an ultrasound checks the size of the abdominal aorta, is offered to all men aged 65+. Any trans woman aged 65+ carries the same risk as a man, and GPs should notify them that they’re eligible for screening and contact the local AAA screening services.
Trans patients are a minority group, but their collective risk of their cancers not being detected on time is significant. We shouldn’t – and don’t – have to wait for a large event to change our attitudes to cancer screenings.
- NHS Population Screening: Information for Transgender and Non-Binary People. Public Health England, July 2017
- Screening Information for Transgender Service Users. Public Health Wales, 2014
Dr Kamilla Kamaruddin is a GP partner in East London