Transgender and Nonbinary People, and Providers, Benefit from Better Awareness of Screening Guidelines

Woman looking at mammogram results

The transgender and nonbinary (TGNB) population is gradually growing across the U.S. However, these individuals are frequently excluded and/or overlooked from clinical breast and cervical cancer investigations, resulting in sparse data to inform critical screening and treatment guidelines. In a JCO Oncology Practice study, MCW Cancer Center investigators closely examined TGNB people’s perceptions of breast and cervical cancer screening and practices to identify opportunities for improving cancer education and care.

“We were surprised to learn that many TGNB people were not getting screened, and that the majority were unsure of what screenings exist. This study revealed the critical need for education on cancer screening guidelines and options, for both the TGNB population and for healthcare providers,” said study co-author Chandler Cortina, MD, MS, FSSO, FACS.

The study team conducted a single-institution survey through the Froedtert & the Medical College of Wisconsin Inclusion Health Clinic, aiming to understand TGNB people’s perceptions of breast and cervical cancer development, screening knowledge and practices, and attitude towards stopping gender-affirming hormone therapy (GAHT) if diagnosed with a hormone receptor-positive (HR+) breast cancer. Responses from 86 TGNB participants revealed that:

  • Most respondents were unaware of breast (77%) or cervical (60%) cancer screening recommendations for their sex assigned at birth or their gender.
  • While 35% reported having concerns about breast cancer development, only 50% of those respondents over age 40 had undergone breast cancer screening.
  • Forty-seven percent of those assigned female sex at birth with a cervix had concerns about cervical cancer development, but less than half had received a Pap smear within the past 5 years.
  • Nearly all respondents (87.2%) were on GAHT, with 35.1% reporting they would not consider stopping if diagnosed with an HR+ breast cancer.

About 1.6% of adults in the U.S. identify as either transgender or nonbinary; the number of these individuals undergoing gender-affirming therapies is also rising. Neither the American Cancer Society nor the U.S. Preventive Services Task Force currently provides breast or cervical cancer screening guidelines specifically for this population.

Dr. Cortina explained the study’s results show the need for large prospective cohort data to elucidate optimal gender-specific screening guidelines, as well as breast cancer treatment algorithms for those with HR+ breast cancer. The team is building on these findings in a new study that uses breast cancer risk models in transmen considering gender-affirming top surgery (removal of breast or chest tissue). They hope to gain a better understanding of how personal breast cancer risk affects surgical decision-making

“The TGNB community continues to experience inequalities throughout the cancer continuum, from screening to treatment and end-of-life care. Improving outcomes for these patients will require providers to have a patient-centered approach that also considers intersectionality,” said Dr. Cortina.