Pilot program offers cervical cancer screening for transgender men, nonbinary individuals
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Transgender men and nonbinary individuals derived benefit from a pilot program designed to offer cervical cancer screening specific to their biological needs and personal preferences, according to study results.
Alison May Berner, MBBS, MCRP, specialty trainee and clinical research fellow in medical oncology at Barts Cancer Institute in London and specialist registrar with the Gender Identity Clinic, part of the Tavistock and Portman NHS Foundation Trust, presented the data at the American Association for Cancer Research Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held virtually Oct. 6-8.
“There are barriers to cervical cancer screening for transgender men and nonbinary people at multiple levels; these groups have also encountered various health inequalities over time,” Berner said in an interview with Healio. “You can think about personal barriers, such as body dysphoria or discomfort. There may be stigmas that the individual has experienced in the past. Then there are barriers in terms of a lack of cultural competency on the part of providers — a lack of experience in addressing these issues.”
Prior research has suggested that transgender men and nonbinary people would be more willing to undergo cervical cancer screening through a transgender-specific sexual health service. The current study introduced a test program in collaboration with Britain’s National Health Service and other organizations serving gender or sexual minority populations. The program provided weekly cervical cancer screening clinics run by professionals experienced in providing care to transgender and nonbinary individuals.
Cervical cancer is the fifth most prevalent cancer in the world, despite being preventable through regular screenings, including a Pap test. In the United Kingdom, screening is advised every 3 years for people with a cervix between the ages of 25 and 49 years, and every 5 years for those between the ages of 49 and 64 years.
Berner spoke with Healio about the outcomes of the pilot program, its future potential and ongoing disparities transgender and nonbinary people face in the health care system.
Healio: How did you conduct the pilot program?
Berner: We introduced the screening program in October 2019. We used six platforms to conduct a social media campaign that reached 40,000 people. This resulted in nine people being screened before the clinic closed in March 2020 due to COVID-19 restrictions. We reopened the clinic in July 2020, and this time we used only the two most popular social media platforms, Facebook and Twitter, and reached 50,000 people in 14 days. Between July 2020 and February 2021, we provided tailored cervical cancer screening to 35 people. Twenty participants provided feedback surveys.
HealioWhat feedback did you receive?
Berner: Sadly, the uptake wasn’t as large as we had hoped, likely due to the pandemic, but we had positive responses from all 20 who filled in our evaluation surveys. Most (12 out of 20) said if the service had not been available, they would not have undergone cervical screening. Nine of the 20 respondents stated a willingness to participate in a transgender-specific screening if their own general practitioner provided it.
Healio: How does the current U.K. call and recall system for cervical cancer screening cause confusion for transgender/nonbinary people?
Berner: A transgender man who is registered with a general practitioner as a male will not be contacted for routine cervical screening. Additionally, these individuals may not be recalled for further testing after an abnormal screening. We are hoping this will change soon.
Healio: Do you think more transgender-specific health services like the cervical screening program are needed?
Berner: I think these bespoke services for the transgender population are incredibly appreciated. I also think the general skill and training for all clinicians needs to be adapted to meet the health care needs of transgender people and address the inequalities they face. We want to provide specific sexual health services, which are among the only physical health interventions outside of transition that many clinicians are familiar with. We’ve been collaborating in offering cervical screening in an ad hoc way with the sexual health screening, but there isn’t really funding to provide screening itself or to advertise the availability of transgender-specific cervical screening. We want to really bring these services to the attention of the community and make them aware that they can access them.
Healio: What do you hope to accomplish next in reducing disparities for these populations?
Berner: The program now also has general services designed to address transition, and it continues to be funded, which is fantastic. There are several transgender-specific sexual health services in areas with a high population of transgender people in the U.K. However, we also want to disseminate the same level of knowledge across general practitioner practices within the Cancer Alliance. We want to end the current recall system, and when the new recall system is in place, we want to try to improve clinician education. In fact, I want to mention Live Through This. It is the U.K.’s only LGBTQ cancer charity that is helping to provide physician education, which is fantastic.
Obviously, what we have done here in terms of numbers is quite small. The difficulty is that we still don’t know the exact statistics on how many people identify as transgender and nonbinary in different parts of the country. I think when we finally get that information, we will realize that the scope of this is significant — that there is a population that is not being reached.
For more information:
Alison May Berner, MBBS, MCRP, can be reached at the Gender Identity Clinic, Lief House, 3 Sumpter Close, Finchley Road, London, MW3 SHR, UK; email: alison.berner@nhs.net.
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Berner A, et al. Presented at: AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved (virtual meeting); Oct. 6-8, 2021.
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