Transgender men, nonbinary people lack information on cervical cancer screening

Many transgender men and nonbinary people assigned female at birth, or TMNB, reported barriers to cervical cancer screening, according to results of a cross-sectional survey of these underserved populations.

“[Transgender men] and nonbinary people experience numerous barriers to screening, as well as inequalities in their overall cancer care,” Alison M. Berner, MRCP, a specialist in gender identity medicine at the Gender Identity Clinic in London, told Healio Primary Care. “Research like this places patient needs at the center and will allow us to develop more inclusive screening policy.”

Berner and colleagues conducted a survey of 137 TMNB adults, 80% of whom identified as transmasculine, 18% as nonbinary, and the remainder reporting other non-cisgender identities. Most of the participants were white.

The participants were asked 75 questions about barriers and facilitators of cervical cancer screening, preferences on receiving details about such screening, ideal ways to test for high-risk HPV, attitudes towards gynecological health and health care engagement and experiences regarding gender dysphoria. The participants could provide “yes,” “no” and “I don’t know” answers, as well as free-text responses.

“This is the largest study of this type to provide both qualitative and quantitative data, and to focus exclusively on trans men and nonbinary people,” Berner said.

The researchers reported in the British Journal of General Practice that 64 of the TMNB adults were eligible for cervical screening and 37 had undergone screening. Just 34 (53%) of eligible participants felt they had sufficient information about cervical cancer screening. Among 134 TMNB adults in the original cohort, 71 (53%) said they would rather self-swab for high-risk HPV and 68 (51%) preferred an automated invitation to cervical cancer screening.

According to the researchers, barriers to cervical cancer screening included TMNB adults having a male gender marker in their health care record, experiencing or expecting stigma and discrimination, having a health care provider with limited health knowledge of transgender people and receiving female-centered screening information. Facilitators to screening included providing a specialist in transgender care, improving screening information and offering self-sampling for high-risk HPV.

Berner said the findings warrant a tailored approach to cervical cancer screening among TMNB adults.

“Providing cervical screening for [transgender men] and nonbinary people requires a personalized approach. One size does not fit all,” she said. “It is about having an informed discussion with the patient and being led by their needs.”

Berner added that information to facilitate such discussions between TMNB and the health care community can be viewed on the website of Jo’s Cervical Cancer Trust.