Transgender and gender-diverse people in the United States are under-screened for cancers – mostly because of barriers to prevention and screening in their communities, according to a new study. The research, published in the journal Seminars in Oncology Nursing, calls for a more detailed study into how the transgender, genderqueer, or nonbinary are at a higher risk of cancer.

“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, 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 added. According to the data from the Behavioral Risk Factor Surveillance System and the Youth Risk Behavior Surveillance System, at least 1.6 million people in the US identify as transgender or non-binary.

According to doctors, both transgender men and women are at a heightened risk of developing breast cancer, as compared to cisgender men, and those who have undergone a mastectomy may be more likely to experience deadly cancer as the procedures do not remove all breast tissue.

Additionally, transgender women who developed breast tissue after taking hormone replacement therapy also need to be educated on the risks of breast cancer – accounting for 30 per cent of cases of all cancers in the US. At present, the US Preventive Services Task Force recommends that all women start their breast cancer screening at age 40 years. While it includes transgender men and nonbinary persons, transgender women are not involved.

According to doctors, cancer risks like smoking and alcohol use are more common among transgenders, even though institutions usually do not provide prevention interventions specifically for these groups. Transgender people are also at a greater risk of getting a human papillomavirus infection, which can, makes them more susceptible to cervical and anal cancer.

The current USPSTF recommendations for cervical cancer screening don’t include transgender men.

A few factors that contribute to disparities among transgenders include:

Many doctors are not properly trained to discuss cancer screening needs with transgender patients, leading to misunderstandings and missed opportunities.

Variation in a patient's assigned sex on medical records and their gender identity many times leads to incorrect screening recommendations.

Many transgenders are uncomfortable discussing their transition process with doctors, leading to incomplete information about their risk factors.

According to studies, cancer screening should be determined on a case-by-case basis considering a transgender person’s medical history, current hormone therapy, and stage of transition.

Also, there is a need for open communication between the patient and the doctor to ensure appropriate screening recommendations are made.

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