I’m trans or non-binary, does this affect my cancer screening?

  • People of all genders are entitled to the same medical care when it comes to cancer prevention, diagnosis and treatment. But research has shown there are additional considerations and barriers felt by gender diverse people.
     
  • This information covers UK cancer screening programmes and eligibility for transgender (trans) and non-binary people.
     
  • It also discusses cancer risk, and how you can reduce your risk of cancer.

Cancer screening is a test that looks for early signs of cancer in people with no symptoms. It can help spot cancers at an early stage, when treatment is more likely to be successful.

There are 3 national screening programmes in the UK: cervical screening, breast screening and bowel cancer screening.

On this page we explain these cancer screening programmes and who is eligible for them, with a focus on trans and non-binary people. 

Your sex assigned at birth, as well as any hormones or surgeries you may have had, is relevant to whether you are eligible for some types of cancer screening.

It’s your choice whether or not you take part in screening. If you are interested in participating in screening you can contact your GP, Gender Identity Clinic, local sexual health clinic or local breast screening service to ask for more information about a screening programme. It's important to understand the possible benefits (pros) and risks (cons) of the screening test. This information can help you make the decision that is right for you.

Remember, cancer screening is for people who do not have symptoms. If you have symptoms or have noticed anything that is not normal for you, tell your doctor - don't wait for a cancer screening invitation. We have advice on talking to the doctor here.

This information has been produced in collaboration with;

Dr Alison May Berner

Academic Clinical Lecturer in Medical Oncology (Barts Cancer Institute); Specialty Doctor in Adult Gender Identity Medicine

based at The London Gender Identity Clinic

 

And with input from OUTpatients (LGBTQI+ cancer charity)

Advice on attending a screening appointment

Some gender diverse people may have concerns about taking part in screening. You might have concerns if the waiting room is a very gendered environment or be worried that the appointment type may inadvertently disclose your sex assigned at birth.

But there are steps you can take to make you feel more comfortable.

You can call the GP or clinic in advance to discuss the waiting room environment and ask to be booked at a time when patients of all genders will be attending appointments. You can also request to be booked for the first or last appointment when it is likely to be quieter.

You may wish to bring a friend or partner with you, and they can come into the consulting room when you are called. You can also ask to be called in by your surname and first initial.

Consider calling the clinic in advance to privately discuss over the phone any preparation that is required before the appointment.

Some clinics specialise in health services for trans and non-binary people. Ask your doctor or Gender Identity Clinic about the nearest specialist clinic.

OUTpatients provide a list of sexual health clinics in England that offer specialist services for trans and non-binary people.

Cervical screening

 

What is cervical screening?

Cervical screening is a way of preventing cervical cancer. It tests for the human papillomavirus (HPV), which causes almost all cases of cervical cancer. Cervical screening can spot any abnormal cell changes in the cervix so that they can be treated before they have chance to develop into cancer.

You may have heard cervical screening called a ‘smear test’. Find more detail on what cervical screening is.

Who is it for?

Cervical screening in the UK is for anyone with a cervix who is aged 25 to 64.
 
This can include the following people if they have not had an operation to remove their womb and cervix (a full hysterectomy):
  • trans men
  • non-binary people assigned female at birth
  • cisgender women
 

Human papilloma virus (HPV)

HPV is a very common virus. It’s passed on through person-to-person contact, usually through sexual activity. For most people, the infection will be cleared from the body and they will never know they had it. But there are ‘high-risk’ types of HPV that increase the risk of some types of cancer. This includes cervical cancer, some types of head and neck cancer and cancers of the vagina, vulva, penis and anus.

Find out more about HPV and cancer.

The HPV vaccine helps to prevent cancer by protecting against HPV. The HPV vaccine is offered to all children aged 11-13 in the UK. But it is also available for free from a sexual health clinic to some men who have sex with men and some transgender people. Find out more about the HPV vaccine.

If you have had an operation to remove your womb and cervix (a full hysterectomy), you no longer need to consider cervical screening.

If you are registered as female with your GP

You will be automatically invited for cervical screening unless you have opted out.

If you are registered as male with your GP

You will not be automatically invited for cervical screening.

  • You can organise your own cervical screening by making an appointment with your GP or at a local sexual health clinic.
  • Some GPs also have a separate register to help remind patients who are not automatically called for screening.

If you decide to take part in screening

At your screening appointment, let the healthcare professional know if you are taking testosterone and whether you are still having menstrual periods. This helps to make sure that the result is accurate.

Let the person taking the sample know if you have any worries. They can suggest changes to the procedure to make it more comfortable for you. This might include asking for a smaller speculum (the tool used to see the cervix) or inserting it yourself. They can also talk you through the process step by step.

Trans women do not have a cervix, so don't need to consider cervical screening.

Trans women who have had a vaginoplasty, which is a type of genital reconstructive surgery, the term 'neo-cervix' is sometimes used to describe the tissue at the deepest part of the vagina. This area is made of a different type of cells to the cervix in a cisgender woman. The risk of cancer in the neo-cervix for a trans woman is much lower than the risk of cervical cancer in a cis woman.

Cancer of the vagina in trans women is very rare. The type of tissue used to create the vagina may affect the risk of cancer, and other complications. If you are a trans woman who has had a vaginoplasty using a loop of bowel, make sure your GP is aware of this if you experience symptoms such as vaginal discharge or bleeding. If you have any concerns, speak to your doctor or gender surgeon. 

Breast screening

 

What is breast screening?

Screening can help to find breast cancers at an early stage, when treatment is more likely to be successful. Breast screening uses a test called mammography which involves taking x-rays of the breasts.

Find more detail on what breast screening is

Who is it for?                  

Breast screening in the UK is for anyone between the ages of 50 and 70 who has breasts, due to either naturally-occurring oestrogen or oestrogen hormone therapy.

This can include:

  • trans men and non-binary people assigned female at birth who have not had an operation to remove the breasts (bilateral mastectomy or 'top surgery')
  • trans women and non-binary people assigned male at birth and who have taken feminising hormones
  • cisgender women

If you have had surgery to remove the breasts it is likely that there will still be a small amount of breast tissue remaining. But it is not possible to examine this by mammography (breast screening). So, if you notice any changes to your nipples, chest area or armpits tell your doctor.

If you are eligible for breast screening and have not had surgery to remove the breasts, consider whether or not to take part in breast screening.

If you are registered as female with your GP

You will be automatically invited for breast screening.

If you are registered as male with your GP

You will not be automatically invited for breast screening.

  • You can organise your mammogram by contacting your GP or by booking an appointment with a breast screening service.

Remember, cancer screening is for people who don’t have symptoms. If you notice any changes to your nipples, chest area or armpits don’t wait for screening – tell your doctor.

If you have not taken feminising hormones, you do not need to consider breast screening as your risk of breast cancer is low.

Feminising hormones, such as oestrogen, take some time to act on the breasts. After taking feminising hormones for five years, you should consider whether or not to take part in breast screening (if you are age 50-70).

If you have had breast implants, this may make it harder to see parts of the breast via a mammogram. This is because the x-rays cannot travel through the implant to the breast tissue behind. Tell the radiographer carrying out your screening if you have implants, so that they can use the best screening technique. You do not need to tell them that you are trans or non-binary.

If you have registered as female with your GP

You will be automatically invited for breast screening.

If you are registered as male with your GP

You will not be automatically invited for breast screening. 

  • You can organise your mammogram by contacting your GP, or by booking an appointment with a breast screening service.

Bowel cancer screening

 

What is bowel cancer screening?

Bowel cancer screening aims to find bowel cancer early or find changes in the bowel that could lead to cancer.

The bowel cancer screening programme sends a bowel cancer testing kit to people who are eligible to take part. You need to be registered with a GP to receive your screening kit, which will be sent every 2 years. You do the test at home and send your sample to the hospital for analysis.

Find more detail on what bowel cancer screening is.

Who is it for?

In the UK, everyone is invited to bowel cancer screening regardless of their gender. In England and Wales, it is offered to people starting from the age of 50-60 up to 74 years. In Northern Ireland it’s offered to people aged 60-74. In Scotland it is offered to people aged 50-74.

If you are a trans woman who has had genital reconstruction surgery (vaginoplasty) using a loop of bowel, make your GP aware of this when you are eligible for bowel screening.

I’m trans or non-binary, am I at increased risk of cancer?

Research into cancer in people who are trans or non-binary is limited. At the moment there is no reliable evidence of an overall increase in the risk of cancer for gender diverse people compared to cisgender people.

A person’s risk of cancer depends on many different things. Some things that increase the risk of cancer can’t be changed, such as getting older or a family history of cancer.

But it is important to remember the proven causes of cancer and the things you can do to reduce your risk. You can lower your risk of cancer by:

  • not smoking
  • keeping a healthy weight
  • staying safe in the sun
  • drinking less alcohol
  • eating a healthy, balanced diet

More about the healthy changes you can make to reduce your risk of cancer.

Family history

Most cancers are not hereditary. But some families have several members diagnosed with breast, ovarian or prostate cancers. There’s a small chance this could be due to an inherited faulty gene. If you have concerns about your family history of cancer you can discuss this with your Gender Identity Clinic or GP. They can refer you to a genetics clinic if they think you may be at an increased risk.

Find out more about inherited cancer risk.

 

Does hormone therapy affect my risk of cancer?

Currently, there isn’t enough quality research to determine the impact of gender-affirming hormone therapy on an individual’s risk of cancer overall. Some areas of research on hormone therapy and cancer risk are outlined below.
 
You can discuss cancer risk and gender-affirming hormones and surgeries with your Gender Identity Clinic or GP. When considering any risks, the benefits of gender-affirming care must also be considered.
 

Oestrogen and antiandrogens 

A recent study found that breast cancer was more common in trans women than in cisgender men.

It is possible the increased risk of breast cancer may be due to the feminising hormones that help breasts develop. Examples include oestrogens, and antiandrogens, like cyproterone acetate.  

But the study showed that breast cancer is still less common in trans women than in cisgender women, and the number of cases of breast cancer in trans women was very small. We need further research in this area to be able to draw conclusions on breast cancer risk in trans people.

The hormone cyproterone acetate is sometimes offered to trans women and people who are non-binary to lower testosterone. It has a small increased risk of benign brain tumours called meningiomas.

Testosterone

Some trans men and non-binary people assigned female at birth take the hormone testosterone. Some studies have suggested that testosterone may increase the risk of thickening of the womb lining (the endometrium), which can lead to womb cancer. But the research is not conclusive, and the long-term effects of testosterone on the womb have not been adequately researched. In most cases, testosterone causes thinning of the womb lining.

If you have not had a hysterectomy and you have been taking testosterone for two or more years, your GP or Gender Identity Clinic may recommend a pelvic ultrasound every two years, to monitor the lining of the womb. This ultrasound is performed in a hospital outpatient setting. 

Tell your doctor about any unexplained bleeding from your genitals.

Cisgender or cis: Someone whose gender identity is the same as the sex they were assigned at birth.

Gender: Often expressed in terms of masculinity and femininity, gender is largely culturally determined and is assumed from the sex assigned at birth.

Gender dysphoria: Used to describe when a person experiences discomfort or distress because there is a mismatch between their sex assigned at birth and their gender identity. This is also the clinical diagnosis for someone who doesn’t feel comfortable with the sex they were assigned at birth.

Gender identity: A person’s innate sense of their own gender, which may or may not correspond to their sex assigned at birth.

LGBTQIA+: The acronym for lesbian, gay, bi, trans, queer, questioning, intersex and ace.

Non-binary: An umbrella term for people whose gender identity doesn’t sit comfortably with ‘man’ or ‘woman’. Non-binary identities are varied and can include people who identify with some aspects of binary identities, while others reject them entirely.

Sex: Assigned to a person on the basis of primary sex characteristics (genitalia) and reproductive functions.

Trans: An umbrella term to describe people whose gender is not the same as, or does not sit comfortably with, the sex they were assigned at birth.

Trans people may describe themselves using one or more of a wide variety of terms, including (but not limited to) transgender, transsexual, gender-queer (GQ), gender-fluid, non-binary, gender-variant, genderless, agender, nongender, third gender, bi-gender, trans man, trans woman, trans masculine, trans feminine and neutrois.

Transgender man: A term used to describe someone who is assigned female at birth (AFAB) but identifies and lives as a man. This may be shortened to trans man, or FTM, an abbreviation for female-to-male.

Transgender woman: A term used to describe someone who is assigned male at birth (AMAB) but identifies and lives as a woman. This may be shortened to trans woman, or MTF, an abbreviation for male-to-female.

Transitioning: The steps a trans person may take to live in the gender with which they identify. Each person’s transition will involve different things. For some this involves medical intervention, such as hormone therapy and surgeries, but not all trans people want or are able to have this. Transitioning also might involve things such as telling friends and family, dressing differently, and changing names, pronouns and official documents.

You can find more definitions and information on the Stonewall website

M de Block et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019

Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Transl Androl Urol. 2020

McFarlane T, Zajac JD, Cheung AS. Gender-affirming hormone therapy and the risk of sex hormone-dependent tumours in transgender individuals-A systematic review. Clin Endocrinol (Oxf). 2018

Last reviewed: 6 February 2024

Next review due: 6 February 2027

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