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

Although research is limited, the evidence so far tells us that in general, being trans or non-binary should not affect your diagnosis or treatment of cancer.

At the moment there is no reliable evidence of an overall increase in your risk of cancer compared to the general population.  

But your sex assigned at birth, hormones or surgeries you may have had, will be relevant for some types of cancer screening.

It’s your decision whether you take part in screening, but we’re going to cover some more detail on these to make sure you have the information you need.

Image: The Gender Spectrum Collection 

This information has been produced in collaboration with;

  • Dr Alison Berner

Specialist Registrar in Gender Identity and Speciality Trainee and Clinical Research Fellow in Medical Oncology

based at

 

Cervical Screening

 

What is cervical screening?

Cervical screening is a way of preventing cancer. It aims to find abnormal cells in the cervix that could develop in to cancer if left untreated. It also tests for the human papilloma virus (HPV), which causes most cases of cervical cancer.

Find more detail on what cervical screening is

Human papilloma virus (HPV)

HPV is very common, and for most people, the infection will get better on its own and they will never know they had it.

Find out more about HPV and cancer

Who is it for?

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

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

If you are registered as female with your GP

You will be automatically invited to cervical screening.

If you are registered as male with your GP

You will not be automatically invited to cervical screening.

  • You can organise your own cervical screening by making an appointment with your GP, or at a local sexual health clinic or a family planning 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

Remember to let the person taking the sample know if you are taking testosterone and whether you are still having menstrual periods. This helps to make sure that the result is accurate.

Some clinics specialise in services for trans and non-binary people. Ask your GP or gender identity clinic where your nearest specialist clinic is.

You do not have a cervix and do not need to consider taking part in cervical screening.

Breast screening

 

What is breast screening?

Screening can help to find breast cancers at an early stage, when they may be too small to see or feel and when treatment is most 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 cancer screening is for anyone between the ages of 50 and 74 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 their breasts (bilateral mastectomy)
  • 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 your breasts (bilateral mastectomy) and male chest reconstruction, there will still be a small amount of remaining breast tissue. It is not possible to examine this by mammography, so if you notice any changes you should visit your GP.

If you are registered as female with your GP

You will be automatically invited to breast screening.

If you are registered as male with your GP

Currently you will not be automatically invited for breast screening.

  • If you have not had surgery to remove your breasts (bilateral mastectomy) and male chest reconstruction and would like to take part in screening, then you can organise your mammogram by visiting your GP or booking an appointment at a screening service. .

If you are taking feminising hormones, they take some time to act on the breasts. So you are unlikely to need to consider taking part in screening during the first two years of taking hormones. After 2 years, you should consider breast screening.

If you have had breast implants, this may make it harder to see parts of the breast and so the mammogram isn’t as clear. This is because the x-rays cannot travel through the implant to the breast tissue behind. Tell the radiographer carrying out your screening so that they can then use the best technique, if you have had implants. There is no need to tell them that you are trans or non-binary.

If you have registered as female with your GP

You will be automatically called for breast screening.

If you are registered as male with your GP

You will not be automatically called under the current system;

  • If you would like to take part in screening you can organise your mammogram by visiting your GP or or booking an appointment at a screening service.

Some gender diverse people may have concerns about taking part in screening. You might experience gender dysphoria if the waiting room is a very gendered environment, and be worried that this 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 when patients of mixed genders will be attending appointments at the same time.

In clinics such as gynaecology or breast screening, there are often more people identifying as female. If you are a trans man or non-binary person, you may wish to take a female friend or partner with you to the appointment, or request to be booked for the first or last appointment.

You can also be asked to be called by your name and initial, and take your partner or friend into the consulting room with you.

There are also clinics that specialise in cervical screening for trans men and non-binary people. These include:

CliniQ (London)

56 Dean Street (London)

ClinicT (Brighton)

Bowel screening

 

What is bowel screening?

The screening programme sends a bowel cancer testing kit every 2 years to people eligible to take part. You need to be registered with a GP to receive your screening kit.

Bowel cancer screening aims to check for bowel cancer or abnormalities that could lead to bowel cancer.

Find more information about bowel screening

Who is it for?

In England, Wales and Northern Ireland, everyone aged 60 to 74 years old is invited to screening regardless of their gender. In Scotland, screening starts at age 50.

Tell your doctor if you are a trans woman and have had genital reconstruction surgery using a loop of bowel.

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

 

Research into cancer rates for people who are trans or non-binary and taking hormones is limited. At the moment there is no reliable evidence of an overall increase in your risk of cancer compared to the general population. 

There are cases where cross-sex hormones or reconstructive surgeries accessed by people who are trans may have a small effect on or remove the risk of some cancers. Your Gender Identity Clinic should discuss these with you.

Family history

Some families have several members diagnosed with breast, ovarian or prostate cancer. If this happens, there’s a small chance it could be due to an inherited faulty gene. But you should discuss this with your GP or Gender Identity Clinic. It may affect how often you are invited to screening, and the investigations you have.

Find out more about inherited cancer risk here

 

Does hormone therapy affect my risk of cancer?

 

Oestrogen, progesterone and cyproterone acetate

A recent study found that breast cancer was more common in trans women than cisgender men, but less common than in cisgender women. The number of cases of breast cancer in trans women was still very small, and these numbers may not be completely accurate.

The possible increased risk of breast cancer may be due to feminizing hormones that help breasts develop. Examples of these hormones include oestrogens, progesterone, and cyproterone acetate. The risk of breast cancer may increase with the amount of time exposed to these hormones.

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 these people may have an increased risk of thickening of the womb lining (the endometrium).

This can lead to womb cancer. But the research is not clear and in most cases, testosterone causes thinning of the womb lining.

As a precaution, a pelvic ultrasound is currently recommended every 2 years to monitor the womb lining.  This applies to trans men and people who are non-binary and assigned female at birth who:

have not had a hysterectomy

have been taking testosterone for two or more years

The ultrasound can be performed in a general outpatients’ department.

You should report any abnormal bleeding to your GP.

Cisgender: Someone whose gender identity is the same as the sex they were assigned at birth. Non-trans is also used by some people.

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 reassignment: Another way of describing a person’s transition. To undergo gender reassignment usually means to undergo some sort of medical intervention, but it can also mean changing names, pronouns, dressing differently and living in their self-identified gender.

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.

Outed: When a lesbian, gay, bi or trans person’s sexual orientation or gender identity is disclosed to someone else without their consent.

Sex: Assigned to a person on the basis of primary sex characteristics (genitalia) and reproductive functions. Sometimes the terms ‘sex’ and ‘gender’ are interchanged to mean ‘male’ or ‘female’.

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, crossdresser, 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 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 but identifies and lives as a woman. This may be shortened to trans woman, or MTF, an abbreviation for male-to-female.

You can find more definitions and information on the Stonewall website

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