Everyone, including trans people, has an increased risk of cancer as they get older. But the earlier doctors find cancer, the sooner they can treat it. Trans people should know the recommendations for transgender people and cancer screenings.
Cancer screenings are tests that look for cancer before you experience any actual symptoms. Identifying cancer before it causes symptoms makes it easier to treat. Early treatment is usually more effective.
Only a handful of cancers are ones that doctors can screen for. Medical groups recommend screening for cancers that have reliable tests without too many false positives. A false positive is a result from a test that suggests you have cancer when you don’t.
Several cancers occur mostly or only in people who have certain body parts. For example, the prostate is a gland that sits behind the penis and provides some of the fluid in semen. Anyone with a prostate needs to be aware of the risk of prostate cancer regardless of their gender.
Transgender People and Cancer Screenings
Some cancer screenings apply to all people, no matter what their gender or sex is.
The American Society of Clinical Oncology recommends that people at high risk for anal cancer receive regular testing. People at high risk include those who have HIV and take part in anal sex. People without HIV who have anal sex should ask their doctor if screening is appropriate for them also.
Breast cancer is more common in cisgender women than in other people, but it can affect people of any gender or sex. Breast cancer screening recommendations depend on different factors, including a person’s age, family history of cancer, genetics, and lifestyle. Not enough research exists to know how common breast cancer is in the transgender population.
Gender affirming care, including hormone treatment and surgery, can also affect a person’s risk of breast cancer.
For example, trans men may need routine breast cancer screenings even if they underwent top surgery. That’s because top surgery (breast reduction or partial mastectomy) still leaves behind some breast tissue that’s at risk for cancer.
The risk of breast cancer in trans women partly depends on whether — and for how long — they’ve taken female hormones. Trans women are also more likely to have dense breasts, which is a risk factor for cancer.
But dense breasts are also more likely to result in false positives. That’s when a mammogram suggests possible cancer when there isn’t cancer.
Some trans people may not need breast cancer screenings, but others might. It depends on each person’s specific situation. Ask your doctor about what recommendations apply to you based on your medical and family history.
Colorectal cancer refers to cancer that occurs in the colon or in the rectum. The colon is the biggest part of the large intestine. The rectum is the part of the large intestine closest to your anus.
Colorectal cancer is the third most common cancer in the U.S., with about 150,000 new cases each year. Everyone 45 and older should receive regular colorectal cancer screenings. There are several types of colon cancer screenings with different risks and benefits. Ask your doctor what screening options exist, and which ones might be appropriate for you.
The U.S. Preventive Services Task Force recommends lung cancer screening for adults between ages 50-80 who smoked for at least 20 years. This recommendation does not apply to people who quit smoking more than 15 years ago.
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Cancer Screenings for Trans Women
Two types of cancer that may affect some trans women are testicular cancer and prostate cancer. Testicular cancer occurs in the testicles, so some trans women who have had undergone removal of the testicles may not need screenings. Trans women with testicles should have physical exams each year for doctors to look for lumps in the testicle area.
Even trans women who have received lower surgeries will usually still have a prostate. Not enough data exists to know how common prostate cancer is in trans women. The World Professional Association for Transgender Health (WPATH) recommends that trans women follow prostate cancer screening recommendations for cis men.
Prostate cancer risk increases as people with a prostate enter their 50s. Prostate cancer screenings involve a physical rectal exam or use of a blood test called a prostate-specific antigen (PSA) test.
Some medical experts do not recommend PSA tests for trans women. But WPATH and the Endocrine Society do recommend PSA tests with a different measure for positive results. The U.S. Preventive Services Task Force states that prostate cancer screenings are an individual decision for each person between ages 55 to 69.
Trans women ages 55 to 69 should talk with their doctor about the risks and benefits of prostate cancer screening. Then they can decide with their doctor whether prostate cancer is right for them and which methods to use.
Cancer Screenings for Trans Men
Cervical cancer screenings are important for all people who have a cervix, the body part that connects the uterus to the vagina. Trans men who have a cervix should follow the recommendations for cisgender women. Those who are 21 to 29 should receive screening with Pap smears every three years.
People with a cervix who are 30 to 65 have three choices for cervical cancer screening:
- Pap smears alone every three years.
- Testing for human papillomavirus (HPV) every five years.
- Pap smear with an HPV test every five years.
Barriers to Cancer Screenings
Trans people often experience discrimination and stigma when trying to seek health care. About one out of five trans people have said a healthcare provider refused to give them care. More than one in four trans people have said they experienced harassment when seeking medical care.
Another barrier to appropriate cancer screenings for trans people is not finding healthcare providers who understand transgender healthcare. Doctors need to understand each patient’s specific anatomy — their body parts — to recommend and provide the best care.
Some trans people may experience challenging emotions when thinking about, or obtaining, cancer screenings for parts of the body that don’t match their gender or because of prior traumatic experiences involving body parts that may need to be screening. It is important to discuss with your provider how to keep the parts of your body healthy and develop safe plans for screening.
Overcoming Barriers to Care
Trans people can receive better and more respectful health care by seeing doctors who understand transgender care. Clinics specializing in transgender care are a good option. You can also call ahead to a doctor’s office to find out whether they offer respectful, gender-affirming care to trans patients.
Patients who develop good relationships with a doctor over time will become more comfortable with that doctor. The doctor will also know more about the patient’s biology and medical and family history so they can offer better care. If you’re not comfortable with certain body parts, talk with a healthcare provider you trust about your concerns.
American Cancer Society. Cancer Screening Overview (PDQ®)–Patient Version. Link
American Cancer Society. Key Statistics for Colorectal Cancer. Link
American College of Obstetricians and Gynecologists. Updated Cervical Cancer Screening Guidelines. April 2021. Link
American College of Radiology. ACR Appropriateness Criteria. Transgender Breast Cancer Screening. 2021. Link
Joshua Sterling and Maurice M. Garcia. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Translational Andrology and Urology. December 9, 2020. Link
MidAtlantic AIDS Education and Training Center. Trans Men Health Screening Recommendations. Link
MidAtlantic AIDS Education and Training Center. Trans Women Health Screening Recommendations. Link
U.S. Preventive Services Task Force. Lung Cancer: Screening. March 9, 2021. Link
U.S. Preventive Services Task Force. Prostate Cancer: Screening. May 8, 2018. Link
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