Cancer screening tests are the best way to catch cancers early.
For the LGBTQ2S community, there are many barriers to healthcare that lead to lower cancer screening rates, says Dr. Ed Kucharski, family physician and Cancer Care Ontario Regional Primary Care Lead, Toronto Regional Cancer Program (South).
“There’s actually not a lot of research because we haven’t historically collected gender identity or sexual identity with screening data,” he says. “But we do know that many in the LGBTQ2S community screen for cancer at lower rates and that can lead to missed cancer, or cancer being diagnosed at a later stage when there are fewer treatment options.”
Dr. Kucharski says a greater number of LGBTQ2S people don’t have primary care providers (family physicians or nurse practitioners, for example), or may avoid medical care due to fear of or past experience of homophobia or transphobia. They may also have been denied or avoid healthcare because their appearance doesn’t match the gender marker on their health card.
“It can also be because healthcare discussions are focused elsewhere and screening then just doesn’t come up,” he says. “For gay men, healthcare discussions have historically focused on HIV or STI screening and less so on cancer screening.”
Dr. Kucharski encourages everyone: If you are eligible for screening, you should be screened, regardless of gender identity and/or sexual orientation. “The trick for us as providers is to do it in a culturally competent manner,” he says.
And, he adds, there’s no one-size-fits-all approach.
“Generally, when recommending screening with my patients, I suggest we look at the organ systems that are present,” says Dr. Kucharski. “From there, we can start conversations carefully, with the understanding that the thought of screening can be very unsettling to some LGBTQ2S people.
“But knowing that cancer screening can help find cancers early, it’s important that we all consider taking part in screening programs or other preventative measures.”
In Ontario, there are three provincial screening programs aimed at finding cancers before you would notice any symptoms.
Here’s an overview of each from Dr. Kucharski:
Cervical Cancer Screening:
Anyone with a cervix who is over the age of 21 and has ever been sexually active should be screened for cervical cancer. Sexually active means any skin-to-skin genital contact with anyone of any gender. In Ontario, cervical cancer screening is a Pap test, which looks for changes in cells in the cervix.
For trans men who are taking testosterone, we still recommend a Pap test, if you have a cervix. If you’ve had a hysterectomy, talk to your doctor to determine if you should still undergo Pap tests — it will depend on what type of hysterectomy you’ve had.
Most trans women who have had gender-affirming surgery do not need cervical cancer screening because the surgery typically does not include the creation of a cervix.
The vast majority of cervical cancer is caused by human papillomavirus (HPV). Whether you take part in screening or not, consider speaking to your primary care provider about getting the HPV vaccine.
Colorectal Cancer Screening:
If you are 50 years of age or over, you should be screened for colorectal cancer, regardless of your sexual or gender identity.
To determine your risk and the best type of screening for you, speak with your primary care provider and/or go to mycanceriq.ca
Gender identity or sexual orientation does not affect colorectal cancer risk. Here’s more information about colorectal cancer screening, including a new and better screening test available in Ontario.
Breast / Chest Cancer Screening:
If you have breast tissue, it’s recommended that you be screened according to the provincial guidelines, regardless of your gender or sexual identity.
That means if you are between ages 50-74, it’s recommended you get screened with mammography every two years. Screening is the best way to find breast cancer early.
For trans men: If you’ve had a chest surgery and have no breast tissue, your risk of breast cancer is reduced. Talk to your primary care provider about your individual risk or go to mycanceriq.ca. If you have not had a chest/top surgery, you should consider mammography screening. To make a screening more comfortable, providers can call ahead to ask about the Ontario Breast Screening Program site’s experience working with LGBTQ2S patients. Further, some patients might consider bringing a friend for support.
For trans women: if you’ve been on gender-affirming hormones (like estrogen) for 5 or more years, and you are over age 50, it’s recommended you take part in mammography screening every two years.
A Note about Anal Cancer:
Men who have sex with men have a higher risk of anal cancer, which is caused by HPV. Men who have sex with men who also have HIV have an even higher risk of anal cancer. While there’s no formal screening program for anal cancer, some providers do recommend and provide an anal Pap test to check for cell changes. Men who have sex with men should also strongly consider the HPV vaccine, which helps reduce the risk of HPV infection.