For the 2SLGBTQ+ community, there are many barriers to healthcare that lead to lower cancer screening rates, says Dr. Ed Kucharski, Chief Medical Officer for Casey House and Assistant Professor at the Temerty Faculty of Medicine, University of Toronto.

“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 2SLGBTQ+ 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 2SLGBTQ+ 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 2SLGBTQ+ 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 four 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 25 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.

Lung Cancer Screening:

Members of the 2SLGBTQ+ community smoke at higher rates than the general population, says Dr. Kucharski, which makes it important to know if you are eligible for Ontario’s lung cancer screening program.

If you are between the ages of 55 to 74 and have smoked cigarettes daily for at least 20 years (cumulative; it doesn’t have to be 20 consecutive years), you should speak to your doctor (or contact an Ontario Lung Screening Program site yourself) about whether you are eligible for screening, regardless of sexual or gender identity.

The cancer screening is done on individuals who may be at risk of getting lung cancer, but who generally feel well.

You can find more information about Ontario’s lung cancer screening program here.

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.

Resources:

Rainbow Health Ontario

Sherbourne Health Centre

Canadian Cancer Society

Check It Out Guys

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*This post was reviewed and amended June 10, 2022

The post Cancer screening in 2SLGBTQ+ communities appeared first on Your Health Matters.

To answer this question, I’ll need to give you a bit of quick background.

Human Papillomavirus (HPV) is one of the most common sexually transmitted viruses in North America. There are about 100 strains of the virus, and several high-risk strains are known to cause cervical cancer and other gynaecological cancers in women as well as other types of cancers that affect men and women (like oral and anal cancer). Most people can clear the virus from their system, and actually don’t even have any symptoms. Some strains cause warts on the genital, vaginal or anal areas (or very rarely in the mouth) a few weeks or months after infection. The warts aren’t cancer.

But, some types of HPV can cause cell changes that could lead to cervical cancer in women, penis cancer in men (rare), or anal / mouth cancer in both men and women. Each year in Ontario, there are 1,090 new cases of cancer and 14,666 new cases of genital warts attributable to HPV.

Yes, HPV is a sexually transmitted disease – but we don’t give pre-teens the vaccination because we think they are sexually active. In fact, the vaccine is most effective if you haven’t already been exposed to the virus and that’s why Ontario’s program works with students in Grade 7. Evidence actually shows that most pre-teens aren’t yet sexually active. Canada’s National Advisory Committee on Immunization recommends vaccination in Grade 7 or 8 because receiving the vaccine at this age (12 going on 13, typically) maximizes the benefits of the vaccine. Studies also show the HPV vaccine produces a higher immune response in pre-teens than it does in older teens and young women.

Since 2007, girls in Grade 8 in Ontario have been offered the HPV vaccine for free. The HPV consists of two doses, given six months apart, through schools now to Grade 7 students. Three doses are required if first dose is on or after 14th birthday.

You are correct in that the vaccine is now offered to boys as well. This change occurred in April 2016. The vaccine helps prevent boys from getting HPV, which can lead to cancer of the penis, throat and mouth, and also helps prevent them from spreading the virus to their sexual partners. Again – this is not because we think your seventh grader is having sex. This helps prevent him from getting the virus and spreading the virus when he does become sexually active, whatever age he may be at that time.

The HPV vaccine covers many, but not all, strains of HPV.  The vaccine currently provided by Public Health covers four major strains (responsible for about 70% of cervical cancer).  A newer vaccine, not currently provided by Public Health, covers nine strains (responsible for about 90% of cervical cancer). Both vaccines prevent about 90% of genital warts.  Speak to your physician to find out more information about the newer vaccine, which can be obtained through your physician’s office; however, you will need a prescription, and the cost is approximately $175 per dose.

Even after getting the vaccine, it’s important to take measures to practice safe sex. Speak to your pre-teen or teen about this. Male condoms worn properly during sex can help prevent spread of HPV and other sexually transmitted infections. Vaccinated women should get screened for cervical cancer through regular PAP tests after age 21.

If you need more information on HPV or the vaccine, here are some great resources: Toronto Public Health  and Health Canada. 

Or make an appointment with your son’s family doctor to discuss the vaccine. While the vaccine is offered through the school-based system through Public Health Units in Ontario – this varies by province – you can also speak to your doctor or a Public Health nurse at a clinic near you wherever you live.

The post Ask a Family Doctor: Why are pre-teens offered the HPV vaccine? appeared first on Your Health Matters.

Oh, the Pap test. ~cue crossed legs and sweaty palms~

But, the discomfort certainly doesn’t seem so bad when you consider a Pap screening test — where a doctor collects cells from the inner part of your cervix — is the only way to find early cell changes that might lead to cervical cancer.

To figure out why a timely Pap test is so important, I talked to Dr. Lisa Del Giudice, family physician on the Sunnybrook Academic Family Health Team and Regional Primary Care Lead, Toronto Central Regional Cancer Program.

What’s a Pap test looking for?
A Pap test is looking for abnormal cells — cancer or pre-cancer — in the cervix. Sometimes other gynecological cancers can be detected during a Pap test.

A Pap test isn’t the same as a test for sexually transmitted diseases (STDs).

“Sometimes an STD can be picked up on a Pap, but it is not really the appropriate way to test for STDs,” Dr. Del Giudice says. “The appropriate STD tests can be done at the same time if there is any concern in this regard.”

How can it help prevent cervical cancer?
In 2015, about 640 women were diagnosed with cervical cancer in Ontario and about 150 women died from the disease, according to Cancer Care Ontario. Cervical cancer is almost entirely preventable with regular screening, appropriate and timely follow-up of abnormal results.
“The Pap test can find the abnormal cells or high-risk human papillomavirus (HPV) early so that next steps can be taken or the patient can be screened more often,” Dr. Del Giudice says. (Some HPV can lead to the abnormal cell changes and cause cancer).

How often should I have it?
It is recommended that women aged 21 to 69 have a Pap test every three years if they are or have ever been sexually active. Sexually active doesn’t just mean sexual intercourse — oral and digital contact also count. Women who have sex with women should have regular Pap tests.

Research suggests that smoking puts you at higher risk for cervical cancer. If you smoke and are sexually active, be extra certain to book your Pap test every 3 years.

“If you’ve had a total hysterectomy (uterus and entire cervix removed) then you no longer need to undergo Pap screening. But, if your cervix was left partially intact you still do. Same if you’ve had your ovaries removed — you should still have regular Pap tests,” Dr. Del Giudice explains.

Who can do the Pap test?
A Pap test can be done at your family doctor’s office. If you don’t have a doctor, you can get a test done at a walk-in clinic or sexual health clinic.

What happens if the Pap test ‘finds something’?
If your doctors sees an abnormality (something that looks like it could be cancer or pre-cancerous cells), they may want to repeat the test, or do further testing to high-risk HPV and/or refer you to a gynecologist for a colposcopy (a test that takes a bigger sampling of your cervix to check for and to remove pre-cancerous or cancer cells.

Any tips for making it a little less uncomfortable?
If you’ve had a painful Pap test in the past, mention it to your doctor. All women are different – your cervix might tilt to the front or back or side. Ask your doctor to note any tilt in your file (so you both can avoid the whole poke-around-down-there-trying-to-find-the-right-of-way next time)

For post-menopausal women, talk to your doctor about possibly applying topical estrogen for one to two weeks before your Pap test.

You can take an Advil a half hour before the test. And try your very best to take a deep breath and relax. (Easier said than done, but try!)

If during the test you are in pain, ask your doctor if you can tip your pelvis up to reposition (by putting your hands under your bum).

I can’t remember if my last Pap was two years ago or three – but I think it’s definitely worth a call to my family doctor (or a look in my MyChart!) to see if it’s time to book one. I think I can stand a few moments of discomfort knowing it’s for a potential lifetime of better health.

The post Is it time for your Pap test? appeared first on Your Health Matters.

But what about when it comes to your health?

Keeping healthy in your 30s starts in your 20s (and even earlier), according to Dr. Sharon Domb, medical director, department of family and community medicine at Sunnybrook. She gave us 7 simple tips for how to get – and stay – healthy by your 30^th birthday and beyond:

1) Protect yourself against HPV

Dr. Domb recommends that women ensure they’ve completed the series of shots to be vaccinated against HPV (Human Papillomavirus). HPV can increase a woman’s risk of developing certain types of cancer, such as cervical, anal and head & neck cancers, making vaccination an important part of your healthy living toolkit.

2) Don’t put off Pap smears

They can be uncomfortable, and are often the most unpleasant part of an annual physical. But Pap smears look for abnormalities that may end up developing into cancer, so it’s important not to put off scheduling one. Beginning at age 21, women should get one every 3 years. “If there is an abnormal result, you will need to get Pap smears more often,” says Dr. Domb.

3) Keep fertility in mind

Fertility is highest in your 20s and early 30s. “You cannot depend on your fertility after your mid-30s,” says Dr. Domb. Issues can arise when putting off pregnancy because fertility significantly drops after the age of 35. While there is no way to preserve or prolong fertility, women can freeze their eggs. Dr. Domb recommends that egg freezing should be done no later than age 37.

If you are considering pregnancy in the near future, see your physician for a preconception appointment. “It’s important to do this well before you stop using your birth control. Your physician may do some blood work, and can also advise you on medications, alcohol, caffeine and smoking,” says Dr. Domb.

4) Get tested regularly for STIs

Some Sexually Transmitted Infections (STIs) have no symptoms and women don’t realize they’ve contracted an infection, which makes regular testing so important. “Left untreated, infections such as chlamydia can scar your fallopian tubes, which can impact your health and fertility later on,” says Dr. Domb. Most STI testing can be done with a simple urine sample, and doesn’t require a pelvic exam.

5) Watch for signs of depression

If you’ve been feeling down for more than a few weeks, tell your doctor. “If your appetite or sleep has been affected, you’re not enjoying the activities you once did, you are feeling withdrawn or you are having thoughts about suicide- these are signs of depression, and they should not be ignored,” says Dr. Domb.

6) Take a multivitamin with folic acid

Even if you aren’t planning on getting pregnant in the near future, taking folic acid before (and during) pregnancy can prevent major birth defects like spina bifida.

7) Swap beer for burpees

For women, no more than nine alcoholic drinks per week should be consumed. A drink is a glass of beer, a 5-oz glass of wine, or an ounce of hard liquor. “Consuming more alcohol than that may impact your liver, and can lead to liver disease,” says Dr. Domb.

At the same time, women in their 20s and early 30s should be getting at least 150 minutes of exercise per week. So set aside the glass of wine, lace up your running shoes and get your body moving!

The post 7 tips for staying healthy at 30 (and beyond) appeared first on Your Health Matters.

1) HPV causes cancer in men, too

When Michael Douglas candidly revealed his oral cancer was caused by HPV earlier this year, many people expressed surprise.

Even though HPV has traditionally been thought of as a disease that affects women and mainly causes cervical cancer, men are actually at higher risk of being diagnosed with certain types of HPV-positive cancers than women.

“It’s not well understood why men are at higher risk for HPV-positive oral cancer, but it does point out that vaccination in men is even more important than we may have previously thought,” says Dr. Durand. Physicians are learning more and more that HPV can also cause other cancers in both women and men, such as anal cancers and head & neck cancers (cancers of the base of the tongue, tonsils and soft palate).

2) Not all HPV infections lead to cancer

You’ve probably read some of the (slightly scary) statistics about HPV: 3 in 4 Canadians will get HPV in their lifetime. It can lead to a variety of cancers and cause genital warts, and there is no cure. But should this keep you up at night, worrying about the potentially deadly consequences of HPV?

Hardly, says Dr. Durand. “Most people who are infected with this virus will clear it- probably 80% of people. It’s the other 20% of people with a persistent infection who may be at risk of cancer, and it’s still only a very small percentage of those people who may go on to develop cancer,” she says.

Many people never even realize they’ve had an HPV infection, as there are usually no symptoms, and the infection often goes away on its own.

3) You’re never too old to get the HPV vaccine

What if you didn’t get the HPV vaccine back in middle school, and now you think it’s too late to get it?

[pullquote align=”right”]”Regardless of your age and your onset of sexual activity, we can vaccinate both men and women, and we can see a reduction in disease,” says Dr. Durand.[/pullquote]It’s actually not too late- the vaccine can still be effective, even in adults who’ve already been sexually active. “Many people think vaccination can only be done before the onset of sexual activity. But regardless of your age and your onset of sexual activity, we can vaccinate both men and women, and we can see a reduction in disease,” says Dr. Durand.

Anyone, male or female, over the age of 9 can be vaccinated. So, if you’ve put off getting the vaccine because you thought you were too old, it’s not too late!

The post 3 things you might not know about HPV appeared first on Your Health Matters.