Nurse training key to improving cancer screening for transgender, gender diverse people

A lack of culturally safe health screenings for transgender and gender diverse (TGD) people increases the risk of cancer going undetected, but nurses can be trained to fill the gap.

That's the view of researchers from Canada and Australia who are calling for improved access to prevention and screening services for people vulnerable to TGD.

A new paper published in Seminar Oncology Nursing It outlines the barriers that TGD individuals face when attempting to access gender-affirming healthcare, particularly in low-income countries and countries where gender and sexual diversity are illegal.

Although TGT people make up a small proportion of the overall community (conservative estimates range from 0.3% to 4.5% of adults), they suffer from the same health problems and may be at higher risk of cancer due to higher rates of alcohol and tobacco use and sexually transmitted diseases.

Study co-author Toni Slotness-O'Brien, a nurse at the University of South Australia, said TGD people deserve the same care as cisgender people, but nurses, doctors and health care workers currently lack the experience to provide inclusive and respectful care to the group.

“There is a lack of knowledge about alternative tests such as self-sampling for cervical cancer screening, and the importance of encouraging transgender women to get mammograms from the age of 50, as they are developing breast tissue,” says Slotness O'Brien. “Transgender men should also get cervical cancer screening, even when they are taking testosterone.”

Despite increasing awareness of sexual diversity, TGD people continue to face discrimination, intimidation and violence as a result of widespread stigma, which leads to poorer physical, emotional and mental health compared to cisgender people, according to the researchers.

“One of the big issues I see is letting personal opinions influence a doctor's decision to provide gender-affirming care.”

Due to actual or fear of discrimination, many TGD people are reluctant to undergo health checks, including cancer screening, which can lead to delayed cancer diagnosis and treatment, poor prognosis, and even death.

The World Professional Association for Transgender Health recommends several guidelines for physicians to follow when considering the needs of TGD patients receiving estrogen therapy, including consideration of the duration of estrogen therapy, dosage, patient age, and age at which gender-affirming hormone therapy should be initiated.

Independent studies have found that the average age at developing breast cancer is younger in transmasculine people who have had a mastectomy, highlighting the importance of regular screening.

The researchers say the risk could be reduced if nurses were trained to work with clinicians to improve access to care for this vulnerable group.

At UniSA's City West Health Clinic, we run a transgender and gender diverse clinic and provide gender-neutral toilets. It's little things like this that make a big difference to trans people.”

Toni Slotnes O'Brien, study co-author, nurse, University of South Australia

sauce:

University of South Australia

Journal References:

Ziegler, E. other. (2024). Cancer screening and prevention in transgender and gender diverse populations: Considerations and strategies for advanced practice nurses. Oncology Nursing Seminar. Translation: doi.org/10.1016/j.soncn.2024.151630.

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