Research shows one size doesn’t fit all for cervical screening in the trans and non-binary community

18 May 2021

“LGBTQ+ people in general, and particularly trans people face a lot of inequalities with regards to their health,” says Dr Alison May Berner, registrar in at the Gender Identity Clinic in London and a cancer specialist at the Cancer Research UK Barts Centre.

“There’s more we can do to try to work with the LGBTQ+ population to identify why some of these inequalities are occurring and level the playing field, doing that in a way that’s acceptable to trans and non-binary people, not putting something upon them.”

Clinicians and researchers from our Gender Identity Clinic, and 56T sexual health clinic (both in London) came together with Jo’s Cervical Cancer Trust to study this population’s attitudes to, and experiences of, cervical screening. They carried out an online survey of 137 trans men and non-binary people assigned female at birth who were patients of either clinic. The results have been published in the British Journal of General Practice.

There are an estimated 300,000 people in the UK who identity as transgender. Trans men and non-binary people are recommended to follow the same cervical cancer screening guidance as for cisgender women unless they have had surgery to remove the cervix.

This group are less likely to be up-to-date with cervical screening — a health inequality that could result in higher rates of cervical cancer. Understanding the facilitators and barriers to cervical screening for trans men and non-binary people, could improve screening uptake and experience. 

Exclusion from the NHS call and recall system of those who have changed their gender marker to male was a key barrier to accessing screening. Changing this and including robust gender identity monitoring are significant improvements that could lead to the implementation of better services for trans and non-binary people.

Participants favoured individualised approaches to screening with a choice of testing method and location, and mode of recall and results communication. Only half of those eligible for cervical screening felt they had sufficient information and it was felt that this should be made more inclusive of trans and non-binary people, with more detailed trans-specific information being made available.