it is essential to reflect on the progress made in healthcare equality and acknowledge the persistent barriers that the transgender community faces, particularly in cancer care. In the UK, trans individuals encounter unique challenges in accessing timely, appropriate, and affirming cancer treatment. These obstacles, ranging from systemic discrimination to gaps in medical knowledge, can have serious health implications. This blog explores the specific issues trans individuals are still facing in the UK's cancer care system and discusses strategies to create a more inclusive healthcare environment.

1. What is the current status of cancer care for the trans community?

Gaps in cancer screening guidelines

One of the most significant barriers is the absence of trans-inclusive cancer screening guidelines within the NHS. Standard screening programs are often designed with cisgender individuals in mind, leading to confusion about eligibility and the appropriate screening procedures for trans people. 

Trans men and non-binary individuals assigned female at birth who retain a cervix are at risk for cervical cancer. However, if they have registered with a GP as male, they may not receive automatic invitations for cervical screenings. Trans women and non-binary individuals assigned male at birth who undergo hormone replacement therapy with oestrogen are at an increased risk of breast cancer compared to cisgender men. Despite this, there are no standardised guidelines for breast cancer screening in trans women, leading to potential under-screening. For more information, see: NHS population screening: information for trans and non-binary people. 

Trans women are also at risk of developing prostate cancer, as the prostate is not removed during the genital reconstructive surgery because of the risk of side effects such as urinary problems and damage to nerves. Despite this, they may not be routinely offered the tests used to diagnose prostate cancer, especially the PSA blood test (Prostate Specific Antigen), which is offered for cis men above 50 years old. See: Trans women and prostate cancer.

These gaps in screening protocols can result in delayed diagnoses and poorer health outcomes for trans individuals. In addition, administrative issues, such as the management of gender markers in medical records, can hinder access to appropriate cancer screenings.

Discrimination and medical mistrust

Trans patients are not routinely invited to breast and cervical screening depending on how they are registered, but they are entitled to request these screenings from their GP. However, experiences of discrimination in healthcare settings deter many trans people from requesting the screenings, and from seeking medical attention in general, even when necessary. Many patients still experience transphobia in medical settings or get refused healthcare by a GP due to their transgender status. Transgender people were found more than twice as likely as cisgender people to experience discrimination and unfair treatment at their GP. LGBTQ+ patients often report incorrect assumptions at their GPs regarding their partners or family, access to contraception or fertility services, as well as their sexual orientation, gender identity, or preferred pronouns. These are considered forms of microaggressions. See: LGBTG - patient experiences in primary care (PDF).

Such negative experiences foster deep medical mistrust, leading to avoidance of healthcare services and delayed diagnoses. Additionally, healthcare providers often lack education on trans-specific healthcare needs. This knowledge gap can result in misdiagnoses or inadequate care, further exacerbating health disparities.

Impact of hormone therapy on cancer risk

Gender-affirming hormone therapy is a vital component of care for many trans individuals, but its effects on cancer risk are not fully understood. Prolonged oestrogen use in trans women may increase the risk of breast cancer. Research indicates that trans women undergoing hormone treatment have a higher risk of breast cancer compared to cisgender men, but lower than a cisgender woman. For trans men, testosterone therapy may affect breast and uterine tissue, though data on long-term risks remain limited. The lack of robust research leaves many trans individuals uncertain about their specific risks and appropriate screening protocols. See: Transgender and non-binary people and cancer.

2. What still needs to be done?

Improving access to screening

The NHS must clarify and adapt cancer screening protocols to explicitly include trans individuals. Screening invitations should be based on a person's anatomy rather than legal gender markers. Encouraging healthcare providers to discuss personalised screening plans with trans patients as part of routine care is also vital.

Improving LGBTQ+ competency training

Implementing mandatory LGBTQ+ competency training across medical and nursing education is crucial. This training should encompass cultural sensitivity by using correct names and pronouns to create an inclusive environment. Healthcare providers must also understand gender-affirming care and recognize the implications of hormone treatments on cancer risk and screening needs. Such training can improve patient-provider relationships and encourage trans individuals to engage with healthcare services.

Raising awareness and conducting further research

Raising awareness within trans communities about cancer risks and screening guidelines is essential. Collaboration between advocacy groups, healthcare providers, and government bodies can ensure that trans individuals receive clear, accessible information about their cancer risks, the importance of screening, and how to access trans-affirming healthcare. Macmillan Cancer Support, Prostate Cancer UK, NHS screening services and other agencies all provide resources to help trans individuals navigate cancer care. 

Increased investment in research is also necessary to develop evidence-based screening guidelines for trans individuals. Without accurate data, it is challenging to understand cancer prevalence, risk factors, and outcomes within the trans community. Ensuring trans representation in medical studies will allow healthcare providers to make informed recommendations for cancer prevention and treatment.

Looking ahead: towards equitable cancer care for trans individuals

Trans individuals deserve equitable, affirming, and accessible cancer care, yet many face significant barriers that compromise their health. Addressing these disparities requires a multifaceted approach, including inclusive screening programs, improved provider education, and better research into trans-specific cancer risks. By taking these steps, the NHS and the wider healthcare system can move toward a future where all patients, regardless of gender identity, receive the care they need. As we reflect on LGBT History Month, we must commit to advocating for a healthcare system that truly serves everyone. Only by dismantling barriers and fostering inclusivity can we ensure that no one is left behind in the fight against cancer.