Preventive Screening

Factors and General Recommendations

Fear of discrimination or past trauma within the health care system may account for lower rates of cancer screening and later diagnosis in some LGBTQIA+ people. Community-informed outreach about the importance of organ-based cancer screenings, peer support provided by trans health navigators, and increased use of self-administered screening tools are strategies found to improve cancer screening rates among trans people.

Behaviors, including substance use and sexual practices, also play a role in increased cancer risk. Increased tobacco use relative to the general population contributes to higher rates of lung and other cancers among many LGBTQIA+ people who have been studied. As recommended for the general population, clinicians should ask all LGBTQIA+ patients questions about tobacco use, encourage smoking cessation, and perform cancer screening for anyone with a history of tobacco use. Higher rates of sex work, unprotected sex, and HIV infection in trans people can also put individuals at greater risk for human papillomavirus (HPV)–mediated cervical and anal cancers. Trans people living with HIV should be screened for AIDS-defining cancers like Kaposi sarcoma and non-Hodgkin lymphoma.

Insufficient evidence exists regarding whether hormone use among trans people increases cancer risk. Cancer screenings should be offered to all patients based on organ inventory and behavioral risk factors, in accordance with current guidelines for the general population. A full medical, surgical, and sexual history is critical to determine which routine screenings are appropriate for an individual trans patient.

Cervical Cancer Screening

All people with a cervix should receive cervical cancer screening. Research into the accuracy and sensitivity of self-collected samples for cervical cancer screening is ongoing, as this option is more [Page 645]acceptable to trans men and nonbinary people assigned female at birth (AFAB) than clinician-obtained samples. Further efforts to improve accessibility and tolerability of preventive cancer screenings for trans people are critical.

Prostate Cancer Screening

Trans people with a prostate should receive prostate exams if indicated, based on guidelines for cisgender men. Androgen suppression likely reduces prostate cancer risk for some trans women and nonbinary people assigned male at birth (AMAB) who undergo surgical removal of the testes, hormone therapy, or both.

Breast Cancer Screening

Breast cancer screening guidelines continue to evolve for cis women, leaving open the question of how to adapt these recommendations for trans people.

Current data suggest that trans women and nonbinary people AMAB taking feminizing hormones have the same or lower incidence of breast cancer as do cis women. Due to variable length of estrogen exposure compared to cis women, screening mammography is not recommended for trans women until the age of 50; after 5 to 10 years of feminizing hormone use, mammography should be performed every 2 years thereafter. Longer duration of feminizing hormone use, significant family risk factors, or genetic mutations like BRCA may be cause for earlier or more frequent screening, at the clinician’s discretion.

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