Worldwide, cervical cancer is the fifth most commonly occurring cancer in women, mostly due to human papillomavirus (HPV) infection. In 2020, globally, an estimated 604,237 women were diagnosed with cervical cancer and about 341,843 died from the disease. In the United States, in 2021, it is estimated that nearly 14,500 cases of invasive cervical cancer will be diagnosed and about 4,300 women will die from the disease.

Although cervical cancer is pervasive and often life-threatening, it can be prevented through regular screening methods, including a Papanicolaou test. For the population of  transgender men and nonbinary people assigned female at birth (TMNB) who have not had surgery to remove their cervix, cervical cancer screening is recommended with the same frequency as for cisgender women. However, research suggests that TMNB people have lower rates of screening.

The results from a British pilot cervical cancer screening program tailored to the biologic needs and personal preferences of TMNB people show that the program was well received and supported patients to engage with cancer screenings who otherwise might not do so; the program could provide a model for similar programs. The study results were presented at the virtual 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved.

Study Methodology

In this study, the researchers launched a test program in conjunction with Britain’s National Health Service and several organizations serving gender or sexual minority populations. The program offered weekly cervical cancer screening clinics staffed by professionals who were experienced in providing screening to the transgender and nonbinary population.

The tailored program launched in October 2019. The researchers launched a 10-day social medial campaign on six platforms, reaching 40,000 people. Nine people were screened before the clinic was closed in March 2020 due to the COVID-19 pandemic. The clinic reopened in July 2020, and the researchers undertook several strategies to inform people about the program, including Facebook and Twitter, reaching 50,000 people in a 14-day campaign. The researchers also emailed clients of London’s Gender Identity Clinic and provided patient testimonials.

Between July 2020 and February 2021, 35 transgender men received tailored cervical cancer screening in the clinic.

Results

Participant surveys from 20 attendees showed 100% positive feedback, with the majority of respondents (12 of 20) stating that if the service were unavailable, they would not have received cervical screening. When asked if their general practitioner could provide a similar service, nine respondents said that they would receive the screening.

This pilot suggests that cervical screening clinics tailored for TMNB are highly acceptable to such patients. Moreover, patients who otherwise would not have engaged with screening might be more inclined to do so with support from these clinics.

“Patients may benefit from such clinics embedded within services across several health-care settings in order to maximize access. Targeted promotion via social media is effective and may encourage screening beyond the service being advertised but should concentrate on platforms most accessed by the community,” concluded the study authors.

“People assume that this population’s health care–related needs are solely related to transition,” said Alison May Berner, MBBS, MRCP, a specialty trainee and clinical research fellow in medical oncology at Barts Cancer Institute in London and a specialist registrar with the Gender Identify Clinic, in a statement. “That’s not true. Trans and nonbinary people are at risk of HPV infection and cervical cancer if they continue to retain a cervix, and they stand to benefit from programs designed specifically for them.”

Disclosure: Funding for this program was provided by RM Partners and West London Cancer Alliance hosted by The Royal Marsden NHS Foundation Trust.