PHILADELPHIA – A pilot program that provided transgender men and nonbinary people with cervical cancer screening tailored to their biological needs and personal preferences was well-received and could provide a model for similar programs, according to results presented at the virtual 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved, held October 6-8, 2021.
Cervical cancer is the fifth most common cancer in the world. It can often be prevented through regular screening via methods including a Pap test. In the United Kingdom, where this pilot program was launched, screening is recommended every three years for people with a cervix between the ages of 25 and 49, and every five years for those between age 49 and 64, (Guidelines in the United States are similar, but recommend beginning screening at age 21.)
These screening recommendations encompass all people who have cervixes, including trans men and nonbinary people. “Trans men and nonbinary people are often reluctant to receive cervical screening, raising their risk of undetected human papillomavirus, which could lead to cervical cancer,” explained the study’s lead author, 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 Identity Clinic, part of the Tavistock and Portman NHS Foundation Trust.
Berner said that many trans men and nonbinary people avoid cervical cancer screening because it may exacerbate discomfort with their bodies or their identities. Many also cite fears that their clinicians will make them feel uncomfortable or stigmatized.
Previous research had indicated that trans men and nonbinary people would be more likely to access cervical cancer screening through a trans-specific sexual health service. 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 trans and nonbinary population.
The tailored screening launched in October 2019. The researchers launched a 10-day social media campaign on six platforms, reaching 40,000 people. Nine people were screened before the clinic closed its doors in March 2020 due to COVID-19 restrictions.
The clinic reopened in July 2020, and the researchers undertook several different strategies to inform people about the clinic. They used only the two most popular social media platforms, Facebook and Twitter, reaching 50,000 people in a 14-day campaign. They also emailed clients of London’s Gender Identity Clinic and provided patient testimonials.
Between July 2020 and February 2021, 35 people received tailored cervical screening in the clinic. Organizers received feedback surveys from 20 participants. A full 100 percent said they were satisfied with the service. Most respondents (12 out of 20) said that if the service had not been available, they would not have undergone cervical screening. Nine out of the 20 respondents said that if their own general practitioner provided a trans-specific screening, they would participate.
Berner said the feedback from the pilot program indicates that trans-specific cervical screening is beneficial and could help ensure that cervical cancer does not go undetected in the trans and nonbinary population.
“People assume that this population’s health care-related needs are solely related to transition. 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,” Berner said.
Berner added that future research will aim to replicate the trans-specific screening within primary care, under the care of general practitioners. She noted that programs like this would be most likely to succeed in large cities with significant numbers of trans and nonbinary people, though sensitive screening is needed everywhere, even in rural areas.
“If you’re a trans or nonbinary person living in a place where these specialist services do not exist, I would encourage you to work with a trusted health care professional to build relationships and ensure that you get the appropriate screenings, while continuing to have your identity respected,” she advised.
As previously noted, the study’s scope was limited by the COVID-19 pandemic, which led to the temporary closure of clinical sites.
This program was developed through funding from RM Partners, West London Cancer Alliance hosted by The Royal Marsden NHS Foundation Trust. Berner declares no conflicts of interest.
Abstract
Title: A UK-based pilot cervical screening clinic tailored to trans men and non-binary people
Trans men and non-binary people experience numerous barriers to accessing cervical screening, including dysphoria related to the procedure, anticipated or experienced stigma and discrimination, lack of provider knowledge and exclusion from routine recall systems. As a result, this population are less likely to attend regularly and a recent UK study showed that the majority prefer to access screening via a trans-specific sexual health service. This pilot sought to trial a weekly dedicated cervical screening clinic for trans men and non-binary people to gauge acceptability and to explore how best to promote the service. Organisations with the expertise of working with this population in the UK collaborated on the project. A communications plan was developed which included promotion of the project to local area stakeholders. A promotional video was produced as well as three patient testimonials from trans people who had attended for screening. The social media campaign comprised initial promotional material on six platforms with post-hoc analysis and a second stage using the two most popular platforms. The clinic commenced in October 2019 within an existing trans-specific sexual health service in London, UK. It was staffed by healthcare professionals with training and experience in performing cervical screening for trans people, including sensitive communication and techniques to facilitate a more comfortable procedure. Appointments could be accessed via a dedicated booking email and telephone number. Patients were asked to complete an evaluation after the procedure. From October 2019, nine people were screened prior to the outbreak of Covid-19 in March 2020. The project was suspended immediately after the first social media campaign launched, having had over 40,000 views over 10 days. In July 2020 the project recommenced, and the second social media campaign ran on Facebook and Twitter for 14 days, with over 50,000 views. A targeted email advertising the service was sent to eligible patients currently under the Gender Identity Clinic London in August 2020 and the service advertised via their website. Between July and February 2021, 35 trans men were screened in the clinic, despite another lockdown. Participant surveys from 20 attendees showed 100% positive feedback. The majority of respondents stated that if the service was unavailable, they would not have attended cervical screening (12/20 respondents). However, when asked if their GP could provide a similar service, nine respondents stated that they would attend (9/20 respondents). This pilot suggests that bespoke cervical screening clinics for trans men and non-binary people are highly acceptable, and support patients to engage with screening who otherwise would not have done so. Patients may benefit from such clinics embedded within services across several healthcare settings, in order to maximise access. Targeted promotion via social media is effective and may encourage screening beyond the service being advertised but should be concentrated on platforms most accessed by the community.