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Ontario Cancer Facts

New policy addresses cancer screening inequities in transgender people

Sep 2019


Cancer Care Ontario has developed a new policy with 17 recommendations on breast cancer and cervical screening for transgender people. The policy will be available on our website in October 2019 on the screening page. “Transgender” (or “trans”) refers to people who identify with a gender that is different from the sex they were assigned at birth. “Transgender” is used as an umbrella term and can refer to a wide variety of people with different gender expressions and identities (please see the Table 1 below for more information).

The policy was developed to address the fact that transgender people are medically underserved and may not be getting screened for cancer regularly through Ontario’s organized cancer screening programs.

The policy includes specific screening recommendations for all transgender people, including people who have undergone hormone therapy and/or gender-affirming surgery. It also includes recommendations on the importance of creating safe spaces in healthcare settings. The policy states that – as with all patients – medical clinics, doctors and nurses should make sure the experience of getting screened for cancer is respectful and comfortable for transgender people.

In addition to the policy, Cancer Care Ontario will be using gender-neutral language in its products and materials, whenever possible. Gender-neutral language recognizes that not everyone identifies as a man or a woman. For example, someone who identifies as a man even though their sex assigned at birth was female may feel excluded if cancer screening materials use “women/woman” throughout.

The policy and using gender-neutral language are in alignment with a new law, called Bill C16, which was approved by the Parliament of Canada in 2017. The purpose of Bill C16 is to protect transgender people and people whose gender expression differs from their assigned sex at birth. It states that organizations should design or change their rules, practices and facilities to avoid negative effects on transgender people and be more inclusive for everyone.

Conservatively, about 200,000 Canadians identify as transgender, which includes 77,000 people in Ontario. Research shows that transgender people do not receive the same quality of healthcare that cisgender people do. This inequity exists because it can be harder for transgender people to access the healthcare services they need. For example, it may be more difficult for transgender people to get screened for cancer because there are no specific guidelines for screening them.

Studies also show that transgender people are more likely to have negative experiences when they use healthcare services and report that healthcare professionals may not fully understand their needs. For example, approximately 40% of transgender people with a family doctor have experienced discrimination from that family doctor at least once. These barriers, among others, can contribute to transgender people being less up to date with breast cancer and cervical screening than cisgender women.

The Cancer Screening program has committed to implementing Cancer Care Ontario’s new transgender policy, which will hopefully help improve the experience for transgender people in the healthcare system. Some elements of the policy will be implemented more easily than others, more complex elements will take longer to fully implement.

Table 1: Key Terms


Someone who is cisgender has a gender identity that matches the sex they were assigned at birth. For example, someone who is assigned the female sex at birth and who feels they identify as a woman is cisgender.

Gender expression

How an individual expresses their gender. For example, this can include their appearance or how they dress.

Gender identity

A person’s internal self-awareness of being a certain gender.

Gender-neutral language

Gender-neutral language avoids identifying someone’s gender by using pronouns such as “people,” “them” or “they” instead of “women,” “men,” “he” or “she”.


Someone who is transgender, trans or gender-diverse has a gender identity that is different from the sex they were assigned at birth. These terms include, but are not limited to, people who identify as transgender women (people who were assigned the male sex at birth, but identify as female), transgender men (people who were assigned the female sex at birth, but identify as male), gender non-conforming, gender variant, gender queer or two-spirit people.

Some transgender people get medical help to make their body match their gender identity. For example, a transgender woman may get breast implants (called gender-affirming surgery) and/or take female sex hormones (e.g., estrogen). However, some transgender people may choose not to get medical help.

For more information, please contact


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