Overarching Policy for the Screening of Trans People in the Ontario Breast Screening Program and the Ontario Cervical Screening Program

Guideline Objective

• This policy provides specific evidence-informed screening recommendations for trans and nonbinary people.
  • Trans people have a gender identity that is different from the sex they were assigned at birth.
  • Nonbinary people have a gender identity that does not fall into male or female categories.
  • Cisgender people have a gender identity that matches the sex they were assigned at birth.
• Trans and nonbinary people are medically under-served^[1]Reference 1 Close reference Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding [Internet]. Washington, DC: National Academies Press (US); 2011. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64806OpenClose and less likely to be up to date with breast and cervical screening than cisgender women.^[2]Reference 2 Close reference Canadian Cancer Society [Internet]. Screening in LGBTQ communities: Why should you get screened? 2019. Available from: http://www.cancer.ca/en/prevention-and-screening/reduce-cancer-risk/find-cancer-early/screening-in-lgbtq-communities/why-should-you-get-screened/?region=onOpenClose ^[3]Reference 3 Close reference Peitzmeier S, Khullar K, Reisner S, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. 2014;47(6):808-12.OpenClose ^[4]Reference 4 Close reference Bazzi, A.R., et al., Adherence to Mammography Screening Guidelines among Transgender Persons and Sexual Minority Women. Am J Public Health, 2015. 105(11): p. 2356-8.OpenClose This is because of barriers to accessing those services such as healthcare providers who may not fully understand their needs^[5]Reference 5 Close reference Bauer G, Zong X, Scheim A, Hammond R, Thind A. Factors Impacting Transgender Patients' Discomfort with Their Family Physicians: A Respondent-Driven Sampling Survey. PLoS ONE 10. 2015;12.OpenClose and a lack of trans-specific cancer screening recommendations.
• These barriers also mean screen-eligible trans and nonbinary people may not be benefiting from all aspects of organized cancer screening. This policy helps make sure trans and nonbinary people are included in Ontario’s breast cancer and cervical screening programs.

Patient Population

Trans and nonbinary people

Intended Guideline Users

Healthcare providers, cervical and breast screening experts and policy makers

Research Questions

N/A