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 non-binary people.
  • Trans people have a gender identity that is different from the sex they were assigned at birth.
  • Non-binary 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 non-binary 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 non-binary people may not be benefiting from all aspects of organized cancer screening. This policy helps make sure trans and non-binary people are included in Ontario’s breast cancer and cervical screening programs.

Patient Population

Trans and non-binary people

Intended Guideline Users

Healthcare providers, cervical and breast screening experts and policy makers

Research Questions

N/A