Transgender people in England are missing out on vital cancer screening, experts warn
Thousands of transgender patients in England are missing out on vital cancer screening because of the way their GP records are kept, experts have warned.
Everyone who is registered as a woman with their GP is automatically invited to the population screening for breast cancer from 50 to 70 years of age and to the regular population screening for cervical cancer from 25 to 64 years of age.
But warnings from experts at the World Cancer Congress in Geneva this week, underscored by official NHS guidelinesshow that many trans patients are not invited to submit to the tests.
In England, trans men who were registered as female at birth and have changed their gender on their medical records to male are not offered breast or cervical cancer screening, regardless of whether they have had breast reconstruction or hysterectomy.
Trans women who are still registered as men with their GP are also not offered routine breast examinations, even if they have been on hormone therapy for a long time. increased risk of breast cancer.
Experts say the problem is the way electronic GP records are updated in England when patients change gender.
NHS England stipulates that when a patient changes their registered gender, they will be issued with a new NHS number and must be registered as a new patient with their GP. All their previous medical history will be transferred to their new medical record and their previous name, birth gender, other gender-specific terms and old NHS number will be removed.
Because breast and cervical cancer screening programs use patient gender as the basis for generating appointment invitations, many trans patients are missing out.
Broader cancer statistics, such as screening participation, stage at diagnosis, treatment adherence and outcomes, are also not recorded for trans cancer patients.
It is estimated that there between 200,000 and 500,000 transgender people in the United Kingdom.
Stewart O’Callaghan, chief executive of the charity OutPatients, told the summit in Geneva: “Even if just 10% change their gender on their GP record, it means tens of thousands of people will be unable to get a routine mammogram or smear test, which could detect cancer at an early stage and save lives.”
NHS guidelines state that trans people who are excluded from these national screening programmes can request a mammogram or smear test from their GP. However, GPs are not routinely trained to discuss screening with trans people or to ensure they have the same access to tests, reminders and follow-up appointments.
Dr Alison May Berner, an oncologist specialising in transgender cancer care who was also present at the World Cancer Congress, said: “We all have busy lives and rely on these vital systems to remind us to get screened. What’s more, these screenings can be dysphoric for transgender people.
“By placing the burden on the individual to go to the GP, existing inequalities in healthcare for trans patients are exacerbated.”
Gemma Peters, director of Macmillan Cancer Support, said: “Research shows that transgender people more likely to be exposed to a number of risk factors for cancer, while their access to timely and effective care is impacted by a range of complex issues. From screening and diagnosis to treatment and support, it is essential that transgender people receive the care they need and are entitled to. The reality is that health disparities put lives at risk.”
O’Callaghan said more could be done. “The system needs to find a way to track trans status without removing a person’s right to privacy.
They added: “One possible solution would be to record both sex and gender at birth in the patient record, but with the latter only accessible at the system level or by clinicians with consent. But any solution to this problem must be co-created directly with trans patients.”