Abstract
BackgroundTransgender men and non-binary people assigned female at birth (TMNB) who have not had surgery to remove the cervix are recommended to undertake cervical screening with the same frequency as cisgender women, but evidence suggests that TMNB have lower odds of lifetime and up-to-date cervical screening uptake.AimTo understand the attitudes towards and preferences for cervical screening among UK-based TMNB.Design and settingCross-sectional survey of TMNB at an NHS gender identity clinic (GIC) and an NHS sexual health service specialising in care of transgender people.MethodRecruitment was via email invitations to patients of the GIC and sexual health service. Inclusion criteria were: female sex assigned at birth; transgender man, masculine, or non-binary gender identity; aged ≥18 years; and UK resident. Quantitative results were analysed using descriptive statistics, and free-text comments were analysed thematically.ResultsIn total there were 137 participants; 80% identified as transmasculine,18% as non-binary, and the remaining participants reported other noncisgender identities. Sixty-four participants (47%) were eligible for cervical screening and 37 (58%) of those had been screened. Only 34 (53%) of those eligible felt they had sufficient information about cervical screening. Just over half (n = 71/134, 53%) stated they would like the option to self-swab for high-risk human papillomavirus. Only half (n = 68/134, 51%) of participants were in favour of an automatic invitation for cervical screening. Thematic analysis identified a number of additional barriers to and facilitators of screening.ConclusionTMNB have identified numerous potential areas for change that may improve cervical screening uptake and patient experience.
Highlights
Cervical cancer is the fifth most common cancer worldwide,[1] with approximately 98% of cases attributable to malignant transformation of the cervical epithelium in response to chronic infection with ‘highrisk’ human papillomaviruses.[2,3,4,5,6] it is largely preventable thanks to cervical screening.[7]
In the UK, this involves the application of a brush to sample ectocervical epithelium, which is tested for highrisk’ human papillomaviruses (hrHPV)
This study indicates that TMNB lack sufficient information about cervical screening, and experience barriers to accessing screening services at personal, interpersonal, and institutional levels
Summary
Cervical cancer is the fifth most common cancer worldwide,[1] with approximately 98% of cases attributable to malignant transformation of the cervical epithelium in response to chronic infection with ‘highrisk’ human papillomaviruses (hrHPV).[2,3,4,5,6] it is largely preventable thanks to cervical screening.[7]. The sample is examined microscopically for evidence of precancerous changes (cervical cytology).[8] Cervical screening is recommended for anyone with a cervix every 3 years from age 25–49 years, and every 5 years from age 50–64 years.[9] Uptake of cervical screening is not uniform across the eligible population, potentially putting some hard-to-reach groups at increased risk of cancer.[10]. Transgender men and non-binary people assigned female at birth (TMNB) who have not had surgery to remove the cervix are recommended to undertake cervical screening with the same frequency as cisgender women, but evidence suggests that TMNB have lower odds of lifetime and up-to-date cervical screening uptake
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