Influence of gender modality on the delivery of breast cancer care from diagnosis to treatment: a systematic review

Abstract

Background: Breast cancer is a global health burden. Although screening and treatment programs have improved breast cancer survival for Canadians, it is unclear if there is a disparity in cancer burden and care received by transgender and Two-Spirit patients due to the general paucity of research concerning breast cancer care of these individuals. Objective/Aims: A systematic review was conducted to examine the burden of breast cancer in transgender and Two-Spirit populations, identify how gender modality/identity may impact the delivery of breast cancer care, and develop actionable recommendations for the provision of more inclusive, high-quality cancer care. Methods: A comprehensive search of PubMed/MEDLINE (OVID), Embase (OVID), and Web of Science databases was conducted using keywords and based on the PRISMA framework. Two independent reviewers performed selection and data extraction of studies that met inclusion criteria related to breast cancer in adult transgender and/or Two-Spirit patients. Results: Of 7,402 articles screened, 61 studies were included, the majority of which focused on binary-identified trans people, with none addressing Two-Spirit people’s experiences of cancer care. Findings determined no clear association between gender affirming hormone therapy and risk of breast cancer in transgender populations. Additionally, the burden of breast cancer could be identified for transgender and/or Two-Spirit patients. Patient-provider and system barriers in the delivery of breast cancer care were identified, including lack of trust and knowledge, discrimination, and insufficient population-wide data collection and research. Conclusion: Significant gaps in literature regarding the experiences, barriers and needs of transgender and/or Two-Spirit patients with breast cancer exist. Developing effective guidelines and clinical practices that encompass all gender identities and expanding the depth and scope of research is crucial toward fostering diverse, inclusive, and equitable healthcare.