GOT ‘EM, SCREEN ‘EM CAMPAIGN
The Got ‘em, Screen ‘em Campaign removes gendered language from cancer screening guidelines, and instead focuses on the body parts that need to be screened and when. All cancer screening guidelines are based on CDC recommendations.
Breast Cancer Screenings: LGBTQ+ Considerations
Who Gets Breast Cancer?
Everyone is at risk for breast cancer. The two most common risk factors are:
- Being female
- Getting older
No matter your age, you should get to know how your breasts normally look and feel. If you notice any changes, see a doctor.
Is there an increased risk for Lesbian, Gay, and/or Bisexual women?
Lesbian, gay, and bisexual women have a greater risk of breast cancer than other women. This is not because of their sexual orientation. Rather, it is linked to breast cancer risk factors that tend to be more common among women in our community. For example, LGB women may be more likely to never have children, or have them later in life. Lesbians also tend to have higher rates of obesity and alcohol use. All of these factors increase breast cancer risk.
Some findings show similar rates of screening mammography among lesbian, gay, bisexual, and heterosexual women. Yet other findings have shown lesbian, gay, and bisexual women may not get regular breast cancer screenings. This may be due to:
- Past experience of discrimination or insensitivity from doctors
- Perceived low risk of breast cancer
- Not having a primary care physician
- Lack of health insurance
Is there an increased risk for Transgender people?
At this time, data on the risk of breast cancer among transgender people is limited. If you are transgender, talk with a doctor about your breast cancer risk and which screening tests may be right for you. It is important to find a doctor who is sensitive to your needs, and to see a doctor on a regular basis. If you are in need of a competent and affirming doctor, please check out the Vermont Diversity Health Project or connect with Taylor for more information.
Cervical Cancer Screenings: LGBTQ+ Considerations
LGB Women and Cervical Cancer Screening
Lesbians, gay, and bisexual women are as likely as heterosexual women to develop cervical cancer, and yet are up to 10 times less likely to undergo regular screening for the disease. This disparity occurs within a broader context of marginalization of lesbian and bisexual women in the healthcare system. Lesbians are less likely to access preventive care compared to other women, and both lesbians and bisexual women are less likely to be insured compared to other women. Although cervical cancer was once one of the most deadly female cancers, early detection through regular screening has transformed this disease into the most preventable female cancer. Due to low rates of regular cervical cancer screening, lesbians and bisexual women are priority populations for cervical cancer control in this country.
Transgender Men and Cervical Cancer Screening
Transgender men with a cervix should follow the same screening guidelines as anyone else who has a cervix. Pap tests can be difficult for transgender men for a number of reasons, including:
- Dissociation between assigned sex and gender identity
- Desire to ignore the existence of natal reproductive structures
- Lack of knowledge that they still have a cervix after receiving a supracervical hysterectomy
- False positives resulting from testosterone-induced changes to the cervical epithelium that mimic dysplasia
- Testosterone-induced atrophy of the vagina that makes passage of a speculum more painful
Sensitivity to these unique barriers is important while still emphasizing the importance of regular screening. If the cervix is completely removed and there was no prior history of high-grade cervical dysplasia or cervical cancer, no Pap tests are necessary. There are no data currently available on the rates of cervical cancer or cervical cancer screening among transgender men.
HPV in the LGBTQ+ Community
Genital HPV is transmitted by skin to skin contact. Risk is therefore present in all LGBTQ+ people who engage in sex. Transmission occurs more easily in the presence of irritated skin, as often occurs with penetrative sex. The most widely used test for HPV is the Pap test, where a sample of cells is collected from the affected tissue and tested for an abnormal rate or pattern of growth, called dysplasia. Dysplasia may range from mild to severe, but because HPV infection is usually contained by the immune system, most healthy adults will never develop it. For persons with poor immune system function, however, infection HPV infection may quickly progress to severe dysplasia and cancer. For this reason, HIV-positive gay or bisexual men have higher levels of both HPV infection and HPV-related disease than heterosexual men. An estimated 61% of HIV-negative and 93% of HIV-positive gay and bisexual men have anal HPV infections, compared to 50% or less of heterosexual men.
The simplest approach to reducing the prevalence of HPV and HPV-related cancer in LGBT communities is to use the established preventative course: regular Pap smears coupled with suggested HPV vaccination for those most at risk.
For more information about HPV, click here.