Preventive Health Screenings for Transgender Patients

Across the general population, many adults do not receive preventive screening tests (such as mammograms) and vaccinations as frequently as recommended by leading medical organizations. Unfortunately, this is even more common in the transgender community, often because healthcare providers aren't always aware of the need for these tests.

While we don’t yet have enough data on the long-term effects of gender-affirming hormone treatments when it comes to cancer risk, we still recommend screenings based on organs that are in situ for a particular individual. At present, all cancer screening guidelines are geared toward cisgender individuals; there are no trans-specific screening guidelines yet.

It's also important for providers to keep in mind that screening based on organs in situ can be emotionally distressing for some patients. Having a thoughtful conversation beforehand is essential to help minimize discomfort as much as possible.

A scoping review (Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Transl Androl Urol. 2020;9(6):2771-2785) of recent screening guidelines recommends the following:

Breast Cancer

Transmasculine patients who have not undergone a complete mastectomy should follow the same screening guidelines as cisgender females. For transfeminine patients, mammograms are recommended every two years for those over 50 who have been on gender-affirming hormone therapy for 5–10 years or longer.

Cervical Cancer

Transmasculine patients undergoing or who have undergone gender-affirming hormone treatments that cause cervical atrophy are nearly 10 times more likely to have an unsatisfactory sample during a Pap smear. This also increases the likelihood of discomfort and pain during the procedure. Providers are encouraged to take steps to improve the chances of obtaining a successful sample without compromising quality, such as swabbing a wider area. Currently, it is recommended that transmasculine patients begin routine Pap smears at age 21.

Malignancies of the Neovagina

For patients with surgically constructed vaginas, current recommendations include an annual manual exam post-surgery and a speculum exam with cytological testing every three years.

Prostate Cancer

Transfeminine patients should adhere to the current prostate cancer screening guidelines for cisgender men, with the caveat that 1 ng/mL should be considered the upper threshold of normal.

Anal Cancer

There are no specific recommendations for trans patients, however, the American Society of Clinical Oncology does recommend “routine testing for high-risk patients,” defined as those with HIV or engaging in anal-receptive intercourse. While there is no agreed upon frequency, patients and providers are encouraged to discuss overall risk and consider annual anal cancer screening for those over the age of 21.

Colon Cancer

Screening should begin at age 45, unless there are additional risk factors (such as a family history) that suggest an earlier onset of cancer. Standard screening tests and intervals are recommended.