Awareness, barriers, experiences and preferences regarding cervical and breast cancer screening among transgender and non-binary individuals.

Abstract

In most countries, breast and cervical cancer screening invitations are sent only to those legally registered as women. In the Netherlands, since 2022, self-registration for receiving invitations enables transgender and non-binary (TNB) individuals to be screened. This study aims to explore their awareness, barriers, experiences, and preferences regarding breast and cervical cancer screening. A cross-sectional survey was co-created with and administered to TNB individuals. Attitudes were measured using the Attitude Scale for Cancer Screening. Respondents were recruited through TNB advocacy and support organizations. Differences across gender identity groups were assessed using Chi-square tests, and open-text responses were analyzed thematically. Analyses were conducted based on the number of participants who completed each section. Among participants who changed their gender registration (n = 219), most (n = 179; 81.7%) were aware this could affect screening invitations, while just over half (n = 110; 50.2%) knew about the option to self-register. The main barriers were discomfort and the intimate nature of exams, distress about body parts inconsistent with gender identity, and missed invitations due to gender registration. Communication preferences varied across gender identities. Non-binary individuals and transgender men placed the highest importance on healthcare professionals acknowledging their transgender history, whereas transgender women considered this less important. Overall, respectful treatment by healthcare professionals was perceived as more important than the screening location itself, and a majority of participants (n = 77; 64.7%) expressed a preference for human papillomavirus (HPV) self-sampling over a Pap smear at the General Practitioner. While many barriers are shared with cisgender populations, challenges specific to gender identity, such as gender dysphoria and missed invitations due to gender registration, require targeted interventions. Increasing awareness of self-registration, providing affirming and accessible information, and training healthcare professionals in gender-sensitive care are essential to ensure respectful, supportive, and inclusive screening experiences.