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Barriers and facilitators to cervical cancer screening among transgender men and non-binary people with a cervix: A systematic narrative review.

Authors
  • Connolly, Dean1
  • Hughes, Xan2
  • Berner, Alison3
  • 1 Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK; Newham University Hospital, Barts Health NHS Trust, Glen Rd, London E13 8SL, UK. Electronic address: [email protected] , (Denmark)
  • 2 St George's University Hospitals NHS Foundation Trust, London SW17 0QT, UK.
  • 3 Gender Identity Clinic, The Tavistock and Portman NHS Foundation Trust, 179-183 Fulham Palace Road, London W6 8QZ, UK; Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BE, UK.
Type
Published Article
Journal
Preventive Medicine
Publisher
Elsevier
Publication Date
Jun 01, 2020
Volume
135
Pages
106071–106071
Identifiers
DOI: 10.1016/j.ypmed.2020.106071
PMID: 32243938
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Cervical cancer mortality in the United Kingdom (UK) has decreased over the last decade, largely due to uptake of cervical cancer screening. However, only those with a female gender marker on their health records are invited, creating a significant barrier to gender minorities accessing screening. We undertook a systematic review to synthesise published literature on cervical cancer screening among eligible gender minorities, aiming to identify barriers and facilitators that might inform changes in UK policy and clinical practice. We conducted a broad search across Medline, Embase, PsycInfo and Global Health databases to 3rd January 2020 and included any original, peer-reviewed research, published in the English language that reported on cervical cancer screening among gender minorities assigned female at birth (AFAB). Twenty-seven studies were critically appraised and included in the final synthesis, which identified significant disparities in cervical cancer screening uptake between gender minorities AFAB and cis women. It revealed a lack of knowledge surrounding the relationship between gender minority status and cervical cancer risk among both service users and providers and highlighted significant barriers to access for gender minorities AFAB. Cervical cancer screening was not universally associated with dysphoria among gender minorities AFAB and we recommend that providers explore patients' preferences around screening, while avoiding assumptions. Providers should be proficient in examination techniques that maximise patient autonomy and minimise gender dysphoria or pain. Self-swabs for high-risk HPV may provide a more acceptable, evidence-based, alternative to Pap smears but there remains a need for further UK-specific research, to inform changes in policy. Copyright © 2020 Elsevier Inc. All rights reserved.

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