Disentangling Gendered Cancer Care From Check-in to Check-out

Session Description: Among the general population, mortality rates of breast and cervical cancer have declined following widespread adoption of screening mammograms and pap smears. However, sexual and gender-diverse patients are disproportionally burdened. Many of these health-promoting screenings take place in clinics specializing in the care of what has traditionally been deemed “women’s” health, including preventative and screening services, as well as contraceptive, prenatal, pregnancy, postpartum, and pre- and post-menopause care. Even practices with broader services tend to label services such as these as “women’s” care. What happens when a person who needs these health-promoting cancer screenings does not identify as a woman?

Approximately 5.6% of U.S. adults now identify as LGBTQ, according to the latest Gallup Poll, with 0.4%-0.6% (over one million individuals) specifically identifying as transgender. These numbers have risen over time and, due to stigma, they are likely an under-representation.

Former American Medical Association Foundation (AMAF) President and founding donor of its LGBTQ Endowment Fund, Joshua M. Cohen, MD, MPH, FAHS, says that, “A key social determinant of health affecting sexual and gender minorities is a shortage of health care providers who are knowledgeable and culturally competent in LGBTQ health.” When transgender patients go to medical centers to see a clinician, they often experience stigma throughout the medical encounter including microaggressions before their clinical visit begins, such as at the front desk. Small changes such as clinicians sharing their own gender pronouns can be impactful to the establishment of patient-provider trust.

In our educational initiative, only 27% of learners responded Yes to the question ‘Are your patient intake forms inclusive of diverse genders and pronouns?’ Furthermore, only 23% of learners responded Yes to the question ‘Have you done any training/ education with your entire team to make sure your office, your forms, and your encounters with patients are inclusive?’ Unfortunately, silos in medical education across care team members lead to disjointed experiences for patients.

Importantly, clinicians must have awareness of unique consideration to be given in the care of transgender persons. In the current initiative, faculty explained that the most effective way to approach assessment of the need for cervical cancer screening is based on current anatomy, not sex assigned at birth. Another example is concern, and possibly misconception, that transgender patients may have that a prescribed therapy may interact with their hormone therapy. If left unaddressed, these misconceptions can lead to nonadherence.

In the proposed education, medical education providers will share the design and outcomes from an initiative that placed education on removing barriers for transgender patients to receive medical care in a clinically relevant context, focused on gaps that transgender patients experience in being screened for cervical and breast cancer. If accepted, a transgender person and a supporter will be invited to join the presentation panel.

While the presented education is specific to oncology screening, transgender individuals deserve equitable care across their medical experiences. Participants will be encouraged to consider gaps for transgender individuals to determine need of ongoing medical education across therapeutic areas and the care continuum.  

The proposed session is aligned to member sections, IACE and MEC, given their prior and ongoing efforts to encourage equitable medical care for all patients.

Unlock Your Potential : The current session will provide visibility to an infrequently discussed unmet need in education, specifically, gaps in the accessibility of equitable care for patients who are transgender. It is incumbent on the medical education community to identify areas of stigma, microaggression, and other barriers experienced by transgender patients, not only in oncology but in all areas of medicine, and provide educational intervention to change behaviors and processes.