Addressing Disparities in Cervical and Breast Cancer Screening: Barriers and Gaps in Preventive Care for Transgender Males

Cervical and breast cancer are highly preventable and treatable when detected early. However, transgender men and nonbinary individuals face significant barriers to preventive screenings, including stigma, discrimination, provider knowledge gaps, and exclusion from gender-affirming care. Despite established guidelines for Papanicolaou tests and mammograms, transgender individuals are often overlooked in public health initiatives. The Behavioral Risk Factor Surveillance System (BRFSS) began including gender identity questions in selected states in 2014, offering a unique opportunity to assess disparities. This study analyzed BRFSS data (2014–2021) to examine screening disparities and inform targeted interventions.

This study used BRFSS data from 2014–2021, including adults (18+) who reported gender identity, cervical cancer screening (Pap test within three years for individuals with a cervix), and breast cancer screening (mammogram within two years for those eligible). Exclusion criteria included missing gender identity data and anatomical ineligibility. Descriptive statistics and logistic regression models assessed disparities, age adjustment, race/ethnicity, income, education, and healthcare access.

Among 2,847,392 respondents, 0.6% (n=17,084) identified as transgender. After applying the criteria, 15,962 transgender and 2,654,873 cisgender individuals were analyzed. Transgender individuals had significantly lower screening rates: 43.2% received Pap tests vs. 73.8% of cisgender individuals (adjusted OR: 0.63; p<0.001). For mammograms, 52.1% of transgender individuals were screened vs. 78.9% of cisgender individuals (adjusted OR: 0.57; p<0.001). Barriers included healthcare discrimination (adjusted OR: 0.41), lack of insurance (adjusted OR: 0.38), and living in states without transgender healthcare protections (adjusted OR: 0.52). Screening rates showed minimal improvement over time (annual change: 1.2%).

Transgender individuals face persistent disparities in cancer screenings due to systemic barriers. Healthcare systems must integrate gender-affirming care, enhance provider training, and implement policies ensuring equitable access to life-saving screenings. Future research should focus on evaluating the effectiveness of targeted interventions and expanding data collection to ensure equitable access to cancer screenings for transgender populations.