Screening MOT
It's screening, on My Own Terms
Cancer screening has the potential to save lives by finding cancers at an early stage, or in some cases even prevent them. However, our community is known to have lower rates of cervical and breast cancer screening.
It is important that you feel that you can access screening with confidence. We advocate for people being able to request certain adjustments to make their appointment a more positive experience. Healthcare teams will be used to these requests and should not have any issues in supporting you.
In this page you will find more information about the breast and cervical screening programmes and some adjustments that can be requested by calling your healthcare provider before your appointment.
Cervical Screening
Cervical screening is a highly effective way of preventing cancer. It looks to find the high-risk types of human papillomavirus (HPV) which are the cause of most cases of cervical cancer. If HPV is found, with the same sample they then look for abnormal cells in the cervix that could develop into cancer if left untreated.
Estimates suggest that screening prevents 70% of cervical cancer deaths, but 83% could be prevented if everyone attended regularly.
Cervical screening is for anyone who was assigned female at birth (AFAB) who still has a cervix. In England it is offered between the ages of 24.5 and 49 every 3 years. At the time of writing, it has been recommended that this is extended to every 5 years, however this has not yet been implemented. For those between the ages of 50 and 64, screening is offered every 5 years.
People who are eligible may include:
- Trans men
- Non-binary people AFAB
- Cisgender women
If you do not have a cervix, you do not need to attend for cervical screening. This may include:
- People AFAB who have had a total or radical hysterectomy as these involve the removal of the cervix
- Trans women and non-binary people assigned male at birth (AMAB)
If your GP records have your gender marker as female
You will be automatically invited to cervical screening unless you have opted out.
If your GP records have your gender marker as male
You will not be automatically invited to cervical screening.
You can organise your own cervical screening by making an appointment with your GP, at a local sexual health clinic or with a local trans health clinic where available.
Some GPs have a separate register to help remind patients who are not automatically called for screening. If your GP has not taken this step, you can request for them to do so and direct them to Royal Marsden Partners (West London Cancer Alliance) who have clear guidelines on how to do this.
The NHS is due to update their systems with an opt-in to the automatic invite system (known as The Call and Recall System). This will allow people with a male gender marker at their GP to opt-in for the automatic reminders for cervical screening. At the time of publication, this service was not yet live, however it may have since been activated. Try asking your GP about this option at your next appointment.
When you arrive at the appointment you will be asked to remove your clothing from your waist down. You’ll be able to do this behind a screen and will be given a sheet to put over you.
The doctor or nurse will ask you to lie back on a bed, usually with your legs bent, feet together and knees apart. Sometimes you may need to change position during the test, such as putting your fists under bottom, to make the cervix easier to see.
A smooth, tube-shaped tool called a speculum will be gently inserted into the vagina with a small amount of lubricant.
The doctor or nurse will then open the speculum so they can see the cervix.
Using a soft brush, they will take a sample of cells from the cervix.
Once the cells have been collected, the doctor or nurse will close and remove the speculum and leave you to get dressed.
The doctor or nurse may give a tissue to wipe the lubricant off yourself but if they do not, you can ask for one if you need it.
You may be asked to come back within 3 months to have the test again if the result is unclear. This is known as an inadequate result. This doesn’t mean anything is wrong but means there wasn’t a good enough sample taken initially.
If your results show that you have tested positive for high-risk HPV, you will be invited for your next screening sooner to check that your body has managed to clear the HPV infection. This will usually be a year after your previous test.
If your results show that there are changes to your cells that are caused by certain types of human papillomavirus (HPV) you will be invited to a colposcopy appointment. This is because these cell changes can turn into cervical cancer if left untreated.
The procedure will usually take place at a colposcopy unit at a local hospital or clinic. For the 24 hours before your colposcopy you should not have penetrative vaginal sex or use any products that you place inside the vagina, such as tampons, vaginal creams or medicines.
There may be some minor bleeding after the colposcopy, so it’s a good idea to bring a sanitary pad or panty liner to the appointment. If this type of product has the potential to trigger any dysphoria, you may choose to opt for a male incontinence pad.
If you have a coil (IUD) it does not usually need to be taken out, but you should tell the person doing the colposcopy that you have one.
During the procedure, a speculum is gently placed into the vagina and opened. A microscope is then used to look at the cervix in greater detail. The microscope stays outside your body. The doctor or nurse will put liquids on the cervix that help them see any abnormal cervical cells.
They may also take a small sample of cells for testing. This is called a biopsy.
Embarrassment and fear of discomfort of pain can be common reasons people give for avoiding a cervical screening appointment. Here are some tips that can lead to a better screening experience:
- Call the clinic ahead of your appointment to discuss how to make it a better experience
- Ask for a double appointment so you have enough time to ask any questions you may have
- Ask to bring a friend, partner or family member with you to your appointment
- Let them know which name and pronouns you would like to use for the appointment
- Ask to be seen at the beginning or end of a clinic to avoid long stays in the waiting room
- Discuss the potential to use topical oestrogen gels before the appointment if you are afraid of pain due to dryness
- If you are anxious about your name appearing on a waiting room screen, ask them to call you in without using the display
- Tell the person carrying out the screening the language you would like them to use when referring to your body
- Ask your GP about pain relief or a medication that can relax you before the test
- Ask for a smaller speculum to be used during the procedure
- Ask if you can insert the speculum yourself
- Ask about the amount of lubrication being used
- Tell the GP or nurse if the test feels too uncomfortable or if you are in pain
- Remember that you can stop the procedure at any time if you need to
- Ask your GP to remind you when you’re next due for a smear test
- Let the person taking the sample know if you are taking testosterone and if you still have menstrual periods. This helps the accuracy of the test.
Breast Screening
Breast cancer screening uses a test called a mammogram which involves taking x-rays of the breast tissue on your chest. The scan looks to find breast cancers at an early stage, when they may be too small to see or feel. Identifying cancer at this stage increases the chance of treatment being successful. These tests are conducted at Breast Screening Clinics or mobile screening centres, not at your local General Practice.
Routine breast cancer screening is for anyone between the ages of 50 and 70 who has breasts, due to either oestrogen produced by the body or oestrogen hormone therapy. This might include:
- Cisgender women
- Trans men and non-binary people assigned female at birth (AFAB) who have not had a a bilateral mastectomy (an operation that removes the breasts) or top surgery (bilateral mastectomy with masculine chest reconstruction)
- Trans women and non-binary people assigned male at birth (AMAB) and who have taken feminising hormones
You may be called for screening earlier if you are known to have a higher risk of breast cancer or undergo a procedure that requires ongoing observation.
If you have had top surgery, it is not possible to perform a mammogram so you should continue to monitor your chest yourself for any signs and symptoms of cancer where breast tissue remains. This may include the nipple and its surrounding area, up to the collarbone and into the armpit. If you have had a complete (radical) mastectomy, you do not need to go for screening.
If you have undergone a breast reduction, you can continue to attend breast cancer screening.
If your GP records have your gender marker as female
You will be automatically invited to breast screening when you reach 50.
If your GP records have your gender marker as male
Currently you will not be automatically invited for breast screening.
- If you have not had top surgery / bilateral mastectomy and would like to take part in screening, you can discuss this with your GP or call the local breast screening service to ask for an appointment.
During the appointment you will have 4 breast X-rays (mammograms) taken, 2 for each breast/ side of the chest. The mammograms are done by a specialist who will be a woman.
The mammograms only take a few minutes. The whole appointment should take about 30 minutes.
Before starting, the mammographer will check your details and ask if you have had any breast problems. You may also be given a questionnaire. They will explain what will happen during the screening and answer any questions you may have.
Before you can have a mammogram, you will need to undress so that you are naked from the waist up. You will be given a private changing area and you may also be given a hospital gown to wear. If you wear a binder, you will need to remove this before having a mammogram.
When you are ready, you will be called into the X-ray room and the mammographer will explain what will happen during the procedure. Remember, you can ask as many questions as you feel you need to.
The mammographer will place your breast / the breast tissue on your chest onto the X-ray machine. It will then be squeezed between 2 ‘plates’ (made out of plastic and metal) to keep it still while the image is taken. This can be uncomfortable but does not take long.
Once completed, the mammographer will tilt the machine and prepare you to be screened from the other side.
Your other breast / side of your chest will be X-rayed in the same way.
You will then return to the changing area to get dressed.
Your results will be sent to you in the post.
Breast cancer and breast tissue are clinical terms and are commonly used during the screening process. If you prefer to refer to this area as your chest, this is something that the healthcare professionals at the screening service should respect. There may be times they need to speak clinically, and times when they can speak personally and should be able to explain to you the difference between these two.
Breast Clinics can be a very gendered environment. Some people find that these spaces may trigger their dysphoria. If you feel that this is the case, here are some tips that may help:
- Call the clinic ahead of your appointment to discuss any concerns
- Let them know which name and pronouns you would like to use for the appointment
- Ask to be seen at the beginning or end of a clinic to avoid long stays in the clinic or waiting room
- Ask to not have any medical students present
- Tell the person carrying out the mammogram the language you would like them to use when referring to your body
- Let the person carrying out the test know if you have implants
- Ask if you can bring a friend, partner, or family member with you to your appointment
- Let the person know if people touching your breasts / chest is a dysphoria trigger for you
- Tell the person carrying out the mammogram the language you would like them to use when referring to your body
- Tell staff about any phrases or words that make you uncomfortable or nervous
- Do not use talcum powder or spray deodorant on the day as this may affect the mammogram – roll-on deodorant is OK
- Wear something comfortable that you can easily undress to the waist
- Remove necklaces and nipple piercings before you arrive for your appointment
- Tell them if you have found screening uncomfortable or painful in the past
Check out our other screening campaigns
Read our cancer screening information booklet written specifically for people who are transgender, non-binary, and gender-diverse. This booklet explains how transition can affect your cancer risk and access to the NHS screening programmes. This project featured clinical and community reviewers to help bring you content that is both accurate and affirming.
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OUTpatients provides a safe space for anyone who identifies as part of the queer spectrum and has had an experience with any kind of cancer – at any stage.