Cancer risk and screening
Information for people who are transgender, non-binary and gender-diverse
What does ‘screening’ mean?
Screening is a type of test we give to healthy people who may have an increased risk of a particular condition. The NHS offers a range of screening tests to people who are most likely to benefit from them.
Cancer screening has the potential to save lives by finding cancers at an early stage, or in some cases even prevent them. Screening is not the same process as when a person goes to their GP with symptoms, which may result in them being referred to a clinic for diagnostic tests.
The NHS currently offers three national screening programmes: Cervical, Breast and Bowel.
The booklet
We have produced a booklet to help our trans, non-binary and gender-diverse community understand screening, cancer risk and how transition relates to these.
This booklet has been reviewed by clinicians and community members to bring you content that is accurate and affirming.
This webpage draws upon key information from this booklet. Here you will find information about cervical, breast and bowel screening and how to reduce risk. For more information about other cancers of interest, you can read the booklet in full by downloading a PDF copy from the button below.
If you are a healthcare professional and would like to order copies of this booklet for your clinic, please email us.
Screening at a glance
Cervical
Breast
Bowel
Cervical
Ages
25 to 49
Every 1, 3 or 5 years depending on previous results and where you live
50 to 64
Every 5 years
65 or older
Only if 1 of your last 3 tests was abnormal or if you have never been screened
Access
By automated letter if the gender marker on your medical records at the GP is female
By speaking to your GP if the gender marker on your medical records at the GP is male
Breast
Ages
50 to 71
Every 3 years
71 and over
By request
Access
By automated letter if the gender marker on your medical records at the GP is female
By speaking to your GP or a local NHS Breast Clinic if the gender marker on your medical records at the GP is male
Bowel
Ages
Scotland: 50 to 74 years
England, Wales & NI: 60 to 74 years
Every 2 years
The programme is expanding to make it available to everyone aged 50 to 59 years. This is happening gradually over 4 years and started in April 2021.
Access
Faecal immunochemical test (FIT) sent in post
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 and Northern Ireland it is offered between the ages of 24.5 and 49 every 3 years. In Scotland and Wales, the test is offered every five years after a person has tested negative for HPV.
For those between the ages of 50 and 64, screening is offered every 5 years.
People who are eligible may include:
● transgender 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)
The HPV vaccine Gardasil is given to protect people from certain types of HPV that are known as “high-risk” because they’re linked to the development of some cancers like cervical cancer, anal cancer, genital cancers, and cancers of the head and neck. Gardasil can also prevent genital warts.
Gardasil does not have any effect in individuals who already have a persistent infection or disease associated with the HPV types in the vaccine. However, because Gardasil offers protection against multiple strains, an infected person receiving the Gardasil vaccine will still gain protection against strains they have not previously been infected with.
Screening is still recommended even if you have been vaccinated because there are multiple types of HPV, some of which the vaccine may not protect against.
Hormone therapy
Testosterone is not known to affect the risk for cervical cancer, but it can sometimes make it harder to take an adequate sample during screening. This is because long term testosterone use can lead to thinning of the vaginal walls and a reduction in the amount of natural lubrication which may make the procedure more uncomfortable.
Surgery
A total hysterectomy will remove the cervix and remove the risk of cervical cancer. Partial hysterectomy leaves the cervix in place, so ongoing screening is required. Check with your surgeon or other health professional if you are unsure what surgery you have had.
Vaginoplasty for people assigned male at birth does not create a cervix so does not create a risk of cervical cancer.
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.
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. Colposcopy is a test that takes a closer look at your cervix using a lighted, magnifying instrument called a colposcope. This is done 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.
During the procedure, a speculum is gently placed into the vagina and opened. The colposcope is then used to look at the cervix in greater detail. The colposcope 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.
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 could use a male incontinence pad.
If you have a coil (IUD, or Mirena coil) it does not usually need to be taken out, but you should tell the person doing the colposcopy that you have one.
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 (GP).
Routine breast cancer screening is for anyone between the ages of 50 and 71 who has breasts, due to either oestrogen produced by the body or oestrogen hormone therapy. This might include:
● transgender 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)
● transgender women and non-binary people assigned male at birth (AMAB) and who have taken feminising hormones
● cisgender women
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.
Current recommendations suggest that trans women should attend routine breast screening after five or more years of taking feminising hormones.
You can always request to be screened if you identify a risk symptom. You should report any of the following symptoms to your GP, even if you have had top surgery / a mastectomy. Symptoms to watch out for include:
● discharge or liquid that comes from the nipple without squeezing
● new, unusual lumps or an area that feels thicker than the rest
● puckering or dimpling of the skin (it may look like orange peel)
● a sudden, persistent or unexplained change in size or shape
● a nipple that becomes inverted or points in a different direction
● a lump, swelling or thickening in your upper chest or armpit area
● redness or inflammation of the skin
● a rash or crusting of the nipple or the surrounding skin
On its own, pain is not usually a sign of breast cancer. But look out for pain in your breast / chest or armpit that’s there all or almost all the time.
Chest binding
There is no evidence that chest binding increases your risk of breast cancer.
Hormone therapy
Research shows that the risk of breast cancer in trans women is about three times lower than it is for cisgender women. The risk is still much higher than for cisgender men (although the risk of breast cancer in cisgender men is low overall). Oestrogen therapy leads to breast tissue growth which can increase breast cancer risk. We also know that oestrogen helps some breast cancers to grow. Some trans women also take the hormone progesterone. There is now evidence that progesterone can produce a slight increase in the risk of breast cancer in cisgender women.
Trans men have a five times lower risk than cisgender women, but this is still higher than for cisgender men. This reduction might be due to taking testosterone which reduces the amount of oestrogen in the body.
Surgery
There are risks with all surgery, and there are risks with all implants (prostheses). However, breast implants do not increase your risk of breast cancer.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon cancer of the white blood cells (lymphoma) that develops in response to the body’s reaction to a breast implant. In the UK, the majority of BIA-ALCL is diagnosed early and cured by removal of the implants with surrounding scar tissue with no additional cancer treatment required. However, in a small number of cases further treatment such as chemotherapy, immunotherapy or radiotherapy may be required. More information about BIA-ALCL can be found on the Government’s website.
Breast implants can make the breast tissue harder to screen with mammography, but breast clinics are trained to handle this.
The risk of breast cancer is reduced after top surgery. This is because most of your breast tissue is taken away during the procedure. Even if your surgeon has attempted to remove all of your breast tissue, approximately 1% can remain. Therefore, it is important to be aware of the signs and symptoms of breast cancer listed above.
If your GP records have your gender marker as female
You will be automatically invited to breast screening when you reach 50, and then every three years until you reach 71.
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.
Some people are identified as very high risk (VHR) for breast cancer, usually due to inherited gene mutations (for example BRCA) or a strong family history of cancer. The national cancer strategy requires that the NHS Breast Screening Programme screens VHR people with digital X-ray mammography and/or magnetic resonance imaging (MRI). The national breast screening system manages the invitation process and records all outcomes for people screened through the very high risk programme.
Every screening service is expected to have arrangements in place for managing people in their area who are eligible for ‘very high risk’ screening.
If it is decided that you require this type of screening, you will be referred into the programme by:
● a genetics service
● an oncology service
● a breast cancer after radiotherapy database (BARD)
If you think you might be eligible but are concerned you may have been missed due to your gender identity being different to your sex assigned at birth, speak to your GP, gender identity clinic, breast surgeon or oncologist.
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
Bowel Screening
Bowel screening checks for bowel cancer or abnormalities that could lead to bowel cancer using a test known as a FIT test (faecal immunochemical test). The FIT test is very good at detecting blood in your poo that cannot be seen by the naked eye.
In England, Wales and Northern Ireland, everyone aged 60 to 74 years old is invited to screening regardless of their gender. The programme is expanding to make it available to everyone aged 50 to 59 years. This is happening gradually over 4 years and started in April 2021, so it is worth checking with your GP if you are eligible. In Scotland, bowel screening already starts at 50.
Gender affirming hormones and surgeries are not known to affect your risk of bowel cancer.
However, if you are offered a colonoscopy (a procedure to look inside of your bowel) as a further investigation after your FIT test and you have had a vaginoplasty using a piece of your bowel, you should let the doctor or nurse know. This is because if abnormal growths called polyps are seen in your bowel, they could also be present in the neovagina.
The bowel screening programme sends out a testing kit every 2 years to people who are eligible to take part. You need to be registered with a GP to receive your kit. The FIT test is simple and done in your own home. About 2 weeks after your test, you will get a letter with your results.
If your letter says ‘further tests needed’ this means that a certain level of blood was found in your sample. This does not necessarily mean you have cancer. You may be offered an appointment to see a specialist nurse at a bowel cancer screening centre who will talk to you about colonoscopy.
If you are asked to attend for a colonoscopy, you will be required to undress from the waist down for this procedure. This makes many people uncomfortable, but you may be more anxious if you are trans. If this is a concern for you, these tips might help:
● Call the clinic ahead of time to discuss your concerns
● Let them know the name and pronouns you wish to use
● Ask to be seen at the beginning or end of a clinic to avoid long stays in the clinic or waiting room
● Ask for a clinician of a specific gender that will make you feel most comfortable
● Ask to bring a friend, partner, or family member to the appointment
● Request a chaperone if it will make you more comfortable
● Ask about the level of privacy in the changing rooms or request to undress in the treatment room
● Request that no additional persons be present (i.e. medical students)
● Ask staff not to use any phrases or words that make you uncomfortable or nervous
● Discuss any dysphoria triggers or concerns you may have related to the procedure
● Discuss the language you wish to use for your body
● Remember that you can pause or stop the procedure at any time
● Plan something enjoyable to do after the appointment
You are entitled to use a changing room that aligns with your gender regardless of any surgery you may or may not have had.
Reducing risk
In the UK, smoking (both active smoking and environmental tobacco smoke) causes 3 in 20 (15%) cancer cases and more than a quarter of all cancer related deaths.
It is important to keep your home and environment smoke free as passive smoking can also increase a person’s risk of cancer.
If you do want to give up smoking, your GP will have resources to help you. You can also download the NHS Quit Smoking app for your smartphone. To find out more, visit: https://www.nhs.uk/better-health/quit-smoking
Macmillan Cancer Support has more information about giving up smoking. If you would prefer to get support from an LGBTIQ+ charity, you can find information and support from LGBT Foundation and Brighton & Hove LGBT Switchboard.
If you have had problems trying to give up smoking in the past or cutting down on your cigarette use, vaping may be a risk-reducing alternative. Although not completely risk free, they are significantly safer than cigarettes. Cancer Research UK states that there is no good evidence that vaping causes cancer. However, we don’t yet know their long-term effects, so people who have never smoked should not use them.
The HPV vaccine given in the UK (Gardasil) protects against HPV types 6, 11, 16 and 18. HPV types 16 and 18 are responsible for approximately 70% of cervical cancer cases, 75–80% of anal cancer cases, 70% of HPV-related pre-cancerous lesions of the vulva and vagina, 75% of HPV related pre-cancerous lesions of the anus. HPV type 16 is responsible for almost 90% of HPV-positive oropharyngeal (mouth and throat) cancers. HPV types 6 and 11 are responsible for approximately 90% of cases of genital warts.
Children aged 12 to 13 years (who were born after 1 September 2006) are offered the HPV vaccine as part of the NHS vaccination programme.
The vaccine helps protect against cervical cancer, some mouth and throat cancers, and some cancer of the anal and genital areas.
Since April 2018, men who have sex with other men (MSM), trans women, and non-binary people assigned male at birth who are up to the age of 45 have been eligible for free HPV vaccination on the NHS when they visit sexual health services and HIV clinics in England.
Trans men and non-binary adults assigned female at birth are eligible if they have sex with men and are aged 45 or under. If they have previously completed a course of HPV vaccination as part of the children’s HPV vaccine programme, no further doses are required.
Eating a balanced diet with lots of nutritious options is good for your body. For example, high fibre foods can help promote good bowel health and reduce the risk of bowel cancer. Limiting the amount of alcohol that you drink can also reduce your risk of cancer.
Being overweight can increase the risk for many different types of cancer. Keeping to a healthy weight can avoid this risk and reduce your risk of other health conditions, like diabetes and heart disease.
Many studies show that having an active lifestyle can reduce the risk of cancer. It is recommended that you should do at least 30 minutes of physical activity every day.
If you are worried about your weight or would like more information about how to improve your diet, speak to your GP or a dietitian.
Getting out into the sunshine can be a great way to get a boost of
vitamin D. However, we need to be careful not to over-expose ourselves to the sun and risk burning our skin as this can increase our risk of cancer.
Some practical steps you could take include:
● covering your skin with clothing or a hat
● using sun cream with a high sun protection factor (SPF) that protects against UVB rays and a high star-rating to protect you from UVA rays
● avoiding the sun at the hottest point of the day
● switching out sunbeds or sun lamps for fake-tanning lotions or sprays
HIV can increase the risk for certain cancers because it can lower your immune system’s ability to respond to disease. If you are HIV negative, you should continue to practise safer sex such as using condoms or dental dams. You may also want to consider taking pre-exposure prophylaxis (PrEP), which is free from NHS sexual health clinics.
According to a 2016 study, people with HIV were more likely to show what we call ‘behaviours associated with developing cancer’, such as smoking or other risk factors mentioned above. If you are HIV positive, it is important that you take your medications as prescribed and try to reduce any additional risk of cancer.
The NHS recommends that people with a cervix who are HIV positive should have a cervical smear when they are first diagnosed with HIV, six months after this, and then every year. Usually, cervical screening will be arranged through your GP.
For more information about sexual health clinics that provide screening visit our page
Get support
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. For more tailored support, please use the following links.