The Care of Trans and Gender Diverse Individuals in Breast Services

With the recent launch of the new ABS guideline on The Care of Trans and Gender Diverse Individuals in Breast Services, this seems like an apposite time to highlight this cause of health inequity.

We live in a changing society where an increasing number of people identify as trans or gender diverse (TGD). The 2021 census highlighted 0.5% of adults in England and Wales identify as having a gender identity different from the sex registered at birth whilst an IPSOS survey in 2022 estimated 3% of people overall identify as TGD. We know that a significant number of TGD individuals may avoid seeking medical care when unwell due to previous negative experiences in the healthcare sector and may have poorer cancer outcomes. The new ABS TGD guideline provides a comprehensive approach to ensuring that TGD patients presenting to breast related healthcare services receive appropriate, informed and effective care. It covers guidance for symptomatic clinics, breast screening and breast cancer care amongst others.

Key Messages:

• TGD people should receive respectful, inclusive and equitable care
• The patient’s preferred names, pronouns and preferred terminology for anatomy should be used.
• Symptomatic breast assessment should follow the usual principles whilst ensuring an inclusive and respectful environment
• TGD patients with breast cancer should receive standard evidence-based cancer management based on tumour biology, stage, patient choice and co-morbidity. Care must remain patient-centred avoiding assumptions about gender identity or treatment goals
• TGD patients should have the same access to familial cancer services and genetic assessment pathways as non-TGD individuals
• Most breast surgeons will encounter TGD patients infrequently and may feel anxious about the treatment of such patients. These guidelines provide a comprehensive framework for the care of TGD individuals including guidance on referral to specialized MDTs and clinics where appropriate. The core message however is a simple one: all patients deserve the highest quality healthcare and to be treated with respect, dignity and compassion.

Useful Resources:

ABS Guidelines: The Care of Trans and Gender-Diverse Individuals in Breast Services

Prevent Breast Cancer: Transgender Chest Awareness

OUTpatients: CANCER RISK AND SCREENING - Information for people who are transgender, non-binary and gender-diverse:

• Best for my chest
  
• Cancer risk and screening
• CHEST CHECK 101

CoppaFeel: Resources for Trans and Non Binary People

Carol-Ann Courtney, ABS Ordinary Trustee