Although breast cancer screening is important for detecting the disease early and improving chances of recovery, not everyone has equal access to it.
Access to healthcare can be difficult for 2SLGBTQIA+ (Two-Spirit, lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and other sexual orientations and gender identities) people, who often face administrative barriers, discrimination and a lack of understanding of their specific realities. These challenges can complicate access to essential care, such as breast cancer screening.
It is important not to forget that breast cancer can affect anyone, regardless of gender or sexual orientation.
Who is at risk?
Breast cancer affects not only cisgender (someone whose gender identity aligns with the sex they were assigned at birth) women. In fact, it is important to consider:
- Trans men, because not everyone chooses to undergo breast surgery.
- A person who chooses breast surgery should be aware of the difference between breast reduction, which decreases the volume of the breasts, and total mastectomy, which completely removes the breast. Although total mastectomy better lowers the risk of breast cancer, this risk is never zero.
- Trans women undergoing hormone replacement therapy, such as estrogen. This can increase the risk of breast cancer (his risk is higher if they take these hormones for at least five years).
Why undergo screening?
Quebecers can have free tests to detect breast cancer , including mammograms, if:
- They are registered as a woman with the RAMQ
- They are 30 years of age or older, are at risk or have possible signs of breast cancer, OR they are aged 50 to 74 and have none of possible signs of breast cancer.
Thus, breast cancer screening is based primarily on gender. This excludes many people from the 2SLGBTQIA+ community. It is crucial to look beyond sex or gender identity when considering who might benefit from screening.
What to do in practice?
Observe your chest and breasts
A simple gesture can make a big difference. That said, this process may be a difficult or sensitive one because of the gender dysphoria (a feeling of significant distress that arises when a person’s gender identity doesn’t align with the sex they were assigned at birth) experienced by some people. Don’t hesitate to consult resource people for help and support (see resources below).
Talk to a healthcare professional
Screening is free if a possible sign of breast cancer is detected. A mammogram must be prescribed by a doctor or specialist nurse practitioner. It is therefore useful to discuss the matter with a medical team that understands 2SLGBTQIA+ realities.
A message for healthcare professionals
Inclusivity is not a luxury; it is a necessity. Some points to consider:
- 2SLGBTQIA+ people can be leery of the healthcare system, often because of past experiences of rejection.
- By adopting an open and respectful approach, professionals can prevent breast cancer. They can also promote breast health.
For more information and a list of community resources:
- https://rubanrose.org/en/inform-me/prevention-and-awareness/breast-cancer-in-2slgbtqia-people/
- Clinique Mauve — Institut universitaire SHERPA
- Action Santé Travesti(e)s & Transexuel(le)s du Québec (ASTT(e)Q) — CACTUS Montréal
- AGIR Montréal
- Sex and gender – support organizations and services | 211 Grand Montréal
- LGBTQ+ resources in Montreal—News—Concordia University
- https://www.blackhealingcentre.com/
Resources for healthcare professionals:
- For an example of inclusivity guidelines: Synthèse Lignes directrices DÉPISTAGE CANCER DU SEIN CMS/CHU 2023
- Deconstruction tool for professionals: Promoting the health and well-being of 2SLGBTQIA+ people | Government of Quebec
References
- Description du programme
- https://www.depistage.ca/femmes-a-risque/
- Réduction mammaire ou redrapage | CHU de Québec-Université Laval
- LIGNES DIRECTRICES DÉPISTAGE CANCER DU SEIN Centre des Maladies du Sein – CHU de Québec –U Laval
- Mastectomie totale | CHU de Québec-Université Laval
- Société Canadienne du Cancer. ().As a trans woman or non-binary person assigned male at birth, do I need to get screened for breast cancer? | Canadian Cancer Society