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Breast and cervical cancer screenings across gender identity: results from the Behavioral Risk Factor Surveillance System before and during the COVID-19 pandemic

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Abstract

Purpose

Although national medical organizations often neglect to include trans and gender diverse (TGD) people in their breast and cervical cancer screening recommendations, the World Profession Association of Transgender Health recommends that TGD people who are at risk for these cancers follow existing guidelines for cisgender women. Despite WPATH’s recommendations, TGD people are less likely to get screened in large part due to discrimination. The COVID-19 pandemic has limited access to cancer screenings among cisgender people, but it is unknown how this has impacted TGD people.

Methods

Using national survey data from the Behavioral Risk Factors Surveillance System (BRFSS), we examined differences in cervical and breast cancer screening noncompliance across gender identity at two time points: before and during the COVID-19 pandemic.

Results

Screening noncompliance increased during the COVID-19 pandemic among cisgender and TGD people (e.g., transgender men, gender non-conforming people). Compared to cisgender women, transgender men and gender non-conforming respondents had higher odds of breast cancer screening noncompliance before and during COVID-19. Transgender men had lower odds of cervical cancer screening noncompliance than cisgender women before COVID-19, but higher odds during the pandemic. Gender non-conforming respondents also had lower odds of cervical cancer screening noncompliance during COVID-19 compared to cisgender women.

Conclusions

Screening noncompliance for breast and cervical cancer was more common among TGD people than cisgender women; while these disparities existed before the COVID-19 pandemic, they were exacerbated during the pandemic. Future work should move beyond descriptive statistics and elucidate underlying causes to inform interventions.

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Data availability

The datasets generated and analyzed during the current study are available from the CDC BRFSS Survey Data from 2018, 2019, 2020, and 2021. Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, [2018–2021].

Notes

  1. U.S. territories reporting to BRFSS include Puerto Rico, Guam, and the Virgin Islands.

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Funding

B.C was supported by grant MRSG CPHPS 130006 from the American Cancer Society.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Isa Berzansky, Colleen A. Reynolds & Brittany M. Charlton

  2. Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA

    Colleen A. Reynolds & Brittany M. Charlton

Authors
  1. Isa Berzansky
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Contributions

All authors contributed to the study conception and design. IB performed the data curation and analysis and wrote the original draft of the manuscript. CAR and BMC contributed to methodology, supervision, review, and editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Isa Berzansky.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The Harvard Longwood Campus IRB determined that this study does not meet the requirements of human subjects’ research, therefore the need for IRB approval was waived.

Informed consent

Informed consent was not applicable to this study because it is based on publicly available data from the Centers for Disease Control and Prevention (CDC).

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Berzansky, I., Reynolds, C.A. & Charlton, B.M. Breast and cervical cancer screenings across gender identity: results from the Behavioral Risk Factor Surveillance System before and during the COVID-19 pandemic. Cancer Causes Control 35, 865–872 (2024). https://doi.org/10.1007/s10552-023-01847-z

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