Cancer screening
Disclaimer
The purpose of this content is to provide health care professionals with key messages and evidence-informed recommendations for gender-affirming care in British Columbia (BC). This content was developed by provincial subject matter experts. The review process involved an internal evaluation by interdisciplinary healthcare professionals at Trans Care BC, as well as an external review conducted by additional interdisciplinary healthcare professionals and community members from across the province.
This content reflects the best available knowledge and resources at the time of publication. Trans Care BC documents are intended to provide information, education, and guidance only and should not be used as a substitute for clinical judgement and assessment of the individual needs of transgender, Two-Spirit, and non-binary people. Health care professionals should continue to exercise clinical judgement and take into consideration context, resources, wise practices, and other relevant factors when providing gender-affirming care.
Provincial Health Services Authority (PHSA) and Trans Care BC are not liable for any damages, claims, liabilities, costs, or obligations arising from the use of this document including loss or damages from any claims made by a third party. PHSA and Trans Care BC also assume no responsibility or liability for changes made to this document without their consent.
Transgender, Two-Spirit, and non-binary (TTNB) people are medically underserved and face unique challenges in accessing health care, including preventative cancer screening [1,2]. Cancer screening protocols based on gender, rather than anatomy, create barriers to access and do not consider the screening needs of TTNB people [1,3].
TTNB people access cancer screening less frequently for a variety of reasons. Barriers to care include:
Avoiding cancer screening or not requesting screening due to healthcare anxiety or gender incongruence/dysphoria [4,5].
Clients may not know what tests they are eligible for and may wait for providers to initiate screening conversations [5].
Clinicians and automated systems may miss screening opportunities due to gender-based guidelines and/or uncertainty about what tests are appropriate for TTNB clients [1,5].
To offer inclusive cancer screening for all clients, clinicians need to be aware of variations in screening recommendations, practice hormone and anatomy inventories for all clients, and consider if automated screening programs are excluding TTNB clients [5].
For more details about gender-affirming care and inclusive cancer screening: Botkin, C., Goldman, L., Cosio, I., & Clark, D. B. A. (2024). Gender-affirming, anatomy-based cancer screening for transgender, Two-Spirit, and non-binary people.
Cancer screening should always consider a client’s personal health history, their hormone and anatomic inventories, and their risk profile for cancer.
For more information on conducting a hormone and anatomical inventory, see the Gender-affirming approach to physical exams clinical handbook section.
Cancer Screening Based on Anatomy
This table provides an overview of screening options and recommendations. Below sections provide further details regarding cancer screening in the BC context.
Chest tissue |
|
No history of chest surgery | Screen according to local guidelines. |
Chest reduction surgery | Screening mammogram may or may not be feasible, depending on amount of tissue remaining. A chest ultrasound is an alternative screening option. |
Complete chest construction | Screening mammogram not feasible. A chest ultrasound is an alternative screening option. |
Breast tissue |
|
Has breast implants | Ineligible for screening mammograms in BC [6]. Diagnostic mammograms can be ordered by primary care providers to screen clients with breast implants. |
Taking estrogen: Less than 5 years total | Discuss screening based on personal and family risk factors. |
Taking estrogen: At least 5 years total | Screen according to local guidelines. |
Cervix |
|
Has a cervix | Screen according to local guidelines. |
No cervix: Surgically removed (complete hysterectomy) | Screening not required if no history of abnormal cervical cytology. If recent history of abnormal cytology, follow local guidelines for follow-up screening. |
No cervix: Vaginoplasty | Not eligible for HPV screening through BC cervical screening program [7]. |
Prostate screening | The Canadian Taskforce on Preventative Health Care does not recommend routine screening for prostate cancer [8]. |
Colon screening | Screen according to local guidelines. |
Lung screening | Screen according to local guidelines. |
Source: Botkin et al. [9], used with permission.
BC Cancer Screening Guidelines
For the most up to date screening guidelines, we recommend reviewing the BC Cancer Screening Guidelines regularly.
Chest/breast screening
For people with an average risk of chest/breast cancer, screening mammograms are available every 2 years after the age of 40 and recommended every 2 years between the ages of 50-74. Before 50 and after 75, BC Cancer recommends that clinicians review the benefits and limitations of mammography. No referral is needed for routine screening [7].
For higher risk or symptomatic clients, additional screening and/or referrals may be needed. For more information, see BC Cancer Screening Guidelines.
Cervical screening
BC Cancer recommends cervical screening every 3 years for clients with a cervix who have had any sexual contact and are aged 25-69 [7]. In many cases, this can be done as a self-screen swab, which may reduce barriers to routine screening for TTNB people with a cervix.
For more details about management of test results, screening frequency for higher risk clients, and when self-screening is appropriate, see BC Cancer Screening Guidelines and BC Cancer’s Cervix Screening Program: Program Overview.
Cervical screening after vaginoplasty
As noted in the table above, screening is not recommended for people who have had a vaginoplasty [10]. This is because cervical cancer arises in the transition zone between ectocervix and the endocervix [11] and there is no risk of this cancer in those in those who do not have a cervix.
Colon screening
BC Cancer recommends that clients between the ages of 50 to 74 with no symptoms be screened for colon cancer using a Fecal Immunochemical Test (FIT) every 2 years [7]. A lab requisition is required for screening.
For higher risk clients, additional tests and/or referrals may be needed. For more information, see BC Cancer Screening Guidelines.
Anal screening
While the International Anal Neoplasia Society developed consensus guidelines to inform anal cancer screening use among various high-risk groups [12], routine screening is not currently recommended in BC.
For more information on anal screening, see the International Anal Neoplasia Society’s consensus guidelines for anal cancer screening.
Lung screening
Clients aged 55 to 74 with a significant history of regularly smoking commercial tobacco (currently or in the past) may be eligible for lung cancer screening using low-dose CT [7]. Clients can self-refer to complete a risk assessment over the phone to confirm their eligibility.
TTNB people are 2-3 times more likely than cisgender people to report current nicotine/tobacco use [13]. As such, it is important for clinicians to inquire about client’s nicotine/tobacco use during an initial intake.
Symptomatic clients are not eligible for screening. For more information, see BC Cancer Screening Guidelines.
Prostate screening
Prostate screening is not routinely recommended in BC. Although serum PSA is widely used to aid in the detection of prostate cancer, it does not meet the standards for a universal screening test as it does not appear to decrease cancer related mortality [14].
For more information, see BC Cancer’s clinical resource for prostate cancer.
Kiran T, Davie S, Singh D, Hranilovic S, Pinto AD, Abramovich A, et al. Cancer screening rates among transgender adults: Cross-sectional analysis of primary care data. Can Fam Physician Med Fam Can. 2019;65: e30–e37.
Meggetto O, Peirson L, Yakubu M, Farid-Kapadia M, Costa-Fagbemi M, Baidoobonso S, et al. Breast cancer risk and breast screening for trans people: An integration of 3 systematic reviews. CMAJ Open. 2019;7: E598–E609. doi:10.9778/cmajo.20180028
Chokshi M, Morgan O, Carroll EF, Fraker JL, Holligan H, Kling JM. Disparities in study inclusion and screening rates in breast cancer screening rates among transgender people: A systematic review. JACR. 2024; S1546144024003636. doi:10.1016/j.jacr.2024.04.006
Roznovjak D, Petroll AE, Lakatos AEB, Narayan R, Cortina CS. Perceptions of transgender and nonbinary persons toward breast and cervical cancer development, screening, and potential impact on gender-affirming hormone therapy. JCO Oncol Pract. 2023;19: e794–e800. doi:10.1200/OP.22.00681
Sterling J, Garcia MM. Cancer screening in the transgender population: A review of current guidelines, best practices, and a proposed care model. Transl Androl Urol. 2020;9: 2771–2785. doi:10.21037/tau-20-954
BC Cancer. Breast screening. [cited 29 July 2024]. Available: http://www.bccancer.bc.ca/screening/health-professionals/breast
BC Cancer. BC Cancer screening guidelines. 2024. Available: http://www.bccancer.bc.ca/screening/Documents/Screening-Guidelines.pdf
Bell N, Gorber SC, Shane A, Joffres M, Singh H, Dickinson J, et al. Recommendations on screening for prostate cancer with the prostate-specific antigen test. Can Med Assoc J. 2014;186: 1225–1234. doi:10.1503/cmaj.140703
Botkin C, Goldman L, Cosio I, Clark DBA. Gender-affirming, anatomy-based cancer screening for transgender, Two-Spirit A term used within some Indigenous communities to reflect complex Indigenous understandings of gender and sexuality and the long history of sexual and gender diversity in Indigenous cultures. Two-Spirit encompasses sexual, gender, cultural and spiritual identity. It may refer to cross-gender, multi-gender or non-binary gender roles, non-heterosexual identities, and a range of cultural identities, roles and practices embodied by Two-Spirit peoples. Some people also use "2-Spirit" or "2S." (Source: Battered Women’s Support Services) , and non-binary Umbrella term referring to people whose gender does not fall within the binary gender system of woman/girl or man/boy. Some individuals identify as non-binary while others may use terms such as gender non-conforming, genderqueer, or agender. Non-binary people may or may not conform to societal expectations for their gender expression and gender role, and they may or may not seek gender-affirming medical or surgical care. people. J Fam Pract Oncol. 2024;43: 1–5.
BC Cancer. Cervix screening program overview. 2023. Available: http://www.bccancer.bc.ca/screening/Documents/Cervix-Program-Overview.pdf
Sharma S, Chauhan D, Kumar S, Kumar R. Impact of HPV strains on molecular mechanisms of cervix cancer. Microb Pathog. 2024;186: 106465. doi:10.1016/j.micpath.2023.106465
Stier EA, Clarke MA, Deshmukh AA, Wentzensen N, Liu Y, Poynten IM, et al. International Anal Neoplasia Society’s consensus guidelines for anal cancer screening. Int J Cancer. 2024;154: 1694–1702. doi:10.1002/ijc.34850
Sawyer AN, Bono RS, Kaplan B, Breland AB. Nicotine/tobacco use disparities among transgender and gender diverse Refers to gender roles and/or gender expression that do not match social and cultural expectations. adults: Findings from wave 4 PATH data. Drug Alcohol Depend. 2022;232: 109268. doi:10.1016/j.drugalcdep.2022.109268
BC Cancer. Prostate PSA Screening. 2012 [cited 10 Aug 2025]. Available: http://www.bccancer.bc.ca/health-professionals/clinical-resources/cancer-management-manual/genitourinary/prostate
| Current version | October 3, 2025 | |
| Authors | Elijah Foran | Knowledge Translator, Trans Care BC |
| Caitlin Botkin | Nurse Educator, Trans Care BC; Registered Midwife (non-practicing) | |
| Lauren Goldman | Nurse Educator, Trans Care BC; RN(C) | |
| Contributors | Ingrid Cosio | Medical Director, Trans Care BC |
Disclaimer
The purpose of this content is to provide health care professionals with key messages and evidence-informed recommendations for gender-affirming care in British Columbia (BC). This content was developed by provincial subject matter experts. The review process involved an internal evaluation by interdisciplinary healthcare professionals at Trans Care BC, as well as an external review conducted by additional interdisciplinary healthcare professionals and community members from across the province.
This content reflects the best available knowledge and resources at the time of publication. Trans Care BC documents are intended to provide information, education, and guidance only and should not be used as a substitute for clinical judgement and assessment of the individual needs of transgender, Two-Spirit, and non-binary people. Health care professionals should continue to exercise clinical judgement and take into consideration context, resources, wise practices, and other relevant factors when providing gender-affirming care.
Provincial Health Services Authority (PHSA) and Trans Care BC are not liable for any damages, claims, liabilities, costs, or obligations arising from the use of this document including loss or damages from any claims made by a third party. PHSA and Trans Care BC also assume no responsibility or liability for changes made to this document without their consent.