Why can’t NHS screening services include trans patients?

NHS patients are regularly invited to screening tests for different conditions. The tests can be inconvenient or uncomfortable, but the evidence on screening clearly shows it identifies risks early, prevents disease, and saves lives. Patients are at greater risk if they don’t receive invitations, or receive the wrong information.

Trans patients can request to alter their gender marker and are given a new NHS number. Any gendered words are replaced with their new pronouns. However, this also changes their eligibility for screening programmes as many of these are gendered; men and women commonly receive different tests.

Trans patients may be given a leaflet about screening programmes and are invited to self-refer, and will receive no invitations other than those relevant to the gender marker on their NHS record. Therefore, for example, not all patients with a cervix are invited to cervical screening. Contrastingly, if a cis woman has a full hysterectomy, for example, their GP has a simple form to fill out to remove the patient from the cervical screening register as it is no longer relevant to her body. Trans patients should be included on screening registers that are relevant to their bodies.

Historic inequalities within healthcare for the LGBT+ community results in patients who are not comfortable in a healthcare setting. The LGBT Foundation, with projects such as Pride in Practice, is aiming to improve this, but whilst Public Health England (PHE) admit there are inequalities within services, they suggest population screening is inherently equitable. Yet, the issues they aim to improve barely mention gender inequality or LGBT+ communities.

Further, LGBT+ communities are prone to risk factors such as higher rates of smoking, alcohol consumption, and drug use, which can increase the risk of cancers including breast, mouth, and bowel cancer. Some trans patients may find some screening tests, discussions of body parts, and intimate examinations distressing; however, given the higher risk of cancer, screening trans patients should be a high priority, or at very least their personal choice.

PHE encouraged gender identity monitoring in the past, but so far nothing has changed about the way trans patients are screened: the responsibility is largely on the patient themselves. In good GP surgeries patients may be supported well, but dependency on individual practices inventing their own solutions isn’t an appropriate or efficient way to handle the problem. The PHE screening information leaflet exists but does not go far enough to fix the inherent problem. Autonomous control over healthcare is a responsibility not given to cisgender patients, who receive regular reminders from the national services. Trans patients are not being treated equally and are left needlessly disadvantaged, regularly losing out on the best chance to catch early signs of cancer.

According to the Equality Act 2010, in this case trans patients are being discriminated against because of their gender reassignment. Screening based on gender binaries effectively assumes a trans patient to have opted out of screening they may still need, and should be encouraged to attend, all without their informed consent. Early intervention following screening preserves patient quality of life better and frequently saves the NHS money by simplifying treatment. It simply isn’t acceptable that trans patients receive substandard care and potentially have their lives put at risk because the system currently isn’t recognising trans patients’ needs.

Screening services must not continue treating the LGBT+ patients as anomalies. There is no reason why the trans community cannot be equally protected and included within the national screening programme on the basis of need, not gender binaries.

* Elle Cronin is a Lib Dem campaigner. She works in the NHS facilitating screening and ongoing care for chronic conditions. Greg Webb is a Lib Dem campaigner and former parliamentary candidate.