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Email: taylor@pridecentervt.org
Phone: 802-860-7812

 

 

Cancer Screening Guidelines

CancerScreeningGuidelines Public page 001

Breast Cancer Screenings: LGBTQ+ Considerations

Who Gets Breast Cancer?
Everyone is at risk for breast cancer. The two most common risk factors are:
  • Being female
  • Getting older
No matter your age, you should get to know how your breasts normally look and feel. If you notice any changes, see a doctor.

Is there an increased risk for Lesbian, Gay, and/or Bisexual women?
Lesbian, gay, and bisexual women have a greater risk of breast cancer than other women. This is not because of their sexual orientation. Rather, it is linked to breast cancer risk factors that tend to be more common among women in our community. For example, LGB women may be more likely to never have children, or have them later in life. Lesbians also tend to have higher rates of obesity and alcohol use. All of these factors increase breast cancer risk.

Screening Rates
Some findings show similar rates of screening mammography among lesbian, gay, bisexual, and heterosexual women. Yet other findings have shown lesbian, gay, and bisexual women may not get regular breast cancer screenings. This may be due to:
  • Past experience of discrimination or insensitivity from doctors
  • Perceived low risk of breast cancer
  • Not having a primary care physician
  • Lack of health insurance
Once you find a provider you like, see them on a regular basis. These visits offer the chance to get routine health screenings and other medical care. Screening tests can find breast cancer early, when the chances of survival are highest. If you are in need of a competent and affirming doctor, please check out the Vermont Diversity Health Project or connect with Taylor for more information.

Is there an increased risk for Transgender people?
At this time, data on the risk of breast cancer among transgender people is limited. If you are transgender, talk with a doctor about your breast cancer risk and which screening tests may be right for you. It is important to find a doctor who is sensitive to your needs, and to see a doctor on a regular basis. If you are in need of a competent and affirming doctor, please check out the Vermont Diversity Health Project or connect with Taylor for more information.

Cervical Cancer Screenings: LGBTQ+ Considerations

LGB Women and Cervical Cancer Screening
Lesbians, gay, and bisexual women are as likely as heterosexual women to develop cervical cancer, and yet are up to 10 times less likely to undergo regular screening for the disease. This disparity occurs within a broader context of marginalization of lesbian and bisexual women in the healthcare system. Lesbians are less likely to access preventive care compared to other women, and both lesbians and bisexual women are less likely to be insured compared to other women. Although cervical cancer was once one of the most deadly female cancers, early detection through regular screening has transformed this disease into the most preventable female cancer. Due to low rates of regular cervical cancer screening, lesbians and bisexual women are priority populations for cervical cancer control in this country.

Transgender Men and Cervical Cancer Screening
Transgender men with a cervix should follow the same screening guidelines as anyone else who has a cervix. Pap tests can be difficult for transgender men for a number of reasons, including:
  • Dissociation between assigned sex and gender identity
  • Desire to ignore the existence of natal reproductive structures
  • Lack of knowledge that they still have a cervix after receiving a supracervical hysterectomy
  • False positives resulting from testosterone-induced changes to the cervical epithelium that mimic dysplasia
  • Testosterone-induced atrophy of the vagina that makes passage of a speculum more painful
Sensitivity to these unique barriers is important while still emphasizing the importance of regular screening. If the cervix is completely removed and there was no prior history of high-grade cervical dysplasia or cervical cancer, no Pap tests are necessary. There are no data currently available on the rates of cervical cancer or cervical cancer screening among transgender men.

HPV in the LGBTQ+ Community
Genital HPV is transmitted by skin to skin contact. Risk is therefore present in all LGBTQ+ people who engage in sex. Transmission occurs more easily in the presence of irritated skin, as often occurs with penetrative sex. The most widely used test for HPV is the Pap test, where a sample of cells is collected from the affected tissue and tested for an abnormal rate or pattern of growth, called dysplasia. Dysplasia may range from mild to severe, but because HPV infection is usually contained by the immune system, most healthy adults will never develop it. For persons with poor immune system function, however, infection HPV infection may quickly progress to severe dysplasia and cancer. For this reason, HIV-positive gay or bisexual men have higher levels of both HPV infection and HPV-related disease than heterosexual men. An estimated 61% of HIV-negative and 93% of HIV-positive gay and bisexual men have anal HPV infections, compared to 50% or less of heterosexual men.

The simplest approach to reducing the prevalence of HPV and HPV-related cancer in LGBT communities is to use the established preventative course: regular Pap smears coupled with suggested HPV vaccination for those most at risk.

For more information about HPV, click here.

Ladies First Program* (name change pending)

Ladies First* (name change pending) helps eligible Vermonters get breast, cervical and heart health screenings. Their members get free mammograms, Pap tests and heart health checkups (blood pressure, cholesterol and blood sugar testing). Ladies First also pays for diagnostic tests when needed, and their clinical navigator is available to provide support and guidance.

The Ladies First Program can pay for the following procedures:
  • Breast Cancer Screenings
  • Cervical Cancer Screenings
  • Heart Health Screenings **NEW** Changes to Ladies First Heart Health Services Starting July 1st
  • Lifestyle Programs
  • Breast Cancer Screenings, including:
    • Annual Screening
    • Clinical breast exam
    • Screening Mammogram
    • Diagnostic follow up tests
    • Diagnostic mammogram
    • Ultrasound
    • Consultation
    • Second opinion
    • Breast biopsy
    • Risk counseling
    • Genetic counseling
    • MRI when clinically indicated
For more information about mammograms and breast cancer screenings, click here.
  • Cervical Cancer Screenings
    • Pelvic exam
    • Pap test
    • HPV test
    • Colposcopy
    • Diagnostic tests
For more information about cervical cancer screenings, click here.
  • Other Services
    • Ladies First can pay for transportation and interpretation services for Ladies First appointments.
    • Ladies First members will be referred for full Medicaid coverage if breast or cervical cancer treatment is needed. For more information please contact the Clinical Navigator at 802-863-7332.
Ladies First cannot cover cancer treatment or HPV vaccinations. Vermonters who can join Ladies First and need treatment for breast and cervical cancer will be referred to the Breast and Cervical Cancer Treatment Program.

For more information please contact the clinical navigator at 802-863-7332 or email kerri.frenya@vermont.gov and include "clinical navigator" in the subject line.

Ladies First Eligbility:

LF Eligibility    LF Income Guidelines

Additional Information:
  • Potential members cannot have Medicare Part B.
  • Potential members must be 30 years and older to participate in Heart Health Screening and Lifestyle Programs.
  • Transgender women, who have taken or are taking hormones and meet all program eligibility requirements, are eligible to receive breast cancer screening and diagnostic services through Ladies First. Although there are limited data about the risk for breast cancer among transgender women, long term hormone use has been shown to increase the risk for breast cancer among women whose biological sex was female at birth. Talk to your provider about the benefits and harms of screening and discuss individual risk factors to decide if screening is medically indicated.
  • Transgender men may still receive cancer screenings through Ladies First if they have not had a bilateral mastectomy or total hysterectomy.
To apply for membership with the Ladies First Program, click here.
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