Jefferson obstetrician-gynecologists share the importance of routine screening and how they aim to break the barriers and promote affirming care.
Cancer screenings and early detection are lifesaving. However, lack of access to screening and adequate care is proven to make cancer more prevalent among certain underserved populations, including the LGBTQ+ community.
Gynecological cancers, specifically, aren’t talked about among the LGBTQ+ community as often as they should be, due to social taboos, suggests Jennifer Hummel, DO. Studies even show that lesbian, bisexual, and transgender individuals are less likely to receive routine gynecological care due to personal and healthcare-related barriers.
Whether it’s insurance issues; hesitancy/concerns stemming from prior negative healthcare experiences; discomfort in discussing or being examined regarding body parts one does not identify with; or a general lack of understanding (and use of affirming dialogue) within the medical community, these issues can lead to severe, long-term health risks, explains Kelly Park, DO.
Dr. Hummel and Dr. Park, obstetrician-gynecologists at Haddonfield Primary & Specialty Care, an LGBTQ+ Affirming Practice, aim to break these barriers. Below, they share the importance of gynecological cancer screening, how it works, and why it’s significantly important for everyone.
Out of cervical, ovarian, and uterine/endometrial cancers, cervical is the only one that requires routine screening via a pap smear/pap test, which uses a small sample of cells scraped from the cervix, explains Dr. Park. Ovarian and uterine screenings can only be done following symptoms. Pap smears should be done every three years, starting at age 21, and every five years (coupled with an HPV test), after age 30. They are very accurate for detecting abnormal cells and results usually come back within seven to 14 days.
“As gynecologists, we also want to stay on top of your breast health, which is relevant for anyone in the LGBTQ+ community who hasn’t had female-to-male gender-affirming top surgery (mastectomy),” adds Dr. Hummel. Breast cancer screening via mammogram is recommended yearly after the age of 40. For those at average risk, a clinical breast exam should be done every one to three years for those aged 25-39 and every year for those 40 and over.
Who needs to be screened?
In general, if you have female sex organs, screening is essential for reducing your cancer risk, says Dr. Hummel. “We understand that it may be nerve-wracking and uncomfortable to discuss your gynecological health, especially if you don’t identify with those body parts, but it’s important to stay on top of every aspect of your well-being.”
“It is our goal to make you feel like you’re in a safe and confidential space and can openly talk about your health concerns,” adds Dr. Park.
Trans men who have not had gender-affirming/bottom surgery should follow cervical cancer screening guidelines, continued Dr. Park. Trans men who have undergone a full hysterectomy, including the removal of the cervix, do not need routine screening, as long as they do not have a history of abnormal pap smears. If they do have this history, continued screening is highly recommended. After hysterectomies, pap smears can be performed using cells from the vaginal cuff.
If you’re a trans woman who has undergone gender-affirming/bottom surgery (vaginoplasty surgery), the risk for cancer development in the neo-vagina and/or neo-cervix is incredibly rare. However, you shouldn’t hesitate to discuss any personal risk factors or concerns with your provider.
“The main risk factor facing the LGBTQ+ community is delayed care/years gone without routine screening,” said Dr. Park. Additionally, according to the American Cancer Society, lesbian and bisexual women may be at higher risk for ovarian and cervical cancer. This may be due to the misconception that you cannot get HPV from a female partner, which is simply not true.
If you were born female, many other risk factors can come into play, including:
- Cervical cancer: early onset of sexual activity; multiple sexual partners; high-risk sexual partners; history of sexually transmitted infections; immunosuppression; oral contraceptive use (less condom use); smoking; and young age at first pregnancy/birth
- Ovarian cancer: older age; early onset of first period/menstrual cycle; late onset of menopause; family history; BRCA gene mutation; and no pregnancies
- Uterine/endometrial cancer: obesity; no pregnancies; irregular menstrual cycle; early onset of first period; late onset of menopause; and family history
- Breast cancer: BRCA gene mutation; older age; white race; early onset of first period; late onset of menopause; no pregnancies; alcohol use; smoking; and family history
Oral contraceptive (birth control) use can decrease the overall risk for ovarian and endometrial cancers, adds Dr. Hummel. However, estrogen alone (without progesterone) – such as feminizing hormone therapy – may increase the risk for endometrial and breast cancers.
When should you see your OB/GYN?
If you suspect any complications regarding your gynecological health, it’s important to come in for a visit, says Dr. Park. Some warning signs/symptoms that you should watch out for include postmenopausal bleeding; abnormal menstrual bleeding; abnormal abdominal pain; abnormal discharge; severe bloating; breast lumps that evolve and don’t resolve with periods; significant weight loss; or a change in urinary/bowel habits.
Why should you seek care at an LGBTQ+ affirming practice?
Our patient care approach is simple, continued Dr. Park. “We strive to provide unbiased care tailored specific to the LGBTQ+ community and provide a safe space to ask questions and discuss any problems, big or small.”
“If you’re hesitant to see an OB/GYN, know that providers who are well-trained on LGBTQ+ health needs are available to provide the best care possible,” added Dr. Hummel. “We can talk you through every part of your visits/exams, step by step. If you have questions, ask them. No question is too silly or unimportant.”