A UBC expert explains how Canadian transgender patients are not receiving medically or culturally competent cancer-related health care
When illness strikes, we turn to our healthcare system. But what if the medical system doesn’t acknowledge your gender identity? Mary K. Bryson, director of UBC’s Institute for Gender, Race, Sexuality and Social Justice, is project leader of the Cancer’s Margins project. Funded by the Canadian Institutes for Health Research, it is the first nationwide project to document how members of sexual and gender minorities experience cancer and access support.
Gender and health are already overloaded with inequalities. Only in the last 20 years have we understood, for example, that cardiac health looks very different for females than for males. Things get much more complex with transgender health, where gender isn’t just binary. For transgender people, it is often the case that their body does not easily map onto the gender identified in their medical documents or their gender presentation. Intake forms at healthcare clinics don’t provide the option for patients to identify their gender identity and gender expression.
When you create a system that makes it impossible for people to communicate their presence, one of the immediate consequences will be minority stress. This has very predictable consequences in terms of quality of life and access to medically and culturally competent healthcare. People simply withdraw from institutional systems of care.
It takes only a few minutes to find out someone’s gender identity. But many healthcare providers don’t. And the consequences are very serious.
How does this inequity affect trans* patients?
People in the trans* (transsexual, transgender or gender variant) community have lower levels of access to a regular GP. They also tend to participate less in forms of cancer health promotion, like cancer screening.
Many of the Cancer’s Margins trans* interview participants report that their cancer healthcare providers had no information or access to appropriate medical evidence concerning gender-affirming care protocols, and simply informed their patients to stop taking hormones. Transgender healthcare needs to be taken into account concurrently with cancer care.
A significant number of interview participants in the Cancer’s Margins project are people whose assigned sex at birth is female and who now identify as men. Pap or mammography screenings are not typically set up to anticipate the participation of trans* men. However, to provide medically and culturally competent cancer care, it’s important to consider pap screening for men with vaginas. If you don’t, gynecologic cancers will be detected later, and cancer mortality will be greater in the trans* population than in the general population.
It shouldn’t be the case that when a trans* man arrives at a breast-cancer clinic, his partner is shown the way into the clinic while he is told to sit outside the waiting room, because clinic staff assume that he could not be the breast cancer patient. Likewise, a transgender man with ovarian cancer may not be well served by a cancer-care agency if it is routinely assumed that all ovarian cancer patients are women.
What knowledge do healthcare workers have of trans-related health issues?
It’s extraordinary how little time is focused on LGB/T health in medical school. Current research on medical education reveals that virtually no time at all is spent on LGB/T health. When it comes to getting culturally appropriate and evidence-based medically appropriate care, trans* people have to go to extraordinary lengths in order to simply get adequate care.
Cancer is already a stressful and difficult experience. For trans* people, to be marginalized and rendered silent about something as important as gender adds to the already very high burden cancer places on people and their families. If we are going to provide cancer health services and cancer education to all Canadians, then we need to deal with the fact that there is a multitude of trans* Canadians who are not being included in the system.