A man with ovarian cancer, a woman with prostate cancer. A situation that oncologists must begin to take into account more and more often, given that the transgender and gender non-conforming population (that is, of a different gender from that declared at birth), is increasing. And the first of those who have undertaken a transition path to the opposite sex in the past are now reaching the age when the risk of developing some form of cancer becomes more concrete. We are talking about them today in Assisi, at the Aiom Conference on the Days of Ethics in Oncology. “Between 2 and 4 percent of cancer patients on active treatment at our facility are transgender,” he says for example. Davide Dalu, oncologist at the Sacco di Milano, “yet health professionals are not yet ready to welcome and manage these patients in the best possible way”, adds Dalu, if it is true that – as shown by the results of a survey carried out in collaboration with ELMA Research on 190 transgender and gender non-conforming people – hospitals represent the fifth place where these patients suffer discrimination (after outdoor common spaces, schools, public transport and night clubs). In fact, 32% report having been the victim of discriminatory behavior by health personnel. A discrimination that can take different forms: from the use of the name assigned at birth instead of the chosen one, to attitudes of inappropriate curiosity, to a less respectful behavior than that reserved for other patients, to ignoring specific needs, to blame for the clinical problem up to the use of aggressive language. The causes? Lack of experience in treating these people’s specific problems, poor knowledge of their clinical needs, sometimes even fear or prejudice.
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Discrimination and difficulties in accessing prevention and treatment
On the other hand, almost half of oncologists (46.2%) recognize that these patients are discriminated against in accessing cancer care and 18.4% have witnessed episodes of this type attributable to gender identity from part of health workers. One consequence of this gap between the LGBTQI + population and the world of health care is that 71 percent of transgender people have never participated in any cancer screening program, and nearly a third are unable to find specific information for cancer prevention based on one’s specific condition. Furthermore, many of them access centers to tackle cancer problems with a significant delay (67.9%), they do not trust healthcare professionals (57%), they do not access treatment centers at all (44.6%). and they do not receive appropriate care (22.6%).
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Understanding and managing the risk of cancer in transgender people
But the risk of cancer for this population exists and must be recognized: in the transition phase between the sexes, these people undergo biological changes so important that they can favor the onset of cancer. “I am thinking, for example, of the administration of hormones in MtF transitions, that is, from man to woman, to inhibit hair growth or to develop breasts”, he points out. Saverio Cinieri, National President of AIOM, “increasing the risk of cancer”. Not only that: even after surgery for the transformation of the genital system, the prostate may not be removed and become the site of a tumor. With an outline of legal issues if the family doctor cannot prescribe a PSA test (the marker that is used to assess the risk of prostate cancer) to what is now a woman even at the registry office.
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Train health professionals
Complex, delicate, often submerged issues involving biological, psychological and social aspects. That Aiom has decided to tackle, given that in the last 5 years 41.3% of oncologists have treated at least one transgender or gender non-conforming patient affected by cancer. “Oncology must be open to the many facets of society and must be ready to welcome them with an inclusive language – he explains Giordano Beretta, President of the AIOM Foundation – Just as we identify subgroups of patients on the basis of molecular alterations to choose the best treatment, we must also understand how to treat certain groups of patients who need special attention to be treated in the best possible way “. To improve the quality of care, the oncologists gathered in Assisi continue, it is necessary to implement the training of professionals, invest in institutional campaigns to protect these citizens from all forms of discrimination based on gender identity and provide for clinical studies that include them, considering their specific needs.
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“The decision to take care of the health of the LGBTQIA + community puts Aiom in line with the decisions taken for some time by the scientific societies of the main European countries and the United States“, he adds Filippo Pietrantonio of Gastroenterological Medical Oncology at the IRCCS National Cancer Institute Foundation in Milan and member of the Aiom National Board. “More efforts need to be made to reduce inequalities in access to cancer treatments and screening, which still exist for some categories. Often the fear of suffering discrimination represents for these citizens a barrier to prevention and treatment “.