An affirming conversation about cervical and breast cancer screenings.
An affirming conversation about cervical and breast cancer screenings.
This provider is in the middle of a new patient visit with a non-binary patient and demonstrates how sexuality and gender identity can be assessed and integrated into conversations about preventive cancer screenings.
Alex, one of the things I like to talk through with new patients is preventive cancer screenings. Since you are only 27, there aren’t many that we need to consider yet. Still, I think it would be valuable for us to discuss what screenings might be a good idea now, and if there are others to consider in the future. Does that sound okay?
Sure, that sounds good.
Great. Cancers are often specific to particular body parts. I would like to ask a few questions to help us identify which body parts we should consider together. Is that okay with you?
Yes.
Thank you. If at any point I use a word that is different from the one you use for your body, please correct me. What term do you use to describe your gender? And what sex were you assigned at birth?
Got it, thank you. I am non-binary, but I was assigned female at birth.
Have you undergone any gender-affirming care, including surgeries and/or hormone therapy?
Yes, I had top surgery about two years ago and I am on testosterone.
Thank you for being willing to share all this, Alex. Based on what you have said, I think it makes sense for us to discuss screenings for cervical cancer and breast cancer. Does that sound reasonable to you?
Sure, though I prefer the term chest cancer. And I guess I thought that having top surgery reduced my risk for that.
Chest cancer – got it. So, starting with chest cancer, people typically don’t start getting screened for that until they are 40 years old. And your risk is reduced based on having top surgery. That said, your surgeon may have left some tissue to help provide the new shape of your chest. It means that you have a lower level of risk, don’t meet criteria for the standard screening guidelines, but some monitoring might still be called for. Let me do a bit of research when we are done here, and I can send you the most up to date guidance.
Ah, I see. I didn’t know that. That would be great.
The screening that we probably do want to consider together is a screening for cervical cancer. Guidelines recommend that, starting at age 21, individuals get screened for that every three years using what’s known as a Pap test.
Oh, I did have Pap tests when I was 21 and 24. I guess I hadn’t thought of it since I transitioned.
Things to consider.
This provider identified relevant cancer risk and screenings by asking respectful, matter-of-fact questions about the patient’s sex assigned at birth and gender-affirming care received. This not only supported the identification of care goals, but also helped establish an identity-safe environment for the patient.
This provider knew some, but not everything about the patient’s risk and relevant screening guidelines based on their gender identity, anatomy, and care history. It is okay to not know everything. The key is establishing a trusting relationship with your patient and being willing to educate yourself when you identify a knowledge gap.
What language in this script could you adopt for use with your clients? What language doesn’t fit, and what language would you use instead?
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