The Canadian Cancer Society recommends sexually active people with cervices over 21 have a Pap test every 1-3 years.^1,2 A Pap test is a procedure where a healthcare provider brushes cells off the cervix (a small circular organ on the inside-end of the genitals). By looking at these cells under a microscope, healthcare providers can treat these cells before they turn into cervical cancer.

But when it comes to the 2S/LGBTQ+ community, data from the Our Health survey—collected April to September 2022—suggest Pap tests are not as accessible as they need to be.

Among cisgender women who participated in the 2S/LGBTQ+ community survey, only 54.5% had an up-to-date Pap test. These lower rates may be driven, in part, by screening delays linked to the COVID-19; however numbers are typically higher for the general population. For instance, a pre-pandemic UK study estimated women who have sex with women have 60% lower odds of having an up-to-date Pap test compared to women who have sex with men exclusively.⁴

Yet, Pap testing is equally important for both groups. The virus that causes most cervical cancer (HPV),⁵ is as common in queer women as it is in straight women.⁶ Likewise, queer women’s chances of having Pap test results that require treatment to prevent cervical cancer are about the same as straight women’s.⁴

*** Learn what prevents or enables Pap tests for 2S/LGBTQ+ people ***

While Pap test access was low for cis women in Our Health, gender non-conforming people and transgender men with uteri had even less access to Pap testing. About one quarter (26.3%) of trans men who completed the survey had a Pap test completed in the past 3 years. Compared to cis women, gender non-conforming people had 15% lower odds, and trans men had 70% lower odds of having an up-to-date Pap test.

These findings align with other research that suggests trans men and masc-identifying people are less likely to have an up-to-date Pap test than cis women and femme-identifying people.^7,8 Yet, trans men may be more likely than cis women to have Pap results that require follow-up.^9,10 While trans men are recommended to be screened at the same rate as cis women,² this isn’t happening in practice. Urgent action is needed to make sure more trans men have access to Pap testing. 

If we want to protect the health of 2S/LGBTQ+ people with cervices, we need to change the way pap tests feature as part of health service delivery.  But reducing the barriers that prevent Pap tests may be complex. It will involve educating care providers, addressing discrimination in clinical settings, and working to improve access to queer-affirming spaces in medicine. 

To reduce barriers to Pap tests for our communities, we’ve put together a new resource: What Prevents or Enables Pap Testing for 2S/LGBTQ+ People. This presents key considerations and practical information for clinicans to improve the accessibility of Pap testing.

After HPV infection, not accessing Pap testing is the most important risk factor for cervical cancer.⁶ It’s time we make Pap tests more accessible for all people who need them.

The views expressed herein do not necessarily represent the views of Health Canada.

References

1. Canadian Cancer Society. When should I be screened for cervical cancer? Accessed February 18, 2023. 
2. Canadian Cancer Society. As a trans man, do I need to get screened for cervical cancer? Accessed February 18, 2023.
3. Ontario Health (Cancer Care Ontario). Ontario Cancer Screening Performance Report 2020. 2021.
4. Saunders CL, Massou E, Waller J, Meads C, Marlow LA, Usher-Smith JA. Cervical screening attendance and cervical cancer risk among women who have sex with women. J Med Screen. Sep 2021;28(3):349-356. doi:10.1177/0969141320987271
5. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol. Sep 1999;189(1):12-9. doi:10.1002/(sici)1096-9896(199909)189:1<12::Aid-path431>3.0.Co;2-f
6. Bustamante G, Reiter PL, McRee AL. Cervical cancer screening among sexual minority women: findings from a national survey. Cancer Causes Control. Aug 2021;32(8):911-917. doi:10.1007/s10552-021-01442-0
7. Johnson MJ, Nemeth LS, Mueller M, Eliason MJ, Stuart GW. Qualitative Study of Cervical Cancer Screening Among Lesbian and Bisexual Women and Transgender Men. Cancer Nurs. Nov/Dec 2016;39(6):455-463. doi:10.1097/ncc.0000000000000338
8. Peitzmeier SM, Khullar K, Reisner SL, Potter J. Pap test use is lower among female-to-male patients than non-transgender women. Am J Prev Med. Dec 2014;47(6):808-12. doi:10.1016/j.amepre.2014.07.031
9. Adkins BD, Barlow AB, Jack A, et al. Characteristic findings of cervical Papanicolaou tests from transgender patients on androgen therapy: Challenges in detecting dysplasia. Cytopathology. Jun 2018;29(3):281-287. doi:10.1111/cyt.12525
10. Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening. J Gen Intern Med. May 2014;29(5):778-84. doi:10.1007/s11606-013-2753-1

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