Supporting transgender patients must be a priority to achieve equity in cancer care
Macmillan’s CEO, Gemma Peters, talks about the importance of health equity and the work Macmillan is doing to support transgender and non-binary people with cancer.
The heartbreaking reality
As the chief executive of Macmillan Cancer Support, I spend a lot of time thinking about health inequalities. People’s experience of cancer care in this country is not equal and it’s not fair.
There is a lot of attention given to new breakthroughs in treatment or the potential of new technology, but what about the thousands of lives that would be saved every year just by people having fair access to what is available already?
Knowing there are still groups of people who can’t or feel unable to access life-saving medical treatment due to their ethnicity, socio-economic background or how they identify is utterly heartbreaking. It’s one of the main reasons I wanted to come and work at Macmillan, because the charity was set up to make sure that everyone, whoever they are and whatever their circumstances, gets the support they need when they are diagnosed with cancer. We have a long and proud history of making things better for people with cancer. It is what everyone at Macmillan comes to work to do every day and it is a unifying issue.
Equity for all
Discrimination in all its forms should have no place anywhere, not least within our healthcare system which, by design, should be there for everyone. And yet, the provision of healthcare services for many is not adequate.
Barriers and risks
This includes transgender people who are more likely to be exposed to a number of risk factors for cancer(i) and are further impacted by complex issues affecting their access to timely and effective care.
There are significant barriers for many trans men in accessing cervical cancer screenings[ii], and although trans men have an increased risk of developing breast cancer than cisgender men[iii], they won’t be automatically called for breast cancer screening if registered at their GP surgery as male[iv].In trans women, the prostate isn’t usually removed in gender affirming surgery and so prostate cancer remains a risk. While rates of prostate cancer appear to be lower for trans women than for cisgender men, diagnosis and treatment can often be more complex[v].
Transphobia in healthcare
Research from TransActual UK[vi] also highlights the transphobia and discrimination that transgender people experience when accessing healthcare. This often leads to them avoiding the vital support they need altogether. In fact, 57% of respondents to the TransActual survey reported avoiding going to the doctor when unwell, 14% reported being refused GP care at least once due to being transgender, and a massive 70% said they had experienced transphobia while receiving healthcare.
These findings are also referenced in a report published in 2022 by the London Assembly Health committee[vii], which also notes that as well as facing “a disproportionate burden of disease”, trans and non-binary people are also more likely to experience mental ill health, often linked to experiences of transphobia, discrimination and violence.
This is unacceptable and disheartening in equal measure, but it doesn’t have to be this way. The reality is that inequality and systemic barriers endanger lives, and we all have to recognise this reality and work together to ensure change.
Answering questions
I understand some people have concerns, but we are listening and learning from a wide range of perspectives and I want to provide reassurance.
We sometimes receive questions from supporters who want to know if by offering specific support for trans and non-binary people, by partnering with organisations such as charity OUTpatients, we are taking away from other groups. The answer is no. The concerns we receive from people contacting our support line have much in common; worries about long waiting times, their finances, sleep, side effects from treatment, making sense of the information they are receiving and telling loved ones about their diagnosis.
Our human worries and needs are largely the same, and this is where Macmillan spends most of its time and money. Making sure that this support feels relevant for everyone, can be accessed easily and without fear of judgement is at the heart of our charitable purpose to make sure everyone with cancer gets the support they need. Making sure that this support feels relevant for everyone, can be accessed easily and without fear of judgement is at the heart of our charitable purpose to make sure everyone with cancer gets the support they need.
Another topic some people raise is around single-sex spaces. I visit hospitals all over the country where healthcare professionals are working their hardest every day to treat their patients with care and respect and to make the best use of the facilities they have. Macmillan nurses and others work hard to ensure the privacy and dignity of all patients is at the heart of their decision making.
Transgender support
At Macmillan, our role is to support this work and bring the voices of people with cancer forward to help improve the experience of all those who face treatment. We have a variety of resources aimed specifically at those who are transgender and non-binary, to make it as easy as possible for them to access the information and care they need, without judgement or prejudice.We also have an online forum, specifically for members of the LGBTQIA+ community, providing a safe and inclusive space for them to find and connect with others who share similar experiences.
An inclusive culture
Building inclusion within our teams at Macmillan is also essential so we can better represent and support everyone who needs us. We’re raising awareness and understanding amongst our colleagues and making sure our policies are inclusive. That has included the introduction of our new Transitioning at Work policy, which sets out the support Macmillan provides to transgender, gender non-conforming and non-binary colleagues.To those who question why this is important to us as a cancer support charity, I want to say that the more we can create an inclusive environment where all colleagues are able to do their best work, the better organisation we will be for people with cancer.
Next steps
My number one priority is to make sure that every pound has the most impact it can for everyone with cancer, and to do that well we need a diverse team of people, bringing their full motivation, knowledge and experience to work. We will risk lives, time, and goodwill by not doing the right thing by them all.I am conscious however that we need to do more and go much further to make sure all our services are fully inclusive, and we will continue to address this as part of our open strategy process.
No one should ever be left without medical treatment, and the fact that some people are being denied care or made to feel unworthy due to their identity is truly shocking.
It is essential that health and cancer care becomes truly equitable and inclusive, and at Macmillan we’re more than ready for the challenge. It could be a matter of life or death.
References
i. Brown J, Pfeiffer RM, Shrewsbury D et al. Prevalence of cancer risk factors among transgender and gender diverse individuals: a cross-sectional analysis using UK primary care data. Br J Gen Pract 2023; 73: e486-e492
ii. Connolly D, Hughes X, Berner A. Barriers and facilitators to cervical cancer screening among transgender men and non-binary people with a cervix: A systematic narrative review. Prev Med 2020; 135: 106071
iii. Corso G, Gandini S, D'Ecclesiis O et al. Risk and incidence of breast cancer in transgender individuals: a systematic review and meta-analysis. Eur J Cancer Prev 2023; 32: 207-214
iv. NHS England. NHS population screening: information for trans and non-binary people. Accessed February 2023
v. Crowley F, Mihalopoulos M, Gaglani S et al. Prostate cancer in transgender women: considerations for screening, diagnosis and management. Br J Cancer 2023; 128: 177-189
vi. TransActual, Trans lives survey 2021. Published September 2021. The survey was carried out online between January and February 2021 by TransActual, a trans-led organisation empowering and advocating for trans people across the UK. The data relates to information provided by 697 respondents.
vii. London Assembly Health Committee. Trans Health Matters: improving access to healthcare for trans and gender-diverse Londoners. February 2022. The report followed an evidence-gathering session on 25 November 2021. A list of those who took part are included in the report.
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