Transgender Men's and Non-Binary People's Experiences of Cervical Cancer Screening-A Journey Mapping Approach

Research indicates various barriers to cervical cancer screening for transgender people, contributing to cancer inequities. Further research is required to better understand how these barriers affect experiences along the screening trajectory, from engaging with information, through invitation and testing, to receiving test results. Research exploring how transgender people navigate these barriers is also required.

To explore the experiences of cervical cancer screening in Sweden among transgender people who were assigned female at birth, and to identify touchpoints in need of improvement along the cervical cancer screening trajectory.

Qualitative interview study inspired by journey mapping.

Semi-structured interviews (n = 18) and interpretive description analysis.

Five phases were identified comprising participants' cervical cancer screening journey, with touchpoints in each phase indicating key experiences, barriers, and strategies to navigate barriers. Experiences of touchpoints were affected by four interrelated dimensions: The embodied person-personal gender identity, relationship with own body, and transition process; System factors-policies, routines, and practices; Gender norms and transphobia; and Prior healthcare experiences. Significant barriers included a lack of trans-specific screening information; an invitation system that does not automatically invite male-registered individuals with a cervix; lack of trans competency among clinics and staff; female-centred clinics; gender dysphoria; anticipation or fear of being mistreated; distrust of healthcare authorities; and participant-staff power dynamics.

To make cervical cancer screening more equitable for transgender people, barriers need to be addressed by considering the four dimensions that affect these barriers.

Findings show that staff involved in policy and clinical practice can improve transgender people's experiences of cervical cancer screening by promoting agency and self-determination in each screening phase. This involves providing inclusive information, continuing invitations for male-registered individuals with a cervix, enhancing trans-competency, and addressing power dynamics in staff-participant interactions.

The Standards of Reporting Qualitative Research (SRQR).

Representatives from the Regional Cancer Centre Stockholm-Gotland were involved in the conceptualisation of this study. Representatives from trans and LGBTQI+ organisations, Regional Cancer Centres, and the National Board of Health and Welfare have provided feedback during the analysis and writing phases.