Alison May Berner

Breast and Gynecologic Cancer Care for Sexual Minority Women and Transgender People

Sexual and gender minority (SGM) individuals continue to experience disparities in cancer risk, screening, treatment, and outcomes. Despite advances following the 2017 ASCO recommendations, inequities persist, driven by systemic barriers, stigma, and discrimination in health care. State-level and federal-level actions threaten health care access to for sexual minority women (SMW) and transgender and gender-diverse (TGD) people creating additional barriers to safe and evidence-based health care. This review outlines the literature and gives practical recommendations for breast and gynecologic cancer care of SMW and TGD people. SMW and transgender men and nonbinary people with a cervix share multiple barriers to cervical cancer screening with lower uptake. TGD individuals face additional barriers, including gender dysphoria during examinations. Current evidence supports offering human papilloma virus self-sampling to improve screening uptake. Evidence supports lower breast cancer risk in TGD people compared with cisgender women but advice must be tailored to surgical history and hormone use. For TGD individuals with cancer, gender-affirming hormone therapy should be managed through shared decision making, balancing oncologic risk with quality-of-life considerations. Cancer care must account for the unique needs of SGM populations, emphasizing cultural humility, structural competency, and trauma-informed care. While broader health care reforms are needed to address the systemic inequities that underlie these disparities, clinicians have an obligation to provide affirming, patient-centered care that recognizes the impact of societal discrimination on health and fosters trust with SGM patients.