Barriers to and facilitators of cancer prevention services for transgender and gender-diverse people: A systematic review
Despite the increasing adoption of gender-inclusive policies, transgender and gender-diverse (TGD) people continue to face significant barriers to cancer prevention services, resulting in low uptake of cancer screening and HPV vaccination. This review aimed to synthesize evidence on barriers and facilitators to cancer prevention among TGD people to inform more inclusive and effective policies and programmes. Searches were performed in Medline (1946), Cochrane CENTRAL (1992), CINAHL (1982), PsycINFO (1806), Web of Science (1975), and EMBASE (1971) from inception up to July 18, 2025. Thematic synthesis was guided by SURE framework, and McLeroy's socioecological model of health behaviour, adapted to cancer prevention context. A total of 1648 records were retrieved; 119 full texts were assessed and 53 studies (55 reports) met inclusion criteria. Most studies addressed cervical cancer and HPV-related prevention. Barriers were identified at individual (knowledge gaps, gender dysphoria, financial precarity), interpersonal (misgendering, discrimination, inadequate communication), healthcare-system (gendered services, insurance mismatches, lack of provider training), and societal levels (gendered messaging, stigma). Facilitators across the same levels included informed provider recommendations, affirming care environments and self-administered screening. Findings show that TGD people continue to experience exclusion within cancer prevention services. Addressing these disparities requires coordinated action across individual, interpersonal, system and societal levels.