Background: Transgender men and non-binary people assigned female at birth (TMNB) who have not had surgery to remove the cervix are recommended to undertake cervical screening with the same frequency as cisgender women but evidence suggests that TMNB have lower odds of lifetime and up-to-date cervical screening uptake. Aim: To understand the attitudes towards and preferences for cervical screening among UK-based TMNB. Design & Setting: Cross-sectional survey of TMNB at an NHS gender identity clinic (GIC) and an NHS sexual health service specialising in care of transgender people. Method: Recruitment was via email invitations to patients of the GIC and sexual health service. Inclusion criteria were: female sex assigned at birth, trans man, masculine, or non-binary gender identity, age ≥18 and UK resident. Quantitative results were analysed using descriptive statistics and free text comments were analysed thematically. Results: There were 137 participants, 79% identifying as transmasculine and 18% as non-binary. Sixty-five participants (46%) were eligible for cervical screening and 56.9% of those had ever been screened. Only 53.1% of those eligible felt they had sufficient information about cervical screening . Just over half (53%) stated they would like the option to self-swab for high-risk HPV. Only half of the participants were in favour of an automatic invitation for cervical screening . Thematic analysis identified a number of additional barriers and facilitators of screening. Conclusions: TMNB have identified numerous potential areas for change that may improve cervical screening uptake and patient experience.

Trans men and non-binary people experience numerous barriers to accessing cervical screening, including dysphoria related to the procedure, anticipated or experienced stigma and discrimination, lack of provider knowledge and exclusion from routine recall systems. As a result, this population are less likely to attend regularly and a recent UK study showed that the majority prefer to access screening via a trans-specific sexual health service. This pilot sought to trial a weekly dedicated cervical screening clinic for trans men and non-binary people to gauge acceptability and to explore how best to promote the service. Organisations with the expertise of working with this population in the UK collaborated on the project. A communications plan was developed which included promotion of the project to local area stakeholders. A promotional video was produced as well as three patient testimonials from trans people who had attended for screening. The social media campaign comprised initial promotional material on six platforms with post-hoc analysis and a second stage using the two most popular platforms. The clinic commenced in October 2019 within an existing trans-specific sexual health service in London, UK. It was staffed by healthcare professionals with training and experience in performing cervical screening for trans people, including sensitive communication and techniques to facilitate a more comfortable procedure. Appointments could be accessed via a dedicated booking email and telephone number. Patients were asked to complete an evaluation after the procedure. From October 2019, nine people were screened prior to the outbreak of Covid-19 in March 2020. The project was suspended immediately after the first social media campaign launched, having had over 40,000 views over 10 days. In July 2020 the project recommenced, and the second social media campaign ran on Facebook and Twitter for 14 days, with over 50,000 views. A targeted email advertising the service was sent to eligible patients currently under the Gender Identity Clinic London in August 2020 and the service advertised via their website. Between July and February 2021, 35 trans men were screened in the clinic, despite another lockdown. Participant surveys from 20 attendees showed 100% positive feedback. The majority of respondents stated that if the service was unavailable, they would not have attended cervical screening (12/20 respondents). However, when asked if their GP could provide a similar service, nine respondents stated that they would attend (9/20 respondents). This pilot suggests that bespoke cervical screening clinics for trans men and non-binary people are highly acceptable, and support patients to engage with screening who otherwise would not have done so. Patients may benefit from such clinics embedded within services across several healthcare settings, in order to maximise access. Targeted promotion via social media is effective and may encourage screening beyond the service being advertised but should be concentrated on platforms most accessed by the community. Citation Format: Alison M. Berner, Tara Suchak, Aedan Wolton, Jacob Bayliss, Katue Craven, Imogen Pinnell, Ricki Ostrov, John Burchill. A UK-based pilot cervical screening clinic tailored to trans men and non-binary people [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-248.

Imogen Pinnell highlights the effect the pandemic has had on younger women accessing the care they need and reminds us of the importance of timely referral for this group