This section describes screening programs suggested to transgender people on the basis of national prevention plan (PnP) 2020-2025 and some suggestions regarding prostate cancer prevention.
Screening programs are free prevention and early diagnosis paths active all year round addressed to general asymptomatic population (which does not have symptoms related to the disease for which the screening is done). The aim is to detect, if present, initial injury which generally do not generate any symptom, in order to cure and avoid the possible evolution into cancer. As of today screening programs relate to breast, uterine cervix and colon rectum cancers. Adhering to these programs can be more difficult for transgender people for various reasons (for example access difficulty after legal name change due to discrimination or stigma).
Local health services (ASL) send an invite with a booked appointment to own residents to carry out screening test in one of centers of reference; appointment can be modified calling the green number highlighted in the mail; test result is sent home by post mail; only if it would be necessary to repeat the test or undergo further assessments in one of the centers of reference of the local health service, one will be contacted by phone; if from further exams a disease is diagnosed, the screening center ensures to the person assistance and a qualified treatment support.
Screening for breast cancer allows to identify cancers which are too small to be visible or perceived with touch through breast palpation. Diagnosis and early treatment offer the best survival probability. For further information regarding breast cancer it’s possible to visit ISSalute.it under section “Breast Cancer”.
For transgender men who underwent chest masculinization, breast cancer screening is important because, despite the mastectomy, a small section of mammal gland can remain. Furthermore the screening is important for who, even if not undergone chest surgery, are taking masculinizing hormonal therapy because breast cancer are described also in these people. Screening is recommended in transgender men with the same times provided for cisgender women based on age (see paragraph “To whom it is addressed”). Because the legal name or masculinizing hormonal effects could represent a barrier to screening for breast cancer, it is recommended to refer to the own general physician or endocrinologist to plan a suitable screening plan. For transgender women are recommended the same screening plans for cisgender ones, based on age (see paragraph “To whom it is addressed”).
HOW SCREENING TEST WORKS
Screening test for breast cancer is a radiologic exam, called mammography. During mammography, each breast is heavily compressed for some seconds between the plate and an X-Ray device. Pressure is necessary to obtain good quality images and reduce radiation dosage. Exam is performed by a physician or a specially equipped technician. Some people find the test uncomfortable and others painful but the distress is short term. Mammography screening usually foresees two images for each breast. People who carry prothesis undergo further radiographic images in order to make visible the most possible quantity of mammary tissue. For transgender men who have undergone chest masculinization surgery, the most useful diagnostic tool is breast ultrasound. During the ultrasound, one is asked to lie down on the back and uncover the chest. It is not necessary to undress completely. If wearing a binder, one will be asked to remove it. Usually the ultrasound is not painful, but it can be slightly uncomfortable because sometimes it is necessary to exert a little pressure.
TO WHOM IT IS ADDRESSED
People between the ages of 50 and 69 (indicative age group which may vary from region to region) registered as women with the National Health Service will receive a letter at home communicating an appointment at the local screening center. In the event that one wishes to change the appointment, one must contact the number indicated in the invitation letter by telephone and set a new date. Screening involves a mammography every two years. In some regions, efficacy is being tested in a wider age group, between 45 and 74 years (with checks every year under the age of 50 and then, above the age of 50, every two years).
People between the ages of 50 and 69 registered as men with the National Health Service will not receive an invitation for breast cancer screening. However, for transgender men who have undergone chest masculinization surgery, breast cancer screening is important because, despite the surgery, a small portion of the mammary gland remains. Furthermore, screening is also important for those who, despite not having had the surgery, are taking masculinizing hormone therapy, since breast cancer cases are also described in these people. Screening is recommended in transgender men with the same time frame envisaged for cisgender women based on their chronological age. It is recommended that you consult your general practitioner or trusted endocrinologist to plan a suitable screening program.
Screening for cervical cancer or cervical screening is aimed at preventing cancer of the cervix (the lower and narrower part of the uterus). It is important to participate in the screening because identifying an alteration before it turns into a cancer offers the best opportunity for a successful therapy. There is a close link between cervical cancer and infection by some types (strains) of human papilloma virus (HPV); these strains are referred to as "high risk". The virus is transmitted through sexual intercourse and prevention, as with all other sexually transmitted infections, is given by the correct use of condoms. There is also a vaccination that guarantees protection from this infection. However, even if one is vaccinated for HPV, it is important to undergo cervical screening. For more information on HPV infection, you can visit ISSalute.it website under the heading "HPV-Virus of human papilloma"
HOW THE SCREENING TEST WORKS
To perform the test, the doctor inserts an instrument, the speculum, into the vagina to examine the uterine cervix and takes a sample of cells with a soft toothbrush that is sent to a specialized laboratory to identify any suspicious cells.
Transgender men under hormone treatment with testosterone for a long time may find screening unpleasant or painful. It is important to talk to the doctor or nurse about the possibility of using a speculum of different sizes with further lubrication.
TO WHOM IT IS ADDRESSED
People between the ages of 25 and 64 (indicative age group which may vary from region to region) who are registered as women with the National Health Service will receive a letter at home communicating an appointment at the local screening center. In case one wants to change the appointment, one can contact the number indicated in the invitation letter by phone and set a new date. Screening involves a checkup every three years.
People who have undergone penile and scrotal inversion vaginoplasty or colon vaginoplasty do not have a cervix, so they do not need to undergo this screening.
Persons registered as women with the National Health Service will still be routinely invited to cervical screening; if one does not wish to receive the invitation, one must contact the own general practitioner who can delete the name from the list of people invited to this screening.
People registered as men with the National Health Service will not receive an invitation for screening. However, for assigned female at birth people who have not undergone hysterectomy, it is advisable to consider undergoing the test, especially if the cervical screening results were not previously normal. If this is the case, one should contact own general practitioner to be able to undergo the test.
It is important to always feel treated with respect for one's dignity. If cervical screening worries you, talk to your general practitioner or other referring physician.
We recommend to consider the possibility of undergoing cervical screening every time the invitation is received even if the results of the previous tests were normal. Even people vaccinated for HPV must undergo cervical screening when they receive the invitation. If one has symptoms such as abnormal vaginal discharge or bleeding or pain during or after intercourse, it is recommended to talk about it with the own general practitioner or other referring physician even if the cervical screening results are normal.
Colorectal cancer screening reduces the risk of death from this disease. Early diagnosis gives you the greatest chance of survival. For more information on colorectal cancer, you can visit the ISSalute.it website under "Colorectal cancer"
HOW SCREENING TEST WORKS
The screening test consists in the collection of a stool sample that will be analyzed to verify the presence or absence of blood not visible to the naked eye (occult blood). This examination is the most effective investigation for early detection of lesions that could develop into cancer. Sample collection can be performed directly at home using a special test tube that can be collected from the Centers listed in the invitation letter. After taking the stool sample, the tube must be placed in the refrigerator until it is returned. If further diagnostic investigations are required (if the test result is positive or doubtful), the person is contacted by telephone and an appointment is proposed to make a visit and subsequently a colonoscopy. For further information relating to the examination for the detection of occult blood in the feces or to the colonoscopy, it is possible to visit the ISSalute.it website under the items "Occult blood" or "Colonoscopy"
TO WHOM IT IS ADDRESSED
Screening for the early diagnosis of colorectal cancer is aimed at all people aged between 50 and 74 (indicative age group which may vary from region to region) registered with the National Health Service.
To reduce the risk of colorectal cancer it is recommended to:
The risk of developing colorectal cancer increases in first degree relatives (children) of a person with cancer or bowel polyps. If you are unsure of your likelihood of risk, it is important to talk to your general practitioner.
Prostate cancer usually grows slowly and remains asymptomatic (in its early stages of development) for many years; moreover, the symptoms it causes are not specific to cancer, but are the same as those of another pathology called "benign prostatic hyperplasia", the most common form of prostate enlargement. For more information on prostate cancer, you can visit the ISSalute.it website under "prostate cancer".
People at risk of developing prostate cancer are those assigned male at birth and over 50 years of age or over 45 years of age with a family history of prostate cancer.
People who have undergone penile and scrotal inversion vaginoplasty or colon vaginoplasty retain their prostate, therefore they can suffer from prostate diseases (for example prostate cancer). It is therefore advisable to contact your general practitioner or referring specialist to plan, based on individual characteristics (age, risk factors), a possible analysis for early diagnosis by digital exploration of the prostate and PSA (prostate-specific antigen). The digital exploration of the prostate consists in the introduction of a finger, after the doctor has put on a lubricated glove, in the anus or in the neovagina of the person who is undergoing the examination and serves to ascertain the volume and consistency of the prostate, as well as the possible presence of suspected prostatic nodules. For further information on the PSA dosage, visit the ISSalute.it website under the heading "PSA - Specific Prostatic Antigen".