Amid high-profile transgender health topics, cancer is often overlooked. There is barely any information on cancer outcomes for transgender people because of an absence of studies investigating cancer incidence and mortality in lesbian, gay, bisexual, and transgender (LGBT) people.There is also the issue of population cancer statistics not including details of sexual orientation or status, so relevant information is often missed.
The National Transgender Network Sri Lanka (NTN) recently hosted a discussion on how to prevent cancer and how it affects the transitional social community, as one of their T-Talk sessions.
Speaking to The Morning Brunch National Transgender Network Sri Lanka Drop-in Centre Manager Dinushi Halloluwa explained the concept behind T-Talk: “In Sri Lanka, the transgender community is not aware as much, so with this initiative, we hope that they can learn more about important topics of discussions for them.”
The risk of cancer in the trans community 
The studies available on this topic suggest that transgender people have a disproportionate cancer burden, but without high-level evidence, health-care providers are stifled in their ability to provide sufficient guidance.
From these studies, we can understand that there is a complex collection of issues affecting the ability of transgender people to access effective cancer care. One such issue is the possibility of discrimination that discourages transgender people from seeking medical help.
Halloluwa noted that breast cancer is an immediate cause for concern for the transgender community. “Doctors have suggested that by obtaining a breast implant, there is a concern of cancer as a side effect.” She also added that there are not many causes of breast cancer in the trans community in Sri Lanka, but the aim of this programme is to raise awareness that they may one day face this risk.
Another cause for concern, Hallowuwa pointed out was that some transgender people choose to undergo medical gender affirmation, which may include therapy with cross-sex hormones and/or surgical change of the genitalia and other sex characteristics. The cross-sex hormones administered for the purposes of changing ones gender may be delivered at high doses and over a period of decades, the carcinogenicity of hormonal therapy in transgender people is an area of considerable concern.
To minimise the risks associated with modifiable behaviours and the environment, one must have sufficient knowledge of cancer risk to take effective action. With this programme, Halloluwa hopes to give the trans community an idea of what they can do if they do have cancer, and an idea of how to prevent the risks specific to the trans community.
Discrimination and gender dysmorphia
Discrimination plays an important part in the logistics of cancer screening as well. Screening programmes for gynaecological and genitourinary cancers might fail to identify eligible transgender participants. These procudures need to improve up the the point where they dont publicly reveal the patients sex at birth. According to a report published by the World Health Organisation (WHO), trans men are often not included in screening programmes for cervical cancer, despite retaining some or all of their natal genitalia. The fear of discrimination could also prevent transgender people from taking advantage of these services.
Halloluwa also added that transgender men and women remain susceptible to cancers of reproductive organs that are no longer in alignment with their gender. For example, trans women might not recognise the persisting risk of prostate cancer. Those who have undergone sex reassignment surgery might be unaware of the continuing possibility of reproductive cancers due to residual tissue that remains after surgery.
This can be complicated by the transgender people opting out of cancer screening and examinations because of emotional or physical distress, commonly known as gender dysmorphia, associated with the discordance between their gender and their natal genitalia.
