ACCESS 4 LGBTQIA+ event
LGBTQIA+ cervical screening project
By Sally Best (She/Her), MCRC Science Writer and Communications Assistant
When it comes to cervical screening, maybe we don’t consider all of the barriers; or at least I hadn’t. As a cisgender, heterosexual white woman, I’m very privileged to have limited experience of such barriers and of the prejudices faced by those in the LGBTQIA+ community. Moreover, due to being 24 and below screening age, I cannot attest to any pain or discomfort that is sometimes associated with the speculum examination used in a cervical screen.
General barriers to screening are usually associated with access as well as the screening method itself. For most, the thought of an uncomfortable speculum examination might be enough to deter from going for a cervical screen, without the added pressures that individuals who identify as LGBTQIA+ face such as gendered waiting rooms, misgendering and gender dysphoria. Additionally, individuals who identify as trans who have not undergone gender confirmation surgery (still have their female sexual organs) do not routinely receive cervical screening invitation letters. This leaves this population at an even higher risk of cervical cancer development and of later detection and thus worsened prognosis.
However, in spite of my privileged and limited experience of these barriers, what we have to remember is: just because we may not experience barriers to cervical screening, it doesn’t mean they don’t exist.
Photo taken by Vanessa Porter
Inclusion (noun): The practice or policy of providing equal access to opportunities and resources for people who might otherwise be excluded or marginalised, such as those who have physical or mental disabilities and members of other minority groups.
Oxford English Dictionary
ACCESS 4 LGBTQIA+ – 16th June 2022
If inclusion means equal access and equal opportunities, the ACCESS 4 LGBTQIA+ event fulfilled all of its criteria, with ‘access’ placed at the forefront of everything that this event did and stood for.
Entering the ACCESS 4 LGBTQIA+ event at Home Manchester was far from the usual anxiety inducing experience of an event that many of us are accustomed with (or at least, I am). Unlike the usual gaze of unfamiliar faces and calculating where to stand to make yourself appear the least awkward, a plethora of smiling faces welcomed us into the room that was filled with an indisputable warmth.
A series of stands lined the outside of the room, including one from the LGBT Foundation which was covered with a series of information packs. On the other side, an assortment of diverse and let’s not forget, inclusive hot meals.
There were leaflets galore, and the lack of stigma and remarkable transparency around sexual health was exceptionally refreshing and led me to think about what a healthcare environment should be. Maybe I am so used to the uncomfortable, gendered and outdated nature of many GP and sexual health clinics I have visited in the past, that I have not thought beyond this to what inclusion actually is.
But, if I, as a heterosexual cisgender woman have experienced discomfort in healthcare settings, it raises the question: What levels of anxiety must those in the LGBTQIA+ community experience around sexual health and cancer services?
Jen Davies-Oliveira (She/Her), lead of the ACES LGBTQIA+ project
Clinical Research Fellow in Gynecology Oncology at St Mary’s Hospital, Manchester and PhD student at the University of Manchester
ACES LGBTQIA+ survey results: Shaping an inclusive future for cervical screening
Current screening for cervical cancer consists of a speculum examination and a cervical sweep with a brush to collect cells and test them for high-risk strains of the human papilloma virus (HPV) (which causes 99% of cervical cancer cases). Those who identify as LGBTQIA+ and have a cervix have lower cervical screening attendance, with 17.8% of lesbian and bisexual individuals never attending screening (compared to 7% in the general female population), and an even higher percentage of those who identify as trans not attending.
The Alternative Cervical Screening (ACES) team at The University of Manchester, led by Professor Emma Crosbie, are investigating the accuracy of a urine test compared to a cervical sample (‘smear’) for cervical screening, in the hope this could increase screening attendance.
Leading the event was Dr Jen Davies-Oliveira who spoke about the results of the ACES LGBTQIA+ survey study. The study aimed to first capture the opinions of the LGBTQIA+ community on alternative self-sampling cervical screening methods. Beginning in January 2022, the first stage was a survey that reached 503 participants mainly from the UK but also reached other countries including the USA, Israel and Australia!
The insights of the respondents revealed a promising acceptability for self-sampling methods for cervical screening with a preference for urine testing especially in people who identify as trans. Additionally, insights were also gathered around the secondary aims of the study: knowledge of cervical screening and understanding the barriers faced in the LGBTQIA+ community with an overall aim of shaping an inclusive future for cervical screening.
Jen’s talk, as all of her talks I have experienced, was eloquent and informative, but most significantly, it was open. Her work around acceptability has elucidated not only the barriers to cervical screening in this community but acted as an exemplar to the progress that can and must be made to include as many people as possible in cervical screening. This is also the only project in early cancer detection research in Manchester to work specifically with the LGBTQIA+ community
However, like any research, this is the first step in a long journey. The ACES team will be continuing this work through focus groups and further development of self-sampling as a cervical screening method.
ACES Team (L-R): Suzanne Carter (Project Manager ACES), Lorna McWilliams (Qual researcher at UoM), Emma Crosbie (Lead of ACES), Emma Thorpe (Project Manager), Jen Davies-Oliveira (ACES LGBTQIA+ project lead), Lee Malcolmson, Rachel Hawkins, Lilly Pinggera (Research Assistant, ACES).
Following Jen’s talk, experts and LGBTQIA+ community members took part in a panel discussion, led beautifully by Claire Mooney. This discussion detailed personal experiences as well as future research directions and what it would mean if the community saw the availability of an additional screening method.
Claire Mooney (host) (She/Her)
Claire Mooney is a singer songwriter with numerous albums and international airplay to her credit. Described by NME as ‘a real talent’ and Music Week as ‘a people’s songstress’ Claire mixes the political with the playful. She hosts a variety of events. She is a patron of a number of lgbtq+ organisations and co-presents the ALLOUT Radio Show on ALLFM.
Stewart O’Callaghan (They/Them)
Founder and Chief Executive of Live Through This, supporting and advocating for LGBTQIA+ people affected by cancer.
Trans masc and non-binary individual who likes to use the word ‘queer’ for themselves. Makes synth pop as well as a being a songwriter who has written for some LGBTQ+ artists such as the Sunday Boys.
Sally Jewsbury (She/Her)
A Consultant in Genitourinary Medicine at Manchester University NHS Foundation Trust. She runs The Onyx clinic, a weekly designated trans and non-binary sexual health and contraception clinic.
Following this was an opportunity for audience participation, where members were encouraged to ask panel members questions on topics raised. An incredible performance from Husk and a raffle with an abundance of exciting prizes finished this spectacular night.
It was a pleasure to host this event. The research was really well presented and the panel helped to give massive insight into the lives of lgbtq+ people, their experience of cancer, the barriers they encounter and positive ways forward. Despite the seriousness of the subject matter the atmosphere at the event was buoyant and, with audience input, the whole evening was inspirational. As someone who’s living with terminal cancer I felt the event was uplifting.
Take home messages
As a take home, using the above definition, inclusion is representation in all settings. It is people that look like you in posters on the wall, it is waiting room staff that welcome you no matter your appearance, it is healthcare professionals that understand your personal barriers and it is screening methods that provide you with minimal discomfort and anxiety.
And if this research that enables the use of an alternative cervical screening method can both act to detect cancer before it develops and to facilitate inclusion in the healthcare environment, then this team have done much to be applauded.
This was such a fantastic event, with a chance to hear from several different voices within the LGBTQIA+ community in an interactive and intimate panel session which followed an informative presentation of the results of the ACES survey. The survey highlighted some key opportunities for new ways of testing within cervical screening, which could be really promising for improving uptake and outcomes for these underrepresented communities.
Rachel Chown (She/Her)
Education and Development Lead, Manchester Cancer Research Centre
L-R: Sally Best and Rachel Chown from the MCRC Operations Team
Screen it loud and clear: At-home urine tests for HPV could be the key to preventing cervical cancer
Dr Jen Davies-Oliveira talks about the importance of early detection research in HPV