Cancer screening guidelines for transgender individuals: a narrative review of current recommendations and practice gaps

This narrative review aimed to synthesize current cancer screening recommendations for transgender individuals, critically assess their content, identify inconsistencies, and highlight key evidence gaps to inform future clinical practice and policy. We searched MEDLINE, CENTRAL and Web of Science through 9 May 2025 for screening guidelines relevant to transgender individuals. We included documents from national or international bodies, academic institutions or recognized expert panels. Guidelines focused on breast, cervical, prostate, endometrial, ovarian and anal cancer. Data were extracted into a structured matrix by cancer type, screening approach and relevance to transgender populations. Of 79 sources screened, 14 met inclusion criteria. Most were transgender-specific. Recommendations varied substantially across cancer types. Breast cancer screening showed the widest divergence, with differing thresholds based on age, gender-affirming hormone therapy duration and risk stratification. For prostate, endometrial, ovarian and anal cancers, dedicated guidance was sparse or absent, often relying on extrapolation from cisgender populations. Key gaps included inconsistent terminology, lack of integration of gender-affirming hormone therapy and surgical history, and limited rationale for screening intervals and age cutoffs. Future efforts should prioritize inclusive data collection, integration of gender identity into cancer surveillance systems and development of evidence-informed, population-specific screening protocols to advance equitable care.