Systematic review of national guidelines on cancer prevention in trans and gender-diverse populations

Abstract Transgender and gender-diverse (TGD) individuals face barriers to cancer screening and HPV vaccination, as many programs rely on legal sex, and systemic issues such non-inclusive records and lack of provider training persist, leading to low uptake. Inclusive guidelines are essential to ensure equitable cancer prevention, but their global availability remains limited. This systematic review aimed to identify and describe national guidelines on cancer prevention addressing TGD populations. The search was conducted in Sept. 2024 using Overton, supplemented by citation mining and manual searches. Documents were classified by service and document type (official guideline vs recommendation). Thirty-seven documents from 11 countries were identified. For breast cancer screening, 9 guidelines from Australia, Canada, US, UK, Ireland, Netherlands and 7 recommendations, from these countries and Italy, were retrieved. For cervical cancer screening 6 guidelines (Australia, Canada, US, UK, Ireland, Netherlands) and 9 recommendations, including from Italy, Belgium and France were identified. Colorectal cancer screening was addressed by the UK and Ireland, but specific TGD adaptations were limited. For anal cancer, 1 Italian society statement addressed high-risk groups. For prostate cancer, 3 recommendation from the US, UK and Ireland were identified. Over 47 countries have implemented gender-neutral HPV vaccination policies, indirectly covering many TGD individuals. Seven guidelines (Canada, US, UK, Sweden), and 6 recommendations including from Italy and Spain, addressed TGD populations specifically. Across all services, only few documents from Canada, the UK, and Ireland provided detailed operational instructions for eligibility, invitations and procedures. Despite growing awareness, most cancer prevention policies inadequately address the needs of TGD populations. Anatomy-based screening pathways and standardized national guidelines are urgently needed to achieve equitable access. Key messages • Few countries have issued cancer screening or HPV vaccination guidelines fully inclusive of transgender and gender-diverse individuals, with major gaps across all services. • Standardized, anatomy-based eligibility and clear invitation protocols are urgently needed to improve equitable cancer prevention for transgender and gender-diverse populations worldwide.