Dr Alison May Berner and her colleagues at Queen Mary University of London are looking to see whether a new type of cervical screening test may work better and be more comfortable for trans and non-binary people.

Human papillomavirus (HPV) is a common virus that spreads through skin-to-skin contact. Some strains of HPV, called high-risk HPV, can cause changes in cells that lead to certain cancers including cervical.

Anyone with a cervix is at risk of cervical cancer, this includes:

• Cisgender women – People who identify as female and were registered as female at birth.
• Transgender men – People who identify as male but were registered as female at birth.
• Non-binary people – People who identify as neither male or female, and in this case were registered as female at birth.

Cervical screening can be particularly difficult for trans men and non-binary people, which can stop them from attending their appointment. This can be because of physical discomfort and emotional distress during screening when a doctor or nurse takes a swab from the cervix.

Currently, when people go for cervical screening, the sample, taken with a soft brush, is tested for high-risk HPV to help determine if that person is at risk of cervical cancer. If there is HPV, the sample is then tested for cell changes that could lead to cancer. Research has shown that taking a swab from the vagina is as good as a doctor or nurse taking a sample from the cervix to test for HPV. If it is positive, people still need to go for a test with a doctor or nurse to take a sample to check for cell changes.

A new type of test, called “methylation testing”, looks at the genetic information in the sample to see whether it is likely to cause cancer. When used, it means that not all people with a positive HPV test will need to go to the doctor or nurse, only those most at risk.

Cervical screening tests don’t work as well for people taking testosterone as it can interfere with the sample. This research will see how well methylation testing works in transgender men and non-binary people on testosterone. We will use samples from people taking part in the Self-TI study. This asked 50 trans men and non-binary people to swab from the vagina and have an extra swab taken by a doctor or nurse as part of routine cervical screening. These swabs will be tested for HPV and have the methylation test. 

This research will help make cervical cancer screening easier for transgender people in the future. We will be able to see if the methylation works well for transgender men and non-binary people and could be used with HPV swabbing at home.