"my brother died of ovarian cancer"

[SCMocha]

attention-grabbing headline for this article from the independent:

inews.co.uk/news/long-reads/ian-duncan-deputy-speaker-house-lords-interview-brother-died-ovarian-cancer-1125221

ovarian cancer apparently "predominantly affects females" (!)

the article talks about the fault of health care providers for not understanding the needs of trans people, rather than focusing on the confusion that might arise from someone registering with a GP as 'male' who then doesn't get smear test notifications.

Correct me of I'm wrong, but I didn't think there was general screening for ovarian cancer. Yes there are tests that can indicate it, but its not a widespread screening like we do for cervical or bowel cancer. I thought ovarian cancer was hard to diagnose as the symptoms are fairly general.
I'm certainly not aware of any screening programme in the UK.

Proves the point you can call yourself what you like and take all the pills in the world but you are what you are.

Just heard that 24 people have had their cancer surgeries cancelled this morning where I live. Actually find it hard to care about trans people who miss out on screening (and there is no screening for ovarian cancer) because they have changed their sex marker. If I moved house and missed my dental appt cards, I wouldn't blame my dentist's surgery if my teeth fell out. I wouldn't expect them to chase after me. The NHS has other pressing priorities, and as other posters have said, hormone treatment is a cancer risk factor anyway. Many women struggle to get HRT for this reason. If you take HRT, you know you have a slightly elevated risk of BC, and should really attend your mammograms without fail. If trans people are flinging cross sex hormones into their bodies and not receiving instruction to have regular cancer screening, that is medical negligence in itself. As much trans 'healthcare' seems to be.

@JustcameoutGC

Can anyone make head or tail of this " The campaign is focused on breast cancer, which trans women are more likely to suffer than men, and trans men less likely to than women. But this is just one cancer of many that arise in parts of the body that, for trans people, can mean they go unscreened. Sometimes because, like Sean Duncan, they exist as part of their previous self; the psychological disconnection from which, while understandable, can prevent early detection"

I don't know who is at risk of what here, If I knew who was male and who was female, then I would, but I cant tell form this word soup

I guess males who take cross-sex hormones have an increased risk of breast cancer compared to the general male population. And females who identify as trans are more likely to have had a double mastectomy and hence won't be at risk of breast cancer in the same way that women are.

I think in addition to the sex marker on patient records accurately reflecting biological sex, the healthcare of trans people should be handled by specialist gender clinics. The average GP has enough on their plate and there's very little research into the long-term effects of cross-sex hormones on the human body. Therefore there needs to be separate healthcare services that monitor transgender people's long-term health and look into issues like the possibility of increased risk of ovarian cancer in transmen etc. These research clinics can send out reminders and recommendations to trans people to run various tests and checks, and trans people can then ask their local GPs to organise referrals and screenings as and when needed.

If activists didn't spend so much time and effort denying reality and language, then the actual focus would be on dealing with the effects of the medical and surgical procedures that trans people have decided to undertake and having separate services to cater to their specific healthcare needs, rather than the rest of population being browbeaten into nonsensical ideological posturing.

Surely the easiest way to solve this is to ensure that all people, regardless of their gender identity, are registered as their biological sex in all medical paperwork?

So many of these issues could be so easily resolved if it was made crystal clear that sex and gender are not the same thing. Your sex is identified (not assigned) at birth and will never change. I thought we'd spent the last year or more insisting on the need to 'follow the science'.

If, socially, you're not content to be a masculine-identifying woman or a feminine-identifying man - even changing your name to reflect this, if you wish - to the extent that you wish to claim a different 'gender identity', that's fine and to be respected - just as other sincere lifestyle changes and identities, such as if you devoutly follow a faith, are a strict vegan, a Goth, whatever. It just has no bearing on your essential official record - it has no need to.

You may be a female who identifies as male, as a devout Buddhist, as a strict vegan, as a campaigner for animal rights, as a passionate mountaineer and as a sustainable cyclist. That's great: it's your life, who you have decided to be and what you do - but as your official record only cares about material facts, only the 'female' element is necessary to be recorded for official purposes. It doesn't in any way diminish your character, personality, lifestyle, interests and identity, it just has no need or interest whatsoever in reaching beyond the basic facts to include that.

In 2007, Sean phoned his brother to deliver the news. By then, Duncan was living and working in Brussels. “Sean said it was ovarian cancer,” he says. “I remember thinking, ‘That must be very difficult to deal with because of who you are’.”

With respect to Duncan, ovarian cancer is very difficult to deal with for EVERYBODY who has it - it doesn't become a petty little annoyance, just because the sufferer is female and has never identified as anything other than female.

Ovarian cancer has poor prognosis rates because doctors dismiss women's reported symptoms until it's too late, and do not order scans & tests. I find it really annoying that this is reported in terms of "trans health" when it is actually a matter of female health, and how badly we are often served by the NHS because clinicians don't take us seriously - see also endometriosis, PCOS, pregnancy, childbirth ad nauseum.

@WeBuiltThisBuffetOnSausageRoll

Surely the easiest way to solve this is to ensure that all people, regardless of their gender identity, are registered as their biological sex in all medical paperwork?

So many of these issues could be so easily resolved if it was made crystal clear that sex and gender are not the same thing. Your sex is identified (not assigned) at birth and will never change. I thought we'd spent the last year or more insisting on the need to 'follow the science'.

If, socially, you're not content to be a masculine-identifying woman or a feminine-identifying man - even changing your name to reflect this, if you wish - to the extent that you wish to claim a different 'gender identity', that's fine and to be respected - just as other sincere lifestyle changes and identities, such as if you devoutly follow a faith, are a strict vegan, a Goth, whatever. It just has no bearing on your essential official record - it has no need to.

You may be a female who identifies as male, as a devout Buddhist, as a strict vegan, as a campaigner for animal rights, as a passionate mountaineer and as a sustainable cyclist. That's great: it's your life, who you have decided to be and what you do - but as your official record only cares about material facts, only the 'female' element is necessary to be recorded for official purposes. It doesn't in any way diminish your character, personality, lifestyle, interests and identity, it just has no need or interest whatsoever in reaching beyond the basic facts to include that.

In 2007, Sean phoned his brother to deliver the news. By then, Duncan was living and working in Brussels. “Sean said it was ovarian cancer,” he says. “I remember thinking, ‘That must be very difficult to deal with because of who you are’.”

With respect to Duncan, ovarian cancer is very difficult to deal with for EVERYBODY who has it - it doesn't become a petty little annoyance, just because the sufferer is female and has never identified as anything other than female.

This.

@Gingercake2018

Also, ovarian cancer is referred to as the 'silent killer' in women so surely the concern here should be about the late diagnosis and poor outcomes for all women.

Exactly this. I've seen my DGM die of it and two of my aunts.

Wow, it’s almost as if Sex is biological and can’t be changed

With respect to Duncan, ovarian cancer is very difficult to deal with for EVERYBODY who has it - it doesn't become a petty little annoyance, just because the sufferer is female and has never identified as anything other than female.

Quite.

It's reminiscent of Tara Hewitt training a group of NHS workers that breast cancer is worse for MTF trans people than women because it robs them of their femininity.

@AmericanSlang

Ovarian cancer has poor prognosis rates because doctors dismiss women's reported symptoms until it's too late, and do not order scans & tests. I find it really annoying that this is reported in terms of "trans health" when it is actually a matter of female health, and how badly we are often served by the NHS because clinicians don't take us seriously - see also endometriosis, PCOS, pregnancy, childbirth ad nauseum.

Yes, although it is the American health system and insurance costs that contributed in this case. The NHS had little to no bearing on the outcome.

In the interests of being pragmatic, I think it would be best if medical records captured both sex (immutable) and gender.

Preaching to the choir on here as to why to retain sex (ie. to ensure all the right people get invited for smear tests etc). But I think if you don't also have a way of recording gender, you invite a whole load of awkwardness when a HCP assumes the wrong person has walked into the room and I think this will deter trans people from accessing necessary healthcare on occasion. It permits a greater degree of dignity, and costs very little. I'd love to live in a world where the computer says the next patient is Kevin, sex female, beardy bloke walks in, and the GP gets all of this and is able to be interested solely in Kevin's ear infection or whatever, but in truth we're not there yet and I don't want Kevin to self-select out of treatment for the ear infection or for Kevin to miss a smear test.

In terms of this particular story, I agree there are niggles to the logic, but mostly I think grief can do that and it doesn't stop this from being a good opportunity to think sensibly about trans access to healthcare and what needs to happen to ensure that everyone is treated with dignity and according to their sexed body.

There's also heart disease - trans women are at greater risk because they take oestrogen:

pubmed.ncbi.nlm.nih.gov/30073551/

Agree with everything everyone else has said. Trans people need to remember their biological sex and the health risks associated with that. Sex needs to be recorded on medical records. Trans people need to know that if they take cross-sex hormones for many years, that will increase their risk of certain illnesses.

Yes I think that there would be many ways that they could record both bits of information about a patient, so that everyone got the tests needed, and more information/counselling for trans patients about making sure that they are aware - if they are so disconnected from their 'former selves' that they can't accept the biology that is still there, then that in itself needs some kind of counselling.

Everyone should have access to appropriate and timely healthcare, and records and procedures need to be put in place to allow this - but some of the most obvious ones, like recording sex alongside gender, seem to cause crises of identity and lead to all this confusing language about what body-parts people have. They could just use male and female to mean what they've always meant, with extra information about trans-identity on top to allow HCP to make sure they are getting suitable tests etc, and also to make sure that any additional risks from hormones and so on are also being monitored.

@NellWilsonsWhiteHair

In the interests of being pragmatic, I think it would be best if medical records captured both sex (immutable) and gender.

Preaching to the choir on here as to why to retain sex (ie. to ensure all the right people get invited for smear tests etc). But I think if you don't also have a way of recording gender, you invite a whole load of awkwardness when a HCP assumes the wrong person has walked into the room and I think this will deter trans people from accessing necessary healthcare on occasion. It permits a greater degree of dignity, and costs very little. I'd love to live in a world where the computer says the next patient is Kevin, sex female, beardy bloke walks in, and the GP gets all of this and is able to be interested solely in Kevin's ear infection or whatever, but in truth we're not there yet and I don't want Kevin to self-select out of treatment for the ear infection or for Kevin to miss a smear test.

In terms of this particular story, I agree there are niggles to the logic, but mostly I think grief can do that and it doesn't stop this from being a good opportunity to think sensibly about trans access to healthcare and what needs to happen to ensure that everyone is treated with dignity and according to their sexed body.

Yes, this makes total sense and in a sane world I think most people could get behind a secondary concept of gender (whether you personally interpreted that as an inner sense of self, presentation or something else) which was worth recording - much in the same way as we record honorifics.

However a scary proportion of the world seems to be going in a different direction and instead of calling that sensible suggestion "pragmatic", is hell-bent on denouncing it as "transphooooooooobia" (I always hear the Covonia bull now).

Yes I agree that the increased risks involved with cross sex hormones are also something that doctors might need to be aware of, so for a younger trans person some conditions are potentially more likely to present than in people of the same biological sex.

It's concerning how naive some trans people are about the human body and biological sex considering what they then put their bodies through.

Many medical decisions are sex dependent, even conditions that are not obviously sex specific.

The criteria for diagnosis of a heart attack is different for men and women (mm of st elevation on ECG).

Blood test parameters are different for males and females.

Peak expiratory flow (asthma) are very different between the sexes.

I'm sure there is an example from every specialism of medicine.

It's both ridiculous and worrying at the same time.

However a scary proportion of the world seems to be going in a different direction and instead of calling that sensible suggestion "pragmatic", is hell-bent on denouncing it as "transphooooooooobia"

Yes, exactly, and the Independent, which is a ridiculously partial news source on this issue, is using this story to point score about trans identity rather than emphasise that biological sex is important to healthcare.

They estimate that the risk of breast cancer in trans women to be about three times less than for cisgender women

That actually seems incredibly high... I suppose maybe it only includes TW taking cross-sex hormones, would make more sense.

Agree with NeilWilsonsWhiteHair about sex and gender being recorded, I'm not an HCP but do deal with patients, and it's helpful to know the situation before patient encounter.

I actually don't think the trans factor was the biggest factor at play here. This story is about it being a silent killer cancer. That's not screened for and difficult to detect.

A woman emigrated. Doesn't have health insurance. Cancer develops and comes back after remission.

The only relevant trans factors are the assumption that they didn't go to the doctor's regularly because of trans factors. My nan 'ignored' her cancer in this way too and it killed her. It's not an exclusively trans behaviour. The psychology behind it needs looking at.

The other thing that could have been a factor was the hormones. But there's a real effort by the LGBT+ lobby to minimise side effects and only stress life saving properties of transition. So that needs to be tackled.

I think the real story here is women's healthcare is not as robust as it should be: a global problem.

They estimate that the risk of breast cancer in trans women to be about three times less than for cisgender women

Well yes, because they aren't women. Male breast cancer rates are much lower.

From Cancer Research site:

About 1 in 100 (about 1%) of breast cancer cases in the UK are in males.

www.cancerresearchuk.org/about-cancer/breast-cancer/stages-types-grades/types/male-breast-cancer

That actually seems incredibly high... I suppose maybe it only includes TW taking cross-sex hormones, would make more sense.

Indeed, that's quite shockingly high.

I'd also be interested to know whether messing about with hormones in such extreme ways and for such long periods of time increases the likelihood of certain hormone mediated cancers.

I have a friend (female) who transitioned in Germany a few years ago going through the entire process which requires many meetings with doctors and psychologists (at least at them moment still) and the HCPs insisted on double mastectomy and hysterectomy because taking testosterone would increase the cancer risk. They were very clear about that. Not sure if they also removed the ovaries.

@Igneococcus

I'd also be interested to know whether messing about with hormones in such extreme ways and for such long periods of time increases the likelihood of certain hormone mediated cancers.

I have a friend (female) who transitioned in Germany a few years ago going through the entire process which requires many meetings with doctors and psychologists (at least at them moment still) and the HCPs insisted on double mastectomy and hysterectomy because taking testosterone would increase the cancer risk. They were very clear about that. Not sure if they also removed the ovaries.

It's very hard for women to get testosterone at all if they AREN'T transitioning, although we can suffer the ill effects of our levels being too low. I've often wondered why doctors are so wary of prescribing it (and yet it can be given in large amounts to teenage girls...)