71% of transgender and gender non-conforming people (of a gender other than that at birth) have never participated in any cancer screening program; one in three are unable to find specific information for cancer prevention declined on their specific condition, and 53% believe that gender identity can have a significant impact on the risk of developing cancer. More generally, hospitals represent the fifth place where transgender people suffer discrimination, after outdoor common spaces, schools, public transport and night clubs. On the one hand, 32% report having been the victim of discriminatory behavior on the part of health professionals. On the other hand, 46.2% of oncologists believe that these patients are discriminated against in accessing care and 18.4% have witnessed episodes of this type attributable to gender identity by health professionals. These are the main results of two surveys, one out of 190 transgender and gender non-conforming people and one out of 305 oncologists, presented in Assisi at the Aiom (Italian Association of Medical Oncology) conference on the ‘Days of ethics in oncology’, and conducted in collaboration with Elma Research. From the surveys – reports the AIOM which is working on ad hoc Recommendations addressed to specialists – it emerges that discrimination by health personnel against transgender people can take different forms: from the use of the name assigned at birth instead of the one chosen attitudes of inappropriate curiosity, less respectful behavior than that reserved for other patients, ignoring specific needs, blaming the clinical problem up to the use of aggressive language. According to oncologists, as a consequence of discriminatory attitudes, transgender people do not participate in screening and prevention programs (73.1%), they access centers to deal with cancer problems with significant delay (67.9%), they do not have confidence in health professionals (57%), do not fully access treatment centers (44.6%) and do not receive appropriate care (22.6%). The causes of the behaviors that discriminate transgender people in the health care environment include the lack of experience in treating the specific problems of these people, lack of knowledge of their clinical needs, and sometimes even fear or prejudice. A significant problem, considering that in the last 5 years 41.3% of oncologists have treated at least one transgender or gender non-conforming patient affected by cancer. To improve the quality of care, experts believe it is necessary to implement training for professionals, invest in institutional campaigns to protect these citizens from all forms of discrimination based on gender identity and envisage clinical trials that include them, considering their specific needs. “We dedicate 2 days to health based on sex and gender identity – says Saverio Cinieri, Aiom national president – Gender medicine has a precise meaning in oncology. There are in fact differences between men and women in biological and molecular terms, in response to antineoplastic and toxicity therapies following cancer treatments. In the second part of the Ethics Days, we turn our attention to the needs of the LGBTQIA + community. The oncological problems in this population are “in fact” completely misunderstood, but very important. Aiom is engaged on this front and will draw up the Recommendations ni for the management of cancer in transgender patients “. “In the transition phase between the sexes, these people undergo biological changes so important that they can favor the onset of cancer. Furthermore, as the survey revealed, in the long and sometimes painful transition process they often neglect the rules of cancer prevention. including screening “, emphasizes Cinieri. “Oncology – points out Giordano Beretta, president of the Aiom Foundation – must be open to the many facets of society and must be ready to welcome them with an inclusive language. Just as we identify the subgroups of patients based on molecular alterations in order to choose the best treatment , we must also understand how to treat some groups of patients who need special attention to be treated in the best possible way “.” Aiom’s Ethics Days’ represent an opportunity to focus attention on transversal and integrative issues, compared to those more traditional therapies and the results of clinical studies – remarks Rossana Berardi, professor of oncology at the Polytechnic University of Marche, director of the Oncology Clinic of the Marche University Hospital and member of the Aiom national board – Gender medicine is a a new topic in the oncology field, for a long time confined only to aspiring reproductive tto. Today we have growing scientific evidence, including epidemiological evidence, which helps to understand how there are important biological differences based on sex in the response to therapies. Diversity in socio-economic terms, linked to gender, in access to treatment and clinical trials must also be considered “.” For the first time Aiom dedicates a conference to gender medicine – observes Filippo Pietrantonio of the Foundation’s gastroenterological medical oncology Irccs National Cancer Institute of Milan and member of the national board of Aiom – The conference focuses not only on the differences between men and women, but also includes a focus on the health of the LGBTQIA + community. This choice puts Aiom in line with the decisions taken for some time by the scientific societies of the main European countries and the United States. More efforts are needed to reduce inequalities in access to cancer treatments and screening, which still exist in some categories. Often the fear of being discriminated against represents for these citizens a barrier to prevention and treatment “.
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