When a transgender man was diagnosed with breast cancer during gender-affirming bilateral mastectomy, every aspect of his treatment became uncharted territory.

“Every medical conversation, every treatment discussion, and even the assumption of desired outcomes — all typically geared toward cisgender, heterosexual women — entered a blind spot,” he told researchers. “No medical professional I encountered was intentionally discriminatory; there simply was no established protocol for treating breast cancer in a transgender man.”

His experience highlights a growing concern across European healthcare: LGBTQI+ patients with cancer face significant barriers to equitable care, from delayed diagnoses to inadequate psychosocial support. Despite oncologists’ best intentions, knowledge gaps about sexual and gender minorities often result in suboptimal treatment outcomes and patient distress.

According to 2024 data from the European Union Agency for Fundamental Rights, only 10% of LGBTQI+ respondents had a mammography in the past year compared with 36% of the general population. Cervical cancer screening rates were similarly low at 27% vs 36% for the general population. Research consistently shows that healthcare providers lack LGBTQI+ awareness and fail to provide adequate psychosocial support — deficiencies that experts say should be addressed through improved medical education and communication training.

Understanding the Barriers

The root of the problem lies in healthcare providers’ limited understanding of LGBTQI+ patients’ specific needs.

“The main problem arises when the LGBTQI+ identity of patients is not recognized by physicians,” said Alberto Giovanni Leone, MD, medical oncology fellow at Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy. “It’s too reductive to think that all patients should be treated in the same way. From a principle of equity, every patient should instead be treated according to their specific needs.”

Alison Berner, MBBS, PhD, medical oncologist at St Bartholomew’s Hospital and lead for the UK Cancer and Transition Service at Chelsea and Westminster Hospital NHS Foundation Trust, both in London, England, categorizes these needs into three areas: communication and rapport, adjustments to care, and additional support requirements. Recent public and legal debates around gender identity and rights in the UK and Europe have heightened patients’ fears about disclosure, making trust-building even more critical.

Medical mistrust can create a cascade of problems. LGBTQI+ patients often feel their identities and relationships are overlooked, according to Tom Bootsma, PhD, postdoctoral fellow at Erasmus MC in Rotterdam, Netherlands. “Key gaps include lack of recognition of partners and chosen family, discomfort around disclosing gender or sexuality, limited attention to body image and gender dysphoria, and inadequate sexual health discussions,” he explained.

A 2024 ESMO-SIOPE survey revealed that oncologists expressed high uncertainty about specific cancer risk factors for LGBTQI+ patients, including smoking rates and human papillomavirus exposure— fundamental information needed for proper screening and prevention.

Addressing these disparities requires comprehensive physician education because most medical schools have not traditionally provided LGBTQI+-specific training. “Thanks to the work of many great colleagues, there are now plenty of resources online and quite a few educational papers in the literature,” Leone noted.

The European branch of the International Lesbian, Gay, Bisexual, Trans & Intersex Association, for example, offers the Health4LGBTI program, with downloadable training courses to help healthcare professionals increase their competency.

Practical Communication Strategies

Effective communication can make an immediate difference. Berner recommends introducing yourself with your name and pronouns as “a strong signal of safety.” Never make assumptions about identity or relationships, even based on referral letters. Instead, ask open questions and explain why personal information matters for tailoring care.

Bootsma offers these additional guidelines:

• Use the term LGBTQIA+ to refer to lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual/aromantic people, with the + representing other identities, such as pansexual individuals.
• Always ask how patients identify and mirror their language respectfully.
• Ask for pronouns and preferred names, using them consistently.
• Ask how patients refer to their own body parts to reduce dysphoria.
• Acknowledge past negative experiences and validate concerns.
• Refer to colleagues with expertise in LGBTQIA+-inclusive care.

For transgender patients specifically, Berner suggests reassuring them that any decisions about hormone therapy changes will be made collaboratively because patients often fear paternalistic interruptions to their gender-affirming care.

Leone also emphasized that oncologists shouldn’t let fear of mistakes overcome them. “Many colleagues tell me they worry about saying or doing the wrong thing with LGBTQIA patients. I want to free them from this fear. Making mistakes is normal, and if it happens, you simply apologize and move on.”

Berner, Leone, and Bootsma reported having no relevant financial relationships.