Brief Training Session Boosts Staff Confidence in Transgender-Inclusive Breast Cancer Screening

A 45-minute virtual training session may help close one of the most overlooked gaps in cancer care: the experience of transgender and gender diverse patients who walk into breast imaging centers and too often walk away without being screened. A new pilot study published in the journal Cancer Causes & Control reports that a short, story-driven educational session for the full breast imaging team, from the schedulers who book appointments to the technologists who perform mammograms and the radiologists who read them, significantly improved staff self-reported knowledge of LGBTQIA+ inclusive care. The finding matters because transgender and gender diverse people are consistently underscreened for breast cancer, and one of the strongest barriers they report is the simple, corrosive expectation that they will face discrimination the moment they enter a clinic.

The study, led by researchers at the University of Cincinnati College of Medicine together with a Gender-Affirming Care Clinical Specialist from Equitas Health, a community health center dedicated to serving the LGBTQIA+ community, set out to test whether a brief didactic intervention could move the needle on knowledge and attitudes among imaging professionals. The training team included medical students, several of whom identified as LGBTQIA+ community members themselves, and the content was adapted from cultural responsiveness trainings that the Equitas Health specialist, a nurse with more than a decade of experience training hundreds of medical professionals, had previously designed and led. What distinguished this effort was its audience: rather than targeting physicians alone, the session was built for the entire patient-facing team involved in breast cancer screening, including clinical support specialists who handle scheduling, mammography and ultrasound technologists, and radiologists.

The clinical stakes are substantial. Nearly one in eight women in the United States will develop breast cancer, which remains the second-leading cause of cancer death among cisgender women, and early detection through screening with clinical breast examination, mammography, molecular breast imaging, ultrasound, or magnetic resonance imaging is the cornerstone of reducing mortality. Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority individuals carry distinct medication-related, behavioral, and reproductive risk factors for cancers that originate in breast tissue, which the researchers refer to with the gender-inclusive term breast/chest cancer. Yet the true prevalence of these cancers in LGBTQIA+ populations remains unclear because sexual orientation and gender identity data are collected inconsistently and inaccurately in clinical records and cancer registries. The data that do exist are sobering: available studies show delays in diagnosis and a threefold higher chance of recurrence among LGBTQIA+ patients.

Why are transgender and gender diverse patients underscreened? The study’s authors point to two converging problems. The first is a knowledge gap among the clinicians who would ordinarily recommend screening, including primary care clinicians and gynecologists, many of whom are unfamiliar with current screening guidelines for transgender and gender diverse patients. The second, and arguably more powerful, barrier is anticipated discrimination. Patients who expect to be misgendered at check-in, questioned about their identity, or made to feel unwelcome in the imaging suite often simply do not schedule the appointment. This is precisely the point in the care pathway where the Cincinnati training intervened, because the people patients meet first, the schedulers and technologists, are rarely included in educational efforts about LGBTQIA+ care.

The training itself was deliberately compact. Delivered virtually over the lunch hour to breast center team members at a large urban academic health center, including staff working on community-based mobile mammography units, the session covered terminology pertinent to the LGBTQIA+ community, the importance of inclusive communication, an overview of current breast/chest cancer screening guidelines for transgender and gender diverse patients, principles of trauma-informed care, and concrete strategies for making clinical spaces more welcoming. Leadership confirmed that participation occurred during paid time free of patient care duties, and continuing education credit was offered, though completing the evaluation surveys was not required for credit. A distinctive feature of the session was storytelling: trainers shared relevant lived experiences, and participant feedback later identified these narratives as the single most valued component of the training.

To measure the effect, participants completed electronic surveys via the REDCap platform immediately before and after the session on their own devices. The evaluation captured demographics, job titles, the frequency of interactions with lesbian, gay, bisexual, transgender, and nonbinary patients, and prior exposure to LGBTQIA+ training. Knowledge was assessed in two complementary ways. First, participants self-rated their knowledge of five key learning objectives on a four-point scale: the definition of LGBTQIA+, the use of inclusive terminology in medical settings, current screening guidelines, ways to create a welcoming environment, and the distinctions between sex, gender, gender expression, and sexual orientation. Second, they answered eight multiple-choice questions, including scenario-based items pilot-tested for readability and difficulty, that asked them to choose the best response to realistic situations such as calling a transgender patient from the waiting room, correcting a verbal pronoun mistake, and confirming a patient’s identity when the appointment name does not match the legal name. Attitudes toward gender diversity were measured with an adaptation of a transphobia scale developed by Stroumsa and colleagues in 2019, using eight statements rated on a seven-point scale.

The pre-survey results alone made a compelling case for the training’s relevance. Among the 17 participants who completed the pre-survey out of 28 attendees, 77 percent reported sometimes, often, or very often working with transgender and gender diverse patients, and 94 percent reported comparable frequency of interaction with lesbian, gay, and bisexual patients. Despite this routine exposure, only three participants, both radiologists and one mammography technologist, had ever received LGBTQIA+-specific training, and only about a third felt they had adequate access to resources on LGBTQIA+ patient care. In open-ended responses, participants described barriers that will resonate with many clinicians: discomfort discussing the topic in front of colleagues, uncertainty about where to start, and worry about how to support LGBTQIA+ patients without unintentionally singling them out.

The outcomes told a nuanced story. Self-reported knowledge of LGBTQIA+ terminology and related content rose from a mean of 2.4 before the training to 3.13 afterward on the four-point scale, a change the researchers found statistically significant with a large effect size, Hedges’ g of 1.1, and every one of the five individual knowledge items improved significantly. Directly assessed knowledge, measured by the multiple-choice questions, increased from an average of 8.08 correct answers to 9.16, a small effect that did not reach statistical significance, likely reflecting the small sample size. Scores on the gender attitudes scale shifted from 42.36 to 44.36, a medium effect size indicating a trend toward greater acceptance of gender diversity, but again without statistical significance. The authors attribute these null findings at least in part to the pilot’s small sample and to a retention challenge: only 14 participants completed the post-survey, a rate the team attributed to insufficient time for surveys within the one-hour lunch slot as staff prepared to resume patient care.

Nevertheless, the researchers argue that this is the first published training aimed at the entire team of imaging professionals involved in breast cancer screening, and its significance lies in where it intervenes. Previous work has offered clinical vignettes to address physician knowledge gaps in transgender breast imaging, and the Cincinnati team had earlier received positive qualitative feedback from radiology residents on a transgender curriculum, but no prior study had measured the impact of education delivered to all critical patient-facing staff, including technologists and clinical service specialists. The findings align with a systematic review of brief LGBTQIA+ cultural competency trainings for health professionals and with a study of interprofessional emergency department teams, both of which found that short sessions can move self-reported knowledge.

The authors are candid that measuring changes in staff knowledge is only a first step. The next frontier is evaluating the training’s impact on patients themselves, including whether affirming screening encounters reduce the anticipated discrimination that keeps transgender and gender diverse patients away from mammography in the first place. They also plan to incorporate additional narratives into the curriculum, given how strongly participants valued the storytelling element. If those efforts succeed, the payoff could be substantial: a screening experience that feels safe and respectful for every patient, higher screening rates among underserved populations, and, ultimately, fewer deaths from a cancer that is highly treatable when caught early. In a field where the difference between early detection and late diagnosis is often measured in lives, a 45-minute conversation about names, pronouns, and welcome may prove to be one of the most cost-effective interventions in cancer prevention.

Subject of Research: A pilot educational intervention training breast imaging professionals in transgender-inclusive breast cancer screening practices

Article Title: Training imaging professionals on transgender-inclusive breast cancer screening practices

Article References: Martinez, A., Whitton, S., Yokoyama, J., Madzia, J., Hartlage, C. S., Kelly, E., Schumacher, M., Sosa, D., Makkad, H., Xu, C., Patel, R., Pickle, S., & Stryker, S. (2026). Training imaging professionals on transgender-inclusive breast cancer screening practices. Cancer Causes & Control, 37(10), Article 163. https://doi.org/10.1007/s10552-026-02241-1

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02241-1

Keywords: transgender health, breast cancer screening, mammography, LGBTQIA+ inclusive care, health disparities, radiology training, cultural competency, gender diversity, cancer prevention, trauma-informed care, health professions education, Cancer Causes & Control