More than 1.6 million adults and adolescents (aged 13 to 17 years) in the United States identify as transgender, according to a report released earlier this year.1
Research has shown disparities in health status and health care between transgender and cisgender patients, with transgender patients often having worse physical and mental health and limited access to equitable health care services.2-4
“Generally, studies have demonstrated that transgender patients face more barriers to access health care for a variety of reasons, including discrimination, financial or socioeconomic barriers, health care system barriers, and lack of provider education on caring for transgender patients,” explained Kevin Liu, MD, DPhil, a resident physician in the Harvard Radiation Oncology Program in Boston.
“However, there is a dearth of data regarding the disparities in cancer outcomes and treatment among transgender patients compared to cisgender patients,” Dr Liu added.
Evidence of Disparities Among Cancer Patients
A few recent studies have provided some insights regarding transgender patients with cancer, including a population-based study published in 2021.5 The study included 589 transgender patients and 11,776,110 cisgender patients from the National Cancer Database.
The researchers found that transgender patients were more likely than cisgender patients to have lung cancer at an advanced stage at diagnosis (odds ratio [OR], 1.76; 95% CI, 0.95-3.28) and less likely to receive treatment for kidney cancer (OR, 0.19; 95% CI, 0.08-0.47) or pancreatic cancer (OR, 0.33; 95% CI, 0.11-0.95).
In addition, transgender patients had a higher risk for death after a diagnosis of non-Hodgkin lymphoma (hazard ratio [HR], 2.34; 95% CI, 1.51-3.63) and cancers of the prostate (HR, 1.91; 95% CI, 1.06-3.45) and bladder (HR, 2.86; 95% CI, 1.36-6.00).
In a study published in 2020, researchers examined data on 95,800 patients in the Behavioral Risk Factor Surveillance System, including 1877 transgender women, 1344 transgender men, 876 gender-nonconforming individuals, 540,389 cisgender women, and 410,422 cisgender men.6
Analyses revealed that transgender men had roughly twice the risk of a cancer diagnosis as cisgender men (adjusted OR [aOR], 2.29; 95% CI, 1.19-4.40; P =.01), but there was no significant difference in cancer prevalence between transgender men and cisgender women (aOR, 1.67; 95% CI, 0.87-3.22; P =.12).
The likelihood of a cancer diagnosis was similar for transgender women, gender-nonconforming individuals, and cisgender men and women.
Among the cancer survivors, transgender men were more likely than cisgender men and women to have poor physical health, cardiovascular disease, and diabetes. Transgender women were more likely than cisgender men to have diabetes and more likely than cisgender women to have cardiovascular disease and diabetes.
Gender-nonconforming cancer survivors were more likely than cisgender survivors to be depressed, engage in heavy episodic alcohol use, and be physically inactive.
“Our findings on health outcomes were alarming,” said study author Ulrike Boehmer, PhD, an adjunct associate professor of social and behavioral sciences at Boston University School of Public Health.
Dr Boehmer pointed to the need for further investigation into the reasons for these differences as well as those observed in the 2021 study.5