The first-ever population-based study of cancer prevalence in transgender people was recently published by Boehmer et al in the journal Cancer. The authors of the report estimate that 62,530 of the nearly 17 million cancer survivors in the United States are transgender.

Methods

The researchers used 2014–2018 data from the Behavioral Risk Factor Surveillance System for the 37 states and one territory (Guam) in the United States. that include gender identity questions on their surveys. The researchers identified 954,908 people who had ever received a cancer diagnosis other than melanoma, including 1,877 transgender women, 1,344 transgender men, 876 nonbinary people, 410,422 cisgender men, and 540,389 cisgender women.

Using multiple logistic regression, researchers estimated cancer prevalence and calculated odds ratios with 95% confidence intervals of physical, psychological, overall health, and health behaviors of transgender vs cisgender survivors.

Results

After adjusting for confounders, the team found that transgender men were twice as likely as cisgender men to have gotten a cancer diagnosis, but not cisgender women. Gender nonconforming individuals and transgender women did not have a rate of cancer prevalence that was significantly different from that of cisgender men and cisgender women.

Among cancer survivors, transgender men were also nine times more likely to have diabetes and heart disease than cisgender women, seven times more likely to have diabetes than cisgender men, and four times more likely to have cardiovascular disease than cisgender men—although they were also the least likely to smoke. Transgender women cancer survivors were also much more likely to have diabetes and cardiovascular disease than cisgender men or cisgender women.

Nonbinary cancer survivors had a particularly high rate of depression and reported much less physical activity and much more heavy drinking.

The researchers also found that transgender and nonbinary people overall had less education, were less likely to have health insurance, and were more likely to be low-income and have unmet medical needs because of the cost of care. The transgender/nonbinary respondents were also less likely to have a personal physician than cisgender women, but not cisgender men.

Commentary

“We hope these findings are a wake-up call for health-care providers that transgender cancer survivors have complex medical needs,” said study lead author Ulrike Boehmer, PhD, Associate Professor of Community Health Sciences at Boston University School of Public Health (BUSPH). “Furthermore, in light of recent efforts to legalize discrimination against this population, any health-care agency that is not publicly [and] visibly welcoming transgender individuals is worsening transgender survivors’ health-care experiences, and possibly augmenting their poor cancer survivorship.”

“The health-care system is absolutely failing transgender cancer survivors, primarily because in the face of such overwhelming evidence of discrimination against this population, there is still no routine data collection about trans status on surveillance or electronic medical records,” said study coauthor Nfn Scout, PhD, Adjunct Clinical Assistant Professor of Community Health Sciences at BUSPH and Deputy Director of the National LGBT Cancer Network—himself a trans man. “Until these data are collected, we will always be trying to look at this population with our hands tied behind our backs,” he concluded.

Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.