Tumors, Treatments, and Trust: Cancer Characteristics, Outcomes, and Screening Uptake in Transgender and Gender-Diverse Patients

• Published in: Annals of surgical oncology Vol. 31; no. 9; pp. 5560 - 5569
• Main Authors: Istl, Alexandra C., Lawton, Samuel, Kamaraju, Sailaja, Stolley, Melinda, Petroll, Andrew E., Cortina, Chandler S.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2024; Springer Nature B.V
• Subjects: Adult; Aged; Cancer screening; Cancer therapies; Early Detection of Cancer - statistics & numerical data; Female; Follow-Up Studies; Gender; Gender-affirming care; Genetic screening; Genetic testing; Genetic Testing - statistics & numerical data; Global Health Services Research; Humans; Lung cancer; Male; Medical records; Medical screening; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - diagnosis; Non-binary gender; Oncology; Patients; Population genetics; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Transgender persons; Transgender Persons - psychology; Transgender Persons - statistics & numerical data
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-024-15319-4

Background More than 2.5 million adults in the United States identify as transgender or gender-diverse (TGD), but little data exist on cancer screening and care for this population. We examined cancer characteristics, screening adherence, genetic testing, and provider inclusive language for TGD patients with cancer. Methods This single institution retrospective cohort study identified TGD patients with cancer between 2000 and 2022. Demographic, clinicopathological, treatment, and screening data were collected, as well as data on gender-affirming care (GAC) and use of patients’ personal pronouns in medical records. Descriptive statistics and regression analyses were used to report outcomes. Results Sixty unique patients with 69 cancer diagnoses were included: 63.3% were transgender women, 21.7% transgender men, 6.7% nonbinary, and 8.3% were genderqueer. Sixty-five percent had a family history of cancer. Only 46.2% of those who met genetic testing criteria were referred. On review of recommended cancer screening, colorectal screening had the greatest uptake (62%), followed by breast (48.3%), lung (35.7%), cervical (33.3%), and prostate (32%); 8.5% of cancers were diagnosed on screening. Individuals with Medicare had reduced odds of screening uptake (OR 0.07, 95% CI 0.01–0.58) versus private insurance. With respect to GAC, 73.3% used gender-affirming hormone therapy and 41% had gender-affirming surgery. After initiating GAC and asserting personal pronouns, 75% were referred to by incorrect name/pronouns in provider documentation. Conclusions Our TGD cancer patient cohort had low rates of disease-specific cancer screening and inadequate genetic referrals. Many providers did not use appropriate patient names/pronouns. Provider and patient interventions are needed to ensure inclusive preventative and oncologic care for this marginalized population.