The first study to look at cancer prevalence in transgender people and examine the health of transgender cancer survivors also found concerning health trends among transgender women and gender nonconforming people.
Transgender men are twice as likely to have had cancer as cisgender men, according to data published in Cancer.
In addition, transgender men and transgender women cancer survivors have higher rates of diabetes and heart disease than cisgender survivors. Researchers also found that nonbinary, or gender nonconforming, survivors of cancer have unusually high rates of depression and unhealthy lifestyle factors.
The survivors included in the study had reported diagnoses of any kind of cancer except skin cancer.
The study was the first to look at cancer prevalence in transgender people and examine the health of transgender survivors of cancer. Its authors, who embarked on the study because the needs of these populations “have received scarce attention”, concluded that doctors must recognize these health disparities and step in to help.
“We hope these findings are a wake-up call for health care providers that transgender cancer survivors have complex medical needs,” study lead author Dr. Ulrike Boehmer, associate professor of community health sciences at the Boston University School of Public Health, said in a press release. “Furthermore, in light of recent efforts to legalize discrimination against this population, any health care agency that is not publicly, visibly welcoming transgender individuals is worsening transgender survivors’ health care experiences, and possibly augmenting their poor cancer survivorship.”
Of nearly 17 million survivors of cancer in the United States, 62,530 are transgender, according to the researchers. They pulled data from the 2014-2018 federal Behavior Risk Factor Surveillance System (BRFSS), focusing on the 37 U.S. states and one territory (Guam) that ask gender identity questions in their surveys.
In all, they found 954,908 people in those states who, in a BRFSS survey, answered questions about whether they had ever received a cancer diagnosis besides melanoma, and also stated whether they considered themselves to be transgender. In all, the study included 1,877 transgender women, 1,344 transgender men, 876 nonbinary people, 410,422 cisgender men and 540,389 cisgender women. All in the study were, on average, in their 40s, and the majority were white. Across the whole study population, transgender men had the highest cancer rate; of them, 9.7% had received a diagnosis. Cisgender men had the lowest cancer rate at 5.6%.
In looking at cancer survivors included in the study, the researchers found additional health disparities: Compared with cisgender survivors, transgender and nonbinary survivors lagged in levels of education, health insurance and income and were more likely to have unmet medical needs because they couldn’t afford care, all factors that can contribute to the development of cancer. Transgender and nonbinary survivors were less likely to have a personal physician than cisgender women, but no less likely than cisgender men.
After they adjusted for differences in education, health care access, income, race/ethnicity and marital status, the researchers found that transgender men were the only group with a significantly elevated cancer incidence. While they were nearly twice as likely to receive a cancer diagnosis as cisgender men, transgender men had about the same likelihood of receiving a diagnosis as cisgender women. In general, the researchers found that rates of cancer among transgender people roughly aligned with the rates associated with their birth genders.
In addition, the researchers found that, among survivors of the disease, transgender men had worse overall health than either cisgender men or cisgender women, although they were less likely to smoke. Transgender men were nine times more likely to have diabetes and heart disease than cisgender women, seven times more likely to have diabetes than cisgender men and five times more likely to have cardiovascular disease than cisgender men. Transgender women were twice as likely to get diabetes as cisgender men or cisgender women, and three times as likely to get cardiovascular disease as cisgender women.
Nonbinary cancer survivors were significantly less likely to be physically active than cisgender men and cisgender women and much more likely to drink heavily. The authors suggested that both of these trends may be related to the fact that this group of survivors is significantly more likely to experience depression.
All of these factors matter because a healthy lifestyle increases cancer survivorship while comorbidities such as diabetes and heart disease can have a negative effect on long-term survival, the authors wrote. “Taken together, the health behaviors and comorbidities of transgender survivors provide evidence that these individuals are an at-risk group for poor survival,” they stated.
The researchers wrote that they lacked information on two other important factors, “the use of hormone therapy and gender reassignment surgery status, which may change cancer risks among transgender individuals as well as overall physical health risks, such as cardiovascular risk.”
They concluded that “clinicians and health services can target gender nonconforming survivors' depression and health behaviors to improve survival and should address the complex comorbidities of transgender men and transgender women.”
“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,” study co-author Dr. Scout, an adjunct clinical assistant professor of community health sciences at the School of Public Health, deputy director of the National LGBT Cancer Network, and a transgender man, said in the press release.
“Until these data are collected, we will always be trying to look at this population with our hands tied behind our backs.”