Transgender Cancer Survivors Have Complex Medical Needs.

Among the nearly 17 million cancer survivors in the US today, an estimated 62,530 are transgender, according to a new, first-of-its-kind School of Public Health study. Published in the journal Cancer, it is the first population-based study of cancer prevalence in transgender people, and the first to examine the health of transgender cancer survivors.

The study found that transgender men are twice as likely as cisgender men to have had cancer, that transgender men and transgender women cancer survivors are many times more likely to have diabetes and cardiovascular disease than cisgender survivors, and that nonbinary cancer survivors have particularly high rates of depression and unhealthy lifestyle factors.

“We hope these findings are a wake-up call for health care providers that transgender cancer survivors have complex medical needs,” says study lead author Ulrike Boehmer, associate professor of community health sciences.

“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,” she says.

Boehmer and colleagues used 2014-2018 data from the Behavioral Risk Factor Surveillance System for the 37 states and one territory (Guam) that include gender identity questions on their surveys.

They found that trans 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 trans/nonbinary respondents were also less likely to have a personal physician than cisgender women, but not cisgender men.

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.

After adjusting for differences in education, health care access, income, race/ethnicity, and marital status, the researchers found that trans men were the only group with significantly elevated cancer prevalence, almost twice as likely to have a cancer diagnosis as cis men (but about as likely as cis women).

The researchers also found that, among cancer survivors, trans men had the worst overall health, and were nine times more likely to have diabetes and heart disease than cisgender women, seven times more likely to have diabetes than cis men, and four times more likely to have cardiovascular disease than cis men. However, trans men were also the least likely to smoke.

Trans women were also much more likely to have diabetes and cardiovascular disease than cis men or cis women. As the authors note, diabetes and cardiovascular disease greatly increase risk of death in people with cancer.

Nonbinary cancer survivors were significantly less likely to be physically active, and much more likely to drink heavily—both probably related to also being significantly more likely to experience depression, the authors note.

“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,” says study co-author Scout, adjunct clinical assistant professor of community health sciences at SPH 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.”

The study was co-authored by: Michael Winter, associate director of statistical programming at the Biostatistics & Epidemiology Data Analytics Center; Jessica Gereige of Boston Medical Center; and Al Ozonoff of Boston Children’s Hospital and Harvard Medical School.

—Michelle Samuels