Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep 4;113(9):1221-1227.
doi: 10.1093/jnci/djab028.

Cancer Stage, Treatment, and Survival Among Transgender Patients in the United States

Sarah S Jackson  1 , Xuesong Han  2 , Ziling Mao  2   3 , Leticia Nogueira  2 , Gita Suneja  4   5 , Ahmedin Jemal  2 , Meredith S Shiels  1
Affiliations

Cancer Stage, Treatment, and Survival Among Transgender Patients in the United States

Sarah S Jackson et al. J Natl Cancer Inst. .

Abstract

Background: Transgender persons face many barriers to health care that may delay cancer diagnosis and treatment, possibly resulting in decreased survival. Yet, data on cancer in this population are limited. We examined cancer stage at diagnosis, treatment, and survival among transgender patients compared with cisgender patients in the National Cancer Database (NCDB).

Methods: Gender (male, female, or transgender) was extracted from medical records from patients diagnosed with cancer between 2003 and 2016. Logistic regression estimated odds ratios (ORs) for the associations between gender and stage at diagnosis and treatment receipt. Cox proportional hazards regression estimated hazard ratios (HRs) for associations between gender and all-cause survival.

Results: Among 11 776 699 persons with cancer in NCDB, 589 were transgender. Compared with cisgender patients, transgender patients may be more likely to be diagnosed with advanced stage lung cancer (OR = 1.76, 95% confidence interval [CI] = 0.95 to 3.28); be less likely to receive treatment for kidney (OR = 0.19, 95% CI = 0.08 to 0.47) and pancreas (OR = 0.33, 95% CI = 0.11 to 0.95) cancers; and have poorer survival after diagnosis with non-Hodgkin lymphoma (HR = 2.34, 95% CI = 1.51 to 3.63), prostate (HR = 1.91, 95% CI = 1.06 to 3.45), and bladder cancers (HR = 2.86, 95% CI = 1.36 to 6.00). Similar associations were found for other cancer sites, although not statistically significant.

Conclusion: Transgender patients may be diagnosed at later stages, be less likely to receive treatment, and have worse survival for many cancer types. Small sample size hampered our ability to detect statistically significant differences for some cancer sites. There is a need for transgender-focused cancer research as the population ages and grows.

PubMed Disclaimer

Comment in

References

    1. Flores AR, JL H, GJ G, et al. How Many Adults Identify as Transgender in the United States? Los Angeles, CA: The Williams Institute; 2016.
    1. Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Lesbian, gay, bisexual, and transgender health: transgender persons. https://www.cdc.gov/lgbthealth/transgender.htm. Accessed June 3 2020.
    1. Cancer risk in the transgender community. Lancet Oncol. 2015;16(9):999. - PubMed
    1. Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington, DC: The National Academies Press; 2011. - PubMed
    1. Braun H, Nash R, Tangpricha V, et al. Cancer in transgender people: evidence and methodological considerations. Epidemiol Rev. 2017;39(1):93–107. - PMC - PubMed

Publication types