The health care system is failing transgender cancer survivors

A new Boston University School of Public Health (BUSPH) study is the first-ever population-based study of cancer prevalence in transgender people, estimating 62,530 of the nearly 17 million cancer survivors in the U.S. are transgender.

Published in the journal Cancer, the study found that transgender men were twice as likely as cisgender (that is, not transgender) men to have gotten a cancer diagnosis.

Among cancer survivors, trans 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 cis men—although they 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. Nonbinary cancer survivors had a particularly high rate of depression, and (possibly as a result) reported much less physical activity and much more heavy drinking.

"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 Dr. Ulrike Boehmer, associate professor of community health sciences at BUSPH.

"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. 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.

The researchers also 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 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 Dr. Scout, 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 says.