P17: Tumors, treatments, and trust: cancer characteristics, outcomes, and screening uptake in transgender and gender-diverse patients

Over 1.6 million US adults identify as transgender or gender-diverse (TGD) but little data exists on cancer characteristics, screening, and care considerations for this population. We aimed to examine 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 diagnosed with cancer between 2000–2022 using ICD codes and self-disclosed demographics. Demographic, clinicopathological, treatment, screening, and surveillance data were collected, as well as data on gender-affirming care (GAC) and the use of patients’ personal pronouns in medical records. Descriptive statistics and regression analyses were used to report and assess outcomes.


Results:

Sixty unique patients with 69 cancer diagnoses met inclusion criteria: 63.3% were transgender women, 21.7% transgender men, 6.7% nonbinary, and 8.3% were genderqueer. Seven patients (11.7%) had multiple cancer diagnoses, 65% had a documented family history of cancer, and only 46.2% of who met criteria for genetic testing were referred. In 38 patients with available staging data, 50% presented with stage I cancer, 7.1% with stage II, 21.4% with stage III, and 19.1% with stage IV. The most common malignancies were non-melanomatous skin cancer (NMSC), lymphomas, and thyroid cancers. On review of recommended cancer screenings, colorectal screening had the greatest uptake (62%), followed by breast (48.3%), lung (35.7%), cervical (33.3%), and prostate (32%). Only 8.5% of cancers were diagnosed via screening. Individuals with Medicare insurance had reduced odds of screening uptake (OR 0.07, 95%CI 0.01–0.58) compared to individuals with private insurance. With respect to GAC, 73.3% used gender-affirming hormone therapy, 41% had gender-affirming surgery and even after initiating GAC and asserting their 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, inadequate genetic referrals, and many providers did not use appropriate patient names/pronouns. Interventions at the policy, provider, and patient levels are needed to ensure inclusive and optimal preventative and oncologic care for this marginalized population.