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

• Authors: Sarah S Jackson, National Cancer Institute, Rockville; Xuesong Han, Emory University; Ziling Mao, American Cancer Society; Leticia Nogueira, Emory University; Gita Suneja, University of Utah; Ahmedin Jemal, Emory University; Meredith S Shiels, National Cancer Institute, Rockville
• Journal Title: JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE
• Volume: Volume 113, Number 9
• Publisher: OXFORD UNIV PRESS INC | 2021-04-24, Pages 1221-1227
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1093/jnci/djab028
• Subjects: Health Sciences, Epidemiology; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; GENDER IDENTITY; PROSTATE-CANCER; BLADDER-CANCER; HIV; RISK; DISPARITIES; MORTALITY; PEOPLE; HEALTH; WOMEN

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.