Abstract PO-177: Cancer burden and survival among transgender patients in the United States
Authors: Jackson Sarah S. , Han Xuesong , Mao Ziling , Nogueria Leticia , Suneja Gita , Jemal Ahmedin , Shiels Meredith S. 
Published: December 2020

Abstract
Background: Cancer burden among transgender patients is currently unknown due to a paucity of available data. Transgender patients face many barriers to healthcare, including discrimination, stigma, and lack of health insurance. Consequently, there may be delays in cancer diagnoses and treatment, resulting in increased cancer mortality among transgender individuals compared to cisgender persons. We sought to examine cancer stage at diagnosis, cancer treatment, and survival among transgender patients compared to cisgender patients in a large national cancer database. Methods: Data from the National Cancer Database (NCDB) included patients diagnosed with cancer between 2003 – 2016. Gender was recorded by physicians in the medical record and we included individuals categorized as “Male”, “Female”, or “Transsexual” (transgender). We examined primary cancers with ≥10 cases occurring in transgender adults aged ≥18 years. Multivariable logistic regression was used to estimate odds ratios (ORs) for advanced stage at diagnosis (stages III and IV versus stages 0, I, and II) and receipt of cancer treatment (e.g. surgery, chemotherapy, radiotherapy, or a combination) comparing transgender and cisgender patients for each cancer site. Hazard ratios (HRs) were estimated with Cox proportional hazards regression to estimate the associations between physician- recorded gender and all-cause survival for each cancer site. Models were adjusted for age at diagnosis, race/ethnicity, insurance status, year of diagnosis, stage at diagnosis, and treatment receipt as applicable. Results: There were 589 transgender cancer patients among the ≥11 million patients in NCDB. Differences in stage at diagnosis, treatment, and survival between transgender and cisgender cancer patients were not broadly observed across cancer sites. However, transgender patients with lung and bronchus cancer may be more likely to be diagnosed at later stages (OR: 1.76, 95% CI: 0.95, 3.28) than cisgender patients. In addition, compared to cisgender patients, transgender patients were less likely to receive treatment for kidney cancer (OR: 0.22, 95% CI: 0.09, 0.55). Finally, survival was worse in transgender patients compared to cisgender patients with non-Hodgkin lymphoma (HR: 2.36; 95% CI: 1.51, 3.70) and urinary bladder cancer (HR: 2.03, 95% CI: 1.31, 3.14). Conclusion: For specific cancers types, transgender patients may be diagnosed at a later stage, be less likely to receive treatment, and have worse survival.
However, this study was hampered by the small number of transgender patients and the lack of self-reported gender identity separate from natal sex. Routine collection of gender identity in cancer registries and patient records will allow for improved estimates of cancer incidence, risk, and more meaningful comparisons between transgender and cisgender cancer patients. There is an urgent need to expand our knowledge of cancer burden among transgender individuals as this population grows and ages.
Citation Format: Sarah S. Jackson, Xuesong Han, Ziling Mao, Leticia Nogueria, Gita Suneja, Ahmedin Jemal, Meredith S. Shiels. Cancer burden and survival among transgender patients in the United States [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-177.