The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network

Sep 21, 2026

The current study examines the prevalence of cancer and pre-cancerous conditions and identifies associated risk factors by comparing transgender and cisgender individuals using 2012–2023 electronic health record data from a large healthcare system. A computable phenotype identified 2,745 transgender individuals and 54,900 matched cisgender individuals. Prevalence of cancers and pre-cancers was assessed for conditions related to HPV, HIV, tobacco, alcohol, and multiple cancer sites, with multivariable logistic models estimating associations between gender identity and cancer or precancer presence. Results show similar cancer odds across identities but elevated pre-cancer risks for transgender individuals, highlighting a need for tailored interventions and policies addressing disparities in cancer health outcomes.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Definitions and epidemiology of transgender populations

Health disparities and cancer risk rationale

Hormone therapy, tobacco, and alcohol as risk pathways

Sexual behavior and infection-related cancer risk

medRxiv preprint doi: [https://doi.org/10.1101/2024.03.24.24304777](https://doi.org/10.1101/2024.03.24.24304777); this version posted March 26, 2024. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network Shuang Yang, MS1, Yongqiu Li, BS1, Christopher W. Wheldon, PhD2, Mattia Prosperi, PhD3, Thomas J. George, MD, FACP4, Elizabeth A. Shenkman, PhD1, Fei Wang, PhD5, Jiang Bian, PhD1,*, Yi Guo, PhD1,* 1Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA; 2Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania, USA;3Department of Epidemiology, University of Florida, Gainesville, Florida, USA; 4Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA; 5Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA Abstract The current study aimed to examine the prevalence of and risk factors for cancer and pre-cancerous conditions, comparing transgender and cisgender individuals, using 2012-2023 electronic health record data from a large healthcare system. We identified 2,745 transgender individuals using a previously validated computable phenotype and 54,900 matched cisgender individuals. We calculated the prevalence of cancer and pre-cancer related to human papillomavirus (HPV), human immunodeficiency virus (HIV), tobacco, alcohol, lung, breast, colorectum, and built multivariable logistic models to examine the association between gender identity and the presence of cancer or precancer. Results indicated similar odds of developing cancer across gender identities, but transgender individuals exhibited significantly higher risks for pre-cancerous conditions, including alcohol-related, breast, and colorectal pre-cancers compared to cisgender women, and HPV-related, tobacco-related, alcohol-related, and colorectal precancers compared to cisgender men. These findings underscore the need for tailored interventions and policies addressing cancer health disparities affecting the transgender population. Introduction Transgender persons are people whose gender identity or expression does not align with society’s expectations based on the sex recorded at birth 1. Global estimates suggest that 0.3% to 0.5% of adults self-identify as transgender2. A recent survey has reported that as high as 1.6% of the general U. S. adults identify as transgender3. Transgender individuals consistently experience disproportionately high prevalence of adverse health outcomes, such as the human immunodeficiency virus (HIV), sexually transmitted infections, mental health distress, and substance abuse4. Despite the growing literature on the unique health challenges faced by transgender individuals, our understanding of cancer burden and cancer risk in this vulnerable population remains sparse5, primarily due to the unavailability of relevant data6. Reluctance to self-identify and participate in health surveys, coupled with the scarcity of inclusion of gender identity measures in national surveillance efforts, pose challenges in obtaining population-based representative samples and conducting longitudinal studies to examine cancer burden in this population. Current insights into cancer risks in transgender populations rely mainly on anecdotal evidence and small-scale studies7,8, resulting in inconsistent findings. Evidence suggests transgender persons may face elevated risk of certain cancers compared to the general population, including breast cancer7, cancers linked to the human papillomavirus (HPV)9 and HIV6, and those related to tobacco and alcohol use 10,11 . First, some transgender individuals choose

FAQs

How does the study compare cancer and pre-cancer risk between transgender and cisgender individuals?

It compares prevalence and risk factors using 2012–2023 electronic health record data, identifying transgender individuals with a validated computable phenotype and using matched cisgender controls. Multivariable logistic models estimate associations between gender identity and cancer or precancer presence.

Which risk areas and outcomes are analyzed in relation to cancer and precancer?

The analysis considers pre-cancer and cancer prevalence related to HPV and HIV, tobacco and alcohol exposure, and cancer sites including lung, breast, and colorectum.

What are the key findings about cancer odds versus pre-cancer risks across gender identities?

The results indicate similar odds of developing cancer across gender identities. However, transgender individuals show significantly higher risks for several pre-cancerous conditions, including alcohol-related, breast, and colorectal pre-cancers compared to cisgender women, and HPV-, tobacco-, alcohol-, and colorectal-related precancers compared to cisgender men.

Sep 21, 2026

Uploaded by Ava Thompson